Call Me Joe
This is a reflective assignment where I will be using the short films released by the Nursing and Midwifery Council (NMC, 2010) “Call me Joe” to consider the significance of evidence-based practice and reflection within health care services using the prospective role of the student nurse and the implications reflection may have on the delivery of effective care to their patients.
The video is based on a scenario of an elderly man residing within a care home setting; the intention of the video is to raise awareness to concerning issues regarding the poor practice that is actually occurring within nursing practice today.
For the purpose of this assignment, I shall be using the constructive reflective model by Rolfe et al (2001) which explores the three questions; What? So What? Now What? To reflect upon the quality of care that is being given and how it directly impacts on the patient, by doing so we can establish what could then be done using the prospective role of a student nurse to improve the quality of care moving forward.
Reflection is a process which enables healthcare professionals to improve practice through continuous monitoring (Dayl et el 2010), it enables the practitioner to critically assess self and their approach to practice (Fleming, 2006)
Practicing nurses are doing exactly that ”practicing”. It is a profession which has and is constantly evolving over time. What once may have been considered best practice may now be considered poor practice as evidence and research has developed and become more accurate and reliable.
Using evidence-based practice; health care professionals are able to gain advanced knowledge which is necessary for the improvement in the delivery of care and therefore beneficial to the health of the patient (Gray, 2009)
What ? And So What?
Joe, as he prefers to be called, is the elderly man who has recently suffered multiple losses, most significantly the loss of his wife Ella. Joe felt that he just could not cope on his own and did not want to be a burden to his daughter who has a family of her own so subsequently, now resides within a care home setting. Joe has a strong sense of pride, therefore, he feels lucky to live there. However, it is observable that his freedom to make his own life decisions has been taken away from him and he has essentially become imprisoned to the daily routine that is convenient for the staff managing the institution.
The opening scene begins with two staff members waking Joe at 5.14am, they are in his room before he has woke, this suggests that they did not knock the door before entering. Everybody has a right to privacy and although Joe resides in a care home setting and is not the legal owner of the property he does have a moral right to the small space of which he is allocated, therefore, entering without consent and not in a case of emergency is an intrusion and an infringement of his right to privacy (Nordenfelt, 2009). ”Joseph it’s time to get up” says the carer, as she pulls back the curtains, allowing in the sunlight directly into the room. Joe was not asked if he had a good quality sleep or if he was ready to awake. Healthcare providers should adequately support the patients normal sleep routine and where physically possible facilitate the individual needs of the patient (Hayes, 2011). In this instance the routine of the institution had been prioritised and Joe was expected to conform.
The two staff members then proceeded to converse between themselves regarding what they had watched on television the previous night, failing to engage with Joe or make any eye contact with him, whilst getting him up and putting on his dressing gown and slippers without consulting him. “Person-centred care has been defined as treating people as individuals and enabling them to make choices about their care” (Galloway, 2011). Care that can be considered person centred involves a holism approach where the physiological entity is considered as well as the physical entity, there is a mutual exchange of information which is crucial to understanding the needs of the patient, the involvement and active participation of engaging the patient within their own care plan and empowering and enabling them to make their own informed choices and decisions within a partnership built on trust where the healthcare professional is able act as an advocate for the patient (Galloway, 2011). In this scenario Joe is not receiving person centred care as the healthcare professionals are failing to recognise his physiological presence and are treating him as if he were an object.
Joe tells the care givers that he needs his glasses multiple times but is ignored and this basic need not met. Impaired vision increases not only the physical risks of falls but also the physiological risks of cognitive decline, depression and therefore suicide (Barker, 2013). A patients care and safety should always be the main priority; therefore, any assistance the patient’s requires to meet a basic need should be recognised, assessed and responded to without further delay (NMC, 2015).
Joe was mobile, using the support of a frame before his move to the care home. We then proceed to see Joe being moved from his bed into a wheelchair, suggesting that he has deteriorated since residing in the home or perhaps the wheelchair not necessary. Reduced mobility can affect personal hygiene; and toileting but also social interaction and daily living. (Brooker and Nicol 2003) The ward sister then approaches the doorway of Joe’s room which was left open as the carers woke Joe and got him up. She does not knock the door or acknowledge Joe. She goes on to ask ”everything ok in here ladies?” specifically directing the question towards the female staff instead of all three people in the room, this is excluding behaviour towards Joe in his own personal space.
She then goes on to say ”Staff meeting at half past remember” which means that there was a 16 minutes time frame between Joe being woken up until the staff meeting commenced. The healthcare professionals are failing to provide fundamental aspects of care due to insufficient time and resources (BMJ, 2013) Joe’s catheter bag is then placed on his lap, having not being emptied and visible for others to see before being wheeled into the dining room with the other service users. Urinary incontinence can be very distressing and this can lead to depression and social isolation (Barker, 2013) Joe should have been treated with dignity and had his catheter bag concealed under his clothes. Although Joe seems to accept the catheter as part of the natural aging process, a catheter should only be used as a last resort for urinary incontinence and should be maintained correctly else there is a particularly high risk of infection (National Health Service, 2017). A catheter should not be used simply for the convenience of care givers.
Joe was given no personal care; he was not offered a wash or help getting dressed into his daytime clothes. Being left in poor hygiene and lacking in any personal care is a sign of neglect (Galloway, 2011) Joe speaks about how he used to be a smart dresser. He is seated alone whilst other service users are dressed in daytime clothes and sat amongst one another able to engage in conversation. Maintaining relationships within a care home setting and outside in the community can require support from staff as the transition into elderly age can be a cause of loneliness and isolation with the death of contemporise and relocation into a care home setting (Wilson, 2013). This is affecting his ability to engage with others during times of social interactions, consequently Joe may feel isolated and withdrawn.
Another staff member approaches Joe and says ”There you go Joseph your favourite” said and places a bowl of porridge in front of Joe. Joe was asked on first coming to the home what he liked to eat and has since received porridge everyday without being offered any variety. Joe reminisces on when his wife Ella would make him a hot cup of tea and a bacon sandwich.
She returns a while later and says ”Are you not hungry this morning?” Joe replies ”I need my glasses” She says ”you silly thing, what did you leave them up there for?” This is patronising and ridiculing behaviour and reflects upon the unequal power between patient and health care professional which could result in the feeling of being ‘reduced’ as a person, humiliation, and embarrassment (Nordenfelt,2009)
The carer then takes away his food without attempting to encourage him to eat or address the underlying issue which is that he cannot see effectively to eat his meal. ”According to the Nursing Home Reform Act 1987, the assistance with eating and drinking, which leads to malnutrition and dehydration is listed under neglect”(Garcia, 2001). If this was a reoccurring situation this could essentially lead to malnutrition, hospital admission and even death.
The staff member was holding a tea pot but it seemed as if Joe had not been given anything to drink at all. This could lead to dehydration and again deterioration of health and possibly death. The elderly population are more susceptible to dehydration due to factors that are a result of the natural aging process (Garcia,2001).
Social Role Valorisation is a concept where by those already living with a devalued social status or those at heightened risk of becoming devalued, for example those living with an impairment, the elderly, those living in poverty ect should still find it just as easily accessible to have the same enjoyable life experiences and opportunities as those who are socially valued (Osburn, 2006)
Now What ?
Joe is a vulnerable adult; he is in need of care services due to his age as he is unable to care for himself and protect himself against significant harm but he is suffering passive neglect at the hands of the institution which is supposed to safeguard him (Galloway, 2011)
Staff should actively encourage the promotion of independence and enable Joe to maintain relationships and engage in social interactions with family, friends and other residents at the care home.
A personalized care plan should be devised between patient and healthcare professional and should be tailored to the needs of the patient allowing them to take control and make decisions in regards to their own care along with timescales (Norman, 2011). The care plan should include things such as normal sleep routines and catheter care for Joe.
Healthcare professionals should ensure that they are delivering person centred care to Joe. His basic needs are not being neglected.
Joe should be monitored using a fluid chart, measuring and recording the volume and frequency of both the input and output of fluids to ensure that he is maintaining healthy fluid levels (Copeman,2011)
Joe should be being encouraged to drink between 6 to 8 glasses of water a day minimum and should be given a variety of choice at mealtimes and encouraged to eat a healthy diet.
Joes weight should have been monitored to ensure that he is maintaining a healthy weight.
- Muir Gray, Evidence-Based Healthcare And Public Health: How to Make Decisions About Health Services and Public Health, 3rd Edition, 2009, p126
- Lennart Nordenfelt, Dignity In Care For Older People, 2009, p23,p134
- Lesley Hayes, Nursing Care Of Older People , 2011, p234
- Jo Golloway, Nursing Care Of Older People, 2011, p15
- Copeman, Nursing Care Of Older People, 2011, p187
- Sue Barker, Caring For Older People In Nursing, 2013, p97 Norman,
- Christine Brown Wilson, Caring For Older People, 2013, p106
- Joe Osburn, An Overview of Social Role Valorization Theory,
- BJM, ‘Care Left Undone During Nursing Shifts: Associations With Workload and Quality Of Care’,2013, p123
- Marcela Esperanza Garcia, Dehydration Of The Elderly in Nursing Homes, 2001,National Health Service,