I choose to discuss personal care and effective communication skills as I have made use of this two skills during an episode of care that I was directly involved in whilst on placement in a dementia ward. Personal care and effective communication is a valuable skill set that is fundamental in the delivery of nursing care.
The values that I exhibited during this episode of care is dignity and respect. Dignity and respect are core values that are highlighted within the professional code of conduct (Nursing and Midwifery Council, 2015).
In this reflective essay, I will explore, reporting, care delivery and will be examined along team working, person center support and patient safety.
The third part of this essay will look at different opinions on the concept of care and how this is linked to my caring and professional responsibility. Finally, I will conclude my essay by summarising key points regarding personal care, effective communication and the role dignity and respect have to play to achieve this.
In this essay, I will be mindful of Nursing and Midwifery Council code of professional standards of practice and behavior for nurses and midwives 2015 regarding confidentiality. I will make use of pseudonyms and referred to the patient as Dandy. It is a legal requirement to maintain privacy and confidentially of my patients and also to protect confidential information about my patients and only use it only for the purpose for which it was given. (Nursing and Midwifery Council, 2015). .
Mr. Dandy has a diagnosis of dementia. He has been admitted to the ward 9 months ago. He has a history of aggressive behavior and sometimes does exhibit challenging in his behaviour, he does not have any sense of danger and always wanting to escape from the ward.Dementia has really affected him in his approach to carrying out a sequence of task such as having personal care needs to be met independently (Alzheimer’s society, 2017). The loss of his memory of events happening around him at the moment and the cognitive impairment he is experiencing is as a result of dementia (Alzheimer’s society, 2017 )
I arrived my placement with a lot of enthusiasm. I was so excited that am beginning to fulfill my dream of being able to help someone, however, I am a bit nervous because this is my first placement. I met with the ward manager who gave me a booklet called ‘dementia survival’. I read the book and it proved very helpful and I learned more about how to communicate with the patients.
During one of my shift on the ward, I observed Mr. Dandy appeared to be uncomfortable in his incontinent pad, he had just opened his bowel and he put his hand into his trouser and reach out for his incontinent pad. He had also urinated on the floor, I called the attention of a Healthcare assistant that was close by to help me mop the floor whilst I concentrated on helping Mr. Dandy.
I approached Mr. Dandy and offered to support him with his personal care needs. He looked at me and did not say a word but because of the knowledge I have acquired through his care plan on how dementia has affected his communication skills and cognitive impairment, I was able to manage the situation effectively.
I waited for some time , move closer to Mr Dandy, got his full attention and I asked him again if he would like me to support him with his personal care needs and I waited for his response because people with dementia may take longer for them to process and understand what has been communicated to them ( Alzheimer’s society, 2016 ). Eventually he responded but unfortunately, he started to hallucinate.
I responded to his hallucination in a calm and reassuring manner. I touched him gently and I did not argue with him or disagree with him from what he has said during the period of hallucination (Alzheimer’s Association, 2017).Sometimes physical causes could be attributed to hallucination, things like bladder or kidney problem, substance misuse, alcohol, or even some medication can cause hallucination ( Alzheimer’sassociation, 2017).
I patted him gently and that seems to work and he focused his attention on me. I reminded him that I am on the ward to help him and on this occasion, it will be a good idea for him to have his personal care. Mental Capacity Act (2015) suggests that patients who have cognitive impairment and are said to lack capacity might be able to make some certain decision for themselves but at other times might be unable to make some other decisions. Hence the need to always inform Mr Dandy and seek his consent to everything I will be doing with him.
Eventually he responded but unfortunately, he started to hallucinate
I asked him if he would like me and my colleague to support him to get changed his incontinence pad and his clothing. He refused and said to me that there is no need for him to have personal care. I explained to him that he had opened his bowel and it would be a nice idea if he can get cleaned up. He ignored me and walked away and was chatting with another resident. I waited and did not interrupt his conversation. When he finished talking with the resident, I moved closer to him and I diverted his attention to his favorite sport and started talking about it. He mentioned his childhood football club and I reminded him of when he used to play for his local club and how he used to be smartly dressed. I reminded him that there is a football match that would kick off soon and it will be nice if he can tidy up before the kickoff.
He consented and asked me what do I expect him to do, I told him that we should go to his room so that I and my colleague can support him with his personal care. He suggested that I should go and bring the incontinence pad and change him in the communal area because he does not want his chair stolen. I reassured him that other nurses are there to look after his chair and moreover we are concern about other people looking at his nakedness. I touched him gently and asked him to follow me, he obliged and we went to his room. I called the attention of an experienced healthcare assistant who happens to be Mr. Dandy’s secondary nurse to come with me to assist Mr. Dandy with his personal care.
When we entered his room, I drew the window blind and shut the door. We explained to Mr. Dandy why we are closing the door and he appeared to be happy with his facial expression that we are taking his privacy seriously. He appeared to be happy and uses a hand gesture.
Thinking about infection control, I quickly washed my hands and I reached out for my gloves and apron, use of gloves is a very good preventative measure for protecting both patients and healthcare workers from infection ( Royal college of nursing, 2012).
I ensure that I listen actively to Dandy and gave him control on how he would like to be supported with his personal care.
I suggested to him to have a bath or does he want only his soil incontinence pad to be changed and get cleaned with flannel. He replied that he does not want to do any of the two. It is evidential that Patients want to be involved in their own health care need, this is very important to them (National Institute for health and care excellence, 2012).I repeated myself and this time around asking the same question but in another way and luckily he eventually consented to have a shower. As I approached him to support him his personal care needs, he became anxious and panicked, looked at me sternly and asked ” who exactly are you”. I stepped back, patiently explained to him that I am a student nurse on placement and I am there to help him. I brought out my ID card and gave him the opportunity to examine the id and to confirm that am the right person as explained. I was very mindful of my body language because if I don’t carry myself very well, that could be a trigger for something else. I patiently waited for his response which took over 5 mins. He apologised and said ”am really sorry ” and I replied him ” that is fine, you have not done anything unusual”. I asked him again if he is ready and he consented with a smile and said thank you.
I supported Dandy to meet his personal care needs, I ensure that I did not use the same flannel for both his face and his private part because of infection control. I ensure I talked him through the whole process of what am doing with his body. I also ensure I call him in his preferred name all through, I was able to achieve this because I listened to the request of Mr. Dandy and he could see what am doing because I was talking him through. Dandy care plan states that you must always remind him and talk him through events.
I gave him the opportunity to make a choice of what he would like to wear, he reached for a T-shirt and I suggested to him that I felt it was inappropriate to wear T-shirt due to the weather condition. He insisted that is what he would like because all his mates in the park are wearing the same T-shirt and they are all waiting for him to come and join them. I suggested to him to put on a cardigan on top of the T-Shirt and he obliged.
Effective communication is a tool that enhances, promote and facilitate patients overall quality of life (The online Journal of issues in nursing, 2014).
I showed care all through the process. As identified in the 6’c, Care is a key component of the NHS, both individual and the community has benefited from the care we deliver because Caring is our main goal and our work. People getting care want the best out of it and they want it throughout every stage of their life (Department of health, 2012).
During this episode of care as described above, I was on the lookout for Dandy’s body language, I did not raise my voice and I was talking to him in simple and plain language. My positioning and body language is not threatening nor confrontational and I also respected his personal space the need to respected his personal space.
The professional values that I demonstrated during the episode of care are dignity and respect. I waited for Dandy’s consent to be supported with his personal care needs and I offered him choices and preferences on how he wanted to be supported.
It is very obvious that because of Mr. Dandy’s cognitive impairment as a result of dementia , I would not have been able to achieve this if I have not been patient enough in communicating with Mr. Dandy(Alzheimer’s society, 2017). My understanding of person-centre care has also afforded me the opportunity to care for Mr. Dandy as stipulated in his care plan, knowing fully well that each person suffering from dementia is Unique and each person will experience dementia in their own way (Alzheimer Society, 2017).
Alzheimer’s society 2017 highlights that patients tend to recover more quickly and live more comfortable life during an episode of care if their dignity and respect are upheld. I showed dignity and respect to Mr dandy throughout this episode of care and I was able to support him to have his personal care meet. I was able to work in collaboration with my colleague I was able to seek the assistance of my colleague and work in my professional competence (Nursing and Midwifery Council ,2015 ).