NHS constitution consists of rights of patients, publicand health professionals (Department of health, 2015). The principles within NHSconstitution was written based on the values of the NHS to improve health andwellbeing. NHS constitution states that these principles were written to help”ensure that the NHS operates fairly and effectively”. (DH, 2015). Theseprinciples are there to enhance the care given to patients as well as improvehealth and wellbeing (DH, 2015). One principle in the NHS constitution states”patients will be at the heart of everything the NHS does”.
This means thatpatients will always come first. If any complaints from patients regarding NHSservices, these must be dealt with effectively for NHS services to developfurther which can improve the quality of care the patient receives (Nursing andMidwifery council, 2015). Furthermore, theNMC code sees prioritising people very important.
Ethics can be kept by givinginformed choices on their own healthcare decisions for example patients havethe right to either accept or refuse treatment or care. This would empower themto have the freedom to choose. It is crucial that the patient’s choice isrespected (NMC, 2015). Overall, every individual is different and the NHSconstitution mainly will focus on meeting patients’ needs to provide withperson-centred care. Care would still be holistic and person centres when thepatient may lack capacity or is unconscious.
In this case, decisions would bedone in their best interest (Mental capacity act, 2005). Example in MOOCscenario (MOOC ethical principles in maternal care), where poor quality carewas delivered to pregnant women who wanted a home birth however due to highBMI, her request was declined by the consultant. The pregnant women didn’t feelcared for as their thoughts and feelings were ignored resulting in poor qualitycare.
A better way to approach this situation would be to discuss with thepatient about their needs, the option available to them and supporting theirchoice give a better birth delivery. Furthermore,care needs and choices of the patient must be focused on and religion, gender,age, disability and culture must be taken into consideration (Royal College ofNursing, 2015). Focusing on individuals can show good care because theirindividual differences are respected (RCN, 2017). For example, Food preferenceswill be different for every individual and this may be due to religion as somereligions don’t allow people to eat meat. Their preferences should be respectedand the care needs should be provided. One main challenges in the NHS is the ageing population (Garza,2016). Ageingpopulation means more demand for care and it questions how care can be given toan ageing population when there are not many young people to give that care.
Staffinglevels is an issue within healthcare because it can lead to poor patient carewhich has been noted down in the Francis report as one of the problems (Francisreport, 2013). Low staffing level can cause harm to patients as it can meancare is left unfinished for example not being able to complete health recordsor give medications on time. Uncompassionate care could result in health careerror (Geraghty, oliver and lauva, 2016). Francis report is an example of poorquality care as a result of no compassion, dignity or respect for patient’s dueto low staffing levels.
It reports the failure of helping patients to the toilet,providing patients with nutrition, failed to keep patient’s hygiene by notgiving them baths and as a result, patients felt ignored and ashamed (Francis report,2013).The 6C’s (Care, compassion, competence, communication, courage and commitment)in nursing was published within the compassion in practice: our vision andstrategy to improve care provided to patients. It was published due to thepoor-quality care provided in mid Staffordshire NHS trust foundation (NHSEngland, 2016). Cumming and Bennett (2012) states “compassion is how care isgiven” (DH,2012). In this situation to give compassion, staffs need to feelempathy and understand what it is like to be in their state (Nouewn et al1982). It is emotion that the person feels when someone is suffering which canurge them to want to help (Goetz et al, 2010). Help can be provided by givingphysical or emotional support for example helping feed patients or listeningand responding to the patient (Ramage et al, 2014).
Example in scenario (MOOC)where a 98 years old elderly with dementia believe they are 70 years old andkeeps searching for their mother. It is unethical to lie to a person becausetrust is broken (Kitwood, 1997) and NMC, 2008 states nurses to “be open andhonest, act with integrity and uphold the reputation of your profession”.However, by empathizing with others and understanding how the elderly mightfeel, not telling the truth might be the right thing to do. Instead atherapeutic lie can be used to avoid challenging behaviours but also decreasestheir distress (James et al, 2006; Culley et al, 2013). Communication involves 2 or more individualssharing information to each other and this can be by verbal communication aswell as non-verbal communication like facial expressions (DH, 2010). “Hello, myname, is…” campaign encourages the importance of introduction which is helpprovide compassionate care and build a relationship (Granger, 2014). Effectivecommunication about the patient’s needs and what treatment plan they want canhelp to begin a trusting relationship. It will help patients gain a sense ofbelonging and doesn’t make them feel helpless (Peplau, 1952).
Patient’sexperience is therefore increased by effective communication as patients feelas though they are in control when making decisions and so feel valued when havinga discussion and having someone listen to them (NICE, 2012). A good body posture can help show thatstaffs are listening (Egan 1982, cited in Burnard & Gill 2008). Bylistening, Staffs are able to show that they care and are able to offer abetter treatment plain suitable for them in terms of holistic care. In the MOOCscenario, where a woman was brought into A&E under mental health actbecause she had tried to cut herself. Food and drinks (physical care) wereasked but not provided for her as staffs were too busy and the carerresponsible for her had to do an assessment with another patient.
The womanmight have felt anxious. A better-quality care can be given by having goodcommunication which helps the staff to understand their psychological wellbeingas well as providing her with food and drink can make her feel valued and atease. Moreover, Health care profession should be aware of communicationbarriers which may be due to the patient’s disability and physical health (Baillie, L. (2017).
For example, hearing impairment canaffect the patient’s ability to communicate because information is not beingreceived by the patient and so communication impacts on care delivery. Bytaking this to account, different types of communication should be used todeliver information and better-quality care (NMC, 2015). This can help to makepatients feel respected, safe and less anxious (RCN, 2015). Moreover, communicatinginformation such as asking for consent can be difficult when the person lackscapacity either due to learning disabilities or mental heal issues.
In thiscase, decisions would be done in their best interest (MCA,2005). Staffs must keep confidentiality and privacy. This meansprotecting patient’s personal health information and ensuring that consent isasked before information is shared to others (DH, 2003). Article 8 in the (Human rights act, 1998) states”right to respect for private and family life” meaning patients have right toprivacy and confidentiality of their health information. It is important forhealth care professions to protect information and respect patient’s privacybecause it maintains patient’s dignity (RCN 2008, p.
8). Dignity can make individual’s feelconfident and in control (RCN, 2008). dignity can be kept by respectingpatient’s privacy for example knocking on door before entering their room orclosing curtains when assisting them with changing clothes (RCN (2008). The confidentiality code of practice can helpto gain trust from patients which is crucial for safe and effective care (Healthand social care information centre, 2013).
Protectinginformation can support patients to feel more comfortable talking about theirhealth problems therefore, health care professions can provide with highquality care by giving effective treatment to improve their health. Whereas, alack of confidentiality may prevent patients from conveying crucial information(Slowther and Kleinman 2008). It is important for staffs to ask consent frompatients to either disclose information of not which is needed to give carewhich helps to empower service users. Example in MOOC scenario, the child’sthoughts and rights were not taken into account when decision making.
There wasno respect for dignity for child as their feelings were neglected. In thissituation, using a child centred approach to understand the child’s needs. Everyonehas the right access to health services regardless of their race, gender,religion, age or disability.
These characteristics are protected under theequality act. This influences good care because it safeguards individuals fromdiscrimination and every person is treated fairly for justice (Equalityact,2010). Also linking this to ethical principles the child must have theright to autonomy. What the medication the child is taking and what the right amountof dosage should be explained to the parents. In terms of beneficence andnon-maleficence, staffs can prevent harm and help the child by negotiating withthe parent. The parents had disagreed on decreasing dosage so there is concernsfor the child’s harm.