Fundamental and key caring skills Reflective report Confidentiality is a crucial and integral aspect of nursing. It must be kept and followed at all times. Therefore there will be no names or places mentioned in this report. This is in conjunction with the code of conduct (NMC, 2008). Day in, day out, we all reflect upon something. Nursing draws on the concept to gain learning through practice. Consequently reflection can be defined as a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations (Hinchliff, S. Norman, S. , Schober, J, 2008). The skill I have chosen to reflect upon is assisting a client to use and get to the toilet. On my first placement I was based at a day centre for adults with learning difficulties and on numerous occasions I supported and assisted clients to the toilet. The majority of these clients used the toilet fairly independently. I am using Gibbs’ model of reflection (as cited by Hinchliff, S. , Norman, S. , Schober, J, 2008) as a framework for my reflection. By using the appropriate communications skills I approached and greeted the client, identifying their needs and gaining verbal consent.
Taking the clients care plan into consideration I could recognise their toileting needs, in this example, help getting to the toilet and being seated onto the toilet. Using the appropriate moving and handling skills I helped the client stand up from a seated position and gave support whilst walking them to the toilet, on the walk I reiterated where we were going. I kept a steady pace as not to rush the client or cause any unnecessary stress. If the patient needs assistance it is important not to hurry them, maintaining a slow steady pace (Pellatt, G, 2007).
Once in the toilet I helped them get onto the toilet seat, I reassured them saying I would be just outside if they needed me, to provide privacy for the client, and I would ask before entering to ensure they were finished. I also made sure the client was aware of the call button. After a couple of minutes I asked if the client was finished and if I could come in, with the reply of yes, I reentered. Once back in the toilet if the client needed help cleansing I did this in accordance with what the day centre sed, which was a cleansing foam and some toilet tissue. I helped them stand up, using myself and a handrail for support. I would then help the client do up their trousers and then started to escort them out to the hand basin. To prevent any potential cross infection and promote general hygiene, hand washing is essential. I helped the client wash their hands and dry them, and then we made our way back to where the client was seated previously. I wanted to ensure that the clients’ dignity and independence was maintained at all times.
Nurses need to deal with elimination sensitively, while maintaining patients’ dignity and self esteem (Pellatt, G, 2007). I tried to put myself in their shoes and thought about how I would want to be treated. By having read the care plan I felt that it gave me a good understanding of the clients needs, which meant I was able to give the right amount of support. In this care setting it was my first time helping these clients to the toilet so naturally I felt a little nervous, but that soon went the more I carried out this particular skill.
It was important to me to keep the clients dignity intact and to ask if they needed help standing up etc, and not just assuming which meant that they did it for themselves whilst I was there for support when it was needed. Communication was key and my aim was to communicate in a way that showed their individuality and dignity was respected and in an easy to understand, clear and concise manner. This experience gave me many positive outcomes. The best thing was being able to help the client and ensuring I was maintaining their autonomy and self-sufficiency.
I felt as though I did it correctly, and the more I helped clients to the toilet the more competent I felt. As the clients got used to me being at the day centre and our relationships grew, some clients that were not sure about me taking them to the toilet let me, this made me feel good and as though they had accepted and trusted me. Alongside the benefits of practicing the skill and assisting the client it gave me the opportunity to observe for any problems with the clients elimination activity.
None were observed but it is an important assessment tool. Nursing interventions will be intimate and will require you to maintain privacy and dignity at all times (Lawson, L. , Peate, I, 2009). This was my way of thinking; it was how I went about conducting the skill, or how I tried to. I endeavored to follow this and kept it as the framework for the skill. I think I did uphold this stance and I feel as though it enabled me to implement the skill in the appropriate manner. I wanted to take a person centred, personalised approach to the clients care.
This is outlined in the nursing and midwifery council’s (NMC, 2010) essential skills clusters. It was important for not only myself but for the client to uphold this as it would ensure their dignity was intact. By assisting the client to the toilet, it enabled them to have the independence of getting there and doing the majority of it without aid. Assistance to the toilet should be provided for those who are too frail or immobile to be self caring in relation to toileting (Jamieson, E. McCall, A. , Lesley, W, 2002). The safe moving and handling of the client was essential. To ensure risk assessments were being followed I read the care plan, so I knew what the correct procedure was for getting them to the toilet and helping them onto the seat. It was important for the moving and handling to be correct for the clients safety and my own. All nurses must learn how to lift correctly for the sake of their patients and for themselves (Kenworthy, N. , Snowley, G. , Gilling, C, 2002).
Factors such as mobility, transfer ability, strength, and flexibility are essential for independent toileting (Earthy, A. , Nativ, A, 2009). In this case the majority of clients had the ability to use the toilet fairly independently. I think it is hugely important for the client to be able to use the toilet, even if it is with help as it is a skill which not only has health benefits such as minimising risk of urinary tract infections and skin soreness from soiled incontinence pads, but also gives them a skill which they can take charge of and do for themselves.
Continence is an important skill for people with a learning disability to master because it increases their independence (Stanley, R, 1997). The clients I assisted with toileting did need some help, and it stated so in their care plan, I know some of the more able clients had some say in their care plans. This is outlined in the department of health’s (DOH, 2010) essence of care. I feel as though when executing the skill I got to grasps with it and it was not so daunting the more times I did it. To begin with it was a little daunting but I feel I soon adjusted and it became quite routine.
From reading numerous extracts on toileting from clinical skills textbooks and journal articles, in hindsight I think I undertook it correctly. I definitely feel more comfortable with this skill now that I have had practice at it. I feel as though I have a good knowledge of the skill, gained from reading around it and actually doing it in practice. All of the clients I assisted were very accepting of me; in another setting it will more than likely be different. Each different experience will give me varying practice of all scenarios and can only benefit me.
I think the client should be able to have more of an input into their care plans, I know that they did have aims they wanted to achieve but as for everyday skills such as toileting I’m not sure that they had as much say as they could. I think some clients were so used to someone assisting them, for example with cleansing after elimination. It seemed as though it had become so routine that they just expected that to happen, and in my opinion if they were to try it and it was unsuccessful then the custom can stay the same, but if it were successful that’s giving the client a significant amount of dignity and independence.
When the situation arises again I will go about the main aspects in the same way. Approaching and greeting the client, identifying their needs and gaining consent to begin the toileting routine. I would also assess the risk of any potential moving and handling. Rather than assuming I am meant to do something such as cleansing the client, I could ask if they would prefer to do it them self first. My aim would be to achieve the utmost level of respect, dignity and independence for the client when it comes to using the toilet.
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