PROMOTING INDEPENDANCE IN AFTER CARE
Promoting Independent Living and Adaptation to Long Term Illness or Disability The aims and objectives of this assignment are to critique the Government’s modernisation agenda, and show relevant initiatives which have affected the care of a patient whilst on placement together with a discussion of the nursing contribution, helping to maximise the health of the patient in collaboration with the multi-disciplinary team. The placement was undertaken on a neurological surgical ward which provides elective and emergency neurological surgery, with pre-operative and post-operative care. ... (Roper et al 1995), together with a recently implemented named nurse system, because of the word limitations on this assignment only a small number of documents that have affected Mr Martin’s care can be critiqued. The National Health Service began in 1948; its founding principle was to provide access to care to all on the basis of need, not ability to pay. ... There are numerous plans for the modernisation of the NHS in the form of National Service Frameworks, Cancer plans, essence of care, policies, and guidelines for every aspect and dimension of the NHS. ... This plan, rather like an extensive care plan is given to all NHS health care organisations in England to implement, this is the stage we are presently at. ... Some relevant initiatives from the agenda are identified in Mr Martin’s care, how they affected the care received will be analysed. One of the core principles in the NHS plan ( DOH 2000) is to offer patient centred care. ... ‘The person who is most expert in the care of an individual older person is that older person’ (DOH 2002), decisions made about treatment and care planning should maintain the older person’s views and wishes throughout the process, and this is exactly what was happening, Mr Martin was consulted and his views were acted upon. Another Government initiative affecting Mr Martin’s care came from the Department Of Health’s Discharge from hospital document (DOH 2003). ... that patients needs are met, that they are able to maximise their independence and feel empowered and part of the care process. ... The Essence of Care document (2001a), a patient-focussed benchmarking for health care practitioners a practical toolkit for nurses and others focuses on essential aspects of care. These aspects of care were paramount to Mr Martin particularly during his post-operative confusion as he wasn’t able to maintain many aspects of daily living particularly personal cleansing and dressing and eating and drinking. The eight aspects covered in the Essence Of Care document all applied to Mr Martin’s care, due to the word limitation imposed only one shall be critiqued, food and nutrition. ... The Essence Of Care document touches on the basic needs of the patient that sometimes, are overlooked. ... These benchmarks contained in the Essence of Care document are crucial, they touch on such basic nursing interventions, and it could be argued that nurses shouldn’t need policies to know how to effectively feed their patients, it is a fundamental basic human need perhaps it is so fundamental it could easily be overlooked and forgotten, it is the role of clinical Governance to ensure that these standards are maintained. ‘…big steps have been taken to improve the quality of NHS care by introducing national service frameworks and the National Institute for Clinical Excellence and an independent inspectorate-The Commission for Health Improvement’ (DOH 2000 pg21). The care given will be inspected to ensure national standards are reached. ... To make this concept successful it requires all participants to want to give the best, and to all work collaboratively to provide the best care. The guidelines are excellent for those who want to strive to ensure patient care is the best it can be, if however the care givers are complacent, demoralised or disillusioned, the modernisation agenda will be fruitless, it can only succeed if the carers themselves implement the plans. ... This ensures that a holistic and individual approach is taken towards Mr Martin’s many health care needs. The nursing process was on going and as his needs changed the care given changed, establishing an individual and unique plan of care. The multi-disciplinary team played a great part in Mr Martin’s care, there were at least ten different disciplines involved and all of whose input had been initiated and co-ordinated by the named nurse. ... A referral was made to the dietician to ask her specialist advice about nutrition, and how to give Mr martin the best care. ... The nurse also planned for Mr Martin to be assisted with his meals, the ward had several other patients that needed assistance with eating and so delegated the duty of feeding and documenting to a specific Health Care Assistant, ensuring there would be no ‘care gap’ (Butterworth 1974). ... ’(Deeks 1995) Stockings were put on Mr Martin to aid venous return, and care was planned to observe for any signs of redness or tenderness. ... The risk assessment showed that Mr Martin was a very high risk so the nurse ordered a more effective pressure relieving mattress and planned care ensuring that he was turned frequently and monitored for any breaks in his skin. ... The new care plan was discussed with Mr Martin’s son to allow him any input as his father’s carer, ‘in line with Guidelines for records and records keeping,’ (NMC 2002). ... The neurological physiologist recommended that Mr Martin would be better managed at home with a care package that needed to be discussed with the social worker. ... The neurological psychologist disagreed he wanted Mr Martin to have a care package set up and be treated from home so that his confusion wouldn’t be increased and the disorientation that he felt would be alleviated and not exacerbated with another move another environment and another set of staff. ... The named nurse felt that with full orientation to the rehabilitation ward it was the safest place for Mr Martin’s care, she felt it important to remember that Mrs Martin was 74 and had health issues herself, Mr Martin’s son did not live with them and he could not provide 24 hour care and patient safety had to be paramount. The Doctor in charge of Mr Martin’s care agreed with the neurological physcologist and nurse and wanted him transferred for intensive rehabilitation, ‘it is he who retains final and legal responsibility for patients. ... Mr Martin’s journey highlighted many of the initiatives, for example being transferred to an intensive rehabilitation ward, funded through the £900 million investment for intermediate care. This would not have been possible prior to the initiatives, Mr Martin would have been on the hospital ward for a considerable time and possibly have been labelled a bed blocker because of his many health care needs, due to the modernisation programme he received the right care at the right time in the right place. This is exactly what the Government have set out to do, to centralize the care around the patient, to bring professions together and end the ‘tribalism’ (Beattie 1993)76 of the disciplines and provide a holistic seamless service. The nurse is at the centre of patient care, referring to colleagues for their expert opinions, communicating, conducting and creating the unique care package, being flexible and open to the input of others, personalising the patient and endeavouring to deliver the three r’s of modernisation, reform, reorganisation and regeneration. Promoting Independent Living and Adaptation to Long Term Illness or Disability The aims and objectives of this assignment are to critique the Government’s modernisation agenda, and show relevant initiatives which have affected the care of a patient whilst on placement together with a discussion of the nursing contribution, helping to maximise the health of the patient in collaboration with the multi-disciplinary team. The placement was undertaken on a neurological surgical ward which provides elective and emergency neurological surgery, with pre-operative and post-operative care. ... (Roper et al 1995), together with a recently implemented named nurse system, because of the word limitations on this assignment only a small number of documents that have affected Mr Martin’s care can be critiqued. The National Health Service began in 1948; its founding principle was to provide access to care to all on the basis of need, not ability to pay. ... There are numerous plans for the modernisation of the NHS in the form of National Service Frameworks, Cancer plans, essence of care, policies, and guidelines for every aspect and dimension of the NHS. ... This plan, rather like an extensive care plan is given to all NHS health care organisations in England to implement, this is the stage we are presently at. ... Some relevant initiatives from the agenda are identified in Mr Martin’s care, how they affected the care received will be analysed. One of the core principles in the NHS plan ( DOH 2000) is to offer patient centred care. ... ‘The person who is most expert in the care of an individual older person is that older person’ (DOH 2002), decisions made about treatment and care planning should maintain the older person’s views and wishes throughout the process, and this is exactly what was happening, Mr Martin was consulted and his views were acted upon. Another Government initiative affecting Mr Martin’s care came from the Department Of Health’s Discharge from hospital document (DOH 2003). ... that patients needs are met, that they are able to maximise their independence and feel empowered and part of the care process. ... The Essence of Care document (2001a), a patient-focussed benchmarking for health care practitioners a practical toolkit for nurses and others focuses on essential aspects of care. These aspects of care were paramount to Mr Martin particularly during his post-operative confusion as he wasn’t able to maintain many aspects of daily living particularly personal cleansing and dressing and eating and drinking. The eight aspects covered in the Essence Of Care document all applied to Mr Martin’s care, due to the word limitation imposed only one shall be critiqued, food and nutrition. ... The Essence Of Care document touches on the basic needs of the patient that sometimes, are overlooked. ... These benchmarks contained in the Essence of Care document are crucial, they touch on such basic nursing interventions, and it could be argued that nurses shouldn’t need policies to know how to effectively feed their patients, it is a fundamental basic human need perhaps it is so fundamental it could easily be overlooked and forgotten, it is the role of clinical Governance to ensure that these standards are maintained. ‘…big steps have been taken to improve the quality of NHS care by introducing national service frameworks and the National Institute for Clinical Excellence and an independent inspectorate-The Commission for Health Improvement’ (DOH 2000 pg21). The care given will be inspected to ensure national standards are reached. ... To make this concept successful it requires all participants to want to give the best, and to all work collaboratively to provide the best care. The guidelines are excellent for those who want to strive to ensure patient care is the best it can be, if however the care givers are complacent, demoralised or disillusioned, the modernisation agenda will be fruitless, it can only succeed if the carers themselves implement the plans. ... This ensures that a holistic and individual approach is taken towards Mr Martin’s many health care needs. The nursing process was on going and as his needs changed the care given changed, establishing an individual and unique plan of care. The multi-disciplinary team played a great part in Mr Martin’s care, there were at least ten different disciplines involved and all of whose input had been initiated and co-ordinated by the named nurse. ... A referral was made to the dietician to ask her specialist advice about nutrition, and how to give Mr martin the best care.