The importance of maintaining dignity within healthcare
The aim of this essay is to explain the importance of maintaining dignity in a healthcare environment. This will be done by reflecting on a positive interaction that I have had with a patient and backed up with literature to support the importance of dignity. Dignity, in accordance with the Oxford dictionary (2018) as cited by Macaden et al (2017), is defined as the state or quality of honour or respect. Dignity is vital in the delivery of care, and it is therefore important to increase knowledge and understanding on this area. This essay will be completed as a reflection, as nurses have been writing reflectively for many years to improve their practice development (Taylor, 2010). Reflection is a conscious attempt to acknowledge an activity that allows us to consider what was positive or challenging and how it can be improved, strengthened or done differently in the future, if necessary (The Royal College of Nursing, 2018). I will use a recognised model of reflection to critically analyse the positive interaction I had. I have explored a range of different reflection models to find one that is appropriate for this and one that I find easy to follow. The model of reflection that I believe will help me to thoroughly analyse the event is Gibbs (1988) as cited by Howatson-Jones (2016). I will follow the framework of Gibbs, as I find the structure simple and easy to understand. Another reason I decided to use this model is that I applied it before and I felt as if it helped me thoroughly examine the specific event. During this assignment I will use a pseudonym for any patient I discuss to maintain confidentiality in accordance with the Nursing & Midwifery Council (NMC) The Code (2018).
Description
During my first placement in the community with my mentor, we went to visit a lady who I’ll call Jessica for this essay. Jessica lived on her own and currently had care from the carers and the district nurses, who came to check and change a wound dressing on Jessica’s bottom. Jessica unfortunately had suffered from a stroke which had left her immobile and she had difficulty with her speech. My mentor explained all of this before we went into her house, so I had a better understanding of why she needed support from the district nurses. As she was immobile, the key was placed in a locked box which needed a code to access it. Even though we had a key, we knocked on her door before we entered, as it is still her home, and we had to respect her privacy. Although Jessica struggled with her speech, I tried to engage with her as much as possible. While the district nurse was writing the notes, I made Jessica a cup of coffee and asked her if I could do anything to make her more comfortable. I sat next to Jessica and made sure that I listened to what she said and that she felt respected and understood. Jessica was bedbound and therefore she needed the help from the district nurses to clean the wound on her bottom and change her dressing. My mentor asked me to close the curtains in Jessica’s room and turn the light on. This upholds Jessica’s dignity by respecting her privacy and Jessica was so thankful for our help. Jessica was able to roll onto her side with minimal assistance which allowed us to look at the wound. My mentor asked Jessica if it was okay if I could change her dressing, as I needed consent to be able to perform the wound dressing change. She was happy for me to do so and I communicated to Jessica throughout the procedure. My mentor watched me as I performed the non-touch aseptic technique wound dressing change and was happy with how the procedure went. We then cleaned up and washed our hands and made sure Jessica was in a comfortable position. Before we left, we checked if she needed any other assistance before her carers came in, and although she didn’t she seemed happy and content.
Thoughts and feelings
At first, I felt nervous as I had never performed a wound dressing change before, nevertheless my mentor was there to assist and help. I also did not feel confident as I had never met a person that had suffered from a stroke before, and it was my first day of placement. However, when I met Jessica I tried to appear confident to ensure she felt in safe hands. After this interaction I felt as though I could do it again and therefore I felt slightly more experienced and competent. The patient was happy and extremely thankful for our help whilst we were there. Even though we did not do a lot, I feel as though she was grateful to have someone to talk to her and make a conscious effort to listen to her. I felt satisfied that we kept her dignity maintained throughout all the aspects of her care that day.
Evaluation
In hindsight the overall experience was good, however there could have been elements that could be improved. The good and the not so good elements, has led to an increased understanding of nursing care and the providing dignity within a patient’s home. I was happy with how I performed the procedure of the wound dressing change. I completed the dressing change in a safe environment and used an aseptic non-touch technique, which can reduce the risk of contamination. I feel that the communication between myself and Jessica went well as Jessica felt valued and comfortable throughout the procedure. One way I could improve the experience, would be to increase my knowledge about a person who has suffered from a stroke. This would enable me to work effectively in the future and help me to provide a high standard of patient care. The interaction with Jessica ended well, as all care was attended to and she was left with dignity intact.
Analysis
The dignity of an individual applies to all who have capacity and those with no capacity. It is therefore fundamental that everyone should be treated with dignified care in all healthcare settings including those living in their own homes (Baillie, Ford, Gallagher & Wainwright, 2009). As a healthcare professional the NMC (2018) insists that you must uphold a patient’s dignity and treat each patient as an individual. By being empathetic to a patient and treating them holistically, allows the nurse to perform quality care to that patient (Flanagan, 2013). According to Van der Cingel (2014), being compassionate and empathetic, can be viewed as a vital part of taking care of a patient. It can also help the nurse to find out important information in order to achieve suitable outcomes of care for the patient. Whilst talking and listening to Jessica, I found that I was able to build trust with her as I was able to understand her points of view and give her my undivided attention by listening and responding to her. Throughout the interaction with Jessica, effective communication was used, this helps nurses to understand their patients’ needs and can help them to build a therapeutic relationship with them. This is clear with literature by Kourkouta and Papathanasiou (2014), which points out that effective communication can in fact improve the quality of care that is given to the patient. According to Benner (1984) as cited by Alligood (2017), a nurse will pass through five levels of proficiency called Benner’s stages of clinical competence (1984). Since I am in the novice stage (first stage), Benner’s theory suggests that it is a common feeling to be lacking in confidence. This is due to a novice lacking in experience and knowledge. I feel that this did play a big part in why I was so nervous to begin with, as afterwards I felt more confident and competent. Wound related pain is a familiar symptom and can often be described by many people as one of the worst parts of possessing a wound injury (Woo, Conceição de Gouveia Santos & Alam, 2009). Part of the nurses role is to help keep the patient as comfortable as they are able to, to feel safe and reassured when needed. Being knowledgeable regarding the wound healing process and the consequences of poor wound management is also important, as this can help the nurse to ensure that the patient is having the right treatment (Hampton & Collins, 2007). By being knowledgeable around wound care, the nurse is therefore able to provide a high standard of practice and care towards the patient, which in turn keeps their dignity intact (NMC, 2018). In this experience my mentor and myself ensured that Jessica was in no discomfort before during and after her wound dressing change. My mentor also explained to me why certain wounds needed different dressings which helped me with my knowledge on wound management. This experience with Jessica gave me the opportunity to gain an insight on how dignity can be maintained in the community setting and ways to improve patients dignity in their homes. In the opinion of Mendes (2015), the smallest thing a nurse does can have the biggest impact on their patient. In the experience I had with Jessica, knocking on her door before entering her house may of had a big impact on her. She may of felt more control than if we just entered into her house without knocking. My mentor also gave Jessica the freedom of choice and the sense of belonging by explaining the procedure and by asking for Jessica’s consent. We also made sure that the curtains were closed before we changed her dressing, this kept her dignity intact and is something which I will continue to do in future placements. Maintaining dignity helps to keep a patient’s self worth and their identity, which is why it’s extremely important for the healthcare professionals to preserve and promote an individuals dignity.
Conclusion
From this experience, I have increased my knowledge around maintaining dignity in an individuals own home environment. I have learnt that the slightest thing can have a big impact on a patient, such as closing the curtains when performing a dressing change. This experience with Jessica has taught me that I am able to communicate effectively which is essential for helping to maintain dignity. Based on this experience, I know that with time I will be able work my way through Benner’s stages of clinical competence (1984), and should improve my confidence due to gaining more knowledge.
Action Plan
In the future I aim to increase my knowledge and awareness on the wound healing process and my knowledge on strokes, in order to give the patient the greatest possible care and treatment. Nurses are accountable for their actions, they therefore must have the knowledge to back themselves up (Baillie & Black, 2014). I will also try and share my knowledge to my peers as it is an essential part of personal growth. The NMC code of conduct (2018) states that nurses should share their knowledge and skills with their colleagues for the benefit of patient care. I will also continue to preserve the dignity of a patient in the community by, recognising that I am entering their home and that I must respect their property as well as their belongings.
Overall Conclusion
By using the gibbs reflective cycle I have been able to identify why it is important to maintain the dignity of a patient in the community. By using literature to backup my knowledge, I have been able to show that by being empathetic and compassionate to a patient is vital to preserve a patient’s dignity. The quality of care the patient receives from the nurse can improve by communicating and getting to know the patient. This reflection has also enabled me to plan for similar events in the future, by allowing me to create an action plan.
References
- Alligood, M. (2017). Nursing Theorists and Their Work. Philadelphia: Elsevier Health Sciences.
- Baillie, L., & Black, S. (2014). Professional values in nursing (1st ed.). London: Routledge.
- Baillie L, Ford P, Gallagher A, & Wainwright P. (2009). Nurses’ views on dignity in care. Nursing Older People, 21(8), 22–29. doi: 10.7748/nop2009.10.21.8.22.c7280
- Flanagan, M. (2013). Wound healing and skin integrity. West Sussex: Wiley Blackwell.
- Howatson-Jones, L. (2016). Reflective practice in nursing (3rd ed.). Dorchester: Learning Matters.
- Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65-7. doi: 10.5455/msm.2014.26.65-67
- Macaden, L., Kyle, R., Medford, W., Blundell, J., Munoz, S., & Webster, E. (2017). Student nurses’ perceptions of dignity in the care of older people. British Journal Of Nursing, 26(5), 274-280. doi: 10.12968/bjon.2017.26.5.274
- Mendes, A. (2018). The big impact of small gestures in community nursing care. British Journal of Community Nursing, 23(8), 412–413. https://doi.org/10.12968/bjcn.2018.23.8.412
- Nursing & Midwifery Council. (2018). The code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Retrieved from http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf
- Royal College of Nursing. (2018). Reflection and reflective discussion. Retrieved November 29, 2018, from https://www.rcn.org.uk/professional-development/revalidation/reflection-and-reflective-discussion
- Taylor, B. (2010). Reflective for Healthcare Professionals (3rd ed.). Maidenhead: Open University Press.
- Hampton, S., & Collins, F. (2007). Tissue viability (1st ed.). London: Wiley.
- Woo, K., Conceição de Gouveia Santos, V. L., & Alam, T. (2018). Optimising quality of life for people with non-healing wounds. Wounds International, 9(3), 6–14. Retrieved from http://search.ebscohost.com.openathens-proxy.swan.ac.uk/login.aspx?direct=true&AuthType=cookie,ip,shib,uid&db=rzh&AN=131918860&site=ehost-live&scope=site&authtype=shib&custid=s8000044
- Van der Cingel, M. (2014). Compassion: The missing link in quality of care. Nurse Education Today, 34(9), 1253–1257. doi: 10.1016/j.nedt.2014.04.003
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