Table of Contents

NAME: Babajide O. AdegboyeCOHORT: September 2017STUDENT ID: 16040364ASSIGNMENT: DOHNPThis essay aims to reflect on my clinical practice and roles in providing nursing care for a patient who had a long-term treatment of intravitreal injection following her diagnosis on age-related macular degeneration (AMD). It will demonstrate my critical understanding of the holistic impact of the patient’s health breakdown. It will further examine how issues were dealt with during and after patient care by the use of evidence-based approach. A critical discussion surrounding the issue of professional practice, ethics and law in relation to my chosen patient will be provided with the theory that will be related to practice and demonstrate the ability to facilitate dignity, safety and respect for my patient. Lastly, the impact and role of the wider health care team on the patient will be analysed and the benefits and challenges of a collaborative approach will be explored.For the purpose of this essay, I will be referring to my patient as Adun, her daughter as Feyi and my mentor as Vicky due to anonymity and confidentiality as outlined by the Nursing and Midwifery Council code of conduct (NMC, 2018). Adun is 65 years old widow who migrated from Nigeria to the UK at the age of 10 with her parent. She lost her parents 10 years ago and lost her husband a year after. She lives in a flat in the northwest of England on her own, she is a poet who enjoys writing poem and makes a living out of it. She has a daughter called Feyi who is her next of kin and permanently based in the southern part of England. Adun enjoys driving to the south once in a month to check on her daughter.Adun was referred by her optician to an eye hospital in the northwest of England whilst I was on spoke placement, following her complain about distorted vision, querying AMD and to commence intravitreal injection treatment if AMD was confirmed. There is currently no cure for AMD, however there is an effective treatment for it which is a routine administration of intravitreal injection to stop the eye from further deterioration (Bloch et al., 2012). The Royal College of Ophthalmologis (RCopth, 2009) has identified AMD as a painless eye disease with the ageing changes to the retina central area known as the macular, this condition leads to vision impairment. It may also cause a rapid reduction in vision or blindness if the affected patient does not seek an urgent medical treatment. The disease targets the central vision of the affected patients and prevent them from recognising faces, reading, driving and to perform other activities of life that involve the use of sight (NICE, 2018). People living with AMD are prone to anxiety, financial difficulty, depression, they are at risk of fall, having the tendency of withdrawing from social activities and reduction in their ability to care for others (Macular Society, 2016).On the first day of Adun in the hospital with possibility of commencing her intravitreal injection if AMD was confirmed, I went to the hospital reception to collect her to the consulting room where my mentor and I were to start her further diagnosis process and admission. Previous findings by Beasley (2011) shows that patient diagnosed with AMD usually have initial feelings of apprehension and anxiety mostly on the first day of their treatment, however establishing a therapeutic relationship by giving Adun a warm reception by smiling whilst walking her to the consulting room alleviated her fear and anxiousness. In as much Adun was not fully diagnosed at this stage with AMD, it could be argued that the same care pathway and the nursing care that is applicable to most vision related ailment which causes distorted vision could also be applicable to potential AMD patients or already diagnosed patient with AMD. According to Foulds et al (2015), having a therapeutic relationship with patients, integration of 6Cs and the NHS core value into practice will ensure nurses provide an appropriate care to their patients. Vicky introduced both of us to Adun and asked if I could participate in her nursing care. Taylor (2013) elaborated that nurses should be aware of the importance of consenting patients and confidentiality, as some patient’s personal information will be revealed in the process of admission.Moore (2006) established that having an eye to eye contact with patients create a connection and increases patient confidence in the care giving by nurses, this was displayed whilst I was asking Adun for her name, date of birth and address to ensure we had the right patient with the right identification for the communication of her identity to other health professionals/MDTs. At the stage of consultation with Adun, it was essential to provide a detailed information and communicate with her about AMD, Prognoses, assessment and what should be involved in her treatment for an upmost patient experience and a greater patient outcome. Houchins et al (2006) confirmed that communication and information required by older AMD patients (age 70 and above) may be different from the younger patients (age 69 and below). The vast majority of older patients experience difficulties in hearing and sometimes not able to comprehend information. However, in the case of Adun, she was able to understand and assimilate the information given to her by Vicky about the treatment pathway as effective communication to patient in ophthalmic settings remains one of the key mechanisms for patient satisfaction (Mozaffarieh et al., 2004).For nurses to meet up with the holistic care and needs of individual patient, Cumming et al (2015) noted that by establishing a further discussion with patients and asking them what matters to them, how they feel, and their family matters to them, also being attentive to their response goes a long way in a positive manner to their care experience. In other words, not being compassionate with patients can make them feel devalued and not having emotional support as stated by Matiti and Bramley (2014). Being compassionate is related to showing respect and protecting patients’ dignity. Also, carers and relatives need to be treated with sensitivity and kindness (Haines, 2013).Research carried out previously by Suhonen et al (2012) shows that interaction between patients and their caregiver is essential for satisfaction of patient with the care they receive. Edvardsson (2010) noted that patient centred care is characterised as a partnership between professionals and their patients. This implies that nurses have the responsibility to listen to their patients and make an adjustment to their care and treatment to meet their individual needs (Slater 2006, Hudon et al., 2012). According to Slater (2006), patient centred care enables them the best possible condition to make choices in regard to their health. In Adun’s situation, the confirmation of her AMD diagnosis created an avenue for nurses responsible for her care to see her on a several occasion during her treatment period, which therefore gave an ample chance to implement and carry out her centred care. Having established a therapeutic relationship with Adun whilst in the consultation room with my communication skills, she further expressed her anxiety and concern if the diagnosis will further confirm AMD mostly as she might not be able to travel as often to see her only child in the southern part of England and reduction of her income as her distorted vision might prevent her from being actively engaged in her poem writing. I was able to calm her down by actively listening to her anxiety and fears, I also seek the opinion of Vicky at this stage if Adun could be offered some medical literature and refer her to some local community services that support people living with AMD. The literature explaining how people living with AMD could be supported by the local council in terms of financial benefits was also handed over to her . During my communication with Adun, a good communication pattern was developed around her holistic patient-centred care (PCC) which is accepted as one of the embodiments of nursing practice (Aghamollae et al., 2007).Ineffective or bad communication can make a bad situation worse as communication is not all about verbal but involving the use of body language speaks volume. Habiba (2001) confirmed that PCC guarantee communication with patients should be focussed on their physical condition than their needs. Using the communication approach and providing all necessary information for Adun made her to be at ease. The essence of therapeutic communication shows empathy and warmth to put patients at ease and secure (Power, 2018). Adun diagnosis process started by taking her baseline observation (blood pressure, pulse, oxygen, temperature, respiration rate) with her consent and asked about her present and past medical history and her allergies which was documented. Bird (2012) emphasised on the importance of record keeping in nursing process as its part of maintaining a good communication standard. He specified that communication and documentation are major element of nursing.Cardona et al (1994) and Greaves et al (2001) denotes initial nursing assessment as a step which enable nurses to individualised patients centred nursing care plan. Conducting key nursing assessment makes it possible for key information to be obtained from Adun and enhanced plan of her care. According to Chapelhowe et al (2005), as a result of nursing assessment, individualised outcomes should be agreed in conjunction with patients, nurses and multidisciplinary team (MDTs). These outcome are evaluated continuously by the nurses looking after Adun to monitor her progress and where appropriate the clinical judgement are to be used to make an adjustment to these outcome to suit the care that will be given to her (Ellen and Estate, 2013).For a successful assessment and diagnosis to take place, Peate (2012) expatiated that a sufficient baseline knowledge is required by nurses. In contrary, Chapelhowe et al (2005) argued that having a baseline knowledge of a patient alone is not enough. Regardless of how knowledgably a nurse could be, without interpersonal skills and effective communication, the care to be given to Adun will be limited as her individual needs might not be met. Therefore, the combination of both will cater for Adun individual needs (NMC,2010).Adun baseline observation was satisfactory except for her medical history which stated her being diagnosed for type 2 diabetes (T2) about a year ago. It was the responsibility of Vicky to independently perform numerous medical examinations to confirm AMD and forward the result to the ophthalmic consultant for the interpretation of the result and to advise the Adun as appropriate in regards to her further medical care. The diagnostic test included visual acuity checks at far and near distances, ophthalmic pressure test, eye drop administration for the dilation of the pupils to enhance the clarity of the retina when using the optical coherence tomography (OCT) machine which is the main diagnostic machine that diagnosis AMD. The picture image from the OCT was passed unto the ophthalmic consultant which confirmed AMD. At this point, Adun was not aware of the result of her diagnosis. However, it could be argued that this result could be classified as bad news. Fallowfield and Jenkins (2004) define bad news in healthcare settings as any sad, bad, or significant information which alters people perception and expectation of their future or present. The ophthalmic consultant was aware of the importance and policies supporting breaking of bad news to patients. Previous researches have shown that most patients will want to be informed about their diagnosis, progresses and treatment options, consequences and outcome (Hagerty et al., 2005 & Clayton et al., 2008). This encourages patients to develop sense of trust and openness between them and healthcare team, it increases their confidence in regards to asking questions for the purpose of contributing to their own care plan and making an informed decision about their health and treatment (Hancock et al., 2007 & Enrichen et al., 2010). Vicky and I were in the consultant