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Ensuring we get the fundamentals right Under the revised NMC Code every nurse must put patients first and deliver care with compassion, as Erin Dean reports The revised code of practice from the Nursing and Midwifery Council includes a section directly influenced by the high-profile reports on care failures that have cast a harsh light on the nursing profession in recent years. This part of the new Code, which came into effect on March 31, emphasises that patients must be treated with compassion, dignity and kindness. Called Prioritising People, it focuses on the fundamentals of
care, which include nutrition, hydration and bladder and bowel care. It stresses that patients must be kept clean and have adequate access to nutrition and hydration, and states that those who need it should be given help to eat and drink. It also says nurses and midwives must deliver any treatment or care without delay, and must work in partnership with patients. The NMC admits this section of the Code was influenced by the
recommendations of Sir Robert Francis, who headed the public inquiry into care failings at Mid Staffordshire NHS Foundation Trust, and Baroness Neuberger, who reviewed end of life care. During the consultation on the draft version, the frequent use of the phrase ‘you must’, as well as the detailed focus on the fundamentals of care, attracted some fierce criticism and claims it was patronising. But the firm language remains.
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SUMMARY
Nurses and midwives need to think carefully about what these changes mean for their practice. The NMC’s revalidation model demands that every registrant consider their practice against the standards of the Code, and that they reflect on feedback from peers, patients and others. The first nurses and midwives to be affected will be those whose registration period ends in April 2016. They will have until April 1 to submit their revalidation applications to enable them to renew their registration. NMC director of continued practice Katerina Kolyva suggests that the fundamentals of care is a good area for reflection for nurses in a range of settings and roles, including those who are not routinely involved in hands-on care. ‘It could be an instance where they have made sure that the fundamentals of care have been observed effectively, or where they have challenged and raised concerns,’ she says. ‘For nurses in management, it could mean how they have improved the environment for delivering fundamentals of care, such as a new policy to improve hydration and nutrition. It could also be research.’ Despite the controversy over the fundamentals of care, most registrants who responded to the NMC consultation on the draft version did support it; in an online poll 83% of nurses and almost 90% of midwives welcomed the Prioritising People section. More than 80% of nurses and midwives thought it would be fairly or very easy to apply this section to their practice, suggesting they believe that they already meet the criteria.
Prioritising People The five statements from the Prioritising People section in the revised Code are:
1
Treat people as individuals and uphold their dignity: to do this nurses must deliver the fundamentals of care, and act with compassion, dignity and kindness.
2
Listen to people and respond to their preferences and concerns: nurses must work in partnership with patients and ensure they properly empower patients to be involved with their care.
3
Make sure that people’s physical, social and psychological needs are assessed and responded to: promote health and wellbeing and provide compassionate end of life care.
4
Act in the best interests of people at all times: respect a person’s right to refuse treatment and gain informed consent before taking any action.
5
Respect people’s right to privacy and confidentiality: respect a person’s right to privacy in all aspects of their care and after their death.
The Prioritising People section of the revised NMC Code gives specific instructions on the fundamentals of care, such as helping patients to eat and drink and keeping them clean. These can be good areas for reflection, even for nurses who are not in front line roles, according to NMC director of continued practice Katerina Kolyva. Author Erin Dean is a freelance journalist
London South Bank University chair of healthcare and workforce modelling Alison Leary is concerned the wording of the section does not reflect the skill involved in giving good, compassionate care. ‘There is no acknowledgement that these fundamentals require various levels of complexity or expertise, and that this requires training and knowledge,’ she says. ‘For example, meeting a patient’s nutritional needs is a skilled task. ‘The fundamentals of care also appear to be limited to physical care and don’t include psycho-social care. There is a lot in this section about responding compassionately, but virtually nothing about knowledge or expertise.’ RCN head of policy Howard Catton says that while the new Code is an improvement on the draft version, it remains a fairly lengthy and strikingly prescriptive document. ‘This Code is a product of its time,’ he says. ‘Because of the difficult period nursing has gone
through, it feels more prescriptive and plays to the public confidence issue. Codes for other professions tend to be less prescriptive and, rather than telling people what to do, trust professions to adhere.’ He adds that the final version of Prioritising People retains a ‘bias’ towards direct clinical practice in acute settings. ‘People in other settings are going to reflect on how relevant it is to their work.’ The omission of spirituality issues from the Code has also caused concern for some nurses. Staffordshire University professor in dignity of care for older people Wilf McSherry considers this a ‘grave oversight’.
Right choices
Wendy Mashlan, lead advance nurse practitioner for care of older people – secondary medicine at the Abertawe Bro Morgannwg University Health Board, south Wales, is among those nurses who believe the NMC has got it right. Her health board was the subject of an independent review in 2014, which found a series of failings and poor professional behaviour in the care of frail and older people. The Trusted to Care review heard that older patients were told to go to the toilet in their beds, medicines had been recorded as given when they were not, and staff tolerated dangerous practice. ‘We now have the See It, Say It approach, telling staff not to be afraid to raise concerns if they think there is poor dignity in care or compassion,’ says Ms Mashlan. ‘This has made a big difference.’ She believes the new Code will support nurses in their efforts to make care more compassionate. ‘The inclusion on fundamentals of care in the Code is welcome. We can easily make reference to it and everyone has to abide by it. We can say as nurses, this is in our code of conduct, so we must do it’ NS This is the second article in our series on the Code and revalidation. The next article, on practising effectively, will be published on April 15. To access all of RCNi’s resources on revalidation go to rcni.com/workplace/ revalidation
NURSING aprilNo8 other :: vol uses 29 no 32 :: permission. 2015 21 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 03, 2015. For personal use only. without Copyright © 2015 RCNi Ltd. All rights reserved.
Ensuring we get the fundamentals right Under the revised NMC Code every nurse must put patients first and deliver care with compassion, as Erin Dean reports The revised code of practice from the Nursing and Midwifery Council includes a section directly influenced by the high-profile reports on care failures that have cast a harsh light on the nursing profession in recent years. This part of the new Code, which came into effect on March 31, emphasises that patients must be treated with compassion, dignity and kindness. Called Prioritising People, it focuses on the fundamentals of
care, which include nutrition, hydration and bladder and bowel care. It stresses that patients must be kept clean and have adequate access to nutrition and hydration, and states that those who need it should be given help to eat and drink. It also says nurses and midwives must deliver any treatment or care without delay, and must work in partnership with patients. The NMC admits this section of the Code was influenced by the
recommendations of Sir Robert Francis, who headed the public inquiry into care failings at Mid Staffordshire NHS Foundation Trust, and Baroness Neuberger, who reviewed end of life care. During the consultation on the draft version, the frequent use of the phrase ‘you must’, as well as the detailed focus on the fundamentals of care, attracted some fierce criticism and claims it was patronising. But the firm language remains.
20 april 8 :: vol from 29 noRCNi.com 32 :: 2015 STANDARD Downloaded by ${individualUser.displayName} on Nov 03, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
SUMMARY
Nurses and midwives need to think carefully about what these changes mean for their practice. The NMC’s revalidation model demands that every registrant consider their practice against the standards of the Code, and that they reflect on feedback from peers, patients and others. The first nurses and midwives to be affected will be those whose registration period ends in April 2016. They will have until April 1 to submit their revalidation applications to enable them to renew their registration. NMC director of continued practice Katerina Kolyva suggests that the fundamentals of care is a good area for reflection for nurses in a range of settings and roles, including those who are not routinely involved in hands-on care. ‘It could be an instance where they have made sure that the fundamentals of care have been observed effectively, or where they have challenged and raised concerns,’ she says. ‘For nurses in management, it could mean how they have improved the environment for delivering fundamentals of care, such as a new policy to improve hydration and nutrition. It could also be research.’ Despite the controversy over the fundamentals of care, most registrants who responded to the NMC consultation on the draft version did support it; in an online poll 83% of nurses and almost 90% of midwives welcomed the Prioritising People section. More than 80% of nurses and midwives thought it would be fairly or very easy to apply this section to their practice, suggesting they believe that they already meet the criteria.
Prioritising People The five statements from the Prioritising People section in the revised Code are:
1
Treat people as individuals and uphold their dignity: to do this nurses must deliver the fundamentals of care, and act with compassion, dignity and kindness.
2
Listen to people and respond to their preferences and concerns: nurses must work in partnership with patients and ensure they properly empower patients to be involved with their care.
3
Make sure that people’s physical, social and psychological needs are assessed and responded to: promote health and wellbeing and provide compassionate end of life care.
4
Act in the best interests of people at all times: respect a person’s right to refuse treatment and gain informed consent before taking any action.
5
Respect people’s right to privacy and confidentiality: respect a person’s right to privacy in all aspects of their care and after their death.
The Prioritising People section of the revised NMC Code gives specific instructions on the fundamentals of care, such as helping patients to eat and drink and keeping them clean. These can be good areas for reflection, even for nurses who are not in front line roles, according to NMC director of continued practice Katerina Kolyva. Author Erin Dean is a freelance journalist
London South Bank University chair of healthcare and workforce modelling Alison Leary is concerned the wording of the section does not reflect the skill involved in giving good, compassionate care. ‘There is no acknowledgement that these fundamentals require various levels of complexity or expertise, and that this requires training and knowledge,’ she says. ‘For example, meeting a patient’s nutritional needs is a skilled task. ‘The fundamentals of care also appear to be limited to physical care and don’t include psycho-social care. There is a lot in this section about responding compassionately, but virtually nothing about knowledge or expertise.’ RCN head of policy Howard Catton says that while the new Code is an improvement on the draft version, it remains a fairly lengthy and strikingly prescriptive document. ‘This Code is a product of its time,’ he says. ‘Because of the difficult period nursing has gone
through, it feels more prescriptive and plays to the public confidence issue. Codes for other professions tend to be less prescriptive and, rather than telling people what to do, trust professions to adhere.’ He adds that the final version of Prioritising People retains a ‘bias’ towards direct clinical practice in acute settings. ‘People in other settings are going to reflect on how relevant it is to their work.’ The omission of spirituality issues from the Code has also caused concern for some nurses. Staffordshire University professor in dignity of care for older people Wilf McSherry considers this a ‘grave oversight’.
Right choices
Wendy Mashlan, lead advance nurse practitioner for care of older people – secondary medicine at the Abertawe Bro Morgannwg University Health Board, south Wales, is among those nurses who believe the NMC has got it right. Her health board was the subject of an independent review in 2014, which found a series of failings and poor professional behaviour in the care of frail and older people. The Trusted to Care review heard that older patients were told to go to the toilet in their beds, medicines had been recorded as given when they were not, and staff tolerated dangerous practice. ‘We now have the See It, Say It approach, telling staff not to be afraid to raise concerns if they think there is poor dignity in care or compassion,’ says Ms Mashlan. ‘This has made a big difference.’ She believes the new Code will support nurses in their efforts to make care more compassionate. ‘The inclusion on fundamentals of care in the Code is welcome. We can easily make reference to it and everyone has to abide by it. We can say as nurses, this is in our code of conduct, so we must do it’ NS This is the second article in our series on the Code and revalidation. The next article, on practising effectively, will be published on April 15. To access all of RCNi’s resources on revalidation go to rcni.com/workplace/ revalidation
NURSING aprilNo8 other :: vol uses 29 no 32 :: permission. 2015 21 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 03, 2015. For personal use only. without Copyright © 2015 RCNi Ltd. All rights reserved.
