Nursing Care

An Essential Guide for Nurses and Healthcare Workers in Primary and Secondary Care

Barbara Smith, Linda Field

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9781138389090
• eBook ISBN: 9780429754234
• Topic: Medicine
• Subtopic: Nursing

This new edition of Nursing Care: An Essential Guide for Nurses and Healthcare Workers in Primary and Secondary Care is a comprehensive introductory textbook to nursing care for pre-registration nursing students and nursing associate students in the UK, and is relevant to other allied health students. This 'back to basics' edition is a concise, clear text on the essentials of nursing care which:

• Comprehensively covers all aspects of essential care
• Puts care into context and relates it to current UK government policy and targets
• Shows how to apply theory in practice using diagrams and case studies
• Provides opportunities to reflect on the theory and think critically on key issues
• Explains clinical skills in the context of care
• Includes features such as recap questions, points for debate, a glossary, further reading lists and a companion website to allow students to reinforce and expand their knowledge

Fully updated to address the latest Nursing and Midwifery Council and government policy, this new edition of Nursing Care: An Essential Guide for Nurses and Healthcare Workers in Primary and Secondary Care is designed to help the student develop a proactive approach to the assessment, planning, implementation and evaluation of the care that they give. The invaluable advice can be applied to all branches of nursing and to all environments where patients are nursed, whether in hospital, at home or care homes.

This book is essential reading for nursing students, qualified nurses and all health and social care workers.

Chapter 1

What is caring?

Case study

Miss Smith was being admitted to hospital for a routine operation. She was anxious and nervous about what was going to happen. On walking into the hospital she was greeted by the receptionist. Immediately Miss Smith felt less anxious. The receptionist introduced herself, wished Miss Smith good morning and asked how she could help. She then directed Miss Smith to the ward. On entering the ward Miss Smith was greeted by a nurse, who showed Miss Smith to a bed and explained the layout of the ward, when meals and drinks were served, where the shop was and about visiting times. Later the nurse formally admitted Miss Smith to the ward and gave her the opportunity to ask any questions. Miss Smith’s fears and apprehension disappeared quickly, and she felt confident about the care she was going to receive.

Introduction

Everything in this case study is about showing courtesy to others; it’s about making someone feel welcome and showing them that they matter. Miss Smith was frightened and nervous about her hospital admission, even though this admission was for a routine small operation. The receptionist and nurse were understanding; they were efficient but took the time to introduce themselves to Miss Smith, to talk to her and to give her the opportunity to ask questions. Miss Smith felt cared for – but how differently she could have felt if the receptionist and nurse had done their duty but not made any extra effort or worse had just continued with their paperwork without acknowledging Miss Smith’s arrival. She would then have been left feeling worried and nervous. In this chapter we explore the notion of caring and look at ways in which you can improve the quality of the care you give.

Learning objectives

By the end of this chapter you will be able to:

1.Explore what is meant by caring

2.Think about the difference between good care and bad care

3.Develop and use strategies to ensure you give high-quality care at all times

4.Show an awareness of the assessment process

What do we mean by ‘caring’?

To think about

Consider a time when you have been ill.

What made you feel cared about?

Why did this make you feel cared for?

What made it a good experience?

Some of the things that made you feel cared for may include being shown kindness, being given drinks or food when you were weak, being made comfortable, warm and safe, and having your needs understood. These behaviours make you feel cared for and feel that you are worth being cared for. Caring behaviours make a difference because they make you feel safe and as comfortable as possible. The 2015 NHS Constitution Care Competencies state that care and compassion matter most; this constitution establishes the principles and values of the NHS (NHS, 2015). A person’s sense of well-being is paramount to their care and how they respond to treatment and care that is given (Nursing and Midwifery Council, 2018).

It is easy to forget or even not consider the positive effect that nurses have on patients. How we treat patients has an impact on the care that they receive. Often it is the smallest details that make the biggest difference. As we saw in the case of Miss Smith, simply greeting the patient, using their name, and knowing why they have been admitted to hospital can allay the patient’s fears. Evidence collected for the Mid Staffordshire NHS Foundation Trust Inquiry (Department of Health, 2010) gives details about the uncaring attitudes of some of the nurses. Nurses should never undervalue the importance of caring and showing patients that they care. In order to do this, we need to be able to understand the behaviour of caring by exploring and reflecting on what caring is. Why are some experiences good and others bad? What are the circumstances that contribute to an experience being good or bad? Consider Case study 1.1.

Case study 1.1

Mrs Vincenzi is an 80-year-old woman who was admitted to a general medical ward a few days ago after a stroke (cerebral vascular accident). The stroke has left her semi-paralysed and unable to communicate. She is dependent on the nursing staff for all care.

Mrs Vincenzi is in unfamiliar surroundings. She can hear muffled sounds and occasional bangs and voices, but she is unable to understand where she is and what is going on. She is finding it difficult to focus but is aware that she feels trapped in the bed, unable to move or get up. Mrs Vincenzi is frightened and confused and does not know what is happening to her. She feels very alone and vulnerable and is completely reliant on others. She is thirsty and her lips are sore and dry. She has pain and feels very weak.

A stroke results from a bleed into, or a blood clot in, part of the brain.

Now consider the following examples of the care that Mrs Vincenzi could receive:

Hello, Mrs Vincenzi. My name is Kathy and this is Fiona. We are nurses and we have come to check that you are comfortable. Is that okay with you? Mrs Vincenzi, is it alright if I change your sheet and help you have a wash? I think you will feel better. Your lips look a little dry; would you like some cream on them? There, how does that feel? Would you like a drink? Have a few sips of water and then I can get you some tea if you would like. Have you any pain? Yes, you have got quite a nasty infection, but you have been started on antibiotics so once these kick in you will soon feel as good as new. You’ve got quite a temperature; I can get you some paracetamol to help ease the aches and pains and bring your temperature down.

The nurses in this first scenario are caring. They tell Mrs Vincenzi what they are going to do and are efficient and reassuring. They introduce themselves to the patient and ask permission before doing any tasks. They come across as being kind and patient.

Now consider this second scenario:

Come on, Shell. Let’s get on and get some of them up. Let’s start here. Oh no! She’s wet! Let’s get her changed. More work: this is a pain. Come on now, roll over and let us get you changed. Fancy wetting the bed! Never mind, eh? Oh no, look what I’ve just put my hand in! Don’t laugh, Shell. Mind you, if you didn’t laugh, you’d cry. Are you going out on your days off? I can’t wait to get off this ward. We do an awful lot of shovelling.

Unfortunately, the second scenario is close to an incident that actually happened. The nurses probably did not mean to be unkind and thoughtless – they were simply trying to make light of a difficult situation. However, in doing so they were failing their patient. This is an extreme example of poor care, but unfortunately this does happen in real life. The nurses are being unprofessional and are not considering the patient’s feelings in any way. They are just as efficient at cleaning Mrs Vincenzi, but their approach is poor and unkind.

Fundamental and essential care

To think about

What do you consider to be essential care?

Why?

You will probably have included some of the following:

• To be listened to and understood, and to understand what others communicate to you
• To be treated with dignity and respect and to have your privacy respected and maintained
• To be free from pain
• To receive adequate edible food and to have enough to drink
• To be able to swallow safely
• To regain independence through restoration and adaptation of physical and psychological functioning
• To be clean and comfortable
• To have any infection treated efficiently and not to be put at risk of getting an infection
• To have your own and your family’s and carers’ views taken into account
• If your condition changes, to have this observed and acted upon

All of the above are aspects of care that are important because they deal with basic human needs. When the Fundamental Standards for Care were introduced, practitioners were encouraged to consider whether care is safe, effective, responsive, caring and well led (Care Quality Commission, 2016). The central theme of this book is about the care you give to your patients. It is about ensuring that this care is of the highest quality and is given in a proactive manner so that you are able to anticipate and fulfil your patients’ needs. Nurses have a duty to provide and promote non-discriminatory, person-centred and, above all, sensitive care. It is important that care and treatment reflects the person’s values, beliefs, spirituality, background, culture, language, needs and preferences (Nursing and Midwifery Council, 2018).

How can you ensure that you give high-quality care? High-quality care is difficult to define; it is about the difference between good quality and poor quality. Poor quality of care has been a cause for concern for many years. Since 1995 there has been a national commitment to drive up standards of fundamental and essential aspects of care. This has been reflected in government policy following pressure from organisations such as Age Concern and from health and social care practitioners, patients and their families. In 2018 the Nursing and Midwifery Council introduced the Standards of Proficiency for Registered Nurses; these proficiencies help meet the public’s expectations of what they perceive as being acceptable nursing care. The standards apply to all branches of nursing and are relevant for associate nurses and all health and social care workers, not just student nurses. They identify the fundamentals of best practice which should be demonstrated throughout any care that is given to patients (Nursing and Midwifery Council, 2018).

To think about

How can good-quality care be defined?

In what ways can the standards of essential care be measured?

How can quality be maintained?

The most effective way of finding out how good care is, and the standard to which it is being delivered, is to ask patients and their families how satisfied they are with the care provided. This is about finding out what is important to the patient and what can be improved. Standards of care can be measured in this way and quality can be maintained by this means and through activities such as benchmarking (as we expla...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Guided tour
• Introduction
• Chapter 1 What is caring?
• Chapter 2 Dignity and privacy
• Chapter 3 Basic observations
• Chapter 4 Hygiene
• Chapter 5 Nutrition
• Chapter 6 Fluid balance and continence care
• Chapter 7 Pain management
• Chapter 8 Pressure ulcers
• Chapter 9 Rehabilitation and self-care
• Chapter 10 Record-keeping
• Index