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The Nursing and Midwifery Council (NMC) of the United Kingdom is a corporate body of professional health care practitioners that form a committee called the council. The function of the NMC is to establish standards for nurses and midwives that will provide guidance in education and training also guidance that are principles and is known as the 'code' (NMC 2002:1). The code is a professional duty that is required to provide care to people, client or patient. It secures people's rights, decisions and choices during their care (Thompson 2006). To explain the code there are details of principles that practitioners should apply to throughout their daily practice to maintain high standards of how to behave, present one self and the principles shown during the care for people.
The first stage of the NMC code clause (NMC 2008:1) state, 'the people in your care', this applies to people and the public that requires the need for healthcare support in a people centred practice. In order to provide care for these people there should be an understanding as to what care mean, who accessing the services, how the care is implemented by providers, what interventions occur during care and why nurses and midwives should care for these people. It is also important to know why nurses and midwives care but is it the reason because of empowerment, choice, decisions, personal care, safety, financial decisions or is it the obligation of the pledge they have made to become a nurse.
The second stage of the clause states, people 'must be able to trust you with their health and wellbeing and the trust is to know your patient well but how can these patient able to provide that trust and how to communicate with them collaboratively and providing the right information on how to establish that trust. There should be continuity to reinforcing the trust in patient through encouragement, and promotion of their health and wellbeing. Not only does that, it stated that trust is to be justified and reasons why, it is to 'make the care of people your first concern, treating them as individuals and respecting their dignity' (NMC 2008:1). Is it by treating people as they are, keeping information confidential and working as a team with families also ensuring patients give their consent but respecting the dignity of people. In discussing the code clause is stated very straightforward to understand but there are challenges introduced to raise expectation of the nurses and midwives but keeping up-to-date with technology and encouraging patients to maintain their quality of life.
Hence, the purpose of the NMC code is to support nurses and midwives within their role. NMC (2008, p4) states the code protects people that are ill, helpless, vulnerable and requires support in your care. 'This guidance applies to nurses, midwives, professionals and students. Its purpose is to establish principles for best practice whilst caring of people in all settings" (NMC 2009, p5). NMC (2008:1) states that the code has three functions, conduct, performance and ethics. The principles of conduct expresses how nurses are expected to conduct inside and outside the profession, performance is based on the knowledge and skills gained to be confident and consistency to deliver safe practice in the role as a professionals and students. The ethical care are the principles applied towards prioritising patients care which includes concerns, needs and interest for the people.
The People in question are the people within your care and they are the one that matters and requires advocacy. Graham (1992 cited in Roper et al 1996) states, advocacy is doing things for patients and nursing has change to a more patient centred care to encourage patient to be more self-sufficiency in making choices and decision about their care. They are the people we refer to as patient, user, individual or client, but their vulnerability requires support from these professionals. Parsons (1951:1987 cited in Stein-Parbury 2005, p9) viewed people as patients or clients and they are ill person with needs for support and advice from professionals, whom they can release all responsibility and decision for their health. However some patient may not be able to make such decision while other patient can be self caring by taking on the role of responsibility for their care Guadagnoli & Ward (1998 cited in Stein-Parbury 2005, p.9) Goodman and Clemow (2008) believes that if patient is defined then their value will not be identified.
'Caring is the spirit of love that is reflected in care, it provides hope for patient of their wellbeing, offering empathy and compassion, by displaying principle and commitment during nursing practice' Farmer (1994 cited in Alexander et al 2000:999). Patients have a significant role that is why we put them first but some people are neglected due to barriers by not accessing the service because of isolation and not able to access the information to get the care required. People who are accessing the service are the one that gets the treatment and the service when it is needed (Sale 2005). The process of nursing commence when an assessment is done by gaining as much information about a patient, this is also referred to a nursing diagnosis. The diagnosis is being able to describe the 'patient problem' with the help of the activities of living model for nursing Marks-Maran(1983 cited in Roper et al 1996:57). The model will help identify health issue and the first concern is performing an assessment to determine if the patient is capable of maintaining a safe environment, able to communicate by the questions asked about daily activities, the level of breathing during physiological measurement, assessment of eating and drinking during meal time and mobility during personal hygiene. From these assessments the nurse is able to identify the actual problem then make a care plan. The care plan includes the problems, goal and intervention. The problem is what the patient admitted with and the goal what the nurse intend to do and intervention should include how the care will be given. The next step is to implement the care by providing the care, including multidisciplinary teams, medication for treatment. An evaluation is made of the patient care against the goal that was set to determine an outcome of achievement if there are changes a re-evaluation can be made of the patients care (Roper et al 1996).
The reasons why nurses care are through obligation, ethical and spiritual belief. We cannot as carer avoid the difference in care but why we continue to care is because mainly of three reasons. The first is the pledge we have made as nurses with the obligation to patient (Brykczynska 1997). The pledge is reaffirming the commitment as promised by the nurses and midwives to the people to provide a service to deliver a very high standards of quality in care DH(2010). Secondly, the ethical care of knowing the right question to ask patients when trying to make an important decision or how they should respond when a situation arises but seeing the goodness in the patients (Brykczynska 1997). Nurse use their intuition or inner feeling or just common sense to make decision (Thompson et al 2006:49:50), but as students the knowledge through practical learning teaches to make ethical decisions and remembering from their teachings or the error they should not make by reflecting on the right and wrong to evaluate a good ethical decision. Other ethical reasons to care are, through quality care, a care which is deserved and should be priority in care. The empowerment of patients, by offering the right to make decisions about their care and offering patients choices to develop confidence while receiving hospital care. This confident encourage them to take control of what is happening in their lives. There are difficulties when making choice and being assisted by a nurse is an important decision that will benefit their health. Decisions are important and should involve planning the minute patients are admitted into hospital (Evans and Tippins (2008 cited in E-learning, PEP Module, Decision Making, p.2). The personal care would be assessed following the Roper et al model for nursing. The assessment will include check for safety, nutrition, manual handling and other risk factors. Management has to make decision on staffing team but a team that will provide a balance in the care. The financial decision is important on the expenditure and management of resources to maintain the operation of care but mainly the quality of care for patients.
The nurses' care is to support spiritual belief by encouraging safe practice during psychosocial distress or pain. Being an active listener, relating to the patient and answering their question truthfully could be comfort or relief for the patient. Anon (2005 cited in Thompson et al 2006), states that nursing is the balm that nourish your restless spirit', while other patients thinks that a balm could solve the problem to their pain.
In order for people to trust you, being knowledgeable about the patient is the first step to patients care and being able to communicate and interaction will establishing a relationship that will help to provide a clear understand to the individual. All data must be up-to-date and accurate about the patient's care and information should be available for feedback to the patients. The balance in the healthcare is to respect the confidentiality of patient's information that they share and through commitment of trust (Hinchliff 2008). A professional relationship is looking after the patient's interest and taking on issues of consent, respect, confidentiality but utilising the practical skill, experience and knowledge accordingly. The offering of informed consent is giving permission but the professional line must not be overstepped. Hinchliff (2008:193) Jonsdottir et al.; Gallant et al. (2004;2002 cited in Stein-Parbury 2005, p.9) states that patient and their healthcares needs to work in partnership during care. DH (2008,p3) reported that people should working collaboratively as a team which includes patient and their families, nursing staff, social carer and the public. Therefore collaborative work with a multi-professional team provides a wider care to patients by communicating with teams and individuals with different training background who shares a common goal to offer a service that include nurses, doctors, physiotherapist, occupational therapist, social workers, dieticians, speech and language therapist, pharmacist, psychologist, ward clerks, cleaner, healthcare assistance, staff management, midwives and IT Technical Support Staff that can be trusted. (Marshall et al (1979 cited in E-learning, PEP Module, Working with others 2009/2010:3).
Trust is ethical values that are accepted in the best interest of patients and giving truthful answers to questions about their health. This is what patients expect but a positive behaviour is what inspires the trust from the patient. It is important to ensuring patient is informed to establish trust then in time the patient can be open to reveal information that will help their health and wellbeing (Hinchliff et al. 2008). DH(2010) reported that people's trust has been destabilised due to poor performance of practice, he believes that with commitment of teamwork trust can be regained. A proposal was made stating that nurses and midwives should reaffirm their commitments to care. The aim of this proposal is to reinforce the trust and confidence in people which will also help to maintain their health and wellbeing. If the patient is ill or well their health should still be promoted with a balance in care and the approach of individual's with psychosocial dilemmas. The nurse's role is important and along with their performance which reflect in the care given to patient. Nurses can maintaining their health and wellbeing by accepting the right support which will result in improvement in practices and wellbeing of patients.
To maintain the quality of health and wellbeing for patients the initial care should begin within patients own environment with their family. Living a healthy life is manageable by people who are confident, strong and receiving support from other whilst others struggle to maintain their health due to difficulties in accessing support or refusing to accept any form of support. The NHS mentioned that a strategy is designed to include the care in communities by local authorities and care partners, to help make social changes for the people with the aim of reducing unhealthy living (DH, 2008). The NHS requires people to gain access to the treatment that is most effective for their health. The NICE guidance purpose is to promote health and wellbeing and evaluate the intervention during care. It is stated that treatment should be given to patient after an assessment by a competent and experience nurse (NICE, 2008) providing the patient offer consent to care and in return nurses respecting the patient's right to make the choice they desire. A competent nurse role is having awareness but to provide a plan that reflect and analyse the problem. The nurse should be able to cope well from being organised to achieving efficiency during management of nursing care (Benner 1984). Patient safety should be the top of priority for quality care. The trust is gained by maintaining patient's safety and one example is to reduce any infectious disease within their environment and safety include the healthcare who are the people that provides care (DH,2008).
The nursing team is expected to respect individuals and their families, not to discriminate during care and avoiding any risk or threat to the right or safety of any patient (NMC 2004). We can assume nurses do care but the obligation that nurses have is through the contract of obligation when they first make the pledge to work as nurses. The nurse's role involves the concept of care which is to provide a service to patient that is caring, the first stage of learning is from their parents, friends and experiences in life and the training received will improve their caring skills (Brykczynska1997).
To be treated as an individual is treating a person with ethical principles such as respecting the rights, autonomy and dignity of patients also to promote the patients well-being (Thompson et al 2006). To offer patient advice on methods to help prevent ill-health and by promoting positive way of living and to have power of owns health (Wills 2007). The patients' right during quality care are their entitlement to shorter waiting time for treatment. A targeting system has to be implemented that will motivates nurses to listen to patents and the public to meet their expectation. Patient has the right to have good communication to ensure they understand the treatment to be received (DH 2009). Reflecting on experience with patient whilst working as a student during placement, some of the principles that had to be delivered are respecting patient's privacy when washing or dressing by pulling curtains and closing doors and knocking the door before entering patient's environment. The rights of patient's choice must be acknowledged and not to disclose patients confidentiality which is respecting human rights and dignity. Also patient should have the right to make choices during meal time of what to eat and when to eat or the choice to refuse medication but it is the nurses role to encourage the patient and possible giving more time and listening to reason for refusing medication DH (2010). Walsh and Kowanko 2002, cited in Dougherty and Lister 2008, enquired with patient about describing their dignity and how they expect to be treated with respect, however patients wanted dignity to include being patience and spending more time to listen and acknowledge patients views and considering the reasons for patient's emotions. DH 2010) states that nurses must be accountable for their actions, thinking of patient's interest, protecting the dignity of patient regardless of choices but treating with equal concerns and respecting belief.
Nurses and midwives should find the NMC guidance really straightforward, depending on the level of role and responsibilities, however Tschudin and Jasper (2006; 2002) states, that the NMC code of practice will not be straightforward to escape difficult situation during care. A student nurse or a registered nurse with limited or no experience of a new setting and will begin their role as a novice and requires support by the policies of the workplace along with the NMC code rules to guide their performance during their role of practice. The advance beginner will be able to perform acceptable because of the experience gained and put into practice the principles learnt but taking their role very important. A competent nurse who is experienced for two to three years is a more aware nurse that plans and analyses but needs to develop speed within role. The proficient nurse learns from his or her experiences, reflecting in action and is able to make effective decision immediately. The expert nurse has a very knowledgeable background, remembers patients, recognises changes and manages clinical decision within his or her patients care (Brenner 1984:20-32). The changes that have been made of the framework for the Nursing and Midwifery Council are more straightforward to understand during the professional development of nurses' duties and their role of responsibilities. The aim of the code is to protect the health and wellbeing of patients. It will be a continuous development in practice (Hinchliff 2008). The change in the guidelines can cause indecision and could cause unnecessary stress for individuals (Lewis 1951, cited in McEwen and Wills 2007). The use of the Roy Adaptation model could be used as a guide by manager to help nurses become more educate about the changes to the guidelines (McEwan and Wills 2007).
Changes however, could cause the guidelines to create challenges for nurse's role by raising the expectation also expecting continuous development of the way they should work by providing quality care that will help to extend the life span of patients. Nurses should keep up-to-date with the new technology of accessing patient's information by taking on additional training. The challenge for nurses is to encourage patients to improve their health and wellbeing by accepting interventions that will improve their quality of life but not under mind patient's choices. The improvement of knowledge about the advancement of treatment and broader area of intervention and increasing standards will result in improved outcomes. High quality work for staff and patient is difficult but ensuring skills are up-to-date and not ignored but the quality of the workplace comes with excellent leadership management that is beneficial for patient's wellbeing DH (2010).
In summary, the code expects profession conduct from all nurses and midwives during their performance in all situations and should reflect good principles of ethical practice. These ethical principles will deliver the right care and should include patient spiritual belief. The belief in providing the right care is reflected in the roles and responsibility of nurses and midwives, this is very important and a huge responsibility to be in a caring profession. The pathway from a novice to expert requires knowledge and continuous development. Whether or not the guidelines of the code appear simple the NMC has revised the code to make it more straight forward for nurses and midwives to understand and implement into practice of care. Caring is about identifying the people who may be patient, client or individuals and treating them with equal concerns, respecting the diversity of people that are able to access the service. These patients are vulnerable and require trust, security and the prospect of improving their health and wellbeing and need to make the right decisions and choices whether good or bad but gaining informed consent. The dignity of patient should be respected at all times and gaining consent is an approval of trust to provide care but remaining within the professional boundaries. To ensuring this occurs, the respect for privacy is maintained whilst providing care of personal hygiene. Nurses make diagnosis during patient care with the help of a useful nursing model to gain information from patient which must be kept confidential. Keeping information confidential is a way of showing patient their trust is being respected. Nurses are hoping to maintain the trust that builds partnerships with patient and families that will including the professionals collaboratively to develop the patient's health and wellbeing. The NICE guidance is to promote health and wellbeing for patient's medication and the NHS (2010:9) promised, 'to promote high quality care for all'.
The code should not be difficult but it is a challenge that healthcare professional will work towards by raising the standards to give more power to patient in making decision about their care and safety. It is the nurses and midwives obligation of the pledge they have made to continue reinforcing care and the support will come from managers by providing the training to broaden the knowledge of our professional. The changes will require higher expectation and a service that is keeping up with technology. A change that will be challenging for nurses and midwives is to encourage patient to maintain their life span through health promotion. The code has its fulfilling purpose which is the responsibility to provide guidance to nurses and midwives, of the care that should be given within the professional role.