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Organisational Aspects of Care: Service users can trust a newly registered nurse

Strengths

I believe that I am able to identify most risks both to myself and the service user and am able to reduce those risks. I think that I can create a safe environment both for myself, my colleagues and the service user. I feel that I am able to work using clinical governance frameworks in order to reduce risks and can promote safety. I feel that I can report incidents that pose a risk to the service user, me or others quickly to help reduce risks to their safety.

Weaknesses

I would say although I can identify most risks I may not identify all risks. Therefore my weaknesses include ensuring that I detect all risks quickly and being able to manage risks which have occurred in a quick and effective manner. Also I believe that another of my weaknesses would be working within the legal framework and remembering the legal framework. I feel that I may be weak on implicating positive risk taking. I feel that I may not know who to inform if an incident has taken place.

Concerns

My concerns are that service users may feel that I have not dealt with risks correctly and efficiently. I am also concerned that I may make mistakes if I forget the legal framework which is in place at my placement. Another of my concerns is that I may not spot risks quickly and report them to the necessary people. I am also concerned that I may not be able to promote safety due to limited clinical experience.

Expectations

During my first placement I expect to be able to overcome most or all of my weaknesses and to be able work on the areas which are of concern to me. I expect to develop my team working skills and practice the skills I learnt during the recent Inter-professional learning week (IPLU). I believe that I can expect to overcome my concerns regarding the legal framework and learn how to work within it. I expect to gain valuable experience from my first placement and achieve a good understanding of what is expected of me and how to deal with risks and how to protect the service user’s health and wellbeing for the duration of my placement.

Organisational Aspects of Care: Service users can trust a registered nurse to: identify and safely manage risk in relation to the service user, the environment, self and others.

This essay will look at why risk assessment and risk management are essential processes for both student nurses and registered nurses when treating service users and working with members of the multidisciplinary team. It will identify risks and how to manage them safely to ensure that the environment, the practitioner and others remain free from hazard. The essay will look at three areas of risk. These are failure to communicate effectively with the service user and other members within a team, infection control and moving and handling. This essay will look at the legal and ethical principles which are in place to protect the service user, the nurse and others. It will cover how health and safety principles reduce risks and at prevent them from occurring. The essay will look at policies and laws which are in place to reduce risks. These risks can occur within hospitals or the community.

It is imperative that nurses can identify and prevent risks. Bird & Dennis (2005) state that ‘Threats to patient safety’ should ‘be identified and controls introduced’ in order to ‘eliminate risks’. Risk management is an on-going process which nurses are obliged to perform throughout their career. The Nursing and Midwifery Council (NMC) code (2008) is a set of ‘standards of conduct, performance and ethics’. It states that as a nurse ‘You must act without delay if you believe that you, a colleague or anyone else may be putting someone at risk’ and that ‘You must report your concerns’ ‘if problems in the environment of care are putting people at risk.’ The nurse must always remember that they are ‘a professional’ and are ‘accountable for actions and omissions’ during their practice (NMC, 2008). This means that if they make a mistake they will be held responsible for their actions. According to the NMC Guidance on professional conduct for nursing and midwifery students (2009) student nurses should ‘seek help immediately’ if the service user they were caring for ‘has suffered harm’. However they also make clear that a student nurse must always work within their ‘limits’ to prevent risks (NMC, 2009). The nurse must remember to treat all service users as individuals and treat them with dignity at all times whilst caring for them.

Communication is vital in risk prevention as a lack of communication can lead to mistakes being made and the health and safety of the service user being jeopardized. A nurse must know how to communicate with service users who are unable to use verbal communication as this will help them to deliver safe and effective care. They should learn how to recognise if a service user is in pain. This may be ascertained by the facial expressions that the service user may display. It is important for the nurse to communicate with the service user to find out how capable they are at carrying out tasks such as standing and walking. If the nurse knows this then they can reduce the risk of injury to themselves when performing moving and handling tasks by getting the service user to assist them. The student nurse needs to learn how to correctly complete a service users medical record and care plan in order to ensure that the information they need to convey can be understood by any member of the multidisciplinary team. According to Elster & Grothier service user records should be ‘factual, legible, clear and concise’ to prevent errors from arising. It is essential that the student nurse learns effective communication skills whilst in the clinical environment, as they must be able to convey information to another member of the team in a clear and correct manner. The nurse needs to realise that using medical terms when talking to another health professional is important as this will help clarify details of a service user’s condition. However it is vital that the nurse understands that whilst the doctor knows what a medical term means the service user may not. Therefore the nurse should use clear and concise language whilst being careful not to belittle the service user. Failure to convey information to the necessary professionals could result in a service user’s health being put at risk or a condition overlooked. The nurse should always listen to the service user as they may tell the nurse if they have developed new symptoms. This is important because the service user’s treatment may need to be altered. The NMC code (2008) states that the student nurse ‘must meet people’s communication needs’ and must ‘share with people’ any information which they may ‘want or need to know about their health’.

It is important for nurses to be aware of new pathogens and the infections they can cause in order to reduce risks. The nurse must know how infections can be transmitted and about the chain of infection. If one of the links in the chain of infection is broken then the transmission of a pathogen will either cease or the rate of transmission will decrease. In order for the nurse to break the chain they must follow standard precautions. These include correct hand washing, not working when ill and isolating infectious service users. The nurse should identify service users who are at high risk of infection. These include those with cancer, AIDS and the elderly. The service users immune system may be unable to provide adequate resistance due to their illness or the drugs they have been prescribed. If the nurse knows how to spot an infection then they can reduce the risks. This is because the early detection of infection will reduce the chances of it spreading between service users or to the health provider and can also increase the chances of it being successfully treated. Failing to spot infection could result in unnecessary suffering or even result in death. Rodgers et al (1999) state that ‘cross infection’ is increased due to ‘close proximity’ to other service users. The nurse is required by UK law ‘to take reasonable care for the health and safety of himself and of other persons who may be affected by his acts or omissions at work’ (Health and Safety at Work etc. Act 1974 (c. 37) section 7). The nurse could be liable to prosecution if they have caused ill health to occur by failing to identify or treat an infection.

If the student nurse fails to identify risks when moving and handling then injury can occur to the service user, others or themselves. The Health and Safety at Work etc Act is an important piece legislation which nurses must adhere to. Roberts & Holly (1996) state that the Act aims to protect the ‘health, safety and welfare’ of employee’s and the public from risks caused ‘by the work of others’. Student and registered nurses must remember that before moving a service user they must ‘gain consent’ and ‘respect and support people's rights to accept or decline treatment’ (NMC Code 2008). Once the nurse has gained consent they should carry out a risk assessment in accordance with the local NHS trusts risk assessment policy. They should identify ‘risks to both the handler and client’ in order to prevent injury to themselves or the service user (Chell, 2003). The nurse needs to be able to identify the risks to prevent injury as according to the Health and Safety executive (HSE) ‘musculoskeletal disorders’ accounted for ‘40% of all sickness absence’ within the health care industry. This is because health care workers are likely ‘to adopt and hold awkward postures’ (HSE, 2010). Moving and handling injuries can result in the nurse having to take time off from duties or may lead to them having to retire from their profession if they suffer permanent injury. The NHS are likely to have to recruit a temporary worker as well as paying the nurse whilst they are off work, this results in extra costs for the health service because they are having to pay for two people instead of one. NHS trusts have implemented risk management, moving and handling and risk assessment policies which both the student nurse and registered nurse must adhere to. The NHS trust has the legal obligation to try to prevent ‘the need for his employees’ to carry out ‘manual handling operations’ which could cause injury (The Manual Handling Operations Regulations 1992 regulation 4).

In conclusion nurses are not only governed by the NMC when reducing risks to the service user but also by UK law. They must follow local policies which are based on these laws. These are introduced to ensure the health and wellbeing of the service user, nurse and other healthcare workers is protected at all times. The nurse must be able to identify risks such as the ones described above to protect the service user. Failure to identify risks can have serious health implications on the service user and nurse and could ultimately lead to unnecessary suffering or death of a service user or prosecution of the nurse.

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