'complete Task On Graded Unit'

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

 

COMPLETE TASK    ON 

HNC HEALTH CARE  GRADED UNIT  2008 

    By:  MOTILAL DASS Scotland

1   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

PLANNING My placement is in local residential care home in Ayr. For completion of graded unit project I have selected a client who has a permanent colostomy and an attachment of colostomy bag at the site. A colostomy means a surgical opening into the colon. This project includes three stages called planning, development and evaluation of a practical activity where I will change a colostomy bag. This client is of 78 years old lady who has been cared for last six months and was transferred from Ayr General Hospital. Due to permanent colostomy bag attachment at the site her normal movement altered and as a result of this normal movement got a diversion. So she is required to change the bag from time to time. This changing of bag will minimize the risk of infection and tissue integrity. The constant moisture condition may aggravate the condition, so it’s important to maintain her hygiene and promote independence. While the bag is attached at the site an extra care has to be taken that the bag is well sealed and not leaking at all. As due to leakage she may have low self esteem, so the social need could be hindered. As a result of her existing condition she is totally confined to the specific area around her .This affects her normal social life and she is emotionally depressed. In order to lift her emotional need it is necessary to talk to her from time to time and to give her a brief history of same types of clients and their prognosis. While I went through the client’s medical notes I kept that information confidential as Nursing and Midwifery Council states that you must treat information about patients and clients as confidential and use it for the purpose for which it was given (NMC-2004). I found that she had a poor educational background. As a result it took time for me to explain the medical terminology but I found she was much interested to learn so I could state that her cognitive need is moderate. By talking to number of relatives I came to know that she belongs to a middle class family.

2   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

Her educational background revealed that she discontinued studies at the earlier stages of her life. Then she started working as a kitchen assistant in a nearby restaurant. She has her own house and her family consists of five members including two sons and a daughter and a husband. In the context of her socioeconomic background and her existing disease condition it could probably be stated that the quality of food consumption and living standard might be the contributing factor of the cancer of the colon and on the basis of the educational history she has knowledge deficit. Donna Myers, (colon cancer 2008) states where you live; who's around you, your occupation, and even when you work may all influence your risk of developing colon cancer In the perspective of the health and well being of this client it is quite clear that she had the opportunity for early screening and detecting the disease process at the preliminary stages. She should have gone for this in order to be treated at early stages and better prognosis. While reviewing her history I could relate this with the conflict theory. The conflict theory states about social stratification and inequality in provision of health care and Kenworthy et al (2002) states that Conflict theory explains social structure and changes in it by arguing that actors pursue their interests in conflict with others and according to their resources for social organization. This client is totally confined to the care home due to the existing condition and henceforth she is emotionally depressed. In the most of the cases her normal life is normally hindered. Her mental state is badly affected and in the context of the psychological need it is found that she is ideal client for whom the cognitive theory is applicable as Kenworthy et al (2002) states that cognition is involved in recognition with the thought process. Her past background revealed that her understanding level of disease process is poor. The client had undergone a colostomy operation and it is as result of the carcinogenic condition of the large colon. Tortora et al (1996) states that the large colon has three parts called ascending colon, transverse colon and descending colon.

3   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

The risks factors of colon cancer are age, hereditary, genetic alcohol consumption, smoking, diabetes, obesity, race and ethnic background, lack of exercise, personal cancer history, medical conditions, family history of colon cancer, large intestinal polyps and diet. Carol (2003) states Colon cancer arises from histopathology and molecular changes caused by complex interactions between genetic susceptibility and environmental factors. These molecular changes include multiple, acquired genetic alterations within colonocyte oncogenes (promoting malignant transformation) and tumor suppressor genes (causing loss of the inhibition of cellular proliferation). To resolve the normal elimination pattern this operation was necessary. The activity I chose is changing of stoma a bag I realized that due to the patient’s condition it is good enough to carry out this task. This will help the client to promote her independence and intellectually she will be more knowledgeable and know the rationale for doing it from time to time. Emotionally she will be more uplifted and socially she will be have more confidence as she keeps on interacting with similar groups of clients, who underwent this procedure. I will be carrying out this activity in a care home by demonstrating the activity of changing the stoma bag from the site and connecting a new bag and in this activity the patient will be involved directly and in the presence of a staff nurse who would be supervising the activity. This activity will be carried in fortnight time from now. The time I have set for the activity is almost one and half hour and overall time scale of this project is to be submitted by planning on March 3rd, development on 1st April and evaluation on May 19th 2008. The aim of the project is to achieve my HNC award. In order to complete this activity I would be needing help from the staff nurse, stoma care nurse and also logging into various educational web sites, magazines and health related books. The appropriate time scale for this planning is in three weeks time from now. The resources needed for this activity are gloves, aprons, alcohol gel, stoma bag, color coded yellow bin for clinical waste, gliding and sliding sheets. While changing the bag the personal protective devices will be worn in order to minimize the risk of infection.

4   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

The soiled bag will be discarded into the yellow bin as the yellow color coded bin is meant for discarding clinical waste It will require turning the patient slightly to the opposite side of the bed, so care must be taken to keep the bed side rails in order to prevent falls and also unnecessary equipments should not be keeping within the area of demonstrating this activity since it may require good space. The patient should be turn with the help of other staff and using the sliding and gliding sheets as these position changing devices facilitates easy way of changing the position and also I made sure that other objects are kept in orderly manner as dropping objects on body parts can cause fractures, abrasions and cuts, etc (Kingston and Chelsea -2008). During my plan I will make sure that the environment is quite safe and secure for my client in order to avoid any further injuries on hazards as the health and safety regulation (Health and Safety Regulation) states that the provision and maintenance of plant and systems of work that are, so far as is reasonably practicable, safe and without risks to health. While I was making this plan I made sure not to disclose any in formations concerning to the patient and even in my planning process I did not mention patient’s name and relevant personal details. To abide by the Data Protection Act 1998 I did it so. Considering to the patient’s need and evaluating her existing condition and talking to the staff nurse regarding this patient I could understand that it would be an appropriate activity to carry out with the patient and it is of course a realistic plan which could be implemented.

5   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

DEVELOPMENT

As previously mentioned, I have chosen to change colostomy bag as a clinical activity for the purpose of completing the graded unit project. After reviewing the medical record of the client I found that she has been suffering from bowel cancer from last few years. Colostomy means surgically opening at the colon and the attachment of a bag for the purpose of collecting the faecal mater into the bag. This bag acts as a reservoir. The colon is divided into three parts ascending, transverse and descending colon and this patient was suffering with cancer of the descending portion of the colon. As a result it was necessary for her to have a colostomy. There are manifold clinical manifestations associated with the colon cancer as Tortora et al (1996) states that increasing age, family history of colon cancer, previous colon cancer, and history of inflammatory bowel disease, high fat –high protein and low fibre diet are closely linked with the colon cancer. So colostomy is done in order to provide palliative treatment.As the client had undergone a colostomy operation and had a bag attached at the site it may change the client’s physical image, and this also interferes with the hygiene needs. If the bag is not changed frequently then there might be chance of developing infection at the site. I have gone through the infection control policies and protocols of the care home and it states that prior to giving any care to patients its mandatory to wash hands and when it comes to care of surgical sites then the gloves and aprons must be worn. I have read the care plans of this patient and found that every second day the bag needs to be changed. I also spoke to the other members of the care team such as staff nurse, stoma care nurse and senior carers of the care home. All of them were co-operative with me. I was told to observe the activity first as the staff nurse carried out and she explained it to me as how to do it.

6   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

But the staff nurse demonstrated it on another patient, who has undergone the colostomy operation. Then I was asked to carry out on the patient I selected. I gathered all the necessary articles needed for carrying out this task. The articles included: •

disposable gloves

•

plastic apron

•

stoma bag

•

alcohol gel

•

yellow colour coded bin

•

scissor

•

cotton swab

I went to the patient and introduced myself to her and I also explained the procedure to the patient to gain her confidence. I sought her permission to carry out the activity as NMC (2004) states that you must obtain consent before you give any treatment or care. I ensured the patient’s privacy and dignity by closing the door and keeping the curtains shut. Staff nurse was there to supervise me. The client was initially anxious and kept on asking me questions, why I was closing the door and keeping the curtains shut and I explained that others may not feel good to see us carrying our the activity, moreover it may give some foul odour. After making everything ready I put on the apron and washed my hands with antiseptic solution provided for hand washing, dried the hands thoroughly and then put on the disposable gloves. I did it to comply with the infection control policy and procedure. Hand washing is important the risk of minimizing the risk of transference of organism. The Postnote (2005) states that probably the single most effective way of combating health care associated infections is to improve hygiene in healthcare settings, in particular hand hygiene. First, I took out the old colostomy bag from the site and cleaned the site with sterile water using cotton swab, made the site dry with dry cotton swab and discarded the bag into the bin to send it for incineration.

7   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

I then opened then clean bag, checked the stoma and its diameter so that it fitted into the mouth of the bag and the stoma. I fixed it properly ensuring that it did not leak at all. During this process I had to turn the patient to have the easy access to the site, which I found initially difficult but finally I could do this with the help of other carers. I made the patient feel comfortable and repositioned her back into the bed. Took all the articles back to the treatment room and cleaned them. I replaced them back to the place they were. I took off the gloves and aprons and discarded them properly, washed my hands and applied the alcohol gel. I came to nursing station and took the patient’s file and recorded the activity which I carried out. I asked the staff nurse on duty to countersign and so she did it. She was much impressed the way I carried out then activity. Throughout the activity I communicated effectively with the patient using verbal method of communication like keeping good eye contact. I cleared all the doubts that the patient had regarding this procedure. Being the communicator in this case I delivered accurate message to her. I was successful in interacting with her since she was able to respond effectively. Kenworthy et al (2002) states that communication is judged as successful when the received message in close enough to that of the sender. As prior to carrying out the activity I discussed it with the staff nurse and she gave me necessary information and I also read the policy and protocol of doing this activity. I gathered all the things in accordance to it. There are many patients who have undergone a colostomy operation and residing in the care home. It’s like a common procedure in the care home. For this reason there were adequate supplies of things needed for this activity. I found all the things needed to hand. The nurse in charge was very supportive for this activity. During the activity I needed to change patient’s position, since the patient was quite heavy and it was difficult for me to do it by myself. During the activity I found it hard to do it but the nurse reminded me and then I got assistance from other carer to do it as Kenworthy et all (2002) states that moving and handling patients within an acute hospital setting, with the availability of other colleagues and lifting aids is more easily achieved safely than trying to move a patient in their own home in a low bed and without the support of the staff and mechanical aids.

8   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

I summoned couple of carer who helped me to do it. It interfered a bit during the work. I adhered to health and safety regulation as Health and safety at work place (2007) states that it safeguard others, including members of the public, who may be exposed to risks from the way work is carried out. Which I felt should have done prior to carrying out the activity. As I was being supervised by the staff nurse I made sure all the used and soiled articles are disposed properly. I promoted my patient’s independence and adhered to all the Health and Safety policies mentioned in the planning stage.

9   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

EVALUATION: As it has been already mentioned in planning and development stage that for the purpose of completing the graded unit project the care of the stoma was selected as a clinical activity. I have selected a patient assessed her needs on the basis Maslow’s hierarchy of need and a plan was formulated. On the basis of the plan the care was implemented to this patient. Now I am intending to evaluate the efficacy of the whole project work that I have undertaken. Evaluation also helps in judging the overall out come of the patient but in this case I am much interested to evaluate the planning and development stage as a whole. The appropriateness of this project is assessed on the basis of patient’s outcome. The patient was prone to develop skin infection at the site of the stoma and irritation or rash could be aggravating so the care of the stoma was an important aspect to consider. In order to minimize the risk of infection at the site this activity was chosen. Particular concentration was given on hand hygiene as the Postnote (2005) states that probably the single most effective way of combating health care associated infections is to improve hygiene in healthcare settings, in particular hand hygiene. All the information regarding this patient kept confidential and it was disclosed to the members of the multidisciplinary team only as NMC (2004) states that you must protect confidential information. The Data Protection Act (1998) also declares that all the records about client which are filled will be seen as data, whether electronic or paper and individuals are given rights which include the right to confidentiality- that the information should not be accessible to unauthorized people. I planned and carried out this activity under the supervision of a staff nurse. Prior to carrying out this activity I had to gather information from various sources such as I had to spent lot times with the staff nurse, logged onto various educational and scientific websites, used library books and leaflets and also consulted the stoma care nurses for adequate information. During the activity I was told that there was a slight discrepancy in gathering articles which was pointed out by the nurse on duty. In later stages I rectified it.

10   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

I was interested to look on the types of stoma bag, its specification, and colour, how often it needs to be changed and also on the manufacturer’s guidance on how to use them. Since the patient was vulnerable and could not follow the instruction while I was instructing on how to take care of it by her but still she was happy to receive the instruction. The activity I planned was effective and it did work well. Effective communication with the patient was one of the main strength that helped me to carry out the activity smoothly. I preferred to use the non-verbal method of communication and I mostly used actions to convey messages to this patient as Kenworthy et al (2002) states that actions speak louder than words. The patient could easily understand me and co-operated well. Some times this patient was restless and did not feel like talking with me but she showed positive gestures. The plan was made on the basis of the patient’s assessment. For this reason the activity I planned well suited to her. The priorities of her needs were identified accordingly. On the other hand I needed support from other carers which initially I could not realize but during the activity I faced difficulty and then summoned assistance from them. Couple of the carers came and helped in turning the position of the client which facilitated the easy access to the site. In the planning stage it was quite difficult for me to gather information and assess the patient’s needs and to select suitable client for carrying out the activity. I was in indecisive state in planning stage. When I started planning the activity I made a rough description of the activity and showed it to the nurse on duty for further guidance and to check the accuracy of it. I was then asked by the nurse on duty to make some changes and to comply with the assessment guidelines. I was also asked to formulate the plan which will promote the independence of the client I chose. In the developing stage I was reminded by the nurse to use sliding and gliding sheets properly. I had to reflect on this area and then made further changes. In the future I will be able to carry out the any project work with much confidence. I will not repeat the same errors I which made here. Initially, I failed to organize properly but gradually with the assistance of my tutors and other staffs I could make it possible.

11   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

Now I am capable of working in a team. The way I have carried out this activity I could relate it to the Belbin’s team role theory as Belbin (1994) stated that team workers make helpful interventions to avert potential friction and enable difficult characters within the team to use their skills to positive ends; they tend to keep team spirit up and allow other members to contribute effectively. In order to collect the relevant information I had to revise all the units taught. I had to integrate information appropriately. I demonstrated evidence based practice by maintaining universal precaution of infection control like proper hand hygiene, use of personal protective equipments, disposal waste materials and also disinfecting the articles used. Due to existing disease condition this patient had low self esteem. I had to provide her psychological support. I talked with her and tried to divert her attention from monotonous feeling. I drew her attention towards music and videos. By the time I finish this project work I found her self esteem improved. Self-esteem is concerned with the person inner belief as Counseling service (2008) states that self-esteem reflects the intrinsic belief in the self, i.e. the overall opinion and value of a person. Low self esteem plays vital roles in person’s life. To find out the details of the disease process and its clinical manifestation I referred anatomy and physiology handouts, notes and many reference books from the library and this helped me to get the precise information needed. By undertaking this project work for Graded unit I have learned manifold aspects of making the project works done within a given time. Now I am confident enough to correlate theory into practice, do research work, find out data as well as back up my work with sufficient evidence, going into in-depth of the work and taking initiative steps and also working in an effective and well co-ordinated manner. I have evaluated the continuity of the project as a whole. I could successfully adhere to the appropriate code of practice. Through out this project I could maintain professional standards incompliance with the code of conduct mentioned in Nursing and Midwifery Council guidelines 2004 which states that you have a duty of care to your patients and clients who are entitled to receive safe and competent care. I was supervised by a nurse. The activity closely followed what was written in the plan. Indeed it was a safe practice done by me so no detrimental situation noted. 12   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

The supervision from the staff nurse helped me to gain confidence. In collaboration with her I could follow meticulous technique. Always I respected my patient’s autonomy and involved her in this activity. Since I am quite good in IT, word processing and browsing so I was benefited in searching online information quickly. I had to negotiate with other carers to carry out my project work within a given time in the placement areas. I also met the time scale of this project. I submitted both planning and development stages on the specific dates mentioned by my Graded unit lecturer. This shows that I am much aware of the times scale for this project. By undertaking this project I have gained confidence and my self-esteem improved. I followed the instruction of my lecturer while I intended to organize this project. I was positive, showed willingness to learn from the carers and staff nurses and I also attended couple of training conducted in this care home. Through this project one of the main pitfalls was initial organization of the whole project. At the beginning of the project I was perplexed and I thought it was not possible by me. I went on with perseverance and finally made it. The encouragement from my mentor and nurses where of great help for me. Now I am capable of undertaking any project of this kind. I learned to organize the project work properly, outline the plan and putting the plan into action. I could gather information in relation to the projects. In future if I am required to do a project I would probably gather precise information. In this project at times I got drifted away but this will not happen in the future project. I applied the knowledge gained in all the units and this project work gave me positive feed back. I gained knowledge on many areas such as disease condition of this patient, referencing accurately for research work and discussing with other members on issues requiring improvement to make a good project work. In conclusion, an effective patient care strategy was demonstrated by me while the care was being given to this patient. Working in collaboration with the multidisciplinary team was the most interesting aspect of this project. I could take own initiative to implement the care. Planning the brief overview of the project, discussing it with the patient and interviewing her directly were another interesting aspect which I enjoyed.This project helped me to acquire evidence based learning resources. It also required me to review all the units of health care topics I was taught.

13   

 

HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

Whole project was done on the basis of holistic approach, in turn which made all the needs of this patient. It required integrity, the knowledge and understanding as a whole. Reflecting on this project work I could state that I learned the skills to undertake such activity in future. I would be mentally prepared to do it without excessive straining for gathering information. In few occasions I missed out using sliding and gliding sheets, which I was not expected to do. In future when I undertake this kind of projects I will not do the same mistakes I did here.

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HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

REFERENCES

Belbin’s Team Role Theory [online] 1994, London; available on: www.srds.co.uk and accessed on April 23rd 2008. Burke CA (2003) Colon Cancer, London [online] available on:www.coloncancer.about.com accessed on March 3rd 2008 Health and Safety Act 2008 London [online] available on www.healthandsafety.co.uk and accessed on February 27th 2008. Kenworthy N, Snowley G, Gilling C (2002): Common Foundation Studies in Nursing 3rd ed.Edinburugh: Churchill Livingstone. p. 207,258,260,411, 453, NMC code of professional conduct: standards for conduct, performance and ethics (Nursing & Midwifery Council) London, p.3, 15 Occupational Therapy Training [online] 2007, London; available on: www.otdirect.co.uk and accessed on April 25th 2008. Postnote (2005) Infection control in health care setting London. [Online]: available www.parliament.uk [accessed on March 25th 2008] The Royal Borough of Kingston and Chelsea 2008, London. [Online]: available on www.rbkc.gov.ukand accessed on March 2nd 2008. Tortora GJ, Grabowski SR (1996): Principles of Anatomy and Physiology 1st ed. Biological Sciences Text Books, Inc. and Sandra Renolds Grabowski. p.793, 794, 1051 Warwick Counseling Service, London (Online): available on www.warwick.ac.uk [accessed on May 19th, 2008]

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HNC HEALTH CARE-GRADED UNIT   

By: M.Dass

Special Note from the desk of the Writer:

This task is entirely based on the Higher National Certificate in Health Care Module. It is kindly requested to the readers to view it as a sample of assignment only. Please do not copy any of its components. However, its materials can be used for referencing other assignments. Comments and suggestions are cordially welcomed. A very special token of thanks to you all for going through this research work.

Motilal Dass Registered Nurse (India) HNC Health Care (Scotland) E-mail: [email protected]

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