Beruflich Dokumente
Kultur Dokumente
Published 2013 by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
711 Third Avenue, New York, NY 10017, USA
The right of Barbara Smith to be identified as author of this work has been
asserted by her in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic,
mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing from the publishers.
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any
information, methods, compounds, or experiments described herein. In using such information or methods they should be
mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any
injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or
operation of any methods, products, instructions, or ideas contained in the material herein.
Spirituality 29
Reflective practice 31
Clinical supervision 31
Dealing with complaints 32
Incident reporting and analysis 32
Governance 32
Clinical practice benchmarking 33
Keeping a reflective diary 36
COMMUNICATION 38
Good practice for communicating effectively 40
Active listening 40
Times of silence 40
Tips for verbal handovers 41
Written documentation 41
Common communication problems 42
Assessing communication 43
While every effort has been made to ensure that the content
of this guide is accurate, no responsibility will be taken
for inaccuracies, omissions or errors. This is a guide only.
The information is provided solely on the basis that readers
will be responsible for making their own assessment and
adhering to organisation policy of the matters discussed
herein. The author does not accept liability to any person for
the information obtained from this publication or for loss or
damages incurred as a result of reliance upon the material
contained in this guide.
CONDUCT AND CARE PROVISION 3
COMPASSION
Student nurses need to be able to show that they can provide
care that is delivered in a warm, sensitive and compassionate
way2 by:
• Anticipating how the person might feel
• Being attentive and showing sensitivity
• Responding with kindness and empathy to provide
physical and emotional comfort
• Getting to know and value patients as individuals3
• To be compassionate is to understand and to be able to
provide the appropriate support
1
e.g. you can contact the Nursing and Midwifery Council.
2
Nursing and Midwifery Council (2007) Essential Skills Clusters, Nursing and
Midwifery Council, London.
3
Nursing and Midwifery Council (2009) Guidance for the Care of Older People,
Nursing and Midwifery Council, London.
COMPASSION 5
4
NMC (2007).
5
Kerr, D. and Wilkinson, H. (2005) In the Know: Implementing good practice,
Information and tools for anyone supporting people with a learning disability and
dementia, Pavilion, Brighton.
6 COMPASSION
6
Kitwood, T. (1997) Dementia Reconsidered: The person comes first, Open
University Press, Buckingham.
COMPASSION 7
7
Adapted from Kitwood, Tom (1997) and Brooks, Lee (2006) Dementia
Awareness, Tribal Education Ltd, York.
8 COMPASSION
8
Adapted from Brooks, Lee (see Footnote 7 above) and Nursing and Midwifery
Council (2007), Essential Skills Clusters, Nursing and Midwifery Council, London.
PERSON-CENTRED CARE 9
• Being patient
• Not rushing the person
• Not taking over
• Thinking about how you would feel if your decisions were
made for you.
■ PERSON-CENTRED CARE
Person-centred care is about putting the person at the
centre of the care, rather than their illness or condition.
It offers a non-judgemental approach to care in which
the person’s religious belief, personality, intellect,
ethnic origin or other individual characteristics do not
prejudice the delivery of high-quality care. It sees each
person as a unique individual with a unique life history.
The person’s needs and feelings are the focus of that care,
around which all other aspects of the care are geared.9
A person-centred approach is about giving the person
the means to have some control of their treatment. The
person and their family are central in the decision-making
process.
• Actively involving the person in their assessment
and care planning and addressing their needs in
accordance with their known wishes or in the person’s
best interests.10
9
Brooks, Lee (2006) Dementia Awareness, and Field, L. and Smith, B. (2008)
Nursing Care: An essential guide, Pearson Education, Harlow.
10
Nursing and Midwifery Council (2007) Essential Skills Clusters, Nursing and
Midwifery Council, London.
10 COMPASSION
These are all aspects that you will need to consider to help
you achieve person-centred care.
Holistic care
Holistic care is about seeing that people have a range of
needs and that these needs are not handled in isolation.
The whole person’s needs are considered and attended to.
11
Brooks, Lee (2006) Palliative Care, Tribal Education Ltd, York.
12
Nursing and Midwifery Council (2007) Essential Skills Clusters, Nursing and
Midwifery Council, London.
12 CARING
CARING
We are people who provide care; the care we give to people
will impact on them and on their families. How can we
determine what is good care? We need to be able to improve
care by measuring the quality of it, by analysing and
understanding it. To help us do this we can follow models
of care and undertake initiatives such as clinical practice
benchmarking. The danger is that we explore care but fail
to improve it.
There are three main elements to providing the
fundamentals of care in a safe and effective way:
1. Nurses are:
• Competent
• skilled
• have positive attitudes
• Assertive:
• challenge bad practice
• Reliable and dependable
• Empathetic, compassionate and kind
2. Nurses deliver care by:
• Promoting dignity
• Communication
• Assessing need
• Respecting privacy and dignity
• Working in partnership with the patient and their family,
carers and other colleagues
3. Caring for people in different care environments
• Community
• Hospital
CARING 13
• As appropriate
• Adequate resourced
• Effectively managed.13
13
Adapted from Nursing and Midwifery (2009) Guidance for the Care of Older
People, Nursing and Midwifery Council, London.
14
Brooks, Lee (2006) Palliative Care, Tribal Education Ltd, York.
14 CARING
■ CARE PLANNING
• Involves effective assessment
• Care-planning discussion:
• Between the patient and the professional
• Addressing the individual’s full range of needs:
Identifies level of need
Comprehensive patient history
• Focuses on goal-setting
• Gives information
• Supports self-care when possible
• Records the outcome of the care-planning discussion
• Uses a model of care:
• The Roper–Logan–Tierney Model of Nursing: based on
activities of living
• The NHS and Social Care Long-Term Conditions Model
• Assesses risk
• Plans care accordingly, referring:
• To other professionals and agencies
• For investigations
• Specific goals:
• Provision of evidence-based care
• Time limited
• Realistic
• Continuous assessment and evaluation
• Work and plan care/treatment with others who provide
care and treatment for the patient.
THE CARING MODEL 15
■ CARE PATHWAYS
• Follows the patient journey from diagnosis through to the
end of an episode of care or treatment or life
• Progressive and identifies steps to achieve outcomes
• Holistic
• Tailored to each individual
• Patient-led not clinician-led
• Collaborative goal-setting
• Action planning
• Problem solving
• Negotiation
• Shared decision making.15
15
Adapted from the Department of Health (2009) Your Health, Your Way, HMSO,
London.
16
Dingman, Sharon K. (2002) The Caring Model TM.
Contact email: sharondingman@aol.com
16 CARING
Critical junctures
A critical juncture is a time when the path or actions that
are chosen influence the resulting care. This can be how
something is expressed or something that is done or not
done. Critical junctures can change a person’s perception
about the care that they receive, and can really make a
difference to the patient’s experience. Sometimes if we
just do that little bit extra or take a little more time and
THE CARING MODEL 17
17
Dingman, Sharon K. (2002) The Caring Model TM (see footnote 16, above).
Field and Smith (2008) Nursing Care, An Essential Guide.
18 CARING
18
Department of Health (2006) Dignity in Care Survey, HMSO, London.
DIGNITY AND PRIVACY 19
19
Department of Health (2006) Dignity in Care Survey.
20 CARING
Maintaining privacy
• Patients are protected from unwanted public view
• Staff do not enter a patient’s space without first
ascertaining permission from the patient:
• bedside curtains are closed with no gaps, for example
when personal care is given
• Appropriate clothing is available:
• dressing gowns are used over theatre gowns when
transporting patients
• use of blankets/towels to protect the patient’s
dignity
• Conversations that need to be kept confidential:
• use a private room if one is available
• ensure aids and equipment to assist hearing are
available
• friends and relatives should be asked to leave
if this is what the patient wants
Discrimination
In health and social care we are striving towards promoting
health and equal access for all people to services and
treatment. However, discrimination is still prevalent.
Types of discrimination
• Age:
• older adults
• babies, children and young adults
• Gender
• Sexual orientation
• Race
• Religion
• Health
• mental health
• physical health
• Learning disabilities
• Specific learning disabilities
• dyslexia
• autism
• Social
• Financial20
21
Adapted from Marie Curie (2009) Spiritual and Religious Care Competencies for
Specialist Palliative Care, www.mariecurie.org.uk
CULTURALLY SENSITIVE HEALTHCARE 23
Buddhism – general
• Buddhist faith is centred on the Buddha
(The Enlightened)
• The Buddha is revered as a way of life rather than
as a God
• Buddhists believe in reincarnation and that how
they live their lives will have consequences in the
future:
• it is forbidden to kill any living creature
• Buddhist symbols include:
• the lotus
• the wheel of life
• images of Buddha and the symbolic maps –
Mandalas
• There are schools of Buddhism in the UK (each with its
own traditions)
22
Adapted from Marie Curie (2009) (see footnote 21 above).
23
Brooks, Lee (2006) Palliative Care, Tribal Education Ltd, York.
24 CARING
Diet/fasting
• Vegetarianism
• Fasting is done during the afternoon and on
festival days
Christianity – general
There are many different variations, each with its own
distinct church and beliefs and practices
• Anglicanism (Church of England, Church of Scotland):
• belief that those who are baptised will have eternal
life
• rejects supremacy of the Pope
CULTURALLY SENSITIVE HEALTHCARE 25
Hinduism – general
• Belief in reincarnation – each person being responsible
for how their existing and future life is
• Belief in karma (you sow what you reap)
• Believe that the person should break free from an
imperfect world
• One God who can be seen in different forms
• Hindu women prefer to be treated by female nurses and
doctors
• Fresh water must always be provided following use of
bedpan etc.
• Killing of animals forbidden
• Most are vegetarians
• Food should not be served for eating if the plate had
previously had meat on it
• Prefer food to be provided by their family
• Hindu priest is known as a Pandit
• Hindu holy books include the Bhagavad Gita
• Sacred practices include a thread and water from the
River Ganges and the tulsi leaf
CULTURALLY SENSITIVE HEALTHCARE 27
Islam – general
• Islam is the Arabic word meaning surrendering oneself
to Allah (God) achieving peace and security
• Allah’s last prophet was Muhammad (he was not a God
but a man to whom Allah revealed his will)
• Jumah Friday prayers
• Qur’an is the Muslim holy book:
• this states that death is the will of God
• people will be judged by the way they live
• Five religious duties:
• pray five times each day
• declare one’s faith
• give alms
• fast during Ramadan
• pilgrimage to Mecca
• Cleanliness very important, hands, feet and mouth are
washed before prayer
• Muslims eat beef from cows killed in accordance with
Muslim ways – Halal
• Eating of pork and birds of prey forbidden:
• includes certain medications such as insulin derived
from pigs
• No alcohol:
• includes medications made from alcohol
• If the person is near to death, bed should face towards
Mecca (the south-east) if possible
• Muslim leader known as an Imam
• When death is imminent, the Creed or the Declaration of
Faith (Shahada) is said
28 CARING
Judaism – general
• Jewish spiritual home is Israel
• Jews worship in a synagogue
• Rabbi is the leader of the Jewish community
• Magen shield (Star of David) is the symbol of
Judaism
• Living life in accordance with Jewish laws and
traditions
• Different types of Judaism include:
• Orthodox
• Ultra-Orthodox
• Conservative
• Hasidic
• Reform Jews
• Shema is a declaration of faith
• Values life and opposes any hastening of death
(even moving a person)
• Can question value of certain medication
• Kosher food (meat slaughtered according to specific
rituals)
• Pork and shellfish are forbidden
• Milk and milk dishes are not eaten at the same meal as
meat and meat products
• If a person is dying the rabbi may come to pray with the
person – Vidui (deathbed confession)
• A dying person should not be left alone
SPIRITUALITY 29
Sikhism – general
• Gurdwara is the Sikh temple of worship
• Sikh men have a full beard and uncut hair which is worn
in a turban
• A Granthi is a person who understands the Sikh
scriptures and is present at the Gurdwara
• Follow Sikh teachings:
• meditation on God, scriptures and other people
• Adi Granth (Guru Granth Sahib) is the holy book
• Five religious symbols (the five Ks):
• kesh (uncut hair)
• kanga (wooden comb)
• kaccha (baggy underwear, usually white shorts)
• kara (steel bangle)
• kirpin (a short sword)
• Believe in rebirth, death is a step in life and not to be
mourned
• Some Sikhs are vegetarians
• Sikhs do not eat beef
• Jatka (one blow to the head) method used for killing
animals
• Alcohol forbidden
• Most Sikh women would prefer to be treated by female
nurses, doctors, therapists and carers
• Amrit (holy water) is given before death
■ SPIRITUALITY
Many people have a spiritual dimension. Spirituality is
whatever gives a person worth and value to their life.
Spirituality is unique to each person; it is what that person
30 CARING
24
Adapted from Marie Curie (2009) Spiritual and Religious Care Competencies for
Specialist Palliative Care, www.mariecurie.org.uk
REFLECTIVE PRACTICE 31
■ REFLECTIVE PRACTICE
Reflective practice is about analysing the care and treatment
that we give and learning from this so that we can constantly
improve and maintain it. Reflective practice is an important
part of continuing professional development.
Clinical supervision
This can be one-to-one and/or group supervision, putting
aside an allotted amount of time in which people can support
each other to reflect on practice and to act as a sounding
board to initiate changes in their own practice with the
overall aim of improving care and treatment for patients.
The central focus of clinical supervision is to ensure that safe
and accountable care and treatment is given at all times.
32 CARING
Incident reporting
• Incident reporting book
• A clear no-blame culture
• Mistakes, errors, near misses all reported
• Prompt analysis of incidents
• Putting systems in place promptly so as to avoid
repetition of the incident
Governance
Governance involves analysing clinical practice to provide
a safe and better health service for patients, and to improve
the quality of care and treatment.
REFLECTIVE PRACTICE 33
25
Adapted from Scally, G. and Donaldson, L. (2001) Clinical governance and the
drive for quality improvement in the new NHS. BMJ, 317, 61–65.
34 CARING
26
Department of Health (2009) Essence of Care: A consultation on the reviewed
original benchmarks, The Stationery Office, London.
REFLECTIVE PRACTICE 35
Using benchmarking
Think about
• Complaints
• Incidents
• Comments from patients, carers, staff
• Local and national surveys
Reflective questions
• What am I doing well?
• What will I celebrate?
• What would I change?
• What will it take?
• What is my responsibility in making it change?
• Who do I need help from?
• What is the first step?
• What will I do?
27
Department of Health (2009) Essence of Care, A consultation on the reviewed
original benchmarks.
REFLECTIVE PRACTICE 37
28
Reflective models such as Gibbs’ Reflective Cycle
help you to reflect on incidents that have occurred
in practice. These give structure and help you with
problem solving and action learning.
Desdription
Whst happened
REREC11VE
CYCLE
EvllIllliDn
conclullDo
What wasgood
What 818e could you
and bad about
have done?
the experience?
AnIr.,...
Whaisellge can
you makB of the
situation?
28
Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods,
Oxford Polytechic, Oxford. Kind permission was granted by Professor Chris
Rust, The Oxford Centre for Staff and Learning Development, Oxford Brookes
University.
38 COMMUNICATION
COMMUNICATION
29
Nursing and Midwifery Council (2007) Essential Skills Clusters.
COMMUNICATION 39
Barriers to communication
• The person wants to talk, you don’t
• The person doesn’t want to talk, you do
• The person wants to talk but feels they ought not to.
You do not know how to encourage the person to talk
• The person appears not to want to talk but really needs
to. You don’t know what’s best and don’t want to
intervene in case it makes things worse30
30
Reid-Searl, K., Dwyer, T., Ryan, J. and Moxham, L. (2006) Student Nurse Clinical
Survival Guide, Pearson Education, Melbourne.
40 COMMUNICATION
Good practice
Right place – is it too noisy, too quiet? Is there too much
going on around? Can other people hear you?
Right time – have you got enough time to talk and to
listen to what the person wants to tell you? Is the person
frightened or angry?
Body language – yours and the other person’s. What do
your or the person’s facial expressions tell you? What about
their gestures?
Active listening
Active listening is about really listening, not only hearing the
words but understanding the feelings and intent behind the
words spoken. It’s about taking the time to listen.
Times of silence
Knowing when not to talk is important, because we need
times of silence in conversations so that we can gather
our thoughts. These times give us the opportunity to think
about what has been said and what we are going to say.
GOOD PRACTICE FOR COMMUNICATING EFFECTIVELY 41
Written documentation
Consider:
• Check you have the right charts etc.
• Ensure that what you write is accurate
• Focus your documentation on the patient
• Document relevant information only
• Be objective
31
Brooks, Lee (2006) Palliative Care, Tribal Education Ltd, York.
32
Reid-Searl et al. (2006) Student Nurse Clinical Survival Guide, Pearson
Education, Melbourne.
42 COMMUNICATION
• Document contemporaneously
• Avoid documenting in advance
• Don’t document on behalf of someone else
• Write legibly
• Use black ink
• Don’t transcribe
• Use only accepted abbreviations (and avoid using them if
possible)
• Date and time
• Sign and give your designation.33
33
Adapted from Reid-Searl et al. (2006) Student Nurse Clinical Survival Guide,
Pearson Education, Melbourne.
GOOD PRACTICE FOR COMMUNICATING EFFECTIVELY 43
Assessing communication
Can the person:
• Verbalise?
• Understand you?
• do they need an interpreter?
• Hear you?
• refer to Audiology
• check hearing aids are in working order
• is a voice output communication aid needed?
• See you?
• refer to the optician.
34
Adapted from the Four Seasons Care and Health Assessment Profile (2008).
Shift roster
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY