I am currently a TNA (Trainee nursing associate) and I am going to be following the John (1995) reflective model to reflect on an experience of delivering an episode of care. This reflective practice is about delivering personal care to a patient that is unable to give consent due to Alzheimer’s and being admitted to a surgical ward with a UTI in an acute hospital setting. I have chosen this reflective model because the model because It gives direction and prompt rather than having to follow a steps in order. There isn’t a specific way in which the model needs to be answered but more of a progression tool with the questions that it is asking. Not all of the questions need to be answered in order to be able to use it as a reflective model and questions can be repeated throughout. I am going to be referring to the individual as ‘Patient’ following the data protection act (2008).
Whilst working alongside a staff nurse that I had been teamed up with for the day early into the shift we were both informed that we were to receive a Alzheimer’s patient that had been admitted from a nursing home that specialised in dementia, suffering a fall following a suspected UTI (Urine tract infection). Immediately hearing the word ”Alzheimer’s and UTI” we immediately start asking questions. Is this patient compliant? Does this patient require 1:1 care? Is this patient calm, agitated or being aggressive? These are all things we needed to know before the patient arrived so we were prepared. The simple reply we got to these questions were “No he’s completely fine”.
Following the arrival of the patient struggling to stand himself, punching and shouting at me while I was trying to change his wet and soiled underwear we realised we quickly that he wasn’t at all “fine”. Although it was a three staff battle to change his wet clothing it was in the best interests of the patient at the time that we placed some clean and dry under wear on him to prevent sores. Duty of care relates to anyone who is involved with the patient. They have responsibility for the patients care whilst under their supervision. Care means anything from personal care through to simple or complex procedures. Standards of care to be expected of a newly qualified nurse is the same as expected from a more experienced nurse preforming the same task (RCN 2018).
Due to the aggression of the patient and not being able to gain consent we had to put a MCA into place to meet the patients best interest. The care quality commission says that “Care and treatment of service users must only be provided with the consent of the relevant person” but if the patient lacks capacity to give consent then the registered person must follow the Mental Health act 1983 if suffering with mental health followed by Mental capacity Act if a mental health condition isn’t present. (CQC 2018).
Staff soon noticed that a trigger for his aggression was when he needed the toilet and with many members of staff walking in and out of his room faces changing daily he was feeling frightened and scared because nobody was familiar to him. This made gaining consent and for the patient to allow us to assist him very difficult. When asking to check or change his pad to make sure he wasn’t wet, or getting sore he would refused and lash out at staff members. Hours went by where medication was missed, his agitation was increasing, staff were becoming reluctant to enter his side room, so following a chat with his wife a decision was made to carry out MCA (Mental capacity assessment) and DOLS (Deprivation of liberty safeguard) into place. We had to remember and take into account that whether that patient has the capacity or lacks capacity we have to treat every individual in their best interest. The NMC states that all relevant laws regarding mental capacity that apply within our country must be kept to. We must practice and make sure that we are working within the best interests and rights of an individual who lack capacity and making sure that they are still involved in the decision making process (NMC code 2015). The decision made was in his best interest and would allow us to try and treat his infection more efficiently by being allowed to place a cannula into his vein to administer IV antibiotics and insert a catheter to try and keep the patient more comfortable and calm. The decision to undertake an mental capacity assessment was based upon judgement that a person lacks capacity and the inability to make decisions. Section 2 of the mental capacity act legislation states that in order for a mental capacity assessment to be undertaken the person is unable to understand information given to him about treatment and unable to retain that information, unable to use the information to weigh up, communicate or to make a decision (MCA 2005). Information and small assessments carried out by the doctor clearly showed that capacity wasn’t there. A DOLS was then put into place. This is an amendment to the Mental capacity act 2005. A basic understanding of a DOLS is it allows restrictions and restraints to be used in a person’s best interest (SCIE 2015). “A DOLS assessment will take place if a person with dementia is in a care home or hospital setting and it is felt that they are being, or will be, deprived of their liberty.” There are six stages to a DOLS assessment and these are: Age (Is the person over 18 years of age), mental health (Does a mental disorder exist?), mental capacity (Does the person lack capacity to make their own decisions?), best interests (Is this in the persons best interest and is it needed to keep the person safe and from harm?), Eligibility (Is the person already under the mental health act 1983?) and no previous refusals (With previous capacity has this person previously refused treatment?). With the patient meeting all of this criteria we were able to work together and give the patient the correct treatment he needed safely.
Regular analgesia was given to relieve discomfort from the catheter and bruising from the fall, Antibiotics given throughout the day to clear up the Urine infection and sedation medication such as haloperidol (an antipsychotic medication) to help calm the patient was prescribed PRN incase the patient became agitated and aggressive we would be able to help calm the patient down.
• Data Protection Act (1998) Available: http://www.legislation.gov.uk (Accessed: 23 November 2018).
• Johns C (1995) Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. Journal of Advanced Nursing. 22: 226-34.
• Nursing and midwifery council (2018) The code. Available at: https://www.nmc.org.uk/standards/code/read-the-code-online/ (Accessed:23 November 2018).
• Health and Social Care Act 2008, c.11. Available at: https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-11-need-consent#full-regulation (Accessed: 20 November 2018).
• Royal college of nursing. (2018) duty of care. Available at: https://www.rcn.org.uk/get-help/rcn-advice/duty-of-care#Duty of care (Accessed: 27 November 2018).
• Mental capacity act, c.3. Available at: https://www.legislation.gov.uk/ukpga/2005/9/part/1 (Accessed: 25 November 2018).
• Social care institute for excellence. (2015) Deprivation of liberty safeguards. Available at: https://www.scie.org.uk/mca/dols/at-a-glance (Accessed: 28 November 2018).
• The Alzheimer’s society (2018) Deprivation of liberty safeguarding. Available at: https://www.alzheimers.org.uk/get-support/legal-financial/deprivation-liberty-safeguards-dols-assessment (Access: 28 November 2018).