Healthcare and Education Graded Unit

As a HNC Health Care student I am required to provide evidence of the following principal aims and objectives: to integrate knowledge, theory and practice, to develop and apply a broad knowledge and skills and to have an individual patient/client focus in my practice. To achieve all of the above I am required to complete project in a form of Graded Unit which consists of three stages: planning, development and evaluation.

After consultation with my work experience mentor and lead lecture (appendix 1 and 2) it was agreed, the project will be a nursing activity, weighing a patient , which will be carried out within an ambulatory care settings which is my current placement .

This will take place on Monday the 22nd of April. The chosen activity is a part of the patients’ treatment care plan and its aims maintaining patient’s safety related to correct medicine administration as well as to detect potential side effects associated with pharmacological treatment. In accordance with applicable law (Data Protection Act 1998) and to maintain patient confidentiality and privacy the name of the patient has been changed.

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I will be referring to the patient as Cinderella. The patients’ personal information had been obtained with her consent and knowledge (NMC Code of Conduct 2008).

Cinderella is a 26 years old patient attending the Peter Burnt Centre at Aberdeen Royal Infirmary where she has been receiving Hepatitis C (HCV) treatment since November 2012. Cinderella lives alone in high rise block of flats in one of Aberdeen City Council estate. She left school at the age of sixteen with no qualifications and used drugs for several years.

She was brought up by single parent - her mother, and has no siblings. With the help from local drug rehabilitation team she managed to stop using drugs for five years. Currently she works as a housekeeper on a part time bases in one of the hotels in the city centre. Recently, she has reduced the number of working hours due to the side effects of medication which make her feel very tired. She also complains of an upset stomach and lack of appetite. After having a chat with Cinderella she has told me that her social life and circle of friends is quite limited as her income is now much lower. She also mentioned that is quiet difficult to make new friends while you have drug use history.

When speaking to Cinderella it became evident to me that being HCV positive makes her feels worse than others and reminds her of when she was using drugs. It is well evidenced that people who have both; history of drug use and disease which can be sexually transmitted such is HCV, are likely to experience stigma and discrimination in their life (Gilman 1999).Stigma and discrimination are socioeconomic factors which have a damaging health, social and financial consequences (Nursing Standard 2008). It is believed that those who are stigmatised and discriminated are more likely to have a lower income and due to this cannot afford to purchase better quality food, better housing, live in safer environments and have worse access to healthcare and education. Cinderella’s low socioeconomic status and negative social attitudes evidently put her physical and mental wellbeing at risk. Stigma and discrimination may relate to Social Symbolic Interaction Theory and in particular to the idea of labelling and its negative impact on people behaviour and self- concept (Miller J, Gibb S 2007).

This would also fit with Carl Rodgers Person- Centred Theory and his idea of self- concept. Self –concept in other words is how we perceive and value our self. Rogers believes that humans need a positive environment to achieve fulfilment in their lives. In Cinderella’s case both her socioeconomic status and unfavorable social attitudes may make her feel negatively about herself and stop her from social integration. I also believe that Abraham Maslow’s Hierarchy of Needs can be applied to the patient situation. According to this psychological perspective every person is motivated by their needs and cannot achieve his/he full potential (self-actualization) if some of these are not met.

I feel that this may relate to Cinderella’s safety, love and belongings needs. Limited social contacts, stigma and fear caused by her illness may stop her from moving on to the next level personality development. To support people in similar to Cinderella’s circumstances the Scottish Government launched the Hepatitis C Action Plan in 2006. The aim of this policy is to improve health care services for people living with HCV and to tackle HCV- related social stigma, by rising public awareness and changing the way HCV is portrayed in media.

I have decided to use Roper Logan and Tierney twelve activities of daily living (A DLs) to asses Cinderella’s needs. The reason for this is that I find it to be the nursing model which is very effective in assessing basic day to day activities which have its own importance to the survival of life; also it follows the objectives of my graded unit. For the purpose of this project I will focus on maintaining safe environment in relation to Cinderella’s HCV antiviral therapy. Cinderella had been referred to Peter Brunt Centre at Aberdeen Royal Infirmary by her GP due to the result of blood test which revealed Hepatitis C antibodies. After a number of blood tests and liver biopsy Cinderella had been diagnosed with Chronic Hepatitis C with genotype 1 and mild liver damage. HCV is a disease caused by blood – borne virus Hepatitis C, which infects the liver and causes its inflammation (British Liver Trust 2010). The term chronic describes illnesses that last for a long period of time (more than six months) or for the whole life. The liver is an organ which is a part of the digestive system and carries out numerous important jobs’ such as; detoxification, aiding digestion or extracting nutrients.

These play a vital role in maintenance of equilibrium of the body internal environment, known as a homeostasis. Due to prolonged liver inflammation scaring of liver tissue occurs (fibrosis) and permanent liver damage is likely to occur (cirrhosis, liver cancer). As a result liver work capacity become impaired and the whole body may become poisoned (WHO 2011). There are several effective HCV treatment options available however none of them gives a one hundred percent guarantee. Nevertheless, adequately matched therapy can permanently clear the virus from blood and prevent liver from further damage. Cinderella after consultation with liver specialist doctor and liver specialist liver nurse decided to undergo HCV treatment known as a ‘triple therapy’ which is recommended by National Institute for Health and Clinical Excellence (NICE) The effectiveness of treatment among other factors lay in an adequate dosage and duration of medicine intake.

Both too low or too high dosage as well as side effects of medication may negatively impact Cinderella’s physical health and put her life at risk. To maintain the patient safety it was agreed that Cinderella will be visiting PBC every Monday for blood tests and weight checks. To ensure Cinderella’s safety I will follow appropriate NHS procedures and policies (NHS Procedure guidelines: Weighing the patient 2008) in line with the Health and Safety at Work Act (1974). To perform chosen activity I will require specific resources which I listed in Appendix 3 and project timescale (see Appendix 4). I have obtained consent from a different patient who is also visiting PBC this day if for some reason I will not be able to complete it with Cinderella.

References

Health Protection Scotland - a division of NHS National Services Scotland. (2009). Blood Borne Viruses & Sexually Transmitted Disease . Available: http://www.hps.scot.nhs.uk/bbvsti/hepatitisc.aspx. Last accessed 25yh March 2013. The Scottish Government (2011). The Sexual Health and Blood Borne Virus Framework 2011-15 . Edinburgh: Scottish Government. p31- 42. Grundy G, Beeching N . (2004). Understanding social stigma ii women with hepatitis C. Nursing Standard. 19 (4), 35-39. Gilman S (1999) Disease and stigma. Lancet. 354, Suppl, SIV15. World Health Organization. (2012). Hepatitis C . Available: http://who.int/mediacentre/factsheets/fs164/en/index.html. Last accessed 5th April 2013. Nicole Cutler. (2007). Breaking the Hepatitis C Social Stigma. Available: http://www.hepatitis-central.com/mt/archives/2007/08/breaking_the_he.html. Last accessed 7th April 2013. British Liver Trust. (2011). Facts and functions of the liver. Available: http://www.bbc.co.uk/health/physical_health/conditions/in_depth/liver/liver_facts_functions.shtml. Last accessed 11th April 2013. Maslow, A. H. (1970). Motivation and Personality. New York: Harper & Row Rogers, Carl. (1951). Client-centered Therapy: Its Current Practice, Implications and Theory. London: Constable. Miller,J and Gibb, S (2007). Care in practise for Higher Second Edition. Paisley: Hodder gibson. 202-204. Nursing and Midwifery Council (2008). The code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC. p2- 8. Roper, Logan, Tierney (1980). The elements of nursing. Edinburgh: Churchhill livingstone. 141.