B991 Health and Social Care : Analysis of the Role in Healthcare

Personal Portfolio Development in Context of Health and Community Care

Part A: Reflection on the analysis of the role in healthcare and current learning needs

The profession of nursing involves a considerable amount of skill and training for professional registered nurses working in the healthcare sector [1]. However, the skills of the nurses are not confined to the health sector alone; the role of the nurse extends to social and governmental care policies [1, 2]. The social and healthcare role of registered nurses is specifically critical whilst dealing with patients with terminal illnesses [1, 2]. Nurses are required to display sufficient skill, technical awareness, patience, and confidence [1, 2]. Patients perceive nurses as being their primary points of contact and they are thus the most influential information providers [1, 2]. They play a vital role in educating the carers and families of the patients about the disease diagnosis, progression, treatment protocol, and social care of the patient [1, 2]. Additionally, they function as primary contact persons for other tertiary and secondary health providers and units [1, 2]. Specifically in cases of patients with dementia and other socially limiting terminal or chronic illnesses, it is essential to facilitate the functionality of the patient and to ensure their preparedness to live in the social setting [1, 2]. In the current essay, I reflect upon the profession of nursing, the advocacy role of a nurse, and the learning outcomes of my experience of dealing with a patient with dementia during my practice that I regard particularly prominent [1, 2].  I shall further critically analyse the governmental policies surrounding dementia in the United Kingdom along with critiquing the merits and points of improvement for those policies in order to improve the overall system of social care [1, 2].  My points of critique primarily focus on the point of view of a nurse deduced from my experience of caring for a person with dementia [1, 2]. I have identified the importance of the role of the nurse as the primary advocate of the patient [1, 2]. They are the healthcare professionals who work most closely with the patients and their families [1, 2]. Nursing involves a complete collaboration of several functions [1, 2, 23]. Nurses are additionally required to possess a crucial set of skills [1, 2, 21]. Nurses are required to perform the treatment protocol and the required procedures that are prescribed by the physicians [1, 2]. They also keep a track of records and observations of the chart of the patients [1, 2, 22].

I have learned during my clinical practice that as a registered nurse, there is a constant need to educate the patient and his/her family about the treatment protocol, disease progression, diagnosis, and problems associated with the disease [1, 2, 25].  Nurses are, in fact, most functional as advocates of patients due to their continuous interaction with the patients and their families [1, 2]. Nursing primarily involves a collaborative functionality where they are required to coordinate between the various health care facilities and sectors [1, 2, 21].

I have found that the nursing care needs to be improvised in the primary health care facility [3, 4, 17, 18]. The care provided by the nursing staff for individual patients comprises of both verbal and non-verbal skills [3, 4, 20, 21]. It includes understanding the patient needs with the help of questions that aid in procuring information about various aspects of patient requirements [3, 4, 14, 17]. The most important aspect of nursing is the support provided to the patients in terms of emotional and healthcare [3, 4]. In nursing, the confidence, skill set, technical knowledge, techniques of clinical treatment, and the skills of communication required to improve the patient care experience [3, 4, 15]. The current article discusses a recent experience of dealing with person with dementia [3, 4, 18]. Nurses are most relied upon to educate the patients and their families along with building a trusting relationship with the patients [3, 4, 18]. The healthcare unit and the stress of unfamiliar diseases result in distress amongst the patients and their families. Therefore, the nurse is perceived as the primary facilitator and information provider [3, 4, 17]. The current article focuses on the various aspects that I found relevant for the improvisation of the patient experience [3, 4, 22]. The current article focuses on the feedback received for the care provided in the hospital and the patient experience. The article discusses the challenges of treatment and the points of improvement for better patient care [5, 6, 23].

The current article follows the Gibbs’ model of reflection and has six parts: description of the incident, my thoughts and feelings during the incident, evaluation of the incident in terms of the feedback provided and the treatment protocol, analysis of the feedback and the challenges in treatment, conclusive remarks, and an action plan for future cases [7, 8, 9].

Confidentiality statement: I understand that the information related to the patient, the location of the incident, and the people associated with the event is strictly confidential and hence I have used pseudonyms throughout the essay where such information has appeared.

The primary carer for Mr. Thomson was his wife, Mrs. Thomson (53) [5, 6]. She provided a feedback regarding the patient experience and the overall treatment procedure at the hospital. Whilst she was mostly appreciative of the facilities and the care provided at the hospital, she reported feeling a lack of information and vulnerability at several instances. Additionally, she reported that the attention given to the patient and the interactions had with the nurse were insufficient.

My thoughts and feelings whilst dealing with this patient in the initial stages were mostly exasperation, frustration, and resentment. However, in a short while after starting to care for the patient, my feelings changed to those of concern and sincere intent to provide effective care. The secondary stages of the treatment included monitoring concurrent effects of the treatment, activities of daily life, and coordinating the care of tertiary and related health care sectors [5, 6]. The final stages of caring following the prognostic follow-up session have introduced sincere empathy towards the patient and his carers. The phase of end-of-life care during the last nine months after diagnosis of pneumonia have had a major impact on my view of the patient, his family, and the general care patterns for these patients. It has been a journey of emotional and professional growth for me, in my career as a registered nurse.

I believe this to have been a learning experience for me as it has provided insight to the limitations of the nurse whilst dealing with the persons with dementia in a primary care setting [5, 6].  

iii) Evaluation: The feedback provided by the carers and family of the patient, Mr. Thomson, clearly stated that the amount of time and attention provided to them along with the information provided to them about the treatment protocol was insufficient. I am inclined to believe that the feedback has a direct implication on my functioning as a registered nurse. I believe that the challenges that I faced during the treatment protocol and the interaction with the patient have led to the communication barrier with the family of the patient. The patient and his family had to make multiple visits to the hospital for the examination, imaging, and the prognosis of the disease. The primary challenge that I faced whilst dealing with the patient was the dearth of time and the number of patients. I found that most of my time was spent in working out the most effective way of communicating to the patient. I found that due to a high number of patients, I was unable to find enough time to answer all the questions that the family had about the treatment.

Part B: Critique of health and social care policy for treatment of persons with dementia (1000)

Dementia is one of the most common terminal illnesses in the UK and across the world [7, 8, 9]. Approximately 70,000 people in the UK have dementia [7, 8, 9]. Dementia additionally costs considerable amounts of money for the health care sector and the government in order to facilitate the health and social care protocols of the individuals [7, 8, 9]. The identification of the disease as dementia is typically delayed and leads to the delayed diagnosis [7, 8, 9]. Most families and patients consult general practitioners (GPs) for the first consultation resulting in delayed diagnosis and analysis of the symptoms [7, 8, 9]. Most often, patients seek medical help within a year of the onset of symptoms [7, 8, 9]. Several times, patients often delay in seeking medical help due to several factors such as not being able to recognise that the symptoms are due to dementia or due to the stigma attached with the diagnosis and care of dementia [7, 8, 9].

However, the families of patients often struggle for obtaining enough support in the health care centres including primary care centres, tertiary care centres, and health and social care units [7, 8, 9]. One of the most important challenges that families face in caring for persons with dementia is the lack of information present at their disposal [7, 8, 9]. The professionals who work with teams of community mental health have often observed that the policies that are present to provide crucial information to the carers are typically absent or displaced in most primary care centres [7, 8, 9]. The situation presents a common challenge to the patients – significant lack of information [7, 8, 9]. The analysis of the information provided to the patients and their familial carers reveals a significant amount of variability in the policies and lack of knowledge about the policy amongst the primary health care providers [7, 8, 9]. Additionally, most health care centres lack adherence to the health care policies present to provide effective care to persons with dementia [7, 8, 9]. The common issues that exist in the health care centres include the following: an undeveloped policy, policy still under development, lack of adherence to the policy in the health care centre, absence of policy, and lack of knowledge about the policy [7, 8, 9]. The percentage of health care centres where the policy is present and adhered to, on a regular basis is often negligible [7, 8, 9]. The available networks of support and care are mostly rare or absent [7, 8, 9]. The primary health care providers and nursing professionals lack the relevant knowledge that helps the families in providing sufficient care [7, 8, 9]. The national clinical guidelines for dementia have specified that the health care and social care professionals are required to ensure that the members of staff who work with the elderly population must have complete access to training and skill development [7, 8, 9].

However, I found that, whilst dealing with the case of Mr. Thomson, I lacked the prior knowledge or skill on the pattern of communication and method of dealing with the patient. Additionally, since dementia is a particularly challenging terminal illness, it is essential to help improve the skill sets of professionals who work with these patients [7, 8, 9]. I believe that in order to deliver the most effective nursing care to persons with dementia, nurses need to be trained in the appropriate communication patterns, physiological and medical aspects of the treatment, family and carer support, tertiary and social care support, and concurrent aspects [7, 8, 9]. I found that I was unaware of most of the concurrent problems associated with dementia [7, 8, 9]. I did not have sufficient prior knowledge about the treatment protocol, health support from other care centres, and the help that the patient would need for his social life [7, 8, 9]. Due to the lack of information, I was unable to educate the familial carers effectively [7, 8, 9]. The health care policy is not in place in most primary health care units and the training provided to the nursing staff is mostly insufficient [7, 8, 9]. Therefore, I found that although there is a wide range of information about the governmental health policies at my disposal, the amount of information is overwhelming and difficult to incorporate [7, 8, 9]. During the experience of dealing with the patient, I realised that I lacked most information and the practical incorporation into the life of the patient was challenging [7, 8, 9]. The most important aspect of dealing with patients of dementia includes the complete information on the governmental policies, social care setup, and information about the various forms of dementia. Since the pathological mechanisms involved in the disease progression have direct implications on the behaviour of the patient, it is essential to develop the nursing care protocol according to the disease pathology [7, 8, 9].

The care protocols advised to the nursing staff and health professionals lack the complete guide to the support that the nurse needs to provide to the patient [7, 8, 9]. I believe that, since nurses are looked up to for emotional support along with technical expertise, it is essential that the health policies be discussed in great detail along with training the nurses to deal with emergencies [7, 8, 9]. Although all health programs include the provision of tertiary and social care services to patients and their families, the information on sourcing the support at the need of hour is not fully understood by nurses [7, 8, 9]. I faced constant dilemma whilst handling the case of Mr. Thomson due to being unsure of the emotional support that I could provide him and his family. In retrospection, I realise that I was unable to communicate the concurrent aspects and convince him to refrain from driving and lifestyle habits [7, 8, 9]. The primary health care units do not incorporate the health care policy and it leads to the lack of information about the patient-care regimen and the pathology of the disease [7, 8, 9]. The prognosis information is not completely coordinated to the training of nurses along with providing information on the governmental policies for the various forms of dementia [7, 8, 9].

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