Nursing Communication

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A discussion took place with Nick, whose name has been changed to respect confidentiality as enshrined in The Code (Nursing and Midwifery Council (NMC) 2008). Nick, a gentleman, aged 51, was admitted to hospital with vomiting and acute abdominal pain. Nick’s experience of admission, examination and testing were mainly positive. Nick’s postoperative experiences were extremely negative. Most aspects of The Code (NMC 2008) were observed on admittance nonetheless, it appears that little of The Code was applied postoperatively. This essay will examine the positive and negative aspects of Nick’s hospital care and employ psychosocial models to critique Nick’s care.

On admission, Nick felt valued and confident when his doctor formatted appropriate questions for his current concern and established Nick’s prior history. Nonetheless, as suggested by Heritage & Maynard (2008), Nick felt too much time was spent in discussion of a prior chronic condition. Conversely, Nick appreciated the need for the doctor to rule out a possible re-occurrence of a previous condition. As required by the NMC (2008) Nick gave informed consent prior to any testing or examination; Nick’s dignity was preserved as described by Cass et al. (2008) and he felt reassured throughout. Nick was diagnosed with acute appendicitis and admitted to a ward to await surgery. Peate (2008) suggests once a diagnosis has been reached it is important for analgesia to be provided. The doctor responded to Nick’s needs and provided appropriate antiemetic and analgesic medication.

Nick awoke postoperatively in considerable pain and discomfort and very thirsty. Cooper et al. (2004) consider that fundamental aspects to patient care are the relief of pain and suffering, yet Nick found himself lying alone on a trolley in a corridor, in considerable pain and very thirsty. Nursing staff were not evident and no bell was within reach. A drip was attached to Nick’s left arm, and there were no curtains or screens surrounding him. Denied an area to safely provide privacy (Department of Health 2003) Nick felt undervalued. Nick removed his drip and walked in a backless gown to find help. Nick found a bell, rang it and waited for over an hour before a nurse arrived. When a nurse appeared, Nick asked for some water and expressed concern about his pain. The nurse returned Nick to his trolley, but did not address the potential harm of not re-attaching his drip (NMC 2008). The nurse checked the chart and told Nick he could have 2 paracetamol every 4 hours. Nick requested stronger pain relief; the nurse told Nick that this would require a doctor. Nick believed the nurse left him, in order to consult a doctor to prescribe more medication and to bring some water to ease Nick’s thirst. Nick felt reassured that his needs would soon be met.

Making the care of people your first concern is a prerequisite for a nurse (NMC 2008). After surgery, Nick’s primary needs for thirst and pain relief remained unmet. Because the nurse failed to return after a further 1.5 hours, Nick took his care and welfare into his own hands. Nick discovered the room he had been admitted into was now occupied, but his clothing remained in the locker by the patient’s bed, so Nick retrieved his clothing, got dressed and left the hospital. As a direct result of Nick’s failure to receive water or pain relief, Thompson (2003) citing Charon et al.(1996) argues that Nick’s loss of trust in the hospital, his abandonment of his treatment, his questioning of the nurse’s integrity and his walking 6 miles home, in the early hours, endangering his recovery, is evidence of Nick’s underlying values, such as a desire for information, personal control, and recognition of individuality.

Whilst Nick’s experience of postoperative care did not match appropriate NMC (2008) standards, this may have been due to other considerations; however Nick described himself as “meat on a slab”. Postoperatively, Nick did not feel as...
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