Graded Unit Planning process

I’m currently studying HNC Care & Administrative Practice (Clinical Route) which involves doing placement hours at a local hospital and complete a Graded Unit which consists of three stages: planning, development and evaluation. In the planning process I must complete and develop a plan to show that I can help a patient I have chosen with a nursing activity. After having a meeting with my mentor to discuss which patient we felt would be a suitable candidate for me to complete this task with, I gained consent from him. I also gained consent from the patient after explaining what and why I was doing the activity, and all information about her would be kept confidential. For this matter I will refer to the patient as Mrs B which keeps her identity anonymous. (Data Protection Act, 1998) Mrs B is 76 years old and has been a widow for 8 years, she has four children and 5 grandchildren who visit her most days, she also has a small dog. Mrs B told me she was a waitress and continued to work up until she took retirement.

Before being admitted into hospital she was very much an independent, active lady, she likes going for walks with her dog three times daily, and also likes to going shopping. Mrs B was putting rubbish into her outside bin but lost her footing, tripped and fell, this caused her to have severe pain and her neighbour called for an ambulance. She was admitted into accident and emergency at hospital where they done xrays of her head and body and found out that she had broken her hip, she underwent a hip replacement operation. Mrs B was admitted to the orthopaedic ward and is now mobilising with a zimmer frame and assistance of one nurse on the recommendation from the physiotherapists, it is important that all members of the multi-disciplinary team work together in harmony to promote a better quality of life for the patient. Activities of Daily Living and Physiological needs

On assessing Mrs B’s needs I decided that the Roper Logan & Tierney nursing model which entails twelve activities of daily living would be the best way to assist her. These activities help a nurse to make a holistic person centred assessment on the individual patients’ needs. ‘When used correctly a nursing model should lead to continuity and consistency of the nursing care received by patients’ (Nursingtimes.net 2002). As Mrs B is in pain from her hip I will be empathetic towards her and do this activity with as little movement as possible. Mrs B needs assistance with mobilising so I have chosen to assist her with the activity of washing and dressing and plan to do this on 20/03/2015. Mrs B is in a six bedded room on a hospital ward so I will ensure the curtains around her bed are closed and this will give her the privacy, respect and dignity that the NMC codes of conduct state (NMC 2015). Mrs B likes to choose her own clothing and I will oversee this to make sure it’s suitable. Before we start the activity I will have all necessary equipment in place.

While Mrs B is washing herself I will assist her by ensuring her zimmer frame is at hand so she can stand and support herself, I will offer to wash the areas she cannot reach and I will assist Mrs B by following the correct moving and handling techniques (Manual Handlings Act 1992). Abiding by this act will maintain the safety for Mrs B and myself. At all times doing this activity I will ensure that I obey the infection control policies that are in place in the hospital by wearing the correct personal protective equipment (PPE) which will protect both Mrs B and myself from any cross contamination, by doing this I am abiding the legislation in place and when carrying out the activity I will be aware of any risks & hazards i.e. infection control, moving & handling, proper disposal of equipment/linen used (Health and Safety at Work Act 1974).

I’ve been able to assess Mrs B’s needs by spending time with her for a few weeks and by using SPECCS I have built a therapeutic relationship with her and in turn Mrs B trusts me which makes the activity a more relaxed environment for her, by spending time with Mrs B I recognise what person centred care is more suitable for her holistic needs and I can then deliver that care to her. As Mrs B has diminished mobility we have to make sure she gets enough exercise and movement so she doesn’t get stiff, so it’s important that she goes for small assisted walks in the ward. Mrs B has a healthy appetite and likes to choose her own meals. Sociological and Psychological needs

Mrs B is an independent woman that’s always looked after herself and her family but now she’s the one receiving care and this can be related to the functionalism theory of sociology, which focuses on the Norms, Roles and Values, stability and continuity interdependence and integration and dysfunctionality. She feels as the head of her family she should be the one giving the care, but the role has been taken away from her so she has become deviant. She feels that she has been labelled that she can no longer look after herself and this can be related to the symbolic interactionist theory of sociology. She fears that her family will put her into a care home but she is adamant to go back to her own home, this behaviour can be understood using the humanistic theory in psychology which is focused on free will and personal choice.

Mrs B has low self-esteem since the accident, she feels she has no personal worth and her friends and family would resent her if she accepts any help from them and because of this she won’t reach self-actualisation. In relation to Maslow’s theory in psychology, and understanding the hierarchy of needs method, where a persons’ lower needs must be met before they can progress onto the higher one and eventually reach self-actualisation, I was able to understand her behaviour. Carl Rogers believed that if a care worker displayed congruence by being genuine, open and sincere with their patient and by showing empathy towards them, it would help them to better understand why their patient was displaying the behaviour they are having and that they can demonstrate a helping, positive, healing relationship. Socio-Economical Factors

Mrs B will need to have homecare set in place before she leaves the hospital but because the Scottish government are aiming to keep people in their own homes to live independently (Careinfo 2014) there’s a backlog of patients in the area she lives so this means that she cannot leave the hospital, because of this Mrs B is losing faith in the healthcare system and may hesitate to seek help from the NHS in future. Contingency Plan

If Mrs B refuses to have the activity done to her due to illness/tiredness then I will attempt to do the activity at a later time that suits her. Timescale I aim to complete and write up the planning stage by 23/03/2015 Aims & Objectives

To successfully carry out the activity with Mrs B with as little discomfort as possible to Mrs B whilst maintaining her dignity and respect at all times. Complete my graded unit within the timescale.

References:

NHS. (2014). Care Information Scotland. Available: http://www.careinfoscotland.co.uk/home.aspx. Last accessed 22nd Mar 2015. Gov.uk. (1998). Data Protection. Available: https://www.gov.uk/data-protection/the-data-protection-act. Last accessed 22nd Mar 2015 NMC. (2015). The Revised Code. Available: http://www.nmc-uk.org/The-revised-Code/The-revised-Code-in-full/. Last accessed 22nd Mar 2015. Nursingtimes.net. (2002). Using the Roper, Logan and Tierney model . Available: http://www.nursingtimes.net/nursing-practice/nursing/using-the-roper-logan-and-tierney-model/199604.article. Last accessed 22nd Mar 2015 Scottish Government. (1974). Health and Safety at Work Act 1974. Available: http://www.legislation.gov.uk/ukpga/1974/37. Last accessed 22nd Mar 2015 Scottish Government. (1992). The Manual Handling Operations Regulations 1992. Available: http://www.legislation.gov.uk/uksi/1992/2793/regulation/4/made. Last accessed 22nd Mar 2015