Care providers analyse and enhance the quality of treatment through monitoring patient encounters. Clinicians significantly influence patient outcomes due to the number of hours they invest in patients. To improve patient outcomes of the quality of treatment, nurses must understand the elements that impact the clinical work atmosphere. Often these revolve around the extent to which the nursing environment facilitates the provision of individualised care.
Contemporary medical practice is based on person-centered care, collaborative decision-making, and interdisciplinary collaboration. Treatment anchored in these values necessitates substantial cooperation between practitioners, patients, and families. More importantly, partnership entails medical professionals cooperating while maintaining their patients’ liberty. In order to get a more detailed understanding of the professional aspects of the work of a nurse, it is necessary to highlight several key factors. So, you need to find out what responsibilities and values are used in the nursing profession, as well as the principles of customer care. In addition, it is important to emphasize the need for communication and continuous monitoring of patients by nurses. Only a combination of analysis of all of the above features will reveal the need and relevance of the NMC Code, developed specifically to adjust the activities of specialists.
The Role of Communication between Nurses and Patients
Medicine and nursing are among the most difficult areas of life in modern society. This can be explained by the fact that professionals in this field have to possess a wide range of skills and abilities. One such skill is communication skills, which can affect the patient-nurse relationship and treatment in general. Numerous studies have shown that quality doctor-patient interaction becomes the key not only to successful treatment, but also to reducing the number of complaints against doctors. Communication skills with the patient are as basic to the nurse as performing surgeries and prescribing treatments (Sibiya, 2018). However, it is important to understand that “good communication” and “effective communication” are different ways of contact (Sibiya, 2018). Effective communication is the mutual receipt of information that the specialist receives from the patient and can then use to make a diagnosis and choose a treatment modality.
The patient also receives information, on the basis of which he or she begins to trust the nurse. In 1996, the Calgary-Cambridge model of specialist-patient communication was proposed (Arnold and Boggs, 2019, p.264). It includes several stages: starting the consultation; gathering information; examining; explaining and planning; and completing the consultation. Studies of consultations of general practitioners in the United Kingdom and the United States show that in about half of the cases the specialist does not identify the patient’s problem (Arnold & Boggs, 2019). The nurse often interrupts the patient’s monologue, clinging to the first complaints and detailing them. All this leads to the fact that the problem with which the patient came is often not detected.
The longer the professional does not interrupt, the more important clinical information he will get from the patient. It is necessary to be able to stimulate the patient to talk, including non-verbal cues, and to observe the response (Sibiya, 2018). Researchers note that when facilitation is used, patients are more satisfied with communicating with the nurse and make fewer complaints. It also leads to an improvement in the quality of information received from the patient.
Approaches to collecting information about the disease can be built on two models: the traditional model and the disease-experience model. The difference of the second, more modern approach is that the nurse records not only symptoms, family history and past diseases. Significant attention is paid to the psychological aspects of the problem: the person may be worried not only about the disease itself, but also about its consequences and risks of treatment (Riley, 2019). Additional questions build trust in the specialist and can prompt new insights into the patient’s problem.
In order to reach the suggested level, it is necessary to teach nurses communication skills. Often this can lead to a complete change in the behavioral pattern of the specialists, but such additional education should be introduced as early as possible in order to create the norm. In the case of patient contact, such models should be applied as soon as they are introduced, that is, at the very first stage (Riley, 2019). In this case, the advantages of the approach described above are realised.
Negligence of Duty
The Legal and Professional Duty of Care
The nurses involved with Gloria’s care were negligent, which led to her death. Medical professionals are held to a standard of care when it is reasonably apparent that they might injure patients with their acts or inactions (Clark, 2017). All nursing specialties fall within this category. It occurs whenever the clinician takes charge of the patient’s treatment. It might be anything as simple as personal hygiene or as complicated as a surgical operation.
Nurses must work in line with the applicable standard of practice to fulfil their legal duty of care. This is often regarded as the level of competence anticipated by a typical qualified professional executing that activity or responsibility (Cusack et al., 2019). Inability to perform nursing duties to this level can be considered negligence. When doing the same work, a freshly certified nurse must provide quality care like an expert nurse. Like a degree of experience, personal characteristics have little impact on the requisite standards.
The case of Donoghue v Stevenson established the present viewpoint on a legal obligation of care. Based on the case facts, a friend of Mrs. Donoghue purchased a bottle of ginger ale, which Mrs. Donoghue drank. Mrs. Donoghue said a rotting slug was discovered inside the beer, and she became unwell and suffered from hysterical trauma (Goh and Round, 2017). Mrs. Donoghue sued the vendor for carelessness, claiming that the company should have anticipated the dangers of keeping ginger beer bottles exposed to the weather in storage that might draw snails and other vermin. (Goh and Round, 2017). Mrs. Donoghue won her lawsuit because the vendor failed to anticipate that their actions and errors would injure the end user. Lord Atkin, one of the case’s justices, said that an individual must take reasonable care to prevent acts or omissions that they might reasonably anticipate would cause harm to their neighbour (Goh and Round, 2017). The judgement serves as a benchmark for cases in a duty of care to date.
The plaintiff must show three things to prove carelessness. Firstly, the caregiver owes a duty of care to the person. That is, there is a connection between the patient and the nurse (Feuillet-Liger and Orfali, 2018). Secondly, the clinician must violate that care duty, which must be apparent. Thirdly, an injury must result from the caregiver’s violation of that care duty. There is no malpractice if there is a violation of the care duty, leading to no harm to the patient (Feuillet-Liger and Orfali, 2018). Nonetheless, the caregiver could still be liable for a disciplinary hearing if it is discovered that they provided poor treatment due to allegations of incompetence or misbehaviour.
A competent nurse must have the ability to anticipate probable consequences from their actions or omissions on an ongoing basis. According to the above scenario, James delegated the duties as per the nurses’ qualifications. He put Bashir in charge of patients’ care and asked Jeanette to follow Bashir to learn for Bashir was experienced. He gave Isla the task of discharge planning and put Fatima under him, for Isla was a registered nurse, and Fatima was a student. He also asked them to report any problems to him. At this point, James fulfilled his primary duty of care for the day by delegating responsibilities to the nurses.
The first instance of negligence was caused by Bashir, who, despite being in charge of the patients’ care, left immediately with Jeannette without guiding Isla and Fatima on managing Gloria. Secondly, Isla and Fatima failed to notify James about Gloria’s sudden change in condition. Nursing and Midwifery Council Code requires nurses to “act without delay if they believe that there is a risk to patient safety or public protection” (NMC, 2018, para.37). Unfortunately, Isla and Fatima did not inform James or Bashsir about Gloria’s swollen legs and chest infection. Nurses are expected to raise concerns about patient situations by escalating issues to superiors (Nursing and Midwifery Council, 2019; Roberts, 2017). Particularly, if this information were made available to Bashir, he would have enhanced monitoring of the patient and prevented further harm as he was in charge of patients’ care. Thus, Isla and Fatima violated their duty of care and can be held be liable.
Fatima gave false information about informing the GP concerning Gloria, yet no one picked the call. The line was engaged; hence, she only left a message. In this instance, she also failed to provide honest, accurate, and constructive feedback to James or Isla about her inability to access the GP violating the NMC code (Harrison, 2018). Overall, Isla showed no concern for failing to ensure that Gloria took her medicine, saying there was nothing they could do when Fatima confronted her. Nurses are expected to be compassionate about their patients, and Isla’s response was unethical from a nursing perspective.
James also exhibited negligence of care because he failed to follow up with the nurses on whether they were discharging their duties appropriately. As the junior charge nurse in the facility, James was supposed to ensure that everything ran smoothly. However, he appeared too busy with his paperwork to the extent that he could not examine the patient during discharge to ascertain her condition. This is also an incident of lack of concern for the patient’s welfare contrary to a senior nurse’s expectations (Roberts, 2017). These lapses in clinical judgment and ethical responsibility cause the patient’s death barely a week after discharge. This implies that more tests would have been done had Isla and Fatima informed James about the leg swellings. It also shows guilt on the part of the duty nurse, who only diagnosed a chest infection and failed to address Gloria’s swollen legs.
Ultimately, all the clinicians involved with Gloria’s care failed to fulfil their professional duty of care. According to the NMC code, nurses have a duty of care and should be trusted with patients’ health and lives in all circumstances. Nurses and midwives are individually liable for their occupational acts and omissions and should constantly defend their choices. In addition, they should dependably comply with regulations, regardless of whether the rules apply to their professional work or private life (Dubree et al., 2017). Gloria’s care team violated the criteria mentioned above, thus breaching their legal and professional obligations of care.
Failure to Provide Coordinated Care
The nurses in the scenario also failed to collaborate when providing care for the patient. Multidisciplinary collaboration supports the adequate provision of patient-centred care, which is based on the values of respect and autonomy. The Equality Act 2010 in the United Kingdom is founded on the ideals of autonomy and respect. A person-centred approach emphasises the necessity of recognizing the patient as a person who has emotions, aspirations, and a purpose for existing (Lindgren et al., 2021). This understanding enables the nurse to include the patient as an active participant in their treatment and care. Respect, trust, and acknowledgment between patient and practitioner are the building blocks of person-centred care.
The practitioner’s primary focus must be on the complete patient and delivering holistic treatment in several dimensions (NMC, 2018). The ideas of person-centred treatment are included in the NMC Code’s guidelines. The code’s opening principle emphasises the necessity of recognizing patients as persons and preserving their decency. This person-centred treatment method is emphasised all over the code (NMC, 2018). James and his team failed to coordinate when treating Gloria, leading to a breakdown in communication and subpar care. They also could not partner with Gloria’s daughter about Gloria’s health and discharge. It allows the patients to keep in touch with their homes and friends.
Additionally, the involvement of family, acquaintances, and relatives is critical in preserving the life quality of admitted patients with serious illnesses. According to Santana et al. (2020), family members can often meet the patient’s basic requirements while in the clinic. Moreover, the family can assist them in reducing their distress and encouraging them to communicate successfully in the rehabilitative approach in use (Crane, 2018). Likewise, family members may guide the patient to engage in self-care practices and efficiently deal with any consequences of their sickness.
Gloria’s care team denied her this opportunity because they did not inform her immediate family member (daughter). Apart from failing to involve the patient’s daughter in her care, the care nurses also failed to inform her that she was due for discharge. According to the daughter, had she been told her mother was being discharged, she would have taken some time off work to help her settle and possibly prevented her death.
Nursing Staff Training and Education
The despicable occurrences depicted in the case scenario and numerous others reported in various UK hospitals underscore the importance of recruiting public health workers with acceptable virtues. Advanced and optimal training and education should guarantee that an adequate number of nursing personnel is equipped with the necessary abilities, ethics, and competencies to offer excellent clinical results and patient-centred care (NMC, 2018b; NMC, 2018c). In addition, administrators must help staff throughout their careers via adequate support, guidance, and assessment.
The Secretary of State for Health has a legislative obligation to guarantee that the NHS and public health systems have a functional training and education system. This role was created in April 2013 when the National Health Service (NHS) gave back the responsibility for local public health in England to the municipal authorities. This reversed the move made four decades ago when the medical officer of health was abolished (Evans, 2021). This obligation was created concurrently with the elimination of crucial medical agencies and the handover of their training and education obligations to Health Education England (HEE) and employers collaborating in local education and training boards (LETBs).
Based on the foregoing, it should be noted that the NMC code performs an essential function in regulating the work of nurses as specialists. First, the activity is characterized by a large amount of interaction with people and patients, as well as a volume of responsibility. Despite the fact that nurses have professional and unique knowledge, it is necessary not only to permanently improve and develop skills, but also to eradicate possible reasons for error. First of all, the danger of mistakes can be explained by the specifics of the profession, since it can lead to serious consequences for people.
In addition, there is also a relationship between the constant workload and concentration of a nurse during work. In order to prevent this from spilling over into burnout or, conversely, disregard for the norms, the developed document is designed to control and regulate medical activities. In addition, the code also has a protective function, for example, eliminating discrimination in the sphere. Thus, the general set of provisions of the code, as well as its orientation, ensure the development and permanent improvement of nursing from the point of view of different spheres, from social, to practical and ethical.
Arnold, E. C., and Boggs, K. U. (2019). Interpersonal relationships. Professional communication skills for nurses. Amsterdam: Elsevier Health Sciences.
Clark, C. M. (2017). ‘An evidence-based approach to integrate civility, professionalism, and ethical practice into nursing curricula’, Nurse Educator, 42(3), 120–126. Web.
Crane, D. (2018). The sanctity of social life: Physicians’ treatment of critically ill patients: Physicians treatment of critically ill patients. Routledge.
Cusack, L. et al. (2019). ‘Re-engaging concepts of professionalism to inform regulatory practices in nursing’, Journal of Nursing Regulation, 10(3), 21-27. Web.
Dubree, M. et al. (2017). ‘Nurses’ essential role in supporting professionalism’, Am Nurse Today, 12(4), 6-8. Web.
Evans, D. (2021). ‘What price public health? Funding the local public health system in England post-2013’, Critical Public Health, 31(4), 429-440. Web.
Feuillet-Liger, B. and Orfali, K. (2018). The reality of human dignity in law and bioethics. New York: Springer.
Goh, B. C. and Round, T. (2017). Wild negligence: Donoghue v Stevenson. In N. Rogers and M. Maloney (Eds.), Law as if Earth Really Mattered (pp. 91-106). Web.
Harrison, P. (2018). ‘NMC Code updated to cover delegation and associates’, Gastrointestinal Nursing, 16(9), 50-50.
Lindgren, B. M. et al. (2021). ‘Balancing between a person-centred and a common staff approach: Nursing staff’s experiences of good nursing practice for patients who self-harm’, Issues in Mental Health Nursing, 42(6), 564–572. Web.
National Health Service England. (2017). NHS England» Health and Safety Policy. England.nhs.uk. Web.
Nursing and Midwifery Council (2018a). The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates – The Nursing and Midwifery Council. Nmc.org.uk. Web.
Nursing and Midwifery Council (2018b) Realising professionalism: Standards for education and training. Part 1: Standards framework for nursing and midwifery education. London: NMC.
Nursing and Midwifery Council (2018c) Realising professionalism: Standards for education and training. Part 2: Standards for student supervision and assessment. London: NMC.
Nursing and Midwifery Council (2019). Raising concerns: Guidance for nurses, midwives and nursing associates. London: NMC.
Riley, J. B. (2019). Communication in nursing. Amsterdam: Elsevier Health Sciences.
Roberts, M. (2017). ‘A critical analysis of the failure of nurses to raise concerns about poor patient care’, Nursing Philosophy, 18(3), e12149. Web.
Santana, M. J. et al. (2020). ‘Improving the quality of person-centred healthcare from the patient perspective: development of person-centred quality indicators’, BMJ open, 10(10), e037323. Web.
Sibiya, M. N. (2018). Effective communication in nursing. IntechOpen.