Urgent_and_Unscheduled_Care

I will initially address the definition and context of Urgent and Unscheduled care. It has been discussed by Norris (2008) that unscheduled care or urgent care covers unplanned or unpredictable care this ranges from patient attendance at Accident and Emergency departments, walk-in centres, or minor injuries units; urgent telephone advice sought in and out of hours; emergency hospital admissions; paramedic services; and emergency mental health or social care provision. (Norris, 2008) With regard to the scenario Susan has attended the minor injuries unit with an urgent care need. It is important that the nurse caring for Susan can provide safe, high quality, appropriately supervised and cost efficient care for her (NHS, 2009) It will now be considered as to whether the scenario falls within the parameters. This scenario is a common occurrence within the United Kingdom and is relevant within today’s setting, the NHS state that in England, an estimated 225,000 people a year attend a minor injury unit or accident and emergency (A&E) department to seek treatment for a dog bite. (2010) consequently it is a relevant urgent and unscheduled care situation. The above scenario allows me to analyse and address many key aspects of urgent and unscheduled care, it is important as a nurse to look at the patient as a whole (NMC, 2010). So with regard to Susan her aspect of Pain management, the wound itself, the shock of the incident and also with regard to her daughter. The social aspect must be also be considered with regard to the safety of the child and mother having contact with the dog again all of these point must be taken into hand whilst the nurse is caring for Susan. The role of the nurse will be Identified and evaluated with regard to Susan’s care. As previously stated it is important that the nurse caring for Susan must provide safe, high quality, appropriately supervised and cost efficient care for her (NHS, 2009). NMC Code of Conduct is crucial in the management of patients, ensuring that you are following guidelines and correct policies and procedures. ‘You must keep your colleagues informed when you are sharing the care of others, and you must work with colleagues to monitor the quality of your work and maintain the safety of those in your care’ (NMC, 2010). This is important for a student to recognise that they must liaise with colleges such as their mentor before carrying out any procedure or documentation. Susan’s wound must be treated using the correct policy and procedures for that particular hospital’s trust. It is important for the nurse to develop and professional relationship with Susan and her daughter maintaining dignity and confidentiality at all times (NMC, 2010) The nurse must establish how the wound occurred, any risks that may be apparent to her and also any previous medical history that may be relevant whilst treating Susan. This could be any blood disorders that could be infectious. Promoting well being not only for the patient but also that of other health care professionals. It must be established the type of dog that caused the puncture wound and also if Susan has had an up to date immunisation history. ‘one possible complication is a bacterial infection that spreads through the bloodstream, known as sepsis.’ (NHS, 2010) Also any allergies that are known must be identified as quickly as possible so treatment can be started. Once the nurse caring for Susan has established how the situation occurred, then Susan’s pain can be managed. Susan’s pain can be assessed with regard to the World Health Organisations (WHO) analgesic ladder (Browman, 1995) this is a 3 step pain ladder and depending on severity of pain it gives guidance on type of analgesia to be prescribed. Susan and her daughter have both been described as distressed. This with regard to Susan could indicate shock. Therefore it is important for the nurse to regularly monitor Susan for signs of shock. Edwards (2001) defines shock as a condition where the cardiovascular system fails to perfuse the body tissues adequately, bringing about widespread disruption of cellular metabolism. It has been previously mentioned that Susan maybe at risk of Sepsis which can lead to Septic shock caused by an infection therefore it is crucial hat Susan is given the correct antibiotics to ensure that this does not happen. ‘Focusing on the provision of high quality patient care and experience is important to all staff. Timely handover of patients is also a central aspect of patient experience of emergency care and it is vital to ensure that all staff, irrespective of the organisation, work together to ensure a positive patient experience.’ (DOH, 2008) . Looking at the scenario it is important to take into consideration the vulnerability of Susan and her daughter. The nurse must also look at the risk of both the mother and daughter and also to whether this could occur again if kept exposed to the dog in question. Safeguarding has then got to be addressed with regard not only to Susan and her daughter welfare but also that of the surrounding community, the question must be asked if the dog can do this to Susan then is it safe for the dog to be around people. Health services have a duty to safeguard all patients but provide additional measures for patients who are less able to protect themselves from harm or abuse. A very new document from the DOH (March, 2011) examines the points that safeguarding adults covers a spectrum of activity from prevention through to multi agency responses where harm and abuse occurs. Multi agency procedures apply where there is concern of neglect, harm or abuse to a patient defined under No Secrets guidance as ‘vulnerable’. Safeguarding adults is an integral part of patient care. Duties to safeguard patients are required by professional regulators, service regulators and supported in law. A vulnerable person is usually suggesting to be that of someone who is either mentally, or physically ill however this is not always the case. In fact anybody can be vulnerable at some point in their lives. ‘Everybody working with women and children should be alert to the frequent interrelationship between domestic abuse and the abuse and neglect of children’ (NSF children young people and maternity services, 2004) this extract from the NSF framework promotes the point that both Susan and her daughter should be considered vulnerable or at risk from the dog. They have both been stated as ‘distressed’ and maybe suffering from shock. Treatment of this is addressed within the assignment. Moving on it is important to identify risks for your patient / significant others. Morgan (2004) states that the likelihood of an event happening with potentially harmful or beneficial outcome for self and others, this supports the view that with Susan’s case the event has caused a harmful effect and must be prevented from happening again. As previously described Susan is at risk of septic shock from a wound infection. The other significant risk is that of the Dog that caused the injury initially. It would be important for the nurse to find out the nature of the attack, whether the dog was provoked for example and then to inform the correct authorities of the attack. There has been much stipulation in the media recently over certain breeds of dogs and attacks on small children, as Susan’s daughter is in this age group, this issue must be addressed. According to the NMC guide lines nurses must, act without delay if you believe that you, a colleague or anyone else may be putting someone at risk. You must inform someone in authority if you experience problems that prevent you working within this code or other nationally agreed standards and also the nurse must report concerns in writing if problems in the environment of care are putting people at risk (NMC, 2010) It is crucial to consider how can risk be managed / reduced. Although risk is often considered a negative point with regard to behaviour and hospital procedure it can also be referred to a positive risk. Morgan (2004) expresses that positive risk taking is about collaborative working, which promotes my previous point of multidisciplinary working with regard to Susan’s case. It is based on the establishment of trusting relationships whereby service users can learn from experiences, based on taking chances. Relating to Susan she must be educated to not take risks with the dog that bit her as it could be her daughter who is injured in the future. It is about understanding the consequences of different courses of action. Also knowing the support is instantly available if things begin to go wrong, so Susan must be informed of services available to her with regard to risk and vulnerability. This could be informing her of department of Health documents or even support groups for vulnerable adults. It must be delivered in a sensitive way as Susan may not consider the dog as a risk to her daughter and may take offence at the suggestion of informing the authorities. ‘No Secrets’ (2000) is a document released from the Department of Health that promotes safeguarding adults in vulnerable situations it is important for the nurse in the care of Susan to report any concerns to other members of the team and also to document any concerns. ‘The aim of 'No Secrets' is to ensure that key local agencies, particularly but not solely health, social services and the police, are able to work together to protect vulnerable adults from abuse, by developing local multi-agency policies and procedures.’ (DOH, 2000) The factors that influence the decision making process will now be addressed, The focus of a nurse’s judgement and decision making relates to issues such as Cioffi (2000) suggests that identifying clinical deterioration, assessment of the patients current and previous condition, prediction of events. With regard to Susan I have previously stated that there must be an initial assessment of previous medical history and also that of her current condition. Although information processing is a crucial part of a nurse’s role whilst caring for Susan, the nurse must also rely on intuition. It is suggested by Benner (1984) that this approach of intuition distinguishes the novice from the expert, the expert no longer relying on analytical principles to connect understanding to appropriate action. As a student nurse it must be recognised that this is not possible and must be overseen by a mentor whilst caring for Susan. A student will not have the knowledge or the experience to go with their intuition but may raise concerns to a senior member of their team; this adheres to NMC code (2010) With regard to the scenario it is important for me to address and include relevant theory, Cognitive Continuum theory is a theory that acknowledges the differences between information processing and intuition. It suggests that reasoning is neither purely intuitive nor purely analytical but it is located somewhere between these two points. The continuum ranges from intuition through to system judgement to analysis. (Cader, 2005) relating this back to the scenario of Susan the nurse caring for her must rely both on knowledge of dog bites and wound care but also on intuition, therefore it must be examined that Susan may not be vaccinated and also maybe prone to infections. This can be related back to the doctor for appropriate antibiotics to be prescribed, pre-empting future problems and admission. Another relevant theory that could be integrated into Susan’s care would be the Social Judgement theory, using Brunswick’s Lens Model (Thompson and Dowding, 2002). This is a way of examining information use between individuals in this case between the multidisciplinary team. It is a systematic approach to treatment. It also has propositional rules that are used to synthesise information. So for example in Susan’s case it would be used to estimate the likelihood of developing an infection using prior knowledge. This would be a valid form of argument that sets stage for judgement. Looking at the cleanliness of the wound would be a sound judgement as to risk of infection at a later date. It is stated within the scenario text that it was wrapped in a clean tea towel and is also bleeding. According to NHS guidelines (2010) the wound must be bled to prevent infection and also to be kept clean all of which has been carried out before admission to the minor injuries unit. There are significant current policies relating to Urgent and Unscheduled Care (UUC) many released by the Department of Health who oversee all of the health care policies within the United Kingdom, maintaining accuracy and best practice. With regard to the development of a nurse’s role within UUC the ‘changing Workforce Programme (2007) has helped to influence and create new role within healthcare. It promotes new ways of working, new professional roles being developed specifically those within an emergency care setting allowing an expansion of breadth and depth of knowledge of skills. It encourages professional boundaries to be broken down and allows team work to become effective. The Emergency Care Practitioner (ECP) Report (DOH, 2004) ‘Right skill, Right time, Right place’ illustrates the development of the ECP role in managing patients who require emergency unscheduled care. This report was developed from the Wanless report (2002) where it was identified that a review of the way care was delivered needed to be expanded upon leading to the opportunity for new roles to develop. These roles are that of a nurse practitioner, it allows a nurse lead approach where the nurse practitioner can assess prescribe and treat minor injuries and ailments. This allows the team of healthcare professionals to be utilised effectively and patient care to be kept to a high standard. These changes have allowed the development of UUC in such that a patient like Susan will be able to be seen and treated effectively with minimal waiting time and therefore prevents time for complications which could lead to admission such as infection. It also promotes staff moral and has allowed a nurse to further develop their role within the health care team. As a whole these new policies introduced will affect the National Health Service as a whole due to waiting times being decreased therefore hopefully preventing admissions and improving quality of care. Looking at the financial costs it will enable fewer hospital admissions if patients are able to be seen and treated in smaller units such as minor injuries units. It will allow Doctors to be free to deal with larger and more complex cases decreasing work load and allowing treatment to become more effective.