Communication and Patient Centered Care Reflection

Communication and Patient Centered Care Reflection INTRODUCTION The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010) was a further development from ‘Better Health, Better Care’ (Scottish Government 2007). In this reflective account I wish to concentrate on the peoples priorities for the people of Scotland outlined within this document, the ultimate aim is to provide the highest quality of care. It has as their objectives that care given should be consistent, person centered, clinically effective and safe and equitable with patients receiving clear communication with regards to conditions and treatment (Scottish Government 2010). Hubley and Copeman, (2008) state communication skills are paramount in healthcare to ensure that tailored advice is delivered effectively. This reflective account is based on an experience from my 3rd year management placement. Using Gibbs’s Reflective Model (1988) I aim to outline what occurred throughout the incident which involved providing clear communication and patient centered care and how this can be linked to the Quality Strategy in relation to the people’s priorities. This reflective model has been selected as it enables reflection on practice in a structured way allowing one to identify critical learning and development from their experience to enhance future practice (Bullman and Schutz, 2008). This scenario will consider how this incident will aid in my transition from student nurse to staff nurse. To comply with patients’ rights to confidentiality and in accordance with the Nursing and Midwifery Council (NMC), (2010) I will use the pseudonym Mrs Wade. DESCRIPTION This reflection involves a 78 year old lady Mrs Wade who was an inpatient on the ward for 10 days after being diagnosed as having a cerebral haemorrhage. This had left Mrs Wade with a left sided weakness and aphasic. It was during afternoon visiting and taking the routine observations I noted Mrs Wade to be scoring one on the National Early Warning Score chart (NEWS) due to reduced oxygen saturation levels of 95%. However, on comparing this with previous readings this was within the parameters of her levels taken over the previous days. . I had just moved on to the next patient when Mrs Wade’s son who was visiting asked me to come back as his mother was indicating that she had pain in her chest radiating to her left jaw. I immediately took another set of observations and Mrs Wade was now scoring 10 on the NEWS chart. I immediately went to seek guidance from my mentor who instructed me to show my findings to the doctor whilst she administered GTN spray. The doctor came and asse ssed Mrs Wade and instructed me to administer 5mg of morphine, 15 liters of oxygen and commence an initial 250ml bag of normal saline and if Mrs Wades BP had still not risen I was to continue with a second bag, whilst he arranged an ECG and chest X-ray. At this time my mentor advised me that I was to take control of the situation and she would assist me if I required help. FEELINGS My initial feeling was one of complete fear. However, I felt within seconds I regained my composure and I took control of the situation. I was relieved that training had indeed prepared me for a situation like this where I automatically began to use the ABCDE assessment (Jevon, 2010). I was also anxious but relieved in being able to communicate effectively with the doctor, my mentor, team members and Mrs Wades son. I felt I was able to handover clearly and concisely. I feel that I was able to do this as I had been dealing with Mrs Wade on each of my days on duty over the previous two weeks. EVALUATION The negative aspect from this incident is how a patient in one’s care can deteriorate so rapidly. However, in the case of Mrs Wade I repeatedly asked myself if I had missed some signs and this incident could have been avoided. The positive aspect of this incident was that Mrs Wade’s deterioration had been caught instantly. I had the opportunity to discuss this incident with my mentor. At this time she praised me on how I had taken control of the situation in a calm and professional manner. I was competent when communicating with team explaining the background to Mrs Wade’s condition thus aiding an effective result in Mrs Wades condition being stabilized. It was also reiterated that this was an unavoidable situation and there was nothing I could have done differently to alter the outcome. ANALYSIS The people’s priorities outlined by The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010) and in caring for Mrs Wade on reflection I wanted to be establishing if I covered all areas and were I could improve. The priorities are to be caring and compassionate, have clear communication skills and be able to explain conditions and treatment have effective collaboration between clinicians, patients and others; A clean and safe care environment; Continuity of care; and Clinical excellence. Jones (2012) advocates that it is essential in nursing to have good communication skills. This is also advocated by Dougherty and Lister (2008) who states that communication is an integral part of maintaining a high quality of record keeping which is regarded as a vital standard of practice by the NMC (2008). Communication and written care records aid to establish a continuity of care. As I found Mrs Wade to have deteriorated it is stated by Hill (2012) that the outcome for a deteriorating patient is dependent on the knowledge and skills of the person or persons who find and care for them and the recognition of the acutely ill. As I was the first responder and having called for help I used my mentor and other team members to assist myself in assessing and stabilizing Mrs Wades vital signs. At this time I also asked my colleague to ensure Mrs Wades son was taken to the day room and someone would come to speak with him as soon as possible. This is fundamental to patient centered-care to communicate openly and honestly with all concerned (Brooker and Nicol, 2008). I used ABCDE approach recommended by Jevons (2010) and The Resuscitation Council (2010). The ABCDE approach is a systematic tool were by you assess your patient and deal with the life threatening situations first. During this time I endeavored to reassure Mrs Wade at all times through effective communication skills (Scottish Government 2010, p6). Although Mrs Wade was aphasic her airways were patent and no obstruction was noted. Therefore it was acceptable to move on to B (breathing) within the ABCDE. Patients presenting with Myocardial Infarction (MI) or Pulmonary Embolism can show an increased respiratory rate. As Mrs Wade’s respiratory rate had increased and was desaturating she was commenced on high flow oxygen (O’Driscoll 2008). Mrs Wades heart rate 109 beats per minute and on palpating the radial pulse it was fast but strong and regular. Mrs Wade’s blood pressure had decreased to 89/56 therefore commenced on a 250ml bag of saline. Urine output was already being monitored and IV access was in place. The next stage is Disability. AVPU is a tool used to assess levels of consciousness within acutely ill patients (Jevon 2009b). This is a quick assessment tool within the NEWS and ABCDE approach; However, NICE 2007 recommend the use of the Glasgow Coma Scale to give a full assessment. At this stage my mentor checked blood glucose levels. Blood glucose levels can rise in acutely ill patients due to a result of sympathetic activation (Floras 2009). However at this stage they were within the normal range of 4-7mmol/L (Diabetes UK 2013). During this situation to communicate my findings I used a systematic approach based on situation, background, assessment and recommendation (SBAR) tool to share the necessary information effectively and concisely (Pope et al 2009). In the emergency situation with Mrs Wade this highlights the involvement of nurses in collaboration with other healthcare professionals and coordinate all resources to provided effective timely care. I feel that I took on the role as lead nurse in this situation I knew it was my responsibility as a student nurse in my final placement to show that I could take control of this situation, whilst in the knowledge knowing I still had my mentor if I felt I required assistance. I felt I had to show I could effectively delegate, show leadership qualities, prioritise the care of Mrs Wade whilst being able to communicate effectively in a challenging situation. CONCLUSION The outcome was positive in the aspect that a holistic approach to Mrs Wade’s condition was taken in accordance with The Scottish Government’s Initiative (2010) on patient centered care. I felt empowered by incorporating the use of the SBAR framework in effective collaboration with the multidisciplinary team aided clear communicating in accordance with The Scottish Government (2010). This resulted in a consistent continuity of care for Mrs Wade. ACTION PLAN A result of this significant event was that it gave me the experience of dealing with an emergency situation. As stated by Scheffer and Rubenfeld (2000) â€Å"Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge†. I was also given the opportunity afterwards to reflect on my role and the role each member of the team took in this situation and where appropriate to remove oneself from a situation I feel for future development I will take responsibility for my own learning in areas where I felt I lacked knowledge. In this situation I had assumed that Mrs Wade was having an MI were in fact it was a PE. I believe that in the future and with more experience I may be able to differentiate and although I would not expect to be an expert I would be better equipped to deal with similar situations in the future (RCN 2013). I was particularly anxious as I know I have no experience in Basic Life Support other than what I had learned at university and knowing this woman was for resuscitation I was anxious that this situation may occur. OVERALL CONCLUSION On reflection of my own experience and in using this to aid in my transition from student nurse to staff nurse I feel I have enhanced my own knowledge on basic life support outlined by the British Resuscitation Council UK (2010) cited by (Dougherty and Lister, 2011) whilst reiterating the importance of good communication skills. It also highlighted the importance of having the confidence to acknowledge one’s own lack of knowledge and be able to admit to this and where to seek guidance to ensure that the correct protocol is followed to ensure patient safety at all times and to provide continuity of care. I feel that the care given to this patient is in line with the initiative of The Scottish Government’s Healthcare Quality Strategy for Scotland (2010). In relation to how this incident reflects on my transition it shows that on graduating as a staff nurse I will immediately assume the role which includes leadership, delegation and supervision. Once NMC registered, a host of expectations are placed upon you. The RCN (2010) reported that newly qualified staff nurses feel unprepared and overwhelmed by their new responsibilities, making the period of transition very stressful rather than exciting and truly enjoyable. However, I hope to overcome these feelings by immersing myself in the knowledge that I will adhere to all policies and guideline by The Scottish Government (2010) to ensure the best possible care and service to all. References Hill Karen Critical to Care: Improving the Care to the Acutely Ill and Deteriorating Patient Karen Hill, Acuity Practice Development Matron Southampton University Hospital NHS Trust May 2010 – January 2011 February 2012 http://fons.org/library/report-details.aspx?nstid=18132 Jones, A 2012, The foundation of good nursing practice: effective communication,Journal Of Renal Nursing, 4, 1, pp. 37-41, CINAHL Plus with Full Text, EBSCOhost, viewed 27 July 2014. Scheffer BK1,Rubenfeld MG (2000) . A Consensus statement on critical thinking in nursing  http://www.ncbi.nlm.nih.gov/pubmed/11103973

Homeopathy :: essays research papers

Samuel Hahnemann, a brilliant German medical doctor and chemist, developed the science of homeopathy at the end of the 18th century. He was responding, in part, to his concern that more people were dying from medical treatments than from their diseases. Hahnemann believed that the purpose of medical therapy should be to restore health quickly, gently and permanently in the least harmful manner without toxic side-affects or the suppression of symptoms which would only return. His work and principles have been carried on and developed by many dedicated homeopaths right to the present day. Homeopathy now rests on the firm foundation of Hahnemann's work and some 200 years of well-documented, successful healing experience. Hahnemann's guiding principles still apply today in the practice of classical homeopathy, but his criteria are otherwise rarely met despite all the improvements and advances in so-called modern medicine.The True Classical Homeopathic Approach to CureFundamental to classical homeopathy is the view that we are each a synergistic whole, every part of our wholistic being effecting every other part. It is the combination of all symptoms and how they are experienced by the individual which should be addressed in attempting to cure that person and their disorders. When someone has a health problem, it is the whole person that has the problem. The problem does not exist in isolation from the person. They can't simply put the problem in a box and forget it. Therefore, when attempting to cure that person it is the whole person that should be considered, not simply what is thought to be a disordered part of the person. This is the wholistic approach of classical homeopathy. This is in contrast to the conventional approach to disease which often oversimplifies it as one isolated symptom or group of symptoms, as a problem affecting only one part or aspect of the body and person. The "sloppy approach" to homeopathy is guilty of the same practice. Classical Homeopathy, by contrast, prescribes remedies on a constitutional basis, treating the entire individual, their symptoms and modalities. To arrive at the correctly chosen remedy for a chronic disorder, the detailed case of all aspects of the individual must be taken. The true classical homeopath delves into the broad collection of symptoms and peculiarities of the individual, their entire mental, emotional and physical make-up. This requires an in-depth sense of the patient, a keen sensitivity to them which is able to grasp their gestalt, that totality of the person and the matching remedies which transcends the mere sum of their parts.

A Complicated Kindness

â€Å"Fire and Rain† by James Taylor is a song mentioned in A Complicated Kindness that Nomi can relate to easily. James Taylor was born March, 12th 1948 in Boston, Massachusetts, although he was mainly raised in North Carolina. By age 14, Taylor was writing songs, singing, and had learned to play the guitar and cello. In 1966, he moved to New York City to form a band with some of his friends and by the end of the year they were performing regularly at cafes. Unfortunately, while in New York, Taylor lost himself in drug abuse for a time, but would later lead to the inspiration of some of his songs, including â€Å"Fire and Rain†. After he was back on track with his life, he recorded a few demos and had them sent to Paul McCartney, whose label signed Taylor immediately. A few weeks later, he fell back into his old habits of drug abuse, and was hospitalized in Massachusetts. After his recovery, in 1970, Taylor released his single â€Å"Fire and Rain† which was inspired by his experiences with drug abuse, depression, the suicide of his friend Suzanne, and the institutional psychiatric treatments he received. â€Å"James Taylor Biography†). While Travis is playing this song for Nomi, she is thinking about herself and her family. Nomi can relate this song to her life, because just like Taylor, she has lost loved ones, her mother, (who likely committed suicide like Taylor’s friend mentioned in the song) and her sister, abuses drugs, and has no faith in life. The song connects to both the themes of endings and loss which are present in the novel. The line, â€Å"I’ve seen sunny days that I thought would never end,† connects to the theme of endings, which Nomi has problems with due to the incomplete ending of her own life. The part about sunny days probably made Nomi recall all the good days and memories she has of when her family was whole. She even begins to cry in the novel, during this line. Nomi can relate, â€Å"But I always thought that I’d see you again,† to how she always thought that Tash and Trudie might come back to see her, which also ties into the theme of loss, because Nomi lost two of the most important people in her life. Another line that Nomi can connect to is, â€Å"You’ve just got to see me through another day,† which simply reflects on Nomi’s discontent with her life and the struggle she has just to get through each day. There are many poetic techniques incorporated into the song as well. Obviously, there is a lot of repetition due to the repeating chorus and the line â€Å"I’ve seen fire and I’ve seen rain. † This line is also a metaphor for the different emotions Taylor, and Nomi, have felt. Fire could be seen as anger, passion, or possibly rage while rain is probably referring to sadness and despair. There is also a lot of rhyming in the song such as â€Å"I’ve seen sunny days that I thought would never end/ I’ve seen lonely times when I could not find a friend,† and â€Å"You’ve just got to see me through another day/ And I won’t make it any other way,† as well as others, which makes the song flow more smoothly. The sound device of assonance is used in the line, â€Å"Sweet dreams and flying machines,† because sweet, dreams, and machines, (although machines is not neighbouring) all have similar vowel sounds. Works Cited â€Å"James Taylor Biography.† Bandbiographies.com. Retrieved 16 January 2013. http://www.bandbiographies.com/james_taylor/biography.htm

Shakespeare s Othello - The Simplicity Of Love - 1521 Words

The Simplicity of Love in Othello Shakespeare’s plays seem to focus essentially on a dominant male character and his struggles that tend to deal with a woman in a few plays. Shakespeare is criticized for the depiction of his novel. There are just three women in the play. They are Desdemona, Bianca, and Emilia. The role of the women serves to present them completely to reflect their ideological prospects within the Elizabethan society as well as the Venetian society. The women are required to love and unselfishly devote their lives to their husbands. Shakespeare presents Desdemona, Bianca and Emila’s relationship with the male characters in a manner that suggests all the women have distinct individual roles although at the end they all relate to one role. In Othello, it is the passionate human conflict and the imminent downfall of the tragic hero due to an overwhelming flaw of absolutism that proceeds to captivate the audience where eventually, through the tragedy of the play, Shakespeare explores lasting aspects of the human emotional condition and love. The main sensation and the force behind the play is love. Everybody acts upon the power of love. Othello utters this line before he commits suicide. â€Å"Of one that loved wisely but not too well,† (5.2.396) at the end the love ripped them off. Desdemona is the strongest and has steadfast love. Desdemona is an attractive, fair woman and a sweet woman that is motivated by fear and love. From the start of the play, she is shownShow MoreRelatedAnalysis Of Shakespeare s Othello 1131 Words   |  5 PagesAn Analysis of Othello by Shakespeare Shakespeare is known for his use of recurring themes throughout his work, including love, death and betrayal. These themes are present in his work of Othello. However, the most fundamental issue is jealousy. The lives of the characthers in Othello are ruined by jealousy from the beginning to the end of the play. The telling of the story is carried out by passion, jealousy, and death. Shakespeare’s Othello reveals devastating tragic inevitability, stunning psychologicalRead MoreAnalysis Of The Play Othello 1119 Words   |  5 Pagesplay â€Å"Othello†, by William Shakespeare and film adaption by Oliver parker explores the idea of how an individual’s sense of identity affects their actions and how this can be manipulated to create conflict. Shakespeare uses techniques such as soliloquies, dramatic irony, imagery, foreshadowing, and symbolism to show us how tragedy occurs from counteracting to patriarchal rules and stereotypes. Identity is a very key, important thematic issue in William Shakespeare s tragic play, â€Å"Othello†. IdentityRead MoreWilliam Shakespeare s Othello As A Tragic Hero1323 Words   |  6 PagesWilliam Shakespeare’s Othello the Moore of Venice is a play about a heroic individual that goes through a tragic event based on his decisions throughout the play. Many of the characters that Shakespeare presents in his plays reveal attitudes and value that is reflective of both the Elizabethan society in sixteenth century England and William Shakespeare; these values are evident in the context of the Venetian society that Othello takes place in. Through Othello Shakespeare embodies his belief ofRead MoreShakespeare s Othello And The Winter s Tale A Comparison1843 Words   |  8 PagesShakespeare’s Othello and The Winter’s Tale a Comparison Between Desdemona and Hermione William Shakespeare, in his Othello and The Winter’s Tale portrays some curious facets of femininity, maybe deliberately or not. Desdemona in Othello is a Venetian beauty with resolute individuality, while Hermione in The Winter’s Tale is more mysterious. When we take the reality aspect, the former is more realistic and true to life, which has implications even in this time. The latter, is to an extent, unrealRead MoreWilliam Shakespeare s Julius Caesar Essay1833 Words   |  8 Pages INTRODUCTION The seemingly straightforward simplicity of â€Å"Julius Caesar† has made it a perennial favourite for almost 400 years. Despite its simplicity, almost Roman in nature, the play is rich both dramatically and thematically, and every generation since Shakespeare’s time has been able to identify with some political aspect of the play. The Victorians found a stoic, sympathetic character in Brutus and found Caesar unforgivably weak and tyrannical. As we move into the twenty-first century, audiencesRead MoreStudy Guide Literary Terms7657 Words   |  31 Pagesrepetition of the initial sounds of several words in a group. The following line from Robert Frosts poem Acquainted with the Night provides us with an example of alliteration,: I have stood still and stopped the sound of feet. The repetition of the s sound creates a sense of quiet, reinforcing the meaning of the line 3. allegory – Where every aspect of a story is representative, usually symbolic, of something else, usually a larger abstract concept or important historical/geopolitical eventRead MoreLangston Hughes Research Paper25309 Words   |  102 Pagesaltar and accepted Christ as his savior, but in his heart, he knew that he had not experienced salvation. That night in bed, Langston wept and admitted to God that he had lied, that he had waited for Jesus and he hadnt come. He felt unworthy of love. Not only had he been abandoned by his parents, but Jesus had not transformed his soul and saved him from sin. Many years later he wrote a poem, Genius Child. In the poem, he compares a child to an eagle that cannot be tamed, with a soul that runs