The Purpose of this essay is to reflect upon an experience which relates to the chosen topic of dignity and respect, this was highlighted in my self-assessment (please see appendix) Acknowledging a persons’ dignity can contribute to their sense of good health, well-being and independence. Dignity is an essential element of high quality care and involves aspects such as respect, privacy, autonomy and self-worth (The Welsh Assembly, 2007)
I have decided to use the Gibbs (1998) Reflective cycle for this essay, this framework guides you through a cycle of questions in order to provide guidance and structure when reflecting on an event or situation. The Gibbs cycle encourages a clear description of the event, the analysis of feelings, the evaluation of the experience and analysis to make sense of the experience in order to examine what you would do if the situation arose again (NHS, 2006) Reflection is particularly important as practitioners are responsible for their own practice and they must ensure through self-analysis that their practice is current and appropriate.
The process of reflection allows actions to be examined in a systematic manner enabling non effective and effective behaviours to be identified. (Ely and Scott, 2007) Gibbs (1998) states that: “It is not sufficient simply to have an experience in order to learn. Without reflecting upon this experience it may quickly be forgotten, or its learning potential lost. It is from the feelings and thoughts emerging from this reflection that generalisations or concepts can be generated. And it is generalisations that allow new situations to be tackled effectively” (1988, p. 9) Description of the event
The particular incident I have chosen to reflect upon occurred during the second day of my first placement. In accordance with the NMC (2008) Professional Code of Conduct, the confidentiality of patient information must be respected. Therefore the names of those involved have been changed to protect their identity. The incident occurred during the first couple of hours of a busy morning shift and involved an elderly patient who I will refer to as Mrs Clarke. During handover it was stated that Mrs Clarke could transfer from the bed to chair with the assistance of one other and also that she had been slightly confused.
The nursing auxiliary (who I will refer to as Catherine) and I went to assist Mrs Clarke. Catherine asked Mrs Clarke if she would like to transfer to the chair as this would be easier for her to wash and would enable us to change the sheets and freshen up her bed. Mrs Clarke stated that she didn’t want to try as she felt unable to move with assistance and was concerned she would fall. Catherine checked Mrs Clarkes’ notes and clarified that she had been mobile the previous day. Catherine then insisted that it would be possible and urged Mrs Clarke to move to the edge of the bed.
Mrs Clarke was initially adamant that she was unable to stand, however, after some persuading Mrs Clarke had managed to reluctantly mobilise with assistance to a sitting upright position on the bed, her legs were over the side in preparation to stand. It was at this point that Catherine leant across the patient and mouthed the words to me “Dying Swan”. Catherine then urged Mrs Clarke to shuffle forward in preparation to stand. She informed her that we would assist and support her to stand. However, upon standing Mrs Clarke slumped to the floor as her legs were unable to take her weight and she became very distressed.
I comforted Mrs Clarke and reassured her, although I was not prepared to manually lift and risk further risk to the patient and myself. Catherine called for assistance and in response another Nursing Auxiliary and a staff nurse came to the bed side. After a brief discussion regarding what action should be taken the three members of staff manually lifted Mrs Clarke from the floor onto the chair. Feelings I felt uncomfortable when Catherine became insistent that Mrs Clarke should mobilise. Mrs Clarke was obviously reluctant and I felt that this was a very sincere and a genuine response to the request.
Initially, I wondered if this was due to her confusion or if her condition had simply deteriorated since the previous day, either way I felt it was a risk that should not be taken. It was apparent by Catherine’s response however, that she thought Mrs Clarkes reluctance was due to confusion or simply unwillingness. Catherine was very dismissive of Mrs Clarke’s opinion and even referred to her as a “dying swan”, which I felt conveyed a level of disrespect. I was very concerned for Mrs Clarkes’ safety although as an inexperienced new student I felt unable to voice my opinion.
However, I also felt I perhaps should have more confidence in Catherine, due to her level of experience. When Mrs Clarke fell I felt concerned she may have hurt herself. I had initially stepped forward to help break her fall, it was an instinctive reaction but unfortunately futile. Mrs Clarke was a very large woman and fell very quickly. I felt guilty that I had not voiced my concerns and that if I had been more assertive Mrs Clarke would not have fallen. In addition to this I felt that this incident compromised the patients’ dignity and demonstrated a lack of respect.
The Dignity and older Europeans Project (2004) states that indignity is caused by exposing older people to situations they are no longer able to manage and that dignity can be promoted by adapting care to the needs of the individual. These points relate to the described incident as Mrs Clarkes care was not adapted to suit her needs and she was encouraged to mobilise despite her inability and reluctance to do so. Evaluation A good point that arose from the situation was that Mrs Clarke did not injure herself and that her severe reduced mobility was now recognised and respected due to this incident.
Mrs Clarke seemed to recover quickly from the incident. Although she was initially distressed this was short lived. There were several bad points that should be acknowledged. Firstly, I think it would have been beneficial if a second opinion from a qualified member of staff was sought, this possibly would have prevented the situation from occurring. Secondly, Mrs Clarkes’ wishes were not respected, she was in a very vulnerable position and this I felt contributed to her being persuaded to mobilise against her will and better judgement.
Mrs Clarke also ended up in a very awkward and exposed position on the floor and the way in which she was manually handled meant her dignity had been considerably compromised. Finally, Mrs Clarke was manually lifted back onto the bed which again potentially put her and the staff involved at further risk of injury. In addition to this, to my knowledge the incident was not reported. Analysis Although it had been mentioned in handover that Mrs Clarke was confused both Catherine and I were unaware of the reason for this.
There are many causes for confusion in older people including, certain medications, environmental change, illnesses and diseases. Confusion can be defined as acute or chronic, the distinction between the two is usually made in terms of onset (Alexander et al, 2006) In Mrs Clarkes situation the classification was not made, which possibly led to Catherine labelling the patient as intellectually compromised and therefore unable to accurately convey her needs. This resulted in Mrs Clarkes’ wishes and needs’ not being appreciated and respected.
As mentioned previously Mrs Clarke was in a very vulnerable position and was eventually persuaded to mobilise. Hinchcliffe et al (2008) suggest that patients tend to put their trust in the nurse and that this element of trust is critical due to the patient being in a vulnerable position. They go on to suggest that such vulnerability particularly affects the elderly and increases upon entering unfamiliar surroundings and situations. In recent years the media has highlighted the issue of respect and dignity in relation to the elderly and there has been several negative articles regarding problems in this area.
Although dignity is an aspect of care that is relevant to everyone it appears to be an issue among the older person in particular (The Royal Marsden, 2011) There have been several government campaigns and initiatives in recent years that have been put in place in order to improve on this area. For example, the dignity in care initiative was launched by the Welsh Government in 2007 in an attempt to ensure the elderly are treated with dignity and respect when receiving health care services. The initiative aims a zero tolerance approach to the lack of dignity in the care of older people.
In addition to this, the Quality Care Commission aim to ensure that all health services provided in England meet the Government standards, which include treating people with dignity and care. The QMC (2011) published a report which summarised the findings of 100 unannounced inspections of hospitals in England. The report found that too many hospital staff fail to respect the older patients’ dignity and often talk to them in a condescending manner. It stated that almost 50% of hospitals were not meeting key standards for dignity and respect for elderly people.
There has been several suggestions put forward as to why issues with dignity and respect occur in healthcare. The Royal College of Nursing (2008) carried out a survey of its members in order to gain an insight and understanding in this area. The survey reported a high level of awareness and strong commitment amongst staff in maintaining dignity in care. However, the respondents highlighted several issues such as inadequate resources and insufficient staff and time to deliver dignified care. Conclusion I had previously thought of myself as an assertive person. However, when reflecting upon this incident I found this was not the case.
I was surprised how much self-doubt I experienced during the incident and I feel this was due to the fact I was inexperienced and new to the ward. I believe that although this was a very unfortunate incident for Mrs Clarke it was definitely a positive learning experience for me. Mrs Clarke’s dignity had been severely compromised throughout the incident and her wishes were not respected. Whilst I appreciate the need to encourage patients to mobilise I am now very aware that this should be done within reason and with the respect and dignity of the patient a consideration at all times.
The act of maintaining a persons’ dignity in the face adversity is an essential human value, whilst respect for the persons’ identity is a crucial aspect in providing a high level of care (NHS Wales, 2011) In addition to this it should be considered that in accordance with The NMC (2008) as a registered nurse, you are personally accountable for your practice. You must always endeavour to treat those in your care with dignity and respect. I understand that as a a qualified nurse this must be adhered to along with current trust policies and procedures and that failure to do so can result in disciplinary action and endanger your registration.