Heart attack has become a common household term in the United States, due to the fact that approximately 16 million American have been diagnosed with coronary artery disease. According to American Heart Association, an American dies every minute due to coronary artery disease. Coronary artery disease also known coronary heart disease or ischemic heart disease encompasses other pathologies, such as angina and myocardial infarction (heart attack). Coronary artery disease occurs when there is a narrowing of the coronary arteries, due to the development of plaques leading to reduce amounts of oxygenated blood to the heart. [2]

Anatomy and Physiology of the Heart:-

The heart is an essential organ that is responsible for pumping blood all throughout the body and supplying it with oxygen and nutrients. It is the central hub for the cardiovascular system and acts as the transport system of the body, which performs via electrical conduction activity. The anatomy of the heart is composed of many structures, such as the four chambers: the right and left atria and ventricles, numerous blood vessels such as the aorta, the pulmonary artery and vein, and the coronary arteries, four valves, three layers of tissue, etc. The aorta is the main artery that pumps the blood out of the heart to the rest of the body; the pulmonary artery and vein transport oxygenated and deoxygenated blood receptively, and the coronary arteries make a crown on the heart muscle and supply the myocardium with oxygenated blood and nutrients. The valves in the heart are responsible for preventing backflow of blood and allow the blood to circulate in an uniform fashion. The electrical conduction system of the heart accounts for the beating of the heart allowing it contract and act as the pump of the body. [2, 3]

Pathophysiology of Coronary Artery Disease:-

When the coronary arteries become occluded due to plaque build up a condition called atherosclerosis occurs. Atherosclerosis means narrowing and hardening of the arteries leading to damage to the blood vessels and is a major contributor to many heart diseases and disorders [4]. These atherosclerotic plaques are formed are from lipid and fat deposits, mainly being cholesterol, which is a reason why diet is also major risk factor in developing coronary artery disease. Arteries are composed of three layers: adventita, intima, and media; the plaque tends to develop between the intima and media layers [5]. These atherosclerotic plaques narrow the lumen of the arteries causing decreased amounts of blood to reach the heart and overtime harden them causing decrease flexibility during vasoconstriction and vasodilatation [4]. Additionally, the atherosclerotic plaques can dislodge causing thrombosis and ischemic events [5]. When the coronary arteries’ function is compromised, the heart does not receive adequate supply of oxygenated blood and nutrients causing decrease cardiac function. At times of stress, the body will try to counteract these changes to achieve homeostasis, by working harder than normal; however, prolonged exertion initiates a cascade to many disease processes and pathologies, such as cardiomyopathy, heart failure, arrhythmias, cardiac arrest, and classically myocardial infarction (heart attack) [4]. Most patients of coronary artery disease experience angina and/or myocardial infarction, or possibly death.

Risk Factors of Coronary Artery Disease:-

Coronary artery disease tends to be the most common cause of death and disability in the United States. The main risk factors of coronary artery disease are as follows: positive family history, physical inactivity, poor diet, smoking and/or alcohol intake, along with other diseases pathologies like hypertension, diabetes, high cholesterol, and obesity. A person that has positive family history of heart disease of a first degree relative is at greater risk of developing coronary artery disease [2]. Physical inactivity, poor diet, and obesity go hand in hand for developing coronary heart disease. Obesity has become an epidemic that affects one in four Americans and results in many life-threatening consequences. Heart disease has become the cause of death in industrialized nations compare to underdeveloped nations, due to sedentary lifestyle and increased fast-food consumption. The American Heart Association encourages patients to exercise regularly and eat healthy and this also accounts for better prognosis of coronary artery disease even if someone has other risk factors [2]. Research indicates that a diet that’s rich in omega 3-fatty acids, such as fish helps protect against vascular disease [2]. One of the most preventable risk factors for any disease is smoking, and for cardiovascular disease it is the number one preventable cause [2]. The World Health Organization states that 1 year after cessation of smoking, the risk of coronary artery disease decrease by almost half [2]. Additionally, increased age and sex are other contributing factors to coronary artery disease. Statistically, males are more likely to develop coronary heart disease at an early age, however the risk equals for both men and women after post-menopause. Other diseases such as diabetes, hypertension, and/or hypercholesterolemia combined with coronary artery disease results life-threatening consequences, which it is why it’s recommended to keep a close eye on cholesterol, blood pressure and glucose levels and checked on regular basis [2, 4].

Symptoms of Coronary Artery Disease:-

Most patients of coronary artery disease are asymptomatic, whereas other patients can present with a variety of symptoms such as: shortness of breath, tightness around the chest, chest pain, Levine’s sign, or possibly death [2]. Patients that exhibit symptoms tend have advance stages of damage to their coronary arteries [4]. Angina is the classic heart pain most patients complain about that is caused by ischemia. Ischemia is the lack of oxygen supply to a region of the heart [4]. Patients can experience angina at anytime, however classically it’s exhibited after a person has been involved in an extraneous activity, such as exercise. Angina can be categorized as stable, unstable, or Prinzmetal’s (variant) angina [2]. The Levine’s sign is the classic presentation of a heart attack that most actors in Hollywood portray, when they are having a heart attack, which is a clenching fist over their chest [1].

Complications of Coronary Artery Disease/ What is a heart attack?

Myocardial infarction occurs when the heart is deprived of oxygenated blood because of rupture of the atherosclerotic plaque, resulting in a state of ischemia. Supply meets demand theory comes into play, because the heart is demanding oxygenated blood and nutrients, but the coronary arteries are unable to provide due to atherosclerosis build up. The area of the heart that the damage occurs to the heart depends on the vessels that are occluded, exhibiting a variety of symptoms and/or complications [4]. For example, if the myocardial infarction occurs at the right atrium and disturbs the electrical conduction activity of the SA node, it may cause the patient to possibly suffer from arrhythmias. Therefore, essentially if a patient experiences a myocardial infarction at a particular region of the heart that area will suffer an ischemic event and kills the heart tissue hence making it non-functional. Overall, a myocardial infarction has poor prognosis and tends to lead to morbidity and mortality [2].

Diagnosis of Coronary Artery Disease:-

Coronary artery disease is a condition that develops overtime; therefore there aren’t any real tests that can indicate if a person is suffering from coronary artery disease [6]. Healthcare providers use patient’s history, physical exam results, and assess risk factors for developing coronary artery disease [2, 6]. Electrocardiogram, stress testing, echocardiography, and laboratory testing prove to be the test of choice by healthcare providers when examining patients that are at risk of developing coronary artery disease. Electrocardiograms also know as an EKG or ECG detects the heart’s electrical activity, rhythm, heart rate, axis, and any abnormal enlargements of the heart [6]. An EKG is a quick and painless test and can tell healthcare providers if the patient had or is having a myocardial infarction [2, 6]. Stress testing can be induced by exercise or medication for evaluating ischemia in a patient [2]. An echocardiography (echo) utilizes sound waves to monitor the heart’s activity, including the size, shape, and blood flow. Laboratory testing, such as blood tests are conducted on a regular basis to assess the levels of cholesterol, sugar, and proteins such as inflammatory markers [2]. Other tools, such as chest x-rays, angiography, positron emission tomography (PET), and cardiac cauterization can be utilized for patients with greater risk factors and/or advance stages of coronary artery disease [2].

Treatment of Coronary Artery Disease:-

Coronary artery disease is a complex disease since it encompasses other pathologies; however treatment options for coronary artery disease tends to be simple at its early stages, such as lifestyle changes. Patients are encouraged to partake in therapeutic lifestyle changes (TLC), such as daily exercise, eating healthy well-balanced meals, and stress and weight management. A comprehensive TLC plan also helps control other diseases, such diabetes, hypertension and obesity [6]. The American Heart Association recommends patients with risk factors to utilize the DASH diet, which encourages consumption of fruit and vegetables on a daily basis, eating fish twice a week, limiting salt and alcohol consumption [5]. TLC helps reduce the risk of heart disease by lowering cholesterol and maintaining a body mass index (BMI) of less than 25, which is considered to be normal [6]. For advanced stages of coronary artery disease medication such as anticoagulants, aspirin, beta-blockers, calcium channel blockers, and nitroglycerin are prescribed to help reduce symptoms, lower cholesterol and blood pressure, prevent blood clots [2, 6]. Aspirin is the leading medication to help relieve angina and prevent myocardial infarction. Patients that have extensive damage to their arteries or have experienced a myocardial infarction may require medical procedures, such as angioplasty or coronary artery bypass grafting (CABG) [6]. Angioplasty or percutaneous coronary intervention (PCI) is a medical procedure done to open blocked or narrowed coronary arteries [6]. Commonly, people refer this medical procedure as having a “stent” put in, which helps prevent future blockage from occurring. CABG is an extensive surgical procedure done where doctors use blood vessels from other areas of the body that aren’t blocked to bypass narrowed and damaged coronary arteries, thus improving the blood flow to the heart [2, 6]. Overall, patient education proves to be the best treatment option to help prevent coronary artery disease.

Conclusion:-

Levine sign- ^ Edmondstone WM (1995). “Cardiac chest pain: does body language help the diagnosis?”. BMJ 311 (7021): 1660-1. PMC 2539106. PMID 8541748.

Chapter 10 pg 341 CMDT

Human Anatomy and Physiology Chapter 18 pg 662; Marieb/Hoehn

Clinical Pathophysiology made ridiculously simple; Berkowitz

AHA Website- http://www.heart.org/HEARTORG/Conditions/HeartAttack/Heart-Attack_UCM_001092_SubHomePage.jsp

http://www.nhlbi.nih.gov/health/health-topics/topics/cad/

Assessment of a depressed patient in at a keen level of mental illness could perhaps be one of the most significant jobs that a registered mental health nurse should deals within their vocation. The significance of achieving the accurate information at this decisive level presents the little scope for mis-acquisition. Sullivan (1990) evidently appraises that the outcomes of a deprived appraisal or misapprehension of a patient appearance can guide to a patient not accepting the treatment they required at a significant level through to the ratio of a casualty due to non admittance to mental health examination. With this information in mind, it becomes crucial that the mental health nurse is proficient in conducting an assessment. The skill of identifying and reporting the most in depth account of the presenting facts, for continual involvement of the multi disciplinary team, and initialization of the care plan and care pathway program, remains the benchmark for a true professional (Lancester, 2000).

This account reflects on such practice whilst witnessing an assessment at an acute unit. It will, analyses and reflect on the skills used to assess the bio-psycho-social needs of the patient and will include references gained from extensive reading to clarify evidence based practice and draw also from the academic study related to the subject of assessment. In compliance with the Nursing and Midwifery Council, code of conduct, (2002), Relating to client confidentiality, the names and locations of people involved to have been changed, and for the purpose of this account the client will be called Mary.

The Gibbs model (1988), exclusively presented by Jasper M (2003), as a reflection paradigm as it gives the author an opportunity to make a well-organized report of the scenario, and viably provides that true reflection in practice has occurred during its research. Mary is a 58-year-old woman that presented herself to the acute unit, after an incident of self-harming due to depression (diagnosed from 10 years). He had informed the admitting nurse that she is not taking any food and does not talking with anyone for any reason, even she would take off her incontance pads, and they would be thrown on the floor and she would scratch and legs until they were black and blue. It can arguably be stated that there are two major type i.e. major depressive disorder and dysthymiac disorder.

Major depressive disorder, also known as major depression, is distinguished by a blend of indications that interfere with a person’s capability of eat, sleep, work, study, and enjoy once-pleasing behaviors. Major depression is hindering and thwarting a person from operating general purpose activities. An affair of major depression may take place only once in a person’s aeons, but more usually, it persists all the way to a life of a person.

Dysthymic disorder, is also known as dysthymia, is distinguished by long-term (two years or longer) but less harsh indications that may not hinder a person but can thwart one from acting usual or working well as the patient in the study have stopped eating and does not responding to her day to day activities. People with dysthymia may also practice one or more affairs of major depression within their lifetimes.

While working on Mary’s condition, I found that she only reacts in her necessities, but the method to attain attention is very awful. She would lash out with the doctors and other staff of the medical unit and sometimes gave them a stern response in their assessment job. Assessment can be described as the evaluation of the client’s biological psychological and sociological needs. However, most importantly it must be the detailed and precise record of what happened and what answers were given to often very structured form of psychological questioning. Thompson and Mathias (2000) similarly describe the process as acquiring information about a person or situation that may include a description of the person’s wants and ambitions.

If we talk about the general issues causing of depression, we cannot find a single issue reasoning of depression. Sometimes, it probably results from a dissimilar interaction of biochemical, genetic, psychological and environmental issues. Mary was undergoing with some of the mentioned factors, which motivates her to this level of depression.

Different school of thoughts specifies that depressive illnesses are disorders of the mental issues. Brain-imaging tools, for example, magnetic resonance imaging (MRI), have reveled that the brains of people who have depression look special than those of people without depression. The divisions of the brain liable for changeable thinking, mood, sleep, appetite and activates materialized to work unusually. Additionally, appropriate neurotransmitters, compounds that brain cells utilize to converse, emerges to be out of equilibrium in life. However, these illusions do not provide why the depression has been raised.

Most of the forms of depression tend to run in families, signifying a genetic connection. Tsuang (1990) describes though, depression can arise in people without family background of depression in addition. Genetics research specifies that jeopardy for depression outcomes from the pressure of multiple genes performing together with ecological or other aspects (Tsuang, 2004).

Additionally, trauma, loss of a loved persons a hard connection, or any traumatic condition may motivate a depressive affair. Subsequent depressive affairs may happen with or without an apparent motivation factor. In the case of Mary the occurrence of depression is from another factor. She does not find a caring deal from her ancestors and fall into depression. This thing led her towards the uncommon behavior with other people surrounding to her. She found her as a lonely soul and always treats everyone as a devilish person. After having good care from the staff members and nurses in the unit, she is now turning back to life, and now she reacts to content her necessities (Beaglehole, 2000).

The process of maintaining eye contact was further used to examine his ability to do the same. Nelson Jones, (2002) mentions that the inability of patients to maintain pro longed eye contact would indicate he may be in a withdrawn state or feels uncomfortable in his condition. Barker (1997) further stated that being over enthusiastic about eye contact could cause an aggressive or confrontational experience. The use of this method was appropriate as the assessment progressed. The nurse tried summarized the interview in a clear language that Mary could understand, but as she is not communicating in any way the nurse phrased the report on the previous assumption. She further gained his acknowledgement that her interpretation was a true reflection of his feelings and thoughts at this time, and afterwards the nurse guided to take Mary to nursing home, that will be good for her to necessities more than this unit. Nelson-Jones (2002) said that this process gives the patient a clear feeling of acknowledgement by another of their deepest feelings while aiding the recovery process.

The skills used in Mental Health assessments have been identified and discussed in this paper and it emphasis the use of a holistic approach at all times in the work of the Mental Health Nurse. One size does not fit all in the profession of Mental Health Nursing and although many tools and strategies are used throughout the process the skill of treating each person as an individual, with their own set of needs and concerns should remain paramount at all times. The assessment witnessed demonstrated that combining these skills promote a good rapport with the patient and most importantly getting a full picture that can be interpreted and shared with the multi disciplinary team for the onward process of the care pathway approach.

I have learnt that being non-judgemental and assessing the current situation at presentation is a key attribute in the skill of assessment. It becomes difficult when the client does not respond or react of any query or conduction, likewise, in the case of Mary. I have further reflected that it becomes necessary sometimes to help a patient with a question by the use of inter personal skills and effective non-verbal stimuli in order to allow them to express their feeling, sometimes at a rather difficult stage in their life. It is only by academic research and observed practice based experience that I will be able to develop these skills. I have further learnt that people in crisis need continual assistance and support through their acute phase. The first experience of the initial assessment has a large bearing on the way and the time it takes them to make improvements in their health.

Within this essay I will be analysing both, the Safeguarding policy and the nursing and midwifery council code of conduct. This essay will include information on both the policy and the code, how they help health professionals and how it is important to have the policy and the code as a student nurse. I will analyse the safeguarding policy and how the policy has been presented, why the policy is there and what other associations help to promote safeguarding. I will analyse the

NMC code of conduct

and how the policy has been presented, how the code offers support and guidance to health professionals. I will discuss three clinical issues which I have found while I have been on placement, I will discuss how the event occurred and how it has affected myself, the patient and the staff involved. I will discuss how the event has been affected with safeguarding and how safeguarding has been involved or not. The three clinical issues I will be completing will be completed as a reflective account using Gibbs module. I have chosen Gibbs module because I wanted to include my feeling towards the event and I felt Gibbs offered that more than other modules (O’Regan, S. Nestle, D. 2015).

Safeguarding policy, 2015

In this section I will be analysing the implication the safeguarding policy (NHS England, 2015) and how it affected my practice. It is important that when in a health profession role your keep up to date with new policies and to read the newest policies. It is also important that policies are up to date as it gives healthcare professionals a step by step guide on what do if they find themselves in a situation when their patient is unsafe, weather that is at home or in a hospital or a care home. When using a up to date policy will then give the patient the best quality of care.

The safeguarding policy has been put in place by NHS England to protect, children, young adults and adults in the care of health professionals (Papanikitas, A (2013) The policy that has been put in pace is to ensure the patients no matter their age, all patients are treated fairly and with the high-quality care. Including respecting their human rights and wellbeing and are free from abuse and neglect (Nursing in practice, 2016). Safeguarding has been put in place to prevent an incidence where a patient has come into harm or made to feel disrespected. The NHS has put the safeguarding policy in place for all health professionals, such as Medical Directors of Nursing, NHS England Regional Directors, NHS England Area Directions, Directors of Human resources and General Practitioners (GP) (King’s college hospital, 2018) The way the policy is presented, is it neat and well structured. The information within the policy is informative, easy to read, all information needed is there. The contents page is well presented.

The most important reason we need safeguarding is because the protection of patients from harm and abuse is extremely important in any situations where there is a health profession. If nurses do not whistle blow (A whistle-blower is a person who exposes any kind of information or activity that is considered illegal, unethical, or not correct within an organization that is whichever private or public) (Lewis, P. Goodman, S. 2007). then patients whom are being neglected or abused will continue and nothing will be done about it and the patients’ health will worsen. The responsibility of a nurse when safeguarding a patient is to know how to communicate and know when it is safe to speak up and know who to contact. For instance, a patient being abused in hospital the nurse can either whistle blow to a sister of a ward manager. It is not always easy to know when a person is being abused to know the signs. However, practice nurses have the upper hand as they are trained to know what to look for and how to escalate it properly (National Institute for Health and Care Excellence. (2016).

The direct audience for this policy is mainly health care professionals, the policy can also be used to offer family and/or friends’ information by offering this information it can help the family’s information of what is next to come when someone is been abused or neglected. The safeguarding policy is in place to help direct health professionals and to lead them in a safe direction when needed. The policy offers information of how to handle situations when the health professional is unsure. The policy I have used was published in March 2014 and updated once since there in June 2015 (Nursing in practice. 2016). Most policies are updated either yearly or every fore year, this policy is now due an update to offer more information and guidance to health professionals. When a health professional is caring for a patient who is being neglected or abused The MCA (2015) has set out an legal framework to offer protection to individuals who do not have the capability to make their own decisions, this this type of situation safeguarding decisions should be made by the persons next of kin or a person who is closest to the person and has the persons best intentions. For patients who do have the capability to make decisions, health professionals have to listen to the person and respect their choices, this can sometimes lead to present problems (Nursing in practice, 2016)

Three clinical issue.

In this section I will be discussing three clinical issues I have found while on placement and how it has affected the patient and the staff involved. I be discussing how the event has had an impact on safeguarding and how it may or may not have been used correctly or not up to the standard needed for patients.

Number one – bed sores for patients on hourly turns.

The first issue I will be discussing is a about a patient which, for confidentially reasons put in place by the nursing and midwifery council, will be knows as Betty Smith, an 89-year-old lady with dementia and arthritis. Betty smith was admitted to hospital for been generally unwell and increased confusion, while in hospital Betty Smith started to get grade one bed sores (Hampton, S. Collins, F. (2004) on her back at the bottom of her spine. The nurse looking after Betty Smith decided to put Betty Smith on two hourly turns to relieve the pressure on Betty Smiths back. While all the documentation for Bettys two hourly turns had been completed. However not all of her turns had been complete, some of the staff on the ward had been falsely documenting Bettys turns. With not all of Bettys turns been completed the grade one bed sore started to worsen and become a grade three sore, her skin damaged and broken. When I completed turns for Betty, I applied cream and barrier spray to the sore and made sure better was off her sore as much as I could without making Betty uncomfortable in bed (Hampton, S. Collins, F. (2004). After three days when I began to work with Betty Smith once more, I noticed her bed sore had gotten increasingly worse to a grade fore in which the skin around the sore ha died and the bone was starting to show. Further down her back in the bottom was a grade one sore. After applying cream and spray to both sores, after turning Betty and making has comfortable I documented a new sore and how much the other sore had got increasingly worse. I immediately told the sister of the ward who assessed Bettys sores and completed a form explaining what had happened. When Bettys family came into to visit the sister explained what had happened why the skin came to be being so damaged. Over the following five days until Betty Smith returned home her skin had before a lot healthier and began to heal.

Because of health professionals not looking after Betty correctly by only documenting a turn, Bettys skin became damaged and painful. If nothing had been drought up to the sister I um unsure of the state Betty would have been in when returning home. The condition of Bettys skin will not be the only patient who has suffered in the health care business, unfortunately a lot of patients have been in the same of similar situation, but not all of the outcomes have been the same as Bettys. In the situation I was in I did not know the members of staff that had not turned Betty, but I knew the sores had got considerably worse. Safeguarding for patients in position Betty was in are important to act quickly so no more damage can occur.

My feeling about the situation were guilt, anger, upset and over all hurt to think a health professional had the ability to do something like this to a person. I felt as though Betty had gone through enough of pain due to her arthritis and dementia, why should Betty have the pain of a grade five bed sore when it could have been avoided. The outcome of the situation, the ward got taken to court and chargers were made to the individual.

Number two – One to one patient falling due to low staffing.

The second issue I will discussing is about three different patients, for confidentially reasons put in place by the nursing and midwifery council, will be knows as; Harry Smith, Bart Smith and David Smith.

Harry Smith, a 68-year-old man with lung disease and delirium. Harry has been admitted to hospital due to a fall at home with no witnesses and can not remember how long he was laying on the floor for.

Bart Smith, a 75-year-old man with dementia and a fractured hip. Bart has been admitted to hospital due to becoming increasingly confused.

David Smith, a 70-year-old man with dementia and delirium. David has been admitted to hospital due to suspected fall, David was found lying on the floor at home unconscious.

Harry, Bart and David are all in the same bay in a local hospital, all three men are one to one patient, meaning a member of staff have to monitor them at all times in case of an accident (Cristian, A (2012). While on the ward, it was a busy day, busier than usual, with a full ward and low staff due to illness. I was caring for an elderly lady who was also confused and was a one to one patient. Because of low staffing Harry, Bart and David were not always watched at all times but there was always staff walking around working. During the morning, Bart and David kept on trying to move out of bed or out of the chair by themselves. With this happening, Bard with a fractured hip he is unable to walk without pain. While staff were trying their best to care for the men the staff were so busy, they did not have a minute to collect their thought or to look after the three men. During the afternoon, I was moved to care for Harry, Bart and David. While in the bay I kept a close eye on them and competed all word needed while in the bay, such as; observations of all patients, care charts, fluid balance charts and generally tidying up the bay. While family was visiting, I was able to leave the bay. While off the bay I had my tea and when I returned back to the bay the family had left and Harry, Bart and David were alone, and all seems to be agitated. I discovered David had been incontinent. I asked other members of staff to assist me to help clean David and make him more comfortable and for another member of staff to keep an eye on Harry and Bart. While myself another health professional were caring for David, I heard a loud clash in the bay, when I looked, Bart way lying on the floor with a table on the floor near him and spilt water next to him. I shouted for help and the staff were already there helping. Lucky, myself and the health professional had Cleaned David and he was back in his chair comfy. When I assisted the other nurses with Bart, he was in a lot of pain as it was suspected he has slipped on the water and fell onto his hip. After assessing Bart and deciding what is best to do, the nurses transferred Bart onto a bed and got an emergency X-Ray. After finding out there was no damage to Bart’s hip, he was put on medication for pain relief.

My feeling during the afternoon, I as weary but felt very confident. During the situation I felt as though I had let Bart down, as though it was my fault. I later found out there was an accident in a different bay resulting in the member of staff has to help another health professional and patient. I spoke to one of the health professionals about how I felt, in a way I felt guilty, the health professional reassured me it wasn’t anyone’s fault, these things happen when there are not enough staff other patients have needs and we cant care for one patient when there are full bays. The outcome of the situation is there was a complaint due to safeguarding submitted by Bart’s family. Safeguarding during this situation was not up to the requirements, low staffing in a common issue in many trusts, unfortunately it is a problem that is not always fixable (By Committee on the Adequacy of Nursing Staff in Hospitals and Nursing Homes, Institute of Medicine (1996).

Number three – Low communication leading to mistakes of medication.

The third issue I will discussing is about a patient which, for confidentially reasons put in place by the nursing and midwifery council, this patient will be known as Tom Smith, a 35-year-old man with a background of UTI’s (urinary tract infection). Tom was admitted to hospital due to a UTI and confusion, while on the ward Tom had a CT scan of his kidney as antibiotics were not easing the pain and health professionals on the ward had queried it to be kidney stones. After having a CT, the results for kidney stones were negative. Tom was then put on a stronger antibiotic. When a health professional was completing medication rounds on the ward, Tom was given a stronger antibiotic called amoxicillin, which was prescribes by the doctors, a few hours after taking amoxicillin Tom began to break out in a rash on his body. The nurses did not know why this was happening. While a health professional was asking the doctor to prescribe a counteract for the rash, the doctor realised her mistake. Tom is allergic to penicillin; amoxicillin has penicillin in it. Tom was having an allergic reaction to the antibiotics which lead to him been in more pain. After a staff meeting with the people involved, including the sister and ward manager. It was decided it was the doctor’s fault for not double-checking Toms allergies, it was then the nurse’s fault second for not looking at Toms allergies.

The outcome of the situation was, Tom spent longer in the hospital because of the allergic reaction. Tom was not upset or angry about the event as he said to me “It was a mistake; the nurses are only human” Tom made a good point it was a mistake of the doctor and the nurse. In my opinion, the doctor is more to blame then the nurse as she should have looked at Toms records to see Toms allergies. However, the nurse as their job has to ask the patient if they have any allergies. My feeling towards the event, I was confused of why Tom did not disclose his allergies to the nurse, and why the nurse did not look at Toms allergies on his boar or on Toms details on the computer. Relating this event to safeguarding, Tom was not protected from harm, safeguarding was not up to the standard to protect a person from harm and neglect. Tom was not treated like other patients; his details were not checked to make staff aware of allergies.

Section three – an analysis of the NMC code

Within this section I will be analysing the Nursing and Midwifery council (NMC) code of conduct and how the NMC code has come into place and why. I will discuss how the NMC code has influenced health professionals and how it will continue to help health professionals through their career, weather the health professional is a student, newly qualified or qualified for a number of years. I will discuss how the NMC code is set out, for example if it set out professionals, makes sense, reads well, and over all a helpful guide. Or if the code is not set out well, for example if it is set out in a way that makes it difficult to read, very cramped, or overall not helpful. I will determine who the NMC is set out to help and why.

The NMC code of conduct has been in place to ensure safety and high-quality care is given to patients (Nursing and Midwifery Council, 2018). The NMC code of conduct has been set out as guidance and support for nurses, midwives and other health professions. Not only health professionals, members of the public are able to access the report to find information and help. The code was first published on the 29th January 2015 and effective from the 31st March 2015. The report has recently been updated on the 10th October 2018 with new information and any new regulations or an update on regulations (Nursing and Midwifery Council. (2015). Since the NMC code has come into play there has still been events occurred in which the NMC standards have not been met by nursing staff. The main even in which this happened was of course the Francis report, 2015 (The Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013), which was because of the events which happened at the mid Staffordshire hospital. After this event happened the NMC updated the code of conduct to a higher standard of care, including what implications could happen if these standards are not met.

Nurses and midwives can use The NMC code to promote safe and effective practice in their workplace, which could be; in hospitals, in a patient’s home, in a care home, etc. The NMC has sent out different guidelines within the code so health professionals know to complete a task. Some of the guidelines include, how to keep a person’s dignity, listening to people and how to respond to their concerns and preferences, how to act in the best interest of patients, how to keep confidentially in a workplace, and many more. Within the code the NMC have includes legal advice and support if an incident were to happen the code offers support and guidance. Overall the NMC offers support and guidance to all health professionals (Nursing and Midwifery Council. (2019).

The was the NMC code is set out professional, the code reads well, the code itself is set out well. Each Chapter includes an introduction and key points with more information for each point.

Overall, this essay has analysed both, the Safeguarding policy and the nursing and midwifery council code of conduct. This essay has included information on both the policy and the code, how they help health professionals and how it is important to have the policy and the code as a student nurse. I have analysed the safeguarding policy and how the policy has been presented, why the policy is there and what other associations help to promote safeguarding. I have analysed the NMC code of conduct and how the policy has been presented, how the code offers support and guidance to health professionals. I have discussed three clinical issues which I have found while I have been on placement, I have discussed how the event occurred and how it has affected myself, the patient and the staff involved.

Reference list

• By Committee on the Adequacy of Nursing Staff in Hospitals and Nursing Homes, Institute of Medicine (1996).
  
  Nursing Staff in Hospitals and Nursing Homes
  
  . 2nd ed. Washington, D.C.: National Academy Press. p149-155.
• Cristian, A (2012).
  
  Physical Medicine and Rehabilitation Clinics
  
  . Pennsylvania: W.B. Saunders Company Ltd. p.265-266.
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