Any legal entity or organization needs some sets of fundamental rules or standardized written down constitutions to govern it for it full operational capacity. Based on these principles, The NHS England has written down its own constitution (2015) focusing on patient centred care as one of its key principles. The constitution also set out the right for patient, public and staff focusing on promotion of diversity, equality and access to basic quality health care. In relation to all these lay down principles, nurses are expected to put their patients first in everything they do and involve them in any decision they make about their care. In this prospect the nurses would be able to deliver a compassionate care and respond to patients’ pain with humanity and kindness (Department of Health, 2015, 1.5).
This essay aim to explore in depth how nurses can put patient at the heart of everything they do in line with health care settings. It will also focus on describing and discussing the ‘Patients Story’ in relation to providing compassionate, relationship-centred care by emphasizing the important meanings to patient centred care and how vital this is to the nurses and relate it to the key NHS concepts in areas of communication, ethical and legal issues in nursing practice.
Also, the essay will discuss in detail the role of the nurse upholding the NHS constitution in promoting choice. It will also explore the principles, values and pledges and discuss them using as an evidence based during their encounter with patients.
Patient stories are stories that a told by the individuals own perspectives for their interest. It can be from the patient own mouth or family members about an excellent care, experience or improvement from the service they received. it can also be an inadequate experience of care received or even an emotional and physical harm to an individual. A team work from members of staff to implement a patient improvement can also be patient story (www.1000livesplus.wales.nhs.uk).
Patient stories has a care foundation to it: this is by identifying avenues for improvement, achieving patient centred care and improving methods by building true engagement (1000 lives).
The NHS uses patient stories to inspire: this helps to arrest both mind and heart whiles making good changes and look at thing otherwise. to educate, by changing the future of our healthcare to acknowledge that both partner and patient are equal to equip the workforce to appropriate skills. in addition, patient stories help to engage media to shift the negative aspect to balance, to promote what is good as well as bringing the NHS to the local communities (1000 lives).
In view of Berglund et al. (2012) patient normally tell their stories according to whatever service they have received in a healthcare environment, being it good or bad to fight for their right.
The values of the NHS constitution are that it has commitment to quality of care, which encourage us to welcome feedback from patient, families, carers, staff and the public. So that caring alongside with compassion will go in hand these.
1-Compassion is defined according the concise Oxford English dictionary ‘as strong feeling of sympathy and sadness for people who are suffering and a desire to help” (Soanes and Stevenson 2006).
2-Compassion is defined according to Cambridge English dictionary “as a strong feeling of sympathy and sadness for the suffering or bad luck of others and a wish to help”. Meanwhile Buddhist add that compassion is the feeling of participating of one’s suffering. But (Michie,2012) also said that compassion should include kindness, love, patience and generosity. For nursing point of view Ryder (2009:9) also said compassion is essence of caring just as want other people to treat you the something you do to others. It can also be defined as the basic kindness with inner awareness of yourself as well as others according to Gilbert (2010: xiii). In all these, the NMC code of practice (NMC.2015) encourages nurses to treat patients with kindness, respect and compassion. (pg 59, compassion in nursing A. Hewison and Y.Sawbridge 2016 palgrave publishers London).
In the Francis Report for Mid Staffordshire there was no compassion what so ever in that hospital, where patient was left to die in distress. This shows no compassion in both nurse and other health professionals. With absent of compassion person-centred can never accomplish is health setting for the public.
Person centred care can be defined as a special relationship that exist between patient and nurse in a historical connection demanding the nurse to consider the person that the patient is and understanding the expectation and implicit in the relationship (B. McCormack and T. McCcane 2016).
Person-centred was first used by psychologist Carl Rogers according to (B. McCorck and T. McCcane 2016). psychologist Carl Rogers was the first person to use the word person-centred in relation to psychotherapy.
Meanwhile in HCPro May 2018 person centred can developed with both patients and their families, which can treat patient holistically but not just a patient. In the other hand they should be treated as a person who has worries, specific fears, issues, want and needs. Especially those who will spend more time in health care environment, the should will be more actively involve them and their families in all aspect of care (HCPro May 2018 vol.16 issue No. 5).
Leiging (2008) also put an argument that person-centred is always difficult for people who are suffering from disease such as dementia can lost his or her personality because deterioration or medication. it can be due to the dominant of biomedical focus of the disease and its process (B McCormack and T. McCance 2016).
(scenario: A new care worker went to work in a dementia unit, she put everyone’s tea in a beaker, although Mrs Z has dementia but is the early stages, which means that she does a lot of things for herself. She called the worker and explain to her that because she is here that not mean that she can’t use a cup. In a situation like that person centred was not used, treating everybody the same.
In the Francis report (2013) for the Mid Staffordshire NHS Foundation Trust it was noted that for a period of about two years between 2005 and 2009 the emphasis of dignity, person-centred care was not met, as well as compassion and respect. Attention was also draw to the failings of proper care to service users. Nurses and other health professionals were not concern about feeding or helping them to eat nor drink, a lot of the service users were dehydrated because of their attitudes towards them. Prescribed medications were also not given to the appropriate owners, whiles sick people were discharged to go home. Suitable personal care was not available in the hospital for the service users. Addressing shortage of nursing, on complete paper work and balancing of books were delayed by the trust. Whistle-blowers who was worried about the poor practice of the trust were ignored. All these contribute that service users’ needs were not met to standard because of poor communication.
Communication is defined as a general word with many meanings, it has described as a transfer of information between a message sender and a message receiver. There are many forms of communication that occur in a healthcare setting. It can be verbal, non-verbal, written or spoken. Personal or impersonal, issue specific or can
be relationship focused on (communication for nurses, L. Kennedy Sheldon and J. B. Foust 3rd ed, talking with patient pg6).
otherwise in the Picker’s Eight Principles it let us understand that for a person-centred care to achieved we should follow the following: respect for patients’ preferences, coordination and integration of care information and education, physical comfort, Emotional support, involvement of family and friends, continuity and transition and access to care (OneView healthcare 2018). Person centred care is more useful when it comes with a good and effective communication.
According to NMC code of practice (2015) nurses should communicate in terms that the service users will understands. Nurses should take a reasonable step to meet service users’ communication need where possible assistance to does who need it. They should be able to use both verbal and non-verb communication methods and consider cultural sensitivities to better understand and respond peoples personal and health care need. Upon doing that there is a relationship between the service user and the nurses that can also bring person-centred care.
Nurses don’t communicate with service users alone, communication within the profession is a vital tool, health professionals do communicate among themselves either by written or oral. Because they are not at work all day and night, they should write or tell their colleague whatever has happen during and after their shift.
Communication can be divide into two, verbal and non-verbal. When nurses use verbal communication, they should be careful about the way they choose to communicate with service users, especially their understanding. Nurses should not use medical jargons when explaining things to them or even acronyms. This will made them feel disappointed or even compromised their care (Lloyd and Craig 2007). Abayomi McEwen and S. Kraszewski pg3 communication skills for adult nurses (2010) print open university.
Stickley (2011) is urging nurses and health professionals that, when talking to service users, for them to feel comfortable and listen to we should sit at an angle that is appropriate. We should uncross our arms and legs to show we are listen and interested in whatever they are saying. Having an eye contact and relaxing will also let me feel at ease as well as to express concern by touching where necessary and our intuition. This will make them trust you to build a relationship with you or even enable them to tell you more about themselves, which can be therapeutic.
Although there is many importance of interpersonal communication for nurses, having an effective therapeutic communication between a nurses and other health professionals and well as service users can improve problem solving and some decision making. It can also improve treatment outcomes (Boyle and Kochinda, 2004; Schmidt and Svarstad 2002). Poor communication between nurse’s, health professionals and service users will have big impact on staff morale, service user satisfaction, treatment outcome and quality of care (Larson 1999; Rosenstein 2002).
Although there is many importance of interpersonal communication for nurses, having an effective therapeutic communication between a nurses and other health professionals and well as service users can improve problem solving and some decision making. It can also improve treatment outcomes (Boyle and Kochinda, 2004; Schmidt and Svarstad 2002). Poor communication between nurse’s, health professionals and service users will have big impact on staff morale, service user satisfaction, treatment outcome and quality of care (Larson 1999; Rosenstein 2002).
Sometimes there can be barriers in communication such as: age, gender, social class, ethnicity, social status and language. Health issues can be barrier for communication for example hearing impairment, multiple scleroses and many more can sometimes affect communication. Expression from professionals can also be a good barrier, lucking of trust is also a potential barrier for communication. If a patient does not trust you, they are not going to tell you things that you should know about them.
Kourkouta and Papathanassiou 2014 are also in favour of good communication, saying it empowers nurses to offer effective service like treatment, education and promotion of good health and prevention. Good communication help nurses to pinpoint problems and come out with a person-based care plans to solve medical conditions. It is the responsibility of the nurse to listen to the patient to give a professional advice for the wellbeing of the patient.
Therapeutic relationship is defined as a relationship that makes the patient feels comfortable and can be open and honest to the nurses that can have a development of productive relationship that will bring a better outcome (Dart 2011). Nurses create a short period of time with patient this doesn’t mean the relationship between a nurse and patient must be deep. Interaction between nurse and service user can be very meaningful (Bassett 2002) the closeness should bring mutual and beneficial. Indicators of nurses confirms participating in informed social and to show kindness that they are valued, trust can be development and reassurance of people both confidence and technical in ability to listen to and help them. The importance of this respond to the concern of service user and family to help reduce pain being it physical, emotional or spiritual (Dawson era 2013). 2ed page 162 compassion, caring and commitment J Baugham and A. Smith Pearson.
There are four main ethical issues that govern nurses through their profession according to (Beauchamp and Childress2013). These are Non-Maleficence, Beneficence, Autonomy and Justice. These principles are back up in the NMC code (2013) of practice as well (Beauchamp Tom L ; Childress James F (2013) principles of Biomedical Ethics. 7ed Oxford University Press, New York.
MNC code of conduct (2015) 4.3 and 4.2 encourages nurses to have a consent from their service users and document it before the take any caring procedure. The MNC also want nurses to put the Mental Capacity Act (2005) in the interest of the service user, who has not got the capacity to make some decision for themselves or their care. For a service user to be given a consent form to sign, there should be some sort of information given before. It the responsibility of the nurses to make sure the service user understands the information given to them and allowed to make their own decision. There should be no burden or anything that can force them to change their mind or sign things, that does not make sense to them. In a situation where a service user lacks capacity, the Mental Capacity Act (2005) is use for their decisions especially for impairment, malfunctioning of the brain. The act also seeks to protect vulnerable who cannot make their own decisions like people with Alzheimer’s or any mental issues.
The constitution for NHS 2015 has its own principles and values, for NHS in England. It has set out some right things in which service users, staff and the public who are eligible, and pledge that the NHS is committed to achieve, together with responsibilities, which the staff, service users and public owe to themselves to ensure the NHS operates equally and effectively. There are seven key principles which the NHS direct all its doings and directed by key values which staff should work towards to. The principles and values are legally bind together and therefore the service user have every right to enjoy what they are entitled to within the constitution and any available choices.
One of the principle of NHS state that health professionals will provide care for everyone irrespective of one’s age, race, disability, religion, believe, gender or sexual orientation. The NMC code of practice 2015 also encourage nurses to treat people as an individual as well as uphold their dignity and respect, that can promote the human rights of people that they care for.
Nurses can face disciplinary or even have their name remove from the NMC register, if found guilty or discriminating against a service because of their age, religion, sexual orientation and failing to comply with the NMC code. NHS has high aim to professional standard of excellence in the care giving to service users this will make the service user at the centre of everything. NMC 2015 inspires nursed to upload the reputation of the profession always and to practice according to the best available evidence.
One of the 6’c is commitment and is in the principles that guide the NHS to be accountable to the taxpayer on how their money is being use. The NHS is not alone, it is in partnership with some other organisation that help to give perfect health and wellbeing to the public. Some principles underpin the work of the nurse to serve the communities.
NHS have values that motivate its members, and this should be experience by the service user, wherever they choose to get medical service to help the individual to allow the NHS to build on these values to create development (NHS Constitution 2015. For the organisation to work together by putting the service user at first nurses and health professionals should acknowledge these values.
Nurses are encouraging to abide by these values to have compassion for their service users, and to improve their health and wellbeing of the quality of care which they are committed to. There are also right of pledges to the service users, aside this values to inspire values for nurses (D o H.
One of the values of nhs is working together for patient, this value help nurses to engage in patient, families, carers and communities. This indicates that the patient comes first before organizational boundaries if only is going to be a better life for the patient (NHS Constitution).
It also supports it members to speak up when anything goes wrong, keeping thing that has gone wrong to yourself will not help you or the organization. NHS also built upon these mistakes to improve their services (D o H 2015).
Respect and dignity are values paramount to the NHS, respecting families, carers, patient and staff are ultimate commitment as well as understanding their needs. The abilities and priorities will enable nurses to put them at the centre before any care will be given (NHS Constitution).
Pledges to you by the NHS are not legally bind because if one is not satisfying about the treatment he or she has received or not a fair treatment you have every right to say what you want (NHS Constitution).
Patient right means the can assess health wherever they found themselves not matter where or when. Patient have the right to received healthcare information anywhere is Europe, Switzerland on admission. Everyone has the right to unlawfully not to discriminant against provision of NHS service on ground of gender, race, disability, age, sex orientation, religion, belief, gender reassignment, pregnancy and marital or civil partnership (NHS Constitution).
A service user’s choice is where they have the right in all aspect of the service we provide. The right for privacy, dignity, independence, security, civil right, choice fulfilment, diversity and quality (trust care 2018). Charter off service user’s right at http://www.trustcare.co/charter-of-service-right.php
Many at times when patient are given choices nurses do not consider the changes or symptoms that has occurred, rather they focused on the outcome like distress choice is classified as an excellent opportunity for the first psychometrically measure from a service user according to (Greenwood KE et al 2010). Development of a new service user-led outcome measure of CBT for psychosis,10.1093/schbul/sbp117, web.b.ebcohost.com.icproxy.shu.ac.uk) schizophrenia Bulletin 2010 vol.36(1), pp.126-35.
The journal sagepub is challenging that although choices make an important in one’s life and enabling their engagement. It must be recognised if all choices by service users will assist their recovery. Maybe someone in a high dependency unit very ill telling the nurse I will be fine when I go home (British journal of occupation therapy 2008). Journals.sagepub.com.icproxy.shu.ac.uk
Health care environment has become very dynamic that is affecting the role of nurses and other health professionals in the industry, it is clear that the demand on nurses have increase so much that it is putting strain on nurses. That is making it difficult for them to perform their duties according to NHS constitution and NMC code. Nurses must endeavour with the guidelines given to them for effective outcome.
References
1-Department of Health. The Handbook to the NHS Constitution. (27 JULY 2017) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/474450/NHS_Constitution_Handbook_v2.pdf.
2-World class healthcare for Wales by 2015, Patient stories for quality improvement. http://www.1000livesplus.wales.nhs.uk/sitesplus/documents/1011/Patient%20stories%20Wales.pdf3-Soanes, C., ; Stevenson, A. (2006). Concise Oxford English dictionary. Pg 291Oxford: Oxford University Press.
4-Hawison. A. ; Sawbridge. Y. (2016) Compassion in Nursing. Palgrave Publishers London
5-Nursing ; Midwifery Council Magazine (2015).The code: Professional standards of practice and behaviour for nurses and midwives. London: NMC.p.5
6-https://dictionary.cambridge.org/dictionary/english/compassion7-Berglund et al.(2012)
6-Michie.(2012)
8-Francis Report (2013) The Mid Staffordshire NHS Foundation Trust
9-McCormack, B. ; McCcane, T. (2016)
9-HCPro (2018)
10-Kennedy Sheldon. L ; B.Foust. J (2010) Communication for Nurses
11-OneView Healthcare (2018)
12-Lloyd and Craig (2007)
13-McEwen. A ; Kraszewski, S. (2010) Communication Skills for Adult Nurses. Print open university
14-Stickley (2011)
15-Boyle and Kochinda (2004)
16-Schmidt and Svarstad (2002)
17-Larson (1999)
18-Rosenstien (2002)
19- Kourkouta and Papathanassiou (2014)
