Assignment Brief
Please, use journals (Evidence) Less than 5 years old and UK Based avidence
Learning Outcomes:
- Demonstrate the ability to systematically appraise and clinically apply a range of evidence including research.
- Examine strategies to facilitate personal and professional development.
- Formulate collaborative and holistic nursing care that safeguards and empowers the public, whilst maintaining comfort, dignity and human rights.
- Analyze and debate professional values, ethical and legal frameworks which impact on holistic care delivery in different clinical settings.
Module: Professional Values and Evidence Based practice
Word Limit: 2000 words
Assignment Guidance
You must write a 2000 word essay, incorporating the requirements of the different sections as set out below. Please refer to the frequently asked questions sheet regarding word count. The sections reflect the content of specific themes and case studies taught/referred to within in the module.
Assignment Content
- Introduction (200 words).
Write a brief introduction to the essay. Describe how you are going to answer each section of the essay, and refer to your field specific case study.
- Section 1- Nursing Care (500 words).
Identify one nursing problem and analyze why that poses a risk to the comfort or dignity of the patient. This is in reference to your field specific case study (Theme 1 or 5). Choose one nursing care intervention, and analyze why that intervention would promote the comfort or dignity of the patient.
To answer this section successfully you must:
- Define and analyze- the concept of comfort or dignity, and how this relates to your case study (Theme 1 or 5), by Identifying and analyzing an actual or potential nursing problem.
- Choose one nursing intervention and analyze how this could reduce the risk of the patient/service user, comfort or dignity being breached. The intervention needs to be specific, with analysis of the arguments for and against the implementation of your chosen intervention.
Section 2 – Empowerment and Collaborative Care (500 words)
Identify one collaborative initiative, and analyze how this could empower the patient/carer to increase their self-management within your field specific case study (Theme 2).
To answer this section successfully you must:
- Define and analyze the concept of empowerment, and discuss how this relates to the case study (Theme 2), by identifying and analyzing a situation that demonstrates disempowerment.
- Choose one collaborative intervention, and analyze how the initiative could increase a patient/carers/services user’s level of empowerment within your case study. The analysis needs to consider the possible barriers to implementation, and how they can possibly be overcome.
Section 3 – Law and Ethics (600 words)
Critically analyse one hospital, or community based situation, from your field specific case study, which has legal and ethical implications within the delivery of care to the patient/ service user (Theme 4 or 5).
To answer this section successfully you must:
- Identify one situation that relates to the patient/service user, and analyse the legal and ethical implications of the situation.
- Choose one of the ethical principles shown below, and analyse how it relates to your field specific case study.
- Beneficence, 2) Non-maleficence, 3) Autonomy or 4) Justice
- Identify and analyze the legal frameworks that exist, and apply them to your case study situation.
One of the legal frameworks must be Human Rights Act (1998)
- Conclusion (200 words) Provide a summary of the main points in the essay. Demonstrate an awareness of what you have learnt and how this will influence your future practice.
Structure and Presentation
The assignment should be structured so that each section and the required content is covered in a systematic and logical manner. Each section should be linked to ensure a clear flow to the next topic and part of the case study. It should be grammatically correct with clear use of appropriate paragraphing.
Sub-headings
The assignment may have sub-headings. If used, these will be: Introduction, Section 1 – Nursing Care, Section 2 – Empowerment and Collaborative Care, Section 3 – Law and Ethics, and Conclusion.
Referencing
The essay must be referenced following the Harvard referencing system.
Marking Criteria
The essay will be marked according to the published university level 5 criteria. The module team would encourage attempts at analysis and debate in the essay.
Assignment – basic plan
Note: this is the assignment stripped right back to the bare essentials. You will need to justify (provide an argument, substantiated by evidence) for the things you put below.
Theme 1
Nursing Care Adult Scenario
Jeremy’s sleep habits had started to change and he often slept during the day and would then be awake in the early hours of the morning. He would wander around the house and try the doors to see if they were open. This worried Shirley as she was afraid he would get out of the house one day. Unfortunately Jeremy went out late at night unnoticed by his sister. He already had a bit of a cold and having got lost on a rainy night he fell and was unable to get up and get home. He was found the next morning by the postman. On admission to hospital it was found he had a chest infection and a urinary tract infection. It was impossible to get Jeremy to take part in an assessment of his memory as he found it very difficult to answer the questions and kept saying his mother would be looking for him and he had to get home.
Jeremy is charming in the mornings and tries to be helpful on the ward. He has been found adjusting the rate of flow of his neighbours drip. In the mornings he can usually understand that he is a patient who is ill and in hospital, but come mid-afternoon he becomes very agitated, repeats words (usually Mama and Shirley over and over again and tries to leave via the fire escape. He has urinated in the waste paper basket and tried to get into bed with a female patient in an adjoining bay. This has caused other patients to be frightened of him and some relatives have complained. In addition Jeremy is very reluctant to take his medication and staff have found some of his tablets tucked under his pillow. When questioned about his behaviour Jeremy becomes very angry with the nurses, some of whom feel it is only a matter of time before he lashes out and hurts someone.
In addition to these issues Jeremy is not taking adequate diet and fluids. He is reluctant to sit for any length of time at a table or in a chair to eat a meal. He becomes agitated at times and tends to wander off. Staff are concerned he will become dehydrated and malnourished.
Theme 2
During his hospital stay, Dr Armstrong’s condition improves to a point that Shirley feels that she will be able to cope with him at home. She is seen by all the members of the hospital social care team. However, she refuses offers of help at home as she feels Jeremy would not like “strangers” in his house. She also does not want to be a burden on the state especially as everyone is short of money and she has read in the news that the NHS is facing cuts.
She also feels that she can get some help from Claire and hopes that his son, James will be more accepting of his father’s condition and offer some more help. They had a family discussion last week and James said that he would do more.
2 weeks later, Shirley comes to the ward in a very upset state. She now realises that she is unable to cope at home. Jeremy is still wandering and is sometimes aggressive although this has improved.
The main problem is that Jeremy is now not sleeping at night. He tends to sleep for periods during the day and spends some of the night knocking on her door, calling out his wife’s name, pacing around the house and talking. She is able to settle him back down so that he gets some sleep. The main problem is that this occurs at around 2 – 4 o’clock in the morning when Shirley should be getting most of her sleep. She thinks the hospital admission altered his sleeping patterns.
The promised increased help from Jeremy’s son has not happened and Claire, his wife can only do so much. Shirley is now asking for care to be put in place so she can cope at home. She says she has the advantages of a large (£500,000) house. Jeremy has £40,000 in savings and a good NHS pension. Shirley herself only has a state pension. However, she has lasting power of attorney for property and financial affairs.
Theme 3
The recent admission to hospital has not helped Jeremy’s confusion and when he returns home he finds it difficult to settle, even though the surroundings are familiar.
Shirley asks for support to adapt the house so it will be safer and more befitting to Jeremy’s needs thus empowering her to continue caring for Jeremy at home. The changes also help empower Jeremy to remain in a more familiar environment.
Small changes are made such as improved lighting and the removal of rugs to help prevent falls. Hand rails are installed on the stairs so Jeremy can climb the stairs more safely. The use of a nightlight is suggested to help with disorientation in the dark.
Pictures and signs were put on the toilet door so Jeremy knew where the toilet was which helped to prevent some of the accidents he was having. Cupboards were labelled with pictures also to help Jeremy identify where things were in the kitchen.
Theme 4
Law and Ethics Scenario
Dr Armstrong has had a stroke and has been readmitted to hospital, his speech and swallowing have been affected and he can only communicate via hand gestures and nods.
The speech and language therapists have assessed him as being unsafe to take diet and fluids orally due to the risk of inhalation, consequently he has had a naso-gastric tube passed and the medical staff are discussing the need for a PEG to be inserted, his son is keen for this to happen.
Dr Armstrong has pulled his naso – gastric tube out on several occasions and he is indicating in gestures that he wants to have a drink orally. When you check in his patient record you find he has written an advanced decision 10 years ago stating that he does not want any unnecessary procedures or interventions if he ever becomes a ‘cabbage’.
What are the legal, ethical and professional issues involved and how would you address this situation?. What say does his son have in this matter?
Theme 5
Towards End Of Life Care
Two weeks ago Jeremy was admitted to hospital. Jeremy had noticeably lost weight over the previous month, become increasingly disinterested in food and increasingly agitated. Shirley finally became unable to cope when he developed a urinary tract infection which caused incontinence. James, Claire and Shirley all felt anxious about his hospital admission though relieved that this would give them some respite and his care would be reviewed.
During his admission to a care of the elderly medical ward Jeremy’s urinary infection responded well to antibiotic treatment. On re-assessment however his MMSE was noted to have declined further to a score of 8, due to having a further stroke. Nursing staff observed that he frequently coughed with the small amounts of oral intake he took. He was referred for a Speech and Language Therapy (SALT) assessment and was found to have mild dysphagia. A soft diet was recommended but both nursing staff and Jeremy’s family all found supporting him to meet his nutritional needs very challenging. Naso – gastric feeding was started but this caused further care and legal and ethical difficulties.
Jeremy developed in his second week on the ward an increasing tendency to spend more hours than normal asleep. Towards the end of that week he developed a fever, his respiratory rate increased, his respiratory pattern become shallow and he appeared to be dyspneoic. Shirley, James and Claire could see clearly that Jeremy looked increasingly unwell. A chest x-ray identified that he had a right lower lobe pneumonia. A MDT meeting was called and it was concluded that it was highly likely that he had developed pneumonia due to aspiration of food (aspiration pneumonia).
The care of the elderly consultant conveyed her opinion to Shirley, James and Claire that Jeremy is unlikely to survive this condition. Discussion was held regarding the possibility of fast track discharge to facilitate his death to occur in the more familiar surroundings of home. Consensus was reached however that in Jeremy and his particular families’ circumstances the most appropriate option was that he stay in hospital for this critically important stage in his life.
We will be looking in the field session, and through the supporting learning resources, at how best to care for Jeremy’s physical, psychological, social and spiritual care needs at this challenging and special time.
