In the last 13 years I have gained invaluable NHS experience, the most recent being the role of Rehabilitation Support Worker/Assistant physiotherapist (RSW) for 37.5 hours a week from September 2014 (Appendix 1: NHS Trust employment certificate). Prior to that, I worked part-time for five years as a Clinical Assistant Practitioner (CAP) and a further five years part-time as a Healthcare Assistant (HCA) in acute medical settings. All the above roles involved hands-on, individualised quality care provision and owing to my clinical experience, I am making a claim for 500 hours(Appendix 2:Payslips covering tax periods 2-5 of 2017).
The Support Worker role involves helping people after illness, injury, or people living with disabilities to gain independence and join in with aspects of everyday life (Manthorpe and Martineau, 2008). As an RSW, I supported a team of physiotherapists and occupational therapists administering in-patient therapeutic interventions including but not limited to; assisting and supervising patients with their mobility which included bed mobility and reinforcing the correct use of walking aids, assessing and assisting patients with safe transfers as appropriate, setting up and undertaking group therapy exercise. As HCA I assisted patients with activities of daily living, bed making, fluid balance and elimination, monitoring and recording vital signs observations and blood glucose monitoring. After undertaking the Foundation Degree Science (FdSc) in Clinical Assistant Practice (Appendix 3: FdSc transcript),I competently completed additional clinical skills such as; recording 12-lead electrocardiogram (ECG), intravenous cannulation, phlebotomy, urethral catheterisation, wound dressing and pressure ulcer care, preparing patients for theatre and assisting doctors and other practitioners during diagnostic procedures like lumbar puncture. All these tasks promoted health and independence and directly link to the nursing role. I kept up-to-date with statutory and mandatory training, as per Trust policy (Appendix 4: statutory and mandatory compliance, July 2017).
In my support roles I assisted patients with personal care, which is an important aspect of an individual’s wellbeing and a fundamental that must be delivered effectively, according to the standards of care set out (NMC, 2015). In healthcare settings, patients may feel unworthy or undignified due their inability to successfully take care of themselves as a result of disease or injury (Caspari et al, 2013). Therefore, I made it certain that my patients’ dignity and self-respect was well preserved and protected whilst undertaking personal care tasks. I sought the patient’s consent before proceeding, unless it was carried out in their best interests However in the situation of sedation, it was administered based on my knowledge of the condition. Northway and Jenkins (2017) stresses that gaining consent is vital for allowing the patients to exercise autonomy and in order to safeguard them from abuse and neglect.
I made sure that the water temperature used for the cleaning purposes was to patient’s preference, and curtains were drawn and doors and blinds were closed in the side-rooms in order to ensure privacy. Additionally, I took care of the fact that the private parts of the patient’s body was kept covered with a clean towel whilst cleaning each section in turn aided maintaining dignity at all times. If patients preferred to wash their own faces, and where appropriate, their private parts, I gave them a choice to make a contribution to their own personal care. Those able to sit out of bed would be offered a washbowl and those able to walk, the option of using the bath or shower with assistance or supervision given as required. Owing to the busy nature of acute medical setting, I exercised caution not to be task-focused but to focus on the patient as an individual (Bach and Grant, 2011), viewing my patient as someone with needs and preferences, and striving to meet these to the best of my ability and without delay (NMC, 2015).
Disinfection and hand-washing is of utmost importance during the prevention of healthcare-associated infections (HCAI) and research has shown that lack of hand-washing majorly contributes to HCAI (Hewkin, 2013). Suboptimal hand-washing is a major problem on a global basis, which leads to prolonged hospital stay, long-term disability, increased antimicrobial resistance, high financial costs and excess deaths (WHO, 2009). The World Health Organization identifies that before and after patient contact there is a need for disinfection of the hands that has been identified being two of the 5 key moments of hand hygiene (Chou, et al 2012). Other moments are that of before the aseptic procedures, after exposure to bodily fluids and after touching patient surroundings (WHO, 2017).I practised effective hand-washing during personal care to reduce transient and resident flora (Pratt, et al, 2007) and wore personal protective equipment including apron, gloves and masks as per infection control policy.
Maintaining skin integrity is vital in healthcare settings to prevent skin breakdown due to pressure damage, NICE (2014). I assisted nurses to regularly turn patients and provide pressure relief equipment in accordance with the patients’ Waterlow scores, as well as utilized SSKIN bundles (McCoulough, 2016). Furthermore, I participated in regularly checking for pressure damage in protruding appendages such as the sacrum, heels, knees, elbows for bedbound patients, in-dwelling catheter damage as well as the ears and nose for those on oxygen therapy. I followed recommendations by the Tissue Viability Nurse specialist and applied pressure relief accordingly.
Spirituality is not just about faith in the supernatural but about the values and beliefs of an individual. When vulnerable due to illness, patients may ant healthcare professionals to know their source of meaning, comfort and support (Fosarelli, 2008).
In the healthcare setting, the spirituality of the person becomes important especially when it is a part of the ageing process. The services of chaplaincy become an intricate part of the healthcare setting for the determination of the belief system and for supporting the individuals. Spiritual needs most of the time arises for the patient as well as their families especially during health or life crises including chronic illness, along with death and dying and life-limiting illness in children or neonate. Spirituality most of time acts as a coping mechanism in hard times therefore individuals may re-adopt religion and religious rituals. It has been reported that the health outcomes of the patients increases when their spiritual needs are attended. The nurses who are ill-equipped for addressing the spiritual needs of the patients are incapable of proving quality care to the patient.
A person’s decision-making can be affected by their spiritual beliefs and more so in end of life care (Puchalski, 2013). End of life can present distressing, uncertain moments and when I have been involved with patients undergoing palliative care, I responded compassionately, comforting the patient and families involved and preserving dignity. The ode (NMC, 2015) requires prioritising people, which I demonstrated by recognising and responding to palliative patients with empathy. Little acts of kindness like holding someone’s hand to let them know you are there when they receive bad news, in my experience provide a great deal of comfort in coping with a poor prognosis. Additionally, my patients were supported in their desire to pray or have a quiet moment in the chapel or multi-faith room, read their religious Holy Book and have chaplains or faith eaders contacted as per patient’s wish. I understand that patients will turn to their faith when in distress and although it may be different to my personal beliefs, as a nurse, I fully support them to alleviate their suffering and improve their wellbeing.
Sometimes a patient’s attitude towards touch is affected by their values and belief system. Devito (2002) warns that although touch may be used to convey messages of support or care, it may be misunderstood as ndicating sexual interest or having power over an individual if used nappropriately. Some patients would rather be washed or examined by same sex practitioners in accordance with their beliefs, or have their partners or a chaperone present during their care interventions. Throughout my caring roles, I have been respectful to the patients’ values and providing care by their preferred gender whenever possible. Additionally, I have often acted as a chaperone for patients during examinations as well as escorting patients to clinic appointments and scans as required, ensuring that the patients were comfortable throughout their therapeutic interactions.
However there are often several barriers faced during the provision of spirituality in the health care setting which includes lack of enough time, along with the differences in the social, religious and cultural factors that exists between patients and the healthcare staff. Often it can be seen that the health care staff lack the understanding of the concept of spirituality and its importance for the patients and their families. However this reduces the capacity of the professionals to provide quality services to their clients. I being a healthcare professional involved in providing care to the patients, I should involve in discussion with the patient that involves discussion of their own religious beliefs. I should never try to impose my religious views on my patients or their families. I should be sensitive as well as respectful towards the spiritual needs of the patients and their families, and try to assess the spiritual needs and make referrals to chaplaincy services which are quite crucial for the provision of effective spiritual care in healthcare settings.
While I was doing health check-ups, I came across patients who had needle phobia or phobia from blood. Being a health care professional I tried to find out methods so that in could address the fear of these patients and make them take the test without any fear. I tried out new ways to calm the patient and made note of the anxiety symptoms of the patients and managed them using the techniques of distraction like the modified progressive muscle relaxation. Providing psychological care also included involving in the behavioural change of the patient which includes the understanding the motivation of the patients through the implementation of the models like the psychological models such as Prochaska and Di Clemente’s Stages of Change. Patient centred care and communication was also practised by me during my placement along with the planning of therapy changes and interventions in order to manage the health condition of the patient.
Professional and effective psychological care cannot be underestimated (Kohl, 2015). I have cared for patients experiencing fear, confusion, anger anxiety and depression, and often times what they needed was someone to acknowledge this. As a RSW, I tried to engage in further discussion to the patient, asking facilitative and reflecting questions and discovered that the patient was not happy being near the bathroom and as afraid they would not be able to take care of themselves on discharge due to pain and restricted mobility. I conveyed an appreciation for their feelings, easing their anxiety and helping them to open up (Bramhall, 2014). I reassured them and then liaised with the staff nurse, who administered pain relief as prescribed, and made arrangements to transfer the patient to a different bay or available side-room. Afterwards, the patient consented to treatment, improving their mobility. The patient was fully involved in the decision-making process and discharge planning, the final outcome being beneficial to them, balancing abilities with the demands of personal mobility needs, self-care, home environment demands (Creek, 2003).
Great psychological care prevents unnecessary hospital admissions, facilitates early discharge as well as support adults of working age in their occupation during an episode of mental illness, COT (2006). As an RSW, I executed therapy interventions by organising and running Pulmonary Rehabilitation Classes for patients with Chronic Obstructive Pulmonary
Disease (COPD). During the group exercises, I worked with the therapists n partnership with the patients, setting different individual goals to be achieved with each patient despite their shared medical condition. Whilst some patients would be anxious due to shortness of breath, others were orried about reduced mobility, inability to go out and socialise or engage n leisure activities. Through active listening and empathy I provided reassurance, building trust with the patients, which in turn nourished the therapeutic alliance and ensured achievement of goals. This gave patients a feeling of self-worth, greatly improving their outlook on life and improving their mental health, bringing their discharge dates within reach.
Often there are events raised like smoking, where the patient is not trying to quit, in such cases the NHS Health Check can provide a valuable opportunity for people to consider how their current lifestyle is affecting them and contemplate whether they would like to change some aspects.
I interacted with individuals with different socio-economic status and from all backgrounds; educational, gender, age, sexual orientation and sexuality in clinical settings. In a deprived part of East London, there were numerous cases of alcoholism and drug dependence. For instance, a male of Eastern European descent who could not find work in a chosen field was plunged into depression, alcohol abuse and self-neglect. In my role, I supported him through alcohol withdrawal and through direction of a staff nurse, referred him to the Drug and Alcohol liaison service, where he received more specialist help. Studies have shown that males engage in expressive forms of behaviours such as drinking or fighting, whereas females tend to internalise the health issues (Hurrelman and Richter, 2006); by acknowledging these gender differences, I was able to attend to his needs more fully. The overcrowded living conditions in his flat put him at risk of opportunistic infections yet he could not afford better housing, and had no adequate heating, nor nutrition. The patient was referred for review to a dietician using the electronic system as well as social services to assist him with his housing needs and any benefits he might be entitled to whilst he recovers and finds work.
In the acute health care setting there was a need of various social interventions which included the establishment of the nature of the risk along with the recommendation of the preventive methods for the reduction of the risks. I should be able to communicate about the available medical evaluation along with treatment and information about how to obtain them. During the placement I was also involved in communicating messages to the client through the available channels. I also informed the patients regarding the other relief efforts present. I was also involved in involving the adults and adolescents in concrete, purposeful, common interest activities which included the assisting in caring for the ill especially caring for the other people.
Conclusion
I have provided a portfolio of evidence detailing my previous experience in clinical practice through my caring roles in the NHS, spanning 13 years. The skills I have acquired ensured patients’ physical, spiritual, psychological and social needs are met holistically. I have developed excellent communication and customer care skills enabling me to provide personalised, quality, safe care. I have demonstrated I have managed conflict and mediated difficult situations involving patients, families and colleagues, and learnt to be the patient’s advocate when they needed a voice.
Holistic care requires a multi-disciplinary approach and effective teamwork puts the patient’s needs at the heart of all interactions, traversing any cultural or religious barriers as well as disability, gender, sexuality and sexual orientation. The skills and values that I have developed through the experience that are outlined above including; performing personal care with respect and dignity, effective hand-washing, maintaining skin integrity, compassionate care at end of life. This involves patients in decision-making processes, understanding the social factors in healthcare, collaborating along with the planning and managing my own workload, which are all the skills that are essential for the nursing practice.
References
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