Enhancing Person-Centred Care in Nursing Practice

In a female-only respiratory ward in the West Midlands, a patient was admitted with complaints of chest pain and shortness of breath. To protect patient confidentiality, her name is withheld (Dimond, 2002). This patient, registered as deaf, faced communication challenges due to a form of Aphasia leading to stuttering.

Recognizing the need for specialized communication, a friend of the family requested that nurses document procedures for the patient. British Sign Language (BSL) was employed to facilitate communication, involving hand gestures, lip patterns, fingerspelling, and facial expressions (National Health Services Choices, 2013).

Person-Centred Care and Ethical Considerations

The patient's care was initiated following advice from the tissue viability (TV) nurses, who recommended daily leg dressings for her ulcerated legs. Her personal care and medication regimen were meticulously organized, and information was conveyed through written notes, in compliance with all NHS policies, procedures, and the Trust's Code of Conduct.

However, a challenge emerged when the patient began to refuse all forms of care. It is crucial to acknowledge that a mentally competent individual has the right to decline treatment (Dimond, 2005, p142).

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Multiple attempts were made to change nursing staff to determine if the patient was more comfortable with a particular nurse.

It became evident that the patient's ability to sleep was severely compromised. The nursing team pivoted to adopt a person-centred care approach, engaging the patient in conversations aimed at obtaining her consent for necessary treatments.

At this juncture, the patient faced the risk of remaining in soiled conditions, which could lead to grave complications, including gangrene.

All healthcare professionals were committed to safeguarding the patient, aligning with the Care Quality Commission's definition of safeguarding, which emphasizes protecting individuals' health, well-being, and human rights (CQC, 2014).

The nursing staff's unwavering dedication was rooted in their respect for the patient's dignity and well-being.

Ultimately, the patient agreed to have her observations recorded, her blood sugar levels monitored, and a urine analysis performed. A urine sample was subjected to a comprehensive test, involving multiple combination strips capable of detecting various parameters such as blood, ketones, glucose, pH, and protein (Henderson, 2004).

Throughout this process, the patient was consistently provided with information to empower her to make informed decisions and participate actively in her care.

Holistic Assessment and Effective Communication

A holistic assessment, encompassing physical, medical, and psychological dimensions of the patient's well-being, was integral to planning her nursing care. Nurses needed to consider various factors, including the patient's age, gender, and emotional state, to gain a comprehensive understanding of her needs.

During the assessment, nurses relied on all their senses, including therapeutic communication through hearing, visual cues, and touch (Smith, 2012, pp.5-7). This holistic approach was essential in addressing the patient's complex communication needs and providing care that aligned with her overall well-being.

The concept of person-centred care, as advocated by The Health Foundation (2014), played a pivotal role in the patient's journey. Person-centred care is rooted in the principle of involving patients in their own care, ensuring they maintain control over their bodies and minds.

This approach extends to include patients, their families, and healthcare staff, fostering collaboration in planning, delivering, and facilitating discharge. Compassion and empathy are central to the role of nurses, especially when patients find themselves in unfamiliar and distressing situations.

Person-centred care was a guiding principle in this scenario, as healthcare professionals actively engaged with the patient's family to discuss her care. Recognizing the need for effective communication, the nursing team liaised with a friend of the family, who had expertise in sign language, to bridge the communication gap.

The journey was further facilitated by the use of basic sign language, allowing the patient to express herself more comfortably and participate in her care. The collaborative effort between the patient, her family, and healthcare staff exemplified the essence of person-centred care.

The patient's needs were always at the forefront, with measures taken to ensure her comfort and dignity. The curtains were drawn for privacy, and consent was sought before entering her bed space, highlighting the commitment to upholding her respect and dignity (The Royal College of Nursing, 2012).

Professional and Ethical Considerations

The nursing profession demands a high degree of professionalism, both within and outside the workplace. The Nursing Midwifery Council (NMC) sets clear standards for registered practitioners, emphasizing competence, skill, and assurance (NMC, 2012).

Professionalism extends to all aspects of a nurse's life, with the NMC's Code of Professional Conduct guiding nurses to maintain a high standard of practice (Burnard and Chapman, 2004, p1).

In this scenario, a student nurse recognized the patient's struggles with communication and took the initiative to utilize her sign language skills. This proactive approach aligns with the professional standards expected of nurses, demonstrating competence and a commitment to patient care.

Ethical considerations are integral to healthcare practice, and Tschudin (1986) argues that ethics are synonymous with caring (Burnard and Chapman, 2004, p6). Healthcare professionals must navigate complex ethical landscapes, respecting patients' individual beliefs and values.

In this case, the patient's unique communication needs and understanding of her care were at the forefront of ethical decision-making. All communication sources were employed to empower the patient and obtain her consent, ensuring her autonomy was preserved.

Effective Communication and Policy Adherence

Effective communication is the cornerstone of quality healthcare. Healthcare professionals must communicate clearly with patients, their families, and colleagues to ensure safe and effective care delivery.

Active listening, keen observation of body language, appropriate speaking speed, and tone all contribute to effective communication. Providing patients with comprehensive information helps them understand their condition and treatment options, enhancing their involvement in decision-making (Collins, 2009).

All policies and procedures in place at the hospital were rigorously followed, including the guidelines outlined in the hospital's leg ulcer management handbook (2013). This ensured a systematic approach to wound care, encompassing assessment, documentation, photography, and appropriate dressing choices.

The involvement of tissue viability nurses in providing guidance further enhanced the patient's care, aligning with the hospital's commitment to delivering top-quality services (The Royal Wolverhampton, 2014).

Moreover, the Department of Health emphasizes the importance of treating patients with respect, dignity, and compassion, while providing care that upholds their well-being (DOH, 2013). This patient-centred approach was evident in the care provided to the individual.

Conclusion

From a nursing perspective, this scenario illustrates the successful implementation of high-quality person-centred care. It recognizes that patient care extends beyond addressing physical ailments and encompasses the unique needs of each individual.

The interprofessional teamwork, commitment to effective communication, and respect for the patient's autonomy were central to the care provided. It is worth noting that the patient's complex communication needs could have been further facilitated if all staff were trained in British Sign Language (BSL).

This training would empower both patients and staff to communicate more effectively, thereby improving the overall quality of care. In summary, this case exemplifies the significance of person-centred care, ethical considerations, and effective communication in nursing practice, ultimately leading to the delivery of high-quality, patient-centred care.