The aim of this assignment is to reflect upon The Nursing and Midwifery Council’s (NMC) video safeguarding vulnerable adults 1 & 2; Call Me Joe (NMC, 2010). I will be using Rolfe et. al’s (2001) reflective model ‘What, So What, and Now What’ to facilitate this reflection and to identify key areas of concern around Joe’s level of care and mental/physical wellbeing. I will be looking at issues surrounding the professional values attitudes and behaviours, safeguarding, communication, and social role valorisations (SRV) surrounding Joe.
I will also examine whether or not the treatment that Joe receives has had a negative impact on his human rights and mental wellbeing. I will be focusing on the lack of compassion, care and professionalism Joe receives from the nursing staff and how the lack or SRV has impacted on his standard of care, in order to facilitate this i will be looking at Wolfensberger 1998 SRV theory in order to ascertain whether or not Joe’s circumstances, and level of care have had a detrimental and negative effect on his wellbeing and determine what might be done to improve things.
I will conclude this with possible reasons and suggestions for improvement on the level of care based on the NMC guidelines and code of practice. I will be reflecting on how as my role as a student nurse can influence and change the standard of care that Joe receives. What? The standard of care in Nursing Homes have been a concern for many years, various reports and studies have been conducted over the years to ascertain areas of concern and failings. Nursing staff and Health care professionals have a duty of care to each and every resident and patient both vulnerable and able.
The study into Joes care raises concerns as to whether or not the NMC code of practice is followed and how deontology ethics impact and effect the consequentialism care overall. When looking over the NMC video safeguarding vulnerable adults 1, Call Me Joe (NMC,2010) it becomes apparent that he is not seen as a person but a number. The video began with the 2 nurses entering his room unannounced and with no introduction at 5:14am. They swiftly opened his curtains flooding his room with light and began the tasks almost on autopilot while chatting to each other about TV programmes from the previous night.
Joe begins to ask for his glasses but this request was ignored, the impact of this requested being ignored impacted on Joe which is evident later in the video when his breakfast was removed uneaten due to the fact he could not see it. The whole time that the nurses were dressing Joe there was no interaction or explanation as to what they are doing, nor was there a choice given about what Joe wanted to wear or if he wanted to even get up. Jo was rushed into his wheelchair by the staff without being washed, hair brushed and even his teeth cleaned.
In the 2nd video of Joe, he states that” you should have seen me as a young man. Quite a sharp dresser me, you know I’d come home after work, wash up, put on a good shirt and make sure my hair was always combed back. ” The fact that he is placed into his wheelchair without these desires met shows they are not adhering to his wants/needs and upholding his sense of pride. Once Joe was placed into his wheelchair his almost full catheter bag was placed on his lap while being taken down to the breakfast lounge in his dressing gown. Joe repeatedly asked several times for his glasses but this request was completely ignored.
Joe used to be mobile with the aid of a walker before moving into the care home and took pride in this, Joe feels like this is all he is now worth, he stated in the video” When I came in to begin with, I was still walking, with a frame but still … worst thing now is not being able to get to the bathroom on my own. Sometimes you know it gets too full and then it pulls. But you know at my age you expect things to start packing up, no point in complaining. It’s just the way things are” (NMC,2010). His liberty has been stripped from him in many ways subconsciously.
In the corridor the other members of staff ho passed Joe in the hallway completely blanked Joe and there was no interaction once again. Jo was taken to the breakfast lounge and seated alone looking unkempt and served his breakfast without any option of what he would like and without any choice while remarking “Here is your favourite’ (NMC,2010). Joe was unable to see his food to eat it and as a result his food was removed uneaten with the staff member belittling Joe, this was evident when she asked if he was not hungry and he replied he could not see the food to which she responded ‘Why did you leave them in your room you silly thing’ (NMC,2010).
The consequences of this would have a number of effects on Joe, Malnutrition from lack of food, Low self-esteem and a lack of self-worth. In the second NMC (2010) video call me Joe, he states that he would love a hot cuppa tea, fried eggs and a sausage sandwich, he states that when he arrived he filled in a form about what he likes to eat but everyday he is served porridge. Joe has family and a deceased wife Ella, he stated his daughter wanted him to come live with her but he feels like a burden, he has resigned himself to the fact that he deserves to be where he is as this is the best he will get, “I do think I am lucky to be here.
My daughter said ‘Come and live with us Dad’, but she’s got her own family to look after (NMC,2010) So What The basic care needs required for sustaining Joe’s life such as meals, drinks, clothing, bathing, warmth, shelter and medication are met. But when looking at Joe’s level of compassion, care and psychological wellbeing it is evident there is a big flaw in this area. Joe appears to be devalued as a person, his requests being ignored will have a massive impact on his sense of normalcy and value as a person.
According to the British Geriatric Society the fact the Joe is ignored and spoke over can be classified as elderly abuse. Psychological abuse can occur with shouting, swearing, frightening, blaming, humiliating or by ignoring and isolating. This can occur in any setting. (Bgs. org. uk, 2017) Wolfenberger states that Normalization and social role valuation is about changing that perception of people classed as a minority ( such s disabled and elderly) and providing the circumstances and opportunities that will allow them to partake in as normal day to day life as possible and be a part of society much the same as everyone else ( Wolfenberger, 1983). This is not happening with Joe, he is seen almost as a number/burden and his wants versus his needs are ignored throughout the video. Joe used to be an independent person who dressed smart and took great pride in his appearance but now he is resigned to the fact he has no need to be kept smart and have his hair combed as he has nowhere to go.
This is having an impact on his deprivation of liberty and freedom of expression. Joe has lost his identity and to a degree is lost, he lost his home, his wife, his belongings the very things that made him who he is have gone, when looking closer at the NMC 2010 Video it is apparent that does room is clinical and impersonal, he has one picture of his wife Ella. The rest ranging from the furniture, the fittings even the decor are stereotypical of a care home setting.
When looking into this issue across the board I saw an article which depicts ways to combat this sense of loss. (Smithe, 2002) states that by allowing seniors to bring in their memories, whether they are favourite furniture or pictures, you ultimately allow them to feel more at ease with the belongings that they feel the most comfortable with. Using these items can make anyone feel comfortable, seniors or not. When they have the things that they were surrounded with to begin with, they are more likely to adapt and feel comfortable in the new home.
When the nurses carried out there care at the start of the video they spoke over Joe as if he was not there, recently an inquiry was carried out by the Equality and Human Rights Commission into older people and human rights in care homes, one thing that came up was a scenario which almost mirrored the situation Joe was in with the care workers ignored him and acted as he was not there, talking about their TV shows from the previous night, the outcome of the enquiry regarding this similar scenario stated that, although this is a lack of respect for the dignity of the service user, it may ot be intentional, it still falls short of the standards of care required by Article 8. (Kelly and Innes, 2012)
It also fails to meet Outcome 1 which is a key component of the Care Quality Commission’s: Essential Standards of Quality and Safety which states that the dignity, privacy and independence of service users be maintained, that service users are enabled to make, or participate in making, decisions relating to their care or treatment and more importantly treat service users with consideration and respect. (Sutcliffe,2008).
When reflecting on all the evidence and information on this video it is apparent to me that a number of factors come into play that contribute to the overall failings. The staff appear to be working on auto-pilot, which could indicate they are to rushed to care. The staff meet Joes basic needs but the effects of their treatment towards him, devaluing him as a person has resulted in him feeling like a burden. The demeaning attitude he got from the care staff who removed his food would result in Joe’s confidence being lowered and his self worth void. What Now?
As a student nurse I have a duty of care and accountability for my actions and patients. In the scenario above I would need to raise these concerns to my mentor or the senior member of staff with the hopes that a review would be carried out and the level of care assessed. I would like to think that in an ideal world this would rectify the situation but if I still had a concern I would follow the NMC;s Public Concern Policy (Nmc. org. uk, 2017) which states “Where possible, you should raise any concern in the first instance with the person you are most directly accountable to.
If this is not possible or you feel it is not appropriate, there are a number of other people you can approach, namely: • The Assistant Director, Governance and Planning • The Chief Executive and Registrar • The Chair Council The consequences of this action will have both positive and negative effects, the best outcome would be the level of care for people like Joe would improve, the areas such as staffing and interaction would improve and things as a whole would be better. The downside to making a formal complaint could result in my feeling alienated from my colleagues.
To improve the situation and level of care that I give my patients one of the biggest things I feel would enable me to do this is reflection, I would take on board all areas of concerns that I have I’ve seen and do my best to make every contact count. Communication and interaction is a major part of care, the simple things can make a big difference to a patient and can help maintain independence. When under pressure and working short staffed it is apparent that the standards of care slip, this is something that I will need to be consciously aware of.
