This assignment is a reflective account that will be focussing on my professional practice concentrating on the impact of medication for patients, my response to the situation, what I learned and what would be done differently. The points that I am concentrating are the legal, ethical and professional aspects of my duty of care in the particular scenario explained. For this assignment, I will be using the Driscoll (2007) cycle of reflection. As per confidentiality Policy, any data that enable someone to identify a person must be considered confidential and it can only be shared with the right person in the right time if they need to know. For confidential reasons and the purpose of this assignment, I will refer to the patient involved as ‘Monty’.
Monty, an elderly man was admitted to the respiratory ward due to exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and he also had a medical history of Small Cell Lung Cancer (National Cancer Institute, 2018) and dementia. The Trainee Nursing Associate (TNA) had been assigned to look after a bay of four patients, one of which was Monty. In the morning, at the beginning of the shift, Monty had required a small amount of help with his living activities and he was alert and lucid and hence the TNA had no concerns.
Late in the afternoon, the TNA noticed Monty slumped in his chair and when approached, he was very drowsy and vague. The TNA being accountable for his actions, took the baseline observations, recorded appropriately and immediately went to the nurse in charge to raise the concerns. As a TNA, he was aware of his limitations and sought support, demonstrating duty of care. All of Monty’s observations were within a normal range (BP-125/85 mmHg, Pulse- 94, Respiratory rate – 20, Temperature – 37.2°C and BM – 6.5 mmol/L). After the discussion with the staff nurse, it was informed that Monty’s current state was due to the drug called Oramorph, he had taken at lunch time. The TNA was shocked at the impact of Oramorph on Monty and this lead to a discussion about whether the medication was in the best interest of the patient.
The TNA demonstrated his professional duty in this scenario, as he displayed duty of care and maintained the patient’s wellbeing. Duty of care is the legal and professional commitment of a healthcare professional towards others, especially towards the people under their care. The law states that, in a reasonably foreseeable situation, where the action or omission of a healthcare practitioner can cause harm to others, duty of care is imposed. There are various standards set out through national and local policies about duty of care. The NMC Code stipulates about the expectations of duty of care from the nurses and midwives while the local Trust policies specifies about the entire staff of the Trust.
By noticing the deterioration of Monty, immediate and appropriate steps were taken to first assess the patient’s condition and ensure that he was safe and not in any immediate danger. This was done is a professional manner. However, it was a challenge to communicate with the drowsy dementia patient, and determine, with the TNA’s limited knowledge and clinical experience, whether the patient was having a clinical deterioration or not. Further he showed accountability for his actions by documenting all the baseline observations and being aware of his limitations, promptly reported the matter to his senior, thus escalating the situation and acting in the best interest of his patient. Monty’s current condition was not due to a decline in his medical condition as first suspected, but as a side effect of the Oramorph he had taken for pain relief. Oramorph belongs to the unlicensed drug category called Opioid or Narcotic Analgesics, which changes the way how brain react to pain in any part of the body. It can make the users very drowsy with the initial few doses and this side effect will gradually decrease as their body get used to the medication. The staff nurse from the previous shift handed over the physical and medical conditions of Monty and was mentioned that, he did not have a very good sleep during the night. This is one thing that could have been easily co-related to Monty’s drowsiness and misinterpreted that he is having a sleep in his chair. If that was the case and Monty was left unattended, and on other hand if he was having an actual medical deterioration, the TNA would have breached his duty of care in legal, ethical and professional aspects.
The TNA also acted as an advocate for the patient by further discussing the appropriateness of the medication, given his medical condition. ‘Patient advocate’ is the term used to refer someone who is acting on behalf of the patient in their needs, when their ability to communicate and/or judgement is compromised. Monty had now lost some of his independence in decision making and judgement, because of the dementia. Knowing this, it was felt that this medication could potentially worsen Monty’s actual medical condition like; constipation, dietary intake could be compromised leading to infections and in turn increased confusion. His mobility may also be compromised and higher risk of falls and/or incontinence, all of which could be potentially detrimental to Monty’s already frail condition. The ethical and humane nature of the TNA is demonstrated by his concern towards the patient’s pain and the impact of the medication that can have on the patient’s wellbeing.
This scenario highlighted the importance of balance and looking at patients individually and holistically when prescribing medication. There are various alternative analgesics available and the TNA questioned the reason Oramorph had been selected and if it could be retrieved. He highlighted the importance of the same and requested the nurse in charge to have a discussion with the doctor who prescribed the medication. This situation was well handled by the TNA as he responded appropriately in time and within own limitations, acting in the best interest of the patient, being accountable for their actions and acting autonomously for the patient.
This scenario demonstrates the need of clear documentation of the condition like dementia and drugs that can further cause drowsiness. Documentation is of paramount importance as this ensures the safety of the patient as well as the health care professional. As working in a team, it is very important to keep all the team members updated, by communicate properly and documenting, about any changes or expected changes in the patient conditions, abnormal values in any of their observations etc.
This also shows the need to look in to the drug chart and need to be aware of possibility that the decline in patient condition may be due to the effect of some drug being administered. By keeping self-educated and familiarise with the drugs, their use and side effects etc will enable us to deal with the situation in a much more.relaxed and professional manner. Also, it will help diagnose the problem and enable confident decision making providing patients with high standards of care. Discussing with the doctors to find alternative medication is something that can be considered and then again this would require monitoring.
In this scenario, all the relevant actions were taken by the TNA in a timely manner. He did an immediate assessment of the patient, knowing own limitations, escalated the situation to the concerned person, ensuring patient safety and acted as patient advocate in the patient’s best interest. Anyone working in the healthcare industry is expected to be working in a certain standard and they legally have a duty of care and responsibility to look after the patients under their care. Relevant trainings are offered, and it is the duty of these healthcare professionals to attend those trainings, which will enable them to give unbiased care to their patients, properly and efficiently, and also enables them to be professionals in their practice. Any change in patient condition must be identified at an early stage so that the relevant action can be taken and prevent the condition from getting worse. Negligence of health care professionals can make the patients under their care to deteriorate very quickly and even lose their lives.
By completing this reflective piece of work, it enabled me to develop my academic and research skills. I started writing short notes about the incidents happening on the ward and research around it and write a reflection. This is a new skill that I developed and enabled me to complete this assignment. Also, a glossary of new terms is being made which will act as a quick reference for me; if in need. After deciding the topic for my assignment, I started reading the policies and guidelines in relation to patient care. I was very well supported by doctors, my manager and my seniors in finding the literatures, making suggestions about time management, which was one of the challenges that I faced. To give top-notch care for patients, good communication and academic skills are needed. These are the two areas that I need to concentrate more on. By putting some extra effort to find more time and taking myself away from other commitments is the strategy that I will be putting in place to achieve this. Also, I became more structured in prioritising things and meeting up the deadlines.
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