1. Person Centred Care

(a) What Is ‘Person-Centred Care’?

Earlier the care of the patients was paternalistic care in which the decision of the doctor for the care of the patient was enough and it was accepted by the patients. In recent times, the care of the patient has shifted from the earlier thought process to the one where the patient is the centre of the care process hence this type of care is termed as patient-centred care. In this care process, the preferences of the patients, desires, values and needs are given the most importance and they have to be incorporated in the care process and the care plan is made accordingly so that the best care outcomes and patient satisfaction can be achieved (American Geriatrics Society Expert Panel on Person‐Centered Care et al., 2016)

(b) Describe Three Ways You Intend to Demonstrate Person-Centre Care in Your Clinical Practice with Patients and Clients.

The first way in which person-centred care can be upheld by the level of communication which needs to be good, transparent and effective so that it is easier to understand the patient and the needs can be incorporated in the care plan (Kilpatrick et al., 2018). There are two aspects of effective communication, verbal and non-verbal and as a healthcare professional, it is required that there is empathetic and active listening. Next thing what can be done to maintain the standard of person-centred care is if the patient is indisposed and cannot answer relevant questions for the development of care plan, it is required that as a nurse this barrier is overcome. The family members or the carer of the patient are involved in the care process so that they can help in filling the required information. Lastly, as a nurse working in the healthcare profession, there is the encounter of people who are from different cultural backgrounds and it is required that the cultural background is identified and reflected such that the care plan can be made which is culturally sensitive and appropriate. If there is any cultural belief or values which the patient might want to uphold should be included in the care plan (Markey et al., 2018).

2.Evidence-Informed Care

In preparation for clinical practice, you are required to demonstrate an understanding of the four components of evidence-informed care.

(a) Name the Four Components of Evidence-Informed Care.

Evidence-informed practise is the one which is designed for the programs which are for the promotion of health and activities which are derived from the works of the published evidence. The four components of evidence-informed care are clinical expertise, best research evidence, values or preferences of the patient and context of practice (Department of Health, n.d.).

(b) Define the Four Components Named and Provide an Example Why Each One Is Important in Nursing And/or Clinical Practice.

1. Clinical expertise- In evidence-informed care, the clinical expertise can be defined as the hybrid of theoretical knowledge and practical skills. In the field of nursing, it is the nurses who are supposed to have the clinical intuition so that they can make clinically critically decision by identifying hidden information can be recognised with the help of clinical expertise (Hole et al., 2016).

2. Best research evidence- The best research evidence is that which lie in the high position on hierarchy of evidence and can best implement in accordance to patient preferences, hospital management and available resources. The published evidence should be of highest level and empirical so that methodology is robust and the results can be used in betterment of people (Schalock et al., 2017).

3. Values or preferences of the patient- As per the person-centred care, it is required that the preference of the patient is taken into consideration and it is the reason that it is included in the evidence-informed care. For example, if a patient is to be given medication but he wants to take them after his prayers so that needs to be included in the care process (Den Hertog&Niessen, 2019).

4. Context of practice- It can be defined as the situation where all the interactions take place. For example, if a patient requires a complicated piece of equipment as per the best research evidence but in a primary healthcare setting, it is not available which makes the context not applicable to the care and will require modification as per the resources available (Hølge‐Hazelton et al., 2019).

3. Critical Thinking and Reflective Practice

(a) Identify and Explain Brookfield’s Four Components of Critical Thinking

There are four components of critical thinking as poised by Stephen Brookfield which were identifying and challenging assumptions, challenging the importance of context, imaging and exploring alternatives and reflective scepticism (Brookfield, 2020). In clinical practice, the assumptions are required to be identified and challenged instead of accepting it for its face value. Next, the context of practice needs to be explored and its importance needs to be challenged. If something is not feasible, the alternatives should be sought out for and checked for effectiveness. Reflective scepticism is the one which is to question the known to get a better answer for the unknown.

(b) Standard 1 of The Registered Nurse Standards for Practice (2016) Requires that An RN ‘thinks Critically and Analyses Nursing Practice’. how Would You Demonstrate that You Are Developing This Skill when You Are on Clinical Placement?

Standard one of the registered nursing practice is the ability of the registered nurse to think critically and analyze the nursing practice such that the care provided to the patient is appropriate and safe (Murray et al., 2018). In a clinical setting, this skill can be improved by observation of the working as a part of the daily practice. Every nurse has their own way of working but that should be appropriate such that the care is appropriate. For example, in clinical posting, there was a patient who was post-operative and was uneventful for the first 24 hours but later he developed fever, his heart rate was increased and respiratory rate. After taking the situation as a whole and considering the condition of the patient, it was deduced that the patient has developed infection and culture was needed for an appropriate course of treatment. As a registered nurse, this is the development of critical thinking as to what could have caused this situation and what measures can be taken is analytic part and is related to the autonomy of the patient. The development of the skill can be assessed by the way to make clinical reasoning in an effective manner and identification of clinical deterioration of the patient and effective decision making.

4. Caring for the Community

In this unit we discussed 9 C’s of Caring.

(a) Name and describe FOUR of the 9Cs of caring.

For the care of the community, there are nine components which include compassion, competence, confidence, conscience, commitment, comportment, culture, communication and courage (Baillie, 2017). Compassion is the sense of understanding by which a healthcare professional understands what the patient might be feeling and behaving accordingly. Confidence is required to believe in the knowledge and skill that is present, to build a relationship with the patient and work within the limitations. Commitment is required for the continuous professional and personal development also to the care of the patient so that appropriate care can be provided of the best quality. Culture means being in the profession of healthcare a nurse comes across people from different cultural background and identification is a relevant skill that is important for the provision of culturally sensitive care (Baillie, 2017).

(b) Explain how these FOUR can be demonstrated by nurses in practice, with an example for each.

In a clinical setting or a community setting, a nurse should understand that the profession of nursing at its core is the one which is full of compassion and it is required so that they can provide not only physical but also emotional support to the patient. For example, if a patient is in end-of-life-care, compassion needs to be one of the core qualities of the nurses to provide support to improve the quality of life. A nurse should be committed to the patients as well as profession. For example, while working if there is an opportunity to take part in a workshop such that the quality of care provided can be improved. As a nurse, this opportunity should be availed and professional development should be done. Confidence should be present in a nurse while providing care and this can be demonstrated by the work done and overcome the challenges that is faced by them. Lastly, a nurse should be able to identify the culture of the patient and reflect on the culture so that the differences can be acknowledged and the provision of care is such that it is culturally safe and sensitive (Markey et al., 2018).

5. Ethics in Nursing

Please answer the following two questions based on the following scenario: You are working as a nurse in an aged care facility during an acute gastroenteritis outbreak. Many of the residents are affected by the symptoms of gastroenteritis (with various degrees of severity), but not all. Some residentshave cognitive impairments, other do not. Some residents’ family members are insisting they be allowed to access their relative’s daily report. Some need to be allocated treatment-related resources that may deprive others. For example, nurses and other staff need to give residents affected by gastroenteritismore diligent and regular attention with toileting and person hygiene. Residents affected have been moved to single rooms with all new linen that is changed frequently that has resulted in restriction of linen available to other residents. Residents not affected are given a lower priority and sometimes need to wait longer for assistance with activities of daily living as staff are very busy.Extra personal protective equipment needs to be purchased and this has impacted on the facultybudget so extra activities such as music and art therapy has been reduced for that month.

(a) Briefly describe the nature of the power relation between nurses and patients in thisscenario. In the light of this, explain why the fiduciary model is the legally prescribed model of the nurse/patient relationship.

In the given scenario, the power relation between the nurses and patients can be viewed as paternalistic and the power in this scenario was more with the nurses and it was seen that they decided the path of treatment was decided by them. Ideally, there should be no power difference between nurses and patient and there should be mutual respect and the care should be such that the outcome of the patient is a prime concern (Gilmour & Huntington, 2017). In the present case, it was seen that not all the needs of all the patients were catered to and there was an imbalance which might have adverse health outcome. Fiduciary model is the best as according to this, the interest of the patient must be of paramount importance by virtue of this the information should be provided to the patients such that they are able to make the decision for themselves (Filipova, 2018).

(b) There are ethical considerations that arise in this scenario. Discuss two of these considerations, explaining their ethical nature by utilising one or more theories or principles you have learned about in this unit.

The first ethical consideration that can be seen in the present scenario is that gastroenteritis is a communicable disease and isolation is not the solution as it may still spread to other patients in the residential care setting. There should have been measures taken to make alternate arrangements as this can cause deterioration of the patient it violates the non-malevolence ethical principle. The second ethical consideration that can be raised in the present scenario is that the patient who is at a low priority. Just because they are at a low priority does not mean they do not require less assistance and it is against the ethical principle of beneficence. For tackling the problem the residential care could hire more help for the time being so that the ratio is not disturbed.

References for Professional and Discipline Studies in Nursing

American Geriatrics Society Expert Panel on Person‐Centered Care, Brummel‐Smith, K., Butler, D., Frieder, M., Gibbs, N., Henry, M., ...&Saliba, D. (2016). Person‐centered care: A definition and essential elements. Journal of the American Geriatrics Society, 64(1), 15-18. https://doi.org/10.1111/jgs.13866.

Baillie, L. (2017). An exploration of the 6Cs as a set of values for nursing practice. British Journal of Nursing, 26(10), 558-563. https://doi.org/10.12968/bjon.2017.26.10.558

Brookfield, S. (2020).Teaching for critical thinking.In Handbook of Research on Ethical Challenges in Higher Education Leadership and Administration (pp. 229-245).IGI Global.

Den Hertog, R., &Niessen, T. (2019). The role of patient preferences in nursing decision‐making in evidence‐based practice: Excellent nurses’ communication tools. Journal of Advanced Nursing, 75(9), 1987-1995. https://doi.org/10.1111/jan.14083.

Department of Health (n.d.) Evidence informed practice. https://www.dhhs.tas.gov.au/wihpw/principles/evidence_informed_practice.

Filipova, A. A. (2018). Direct-to-consumer advertising effects on nurse–patient relationship, authority, and prescribing appropriateness. Nursing Ethics, 25(7), 823-840.

Gilmour, J., & Huntington, A. (2017).Power and politics in the practice of nursing. Contexts of Nursing: An Introduction, 183.

Hole, G. O., Brenna, S. J., Graverholt, B., Ciliska, D., &Nortvedt, M. W. (2016). Educating change agents: A qualitative descriptive study of graduates of a Master’s program in evidence-based practice. BMC Medical Education, 16(1), 71.https://doi.org/10.1186/s12909-016-0597-1.

Hølge‐Hazelton, B., Bruun, L. Z., Slater, P., McCormack, B., Thomsen, T. G., Klausen, S. H., &Bucknall, T. (2019). Danish translation and adaptation of the context assessment index with implications for evidence‐based practice. Worldviews on Evidence‐Based Nursing, 16(3), 221-229. https://doi.org/10.1111/wvn.12347.

Kilpatrick, J., Elliott, R., & Fry, M. (2019). Health professionals’ understanding of person-centred communication for risk prevention conversations: An exploratory study. Contemporary Nurse, 55,(1), 495-506. https://doi.org/10.1080/10376178.2019.1664925.

Markey, K., Tilki, M., & Taylor, G. (2018).Understanding nurses’ concerns when caring for patients from diverse cultural and ethnic backgrounds. Journal of Clinical Nursing, 27(1-2), e259-e268.https://doi.org/10.1111/jocn.13926.

Murray, M., Sundin, D., & Cope, V. (2018). New graduate registered nurses’ knowledge of patient safety and practice: A literature review. Journal of Clinical Nursing, 27(1-2), 31-47. https://doi.org/10.1111/jocn.13785.

Schalock, R. L., Gomez, L. E., Verdugo, M. A., &Claes, C. (2017). Evidence and evidence-based practices: Are we there yet?. Intellectual and Developmental Disabilities, 55(2), 112-119. https://doi.org/10.1352/1934-9556-55.2.112.

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