3
126 (finical Notes In ortler lo develop the care provision the support oi setiior nianagets is crucial. This itivolves establishing a Steering (irouji and regularly inibrtiiing the group oi'development. This grou|) also provided an opportunity for dissemination oi'ideas throughout the hospital. (Conclusion This brief overview oi'the starting point oi'tbe NDU at the (jtv Hospital Abertleen has been provided in order to illustrate some of the key issues that must be addressed. 'Ihe move towards truly iiaticnt-centred care is muUi- i'aceted and by tio mcatis a seli'-evidetit process. It is not axiomatic that it is only tbe duty of clinical nurses. There are no quick solutions and the whole developtnent process requires tbe support at e\ery level wilhin tbe organization. References (jirmack i). (lul.) (I9S.S) (ieniilrif Xursiiif, a (jiiuclUinil/lppriniili. iilackucll Sciciili/ic I'ublications i,ld, Oxford. I iihbs V. (1''87) liliu-vahlt- Hiiiiilnrds of iarc jiir llic elderly pnliciil Hired liir in llic mule iisicssnwnl wards, nursuig hoincs, iiinlinumg (are uuirds. nurstnu, hiinn's and diiy hospitals withni ihc (Aty £5' llaihicy lleallh .lulliiirily. Kin^''s i'lind i'rojcct Paper. Kinfj's I'und (xTilrc, i.oiuloii. I'urlhcr inlormalion (jn cacii (i( tlic themes idciilidcd is avaiiaiilc from: l)r iicrnicc J.M. West, kannodi i iousc, Niirsiiif? Ocvciop- mcni Unit, (jtv ilospilal, Lrquhart l{oad, Aiicrdccn. Moving forward by looking baek .SARAH A. i i L \ ' l ' RCiN, t<:\t, Di'SX Jiiiiiiir Sisli-r. I'lvc Day .Surti^tail t'nil, HedJ'iird Ilospilal I'rusl. Kcmpslon Riiiid, licdjord, Ri'ils. As ]iart oi the course requirements i'or a Diplotna in Proi'essional .Studies iti Nursing (South Bank University) I kept a reilcctive diary i'or 6 weeks. This tool etiabled me to look at all aspects oi my practiee, however trivial tbey seemed. It helped me to assess whether or tiot I could have improved that care and ii'so how. The reilective diary is proposetl as a useiul tool for ward sisters and managers, in order lo eiVeet, monitor and evaluate change (Dewing, 1990). Reflecting on practice helps to prevent ritualistic care irom being given. I attenii)ted to cotiiplete a diary at the end oi each working clay. Hy becotning reilective [ have started lo question my own practice closely. One particular problem higblighled bv using a fedcctivc diary was that of tiol giving adequate preojierative inibrmation to patietits which may affect recovery irom siu'gery. .Many o( our patients have caticcr and may require mutilating surgery causing a substantial change in body image. Il was ibutid that many of these patients did not understand the nature oftheir disease or the extetit oi'tbe surgery required, due lo cotnmunication breakdown between patietit and staiT. Tbis may have arisen due to itiapproprtale use oi tnedical lertns, avot- dance oi'the word 'cancer' or a defensive approach being taken by tnedical stail'. One particular patient who highlights this problem is .Mr I who was admitted i'or oesophago-gastrcclomy and neiihrectoniy. Neither the patient nor his wiib api^eared to be aware oi'lhe extent of bis disease or the implications of the surgery be bad beeti admitted for. I le was also unaware that if the medical stall'were unable to peri'orm tbe surgery they would insert a Mousseau Harbin tube to prevent obstruction oi the oesophagus. There seetned to me two possible reasons ibr this situation occurring. I'irstly a breakdown in communication between tbe medical stafl and the patient and, secondly, that Mr I had only retaitied a stnall atnount of the inibrtnation given lo him. Hysshe (1988) suggested thai as little as 40% of information given to patients is retained. A small proportion of ihc informa- lion is given on the unit by medical slaiT; however. Speck (1991) suggested thiU many medical schools do not give their students adequate ptcparation for communication. In order lo ensure ibat Mr and Mrs I understood that he bad extensive disease and the doctors' proposals ibr sur- gery I lirsl asked the registrar lo speak to them. They were absolutely devaslated thai he had cancer, consequetitly wlieti I went to discuss the impenditig surgery with Mr 1 it was diilicult to gel him to lalk about how he fell about having cancer and the ibrthcotning surgery. This was hardly surprising as he was experiencing a grief react ion to the inibrmation thai liati been given lo him. IJy redecting on each working day and jolting down the days events I realized tbat Mr 1 was noi the only patient being adtnilled to hospital inadequately prepared ibr surgery. I felt that as the palients' advocate, we as nurses needed to try and change tbe situation in order lo enhance posl-operative recovery and hel]-) the palients through the grief reaction. In Mr I's case, according lo his family, bud he been adequately informed preoperalively he would probably bave chosen not to have surgery al all. Instead he died in Ilospilal ai'ler a massive haemorrbage about 10 clays posl-insertion oi a Mousseau Harbtti tube. In conjunction with our liospital-ba.scci Macmillan Nurse I decided to tackle the problem by approaching the medical stalT'to try to educate tbem about the methods of giving patients more systematic inibrmation; atul the

Moving forward by looking back

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Page 1: Moving forward by looking back

126 (finical Notes

In ortler lo develop the care provision the support oi setiiornianagets is crucial. This itivolves establishing a Steering(irouji and regularly inibrtiiing the group oi'development.This grou|) also provided an opportunity for disseminationoi'ideas throughout the hospital.

(Conclusion

This brief overview oi'the starting point oi'tbe NDU at the(jtv Hospital Abertleen has been provided in order toillustrate some of the key issues that must be addressed.'Ihe move towards truly iiaticnt-centred care is muUi-i'aceted and by tio mcatis a seli'-evidetit process. It is notaxiomatic that it is only tbe duty of clinical nurses. Thereare no quick solutions and the whole developtnent processrequires tbe support at e\ery level wilhin tbe organization.

References

(jirmack i). (lul.) (I9S.S) (ieniilrif Xursiiif, a (jiiuclUinil/lppriniili.i i l a c k u c l l S c i c i i l i / i c I ' u b l i c a t i o n s i , l d , O x f o r d .

I iihbs V. (1''87) liliu-vahlt- Hiiiiilnrds of iarc jiir llic elderly pnliciilHired liir in llic mule iisicssnwnl wards, nursuig hoincs, iiinlinumg(are uuirds. nurstnu, hiinn's and diiy hospitals withni ihc (Aty £5'llaihicy lleallh .lulliiirily. Kin^''s i ' l ind i'rojcct Paper. Kinfj's

I 'und (xTilrc, i.oiuloii.

I ' u r lhcr in lormal ion (jn cacii (i( tlic themes idciilidcd is avaiiaiilc

from: l ) r i icrnicc J . M . West , k a n n o d i i iousc, Niirsiiif? Ocvc iop-

mcni Uni t , ( j t v i lospi la l , L r q u h a r t l{oad, Aiicrdccn.

Moving forward by looking baek. S A R A H A. i i L \ ' l ' RCiN, t<:\t, Di 'SX

Jiiiiiiir Sisli-r. I'lvc Day .Surti^tail t'nil, HedJ'iird Ilospilal I'rusl.Kcmpslon Riiiid, licdjord, Ri'ils.

As ]iart oi the course requirements i'or a Diplotna inProi'essional .Studies iti Nursing (South Bank University) Ikept a reilcctive diary i'or 6 weeks. This tool etiabled me tolook at all aspects oi my practiee, however trivial tbeyseemed. It helped me to assess whether or tiot I could haveimproved that care and ii'so how. The reilective diary isproposetl as a useiul tool for ward sisters and managers, inorder lo eiVeet, monitor and evaluate change (Dewing,1990). Reflecting on practice helps to prevent ritualisticcare irom being given. I attenii)ted to cotiiplete a diary atthe end oi each working clay.

Hy becotning reilective [ have started lo question myown practice closely. One particular problem higblighledbv using a fedcctivc diary was that of tiol giving adequate

preojierative inibrmation to patietits which may affectrecovery irom siu'gery. .Many o( our patients have caticcrand may require mutilating surgery causing a substantialchange in body image. Il was ibutid that many of thesepatients did not understand the nature oftheir disease orthe extetit oi'tbe surgery required, due lo cotnmunicationbreakdown between patietit and staiT. Tbis may havearisen due to itiapproprtale use oi tnedical lertns, avot-dance oi'the word 'cancer' or a defensive approach beingtaken by tnedical stail'.

One particular patient who highlights this problem is.Mr I who was admitted i'or oesophago-gastrcclomy andneiihrectoniy. Neither the patient nor his wiib api^eared tobe aware oi'lhe extent of bis disease or the implications ofthe surgery be bad beeti admitted for. I le was also unawarethat if the medical stall'were unable to peri'orm tbe surgerythey would insert a Mousseau Harbin tube to preventobstruction oi the oesophagus. There seetned to me twopossible reasons ibr this situation occurring. I'irstly abreakdown in communication between tbe medical stafland the patient and, secondly, that Mr I had only retaitieda stnall atnount of the inibrtnation given lo him. Hysshe(1988) suggested thai as little as 40% of information givento patients is retained. A small proportion of ihc informa-lion is given on the unit by medical slaiT; however. Speck(1991) suggested thiU many medical schools do not givetheir students adequate ptcparation for communication.

In order lo ensure ibat Mr and Mrs I understood that hebad extensive disease and the doctors' proposals ibr sur-gery I lirsl asked the registrar lo speak to them. They wereabsolutely devaslated thai he had cancer, consequetitlywlieti I went to discuss the impenditig surgery with Mr 1 itwas diilicult to gel him to lalk about how he fell abouthaving cancer and the ibrthcotning surgery. This washardly surprising as he was experiencing a grief react ion tothe inibrmation thai liati been given lo him.

IJy redecting on each working day and jolting down thedays events I realized tbat Mr 1 was noi the only patientbeing adtnilled to hospital inadequately prepared ibrsurgery. I felt that as the palients' advocate, we as nursesneeded to try and change tbe situation in order lo enhanceposl-operative recovery and hel]-) the palients through thegrief reaction. In Mr I's case, according lo his family, budhe been adequately informed preoperalively he wouldprobably bave chosen not to have surgery al all. Instead hedied in Ilospilal ai'ler a massive haemorrbage about 10 claysposl-insertion oi a Mousseau Harbtti tube.

In conjunction with our liospital-ba.scci MacmillanNurse I decided to tackle the problem by approaching themedical stalT'to try to educate tbem about the methods ofgiving patients more systematic inibrmation; atul the

Page 2: Moving forward by looking back

Clinical Notes 12/

bcncliis of doing so. Unlbrtunatcly some of the moresenior niediciil slalT seemed lo use ax'oiciance techniquesutilil they had the liistoloi^} in black aiui white. The tnorejunior medical stall were tnore vvillitig to be straight withthe patients but tieeded the support of tlie tutrsinu: staft inorder to provide adequate preoperative itifortiiation lor thepatietit to be able to make an ititbrtiied ehoice aboutsurgery. 'I'he eounsellinp skills of the Maemillan Nursewere ottered at their clitiics atid eftbrts were tnade toensure that the ward nurses spctid time fnulitig out howtnuch ihe patient has understood so that further discussioticould take place with both a nurse and a metnber ofthetnedical teatn. hi this way the nursinji start knows exactlywhat the patietit has been told atid is therefore more able to

reintbree the itiformatioti whieh has beeti giveti. Some ofthe eotisultants tiow tiiake more use ol the MaetnillatiNurse atid tlie ward tiursing stalTetisure that patients arereferred to them where this is thottght to be appropriate.The proeess ol etisurint; adequate ititormation givtng isstill left to the jutiior tnedical and the tiursins; staff. Sotneof the tnore setiior tnedical stall" appears to be tnoreenlightened. I hope this is goitig to be a eotitinuing trend.

References

Bysshc |. (f')<S,S) The ctVcct ot'tiiving information to patients lu-torc

surgery. Xtirsitig 3(M)), Mi .1').Dewing J. (l'>i)t)) Rctlcctivc practice. Sfiinn- Xiirsc 10(10). 2() 2S.Speck P. (19')1) liroaking bad news. Xiirnii^!; Tniics 87(12), 24 2(i.

Erratum

Teggart L.M. (1993) Measuretiietit of care planning.Joiirniil of Clitiical Ntirslug 2: 63 64.1 he address of (he author for the above Clitiical Note wasgiven incorrectly iti the March issue of the journal. Itshould tead as follows:Project Leader, Middlesex Professorial Ntirsin;j; Unit alCohndalc, Coliiidale llospiUil, Colindalc Avenue, LondonNW<) 5IK;, UK.

Page 3: Moving forward by looking back