With reference to the NMC Professional Code of Conduct (2008) how should a nurse act in order to promote and maintain a client’s dignity?

34 year old Mary White is in your care. She has limited mobility which means that she is unable to walk without assistance. Her chronic and life limiting condition has recently led to a problem with eating and drinking and now Mary is unable to feed herself (although she can take food from a spoon and drink from a beaker) and requires total assistance in this activity. Whilst her body has deteriorated and her speech is limited Mary White’s cognitive function is intact although she is tearful and depressed. It is meal time and you are preparing to attend to Mary White’s nutritional needs.

Objectives: 

• Define the concept of dignity and discuss the importance of dignity in nursing care
• Discuss how the Code of Professional Conduct (NMC 2008) will guide your actions
• What are the issues that need to be considered when helping a patient to eat and drink
• What skills would you need to use to encourage Mary to eat and drink
• Reflect on how your understanding of dignity in health care may affect your future practice

Essay:

Nurses play an important role in the healthcare industry.  It is required of them to take care of difficult and uncooperative patients.  Their services are invaluable in the domain of palliative care as well.  But in recent years, from being a humanitarian service, nursing has grown into a specialized branch of healthcare industry.  The profession of Nursing has undergone several changes over the last few decades.  From being an ad hoc service, it has now become a separate field of study in its own right.  As a result of growing expectations, new standards of accountability have also been developed and enforced.  This is true here in the UK and much of the developed world (Tortora, 2005).  This essay will deal with Scenario Two, namely that of patient Mary.  By referring to the recently constituted Nursing and Midwifery Council’s Professional Code of Conduct this essay will layout the dos and don’ts for a Nurse in the hypothetical scenario of caring for patient Mary.

The Code of Conduct is a comprehensive document that outlines the core responsibilities of Nurses in the United Kingdom.  Each aspect of nursing is neatly organized under a separate heading with two further levels of relevant subheadings.  The first principle to be followed is stated as “Make the care of people your first concern, treating them as individuals and respecting their dignity”. Here, the key concept is ‘dignity’.  In fact, it would not be far fetched to state that ‘dignity’ is at the centre of all nursing activity.  In the case of Mary, since she is immobile and has limited speaking ability, it is quite easy to forget that she is a full human being.  A testament to her complete humanness is her fully functioning cognition.  While Mary might not be able to articulate what she wants or what she feels, she can feel pain, hurt, anger, disappointment, happiness, etc.  In other words, the entire gamut of human emotion is accessible to her functioning brain, although recognition of this fact might escape a casual observer at first (Marieb, 2005).  As a Nurse adhering to the principles set forth in the Code of Conduct, I would first let Mary know that I treat her on par with any other human being.

While taking complete care of a bed ridden patient can at times get tedious and monotonous, I would find ways of circumventing these.  The best way of avoiding the monotony associated with nursing a bed ridden patient is by developing a personal bond with her.  In the case of Mary, I will express through my words, gestures and general demeanour that I really care about her health and well being.  Since Mary’s cognitive functions are fully alright, she can hear and understand what I am speaking to her.  As any good nurse will do, I will attempt to win over her confidence and trust through my words and actions.  A pedagogic approach would be unsuitable in the case of Mary, as her health condition is not frequently encountered in nursing practice.  A more flexible and pragmatic approach would be more suitable.  For example, a NMC president Nancy Kirkland says, “Rather than be prescriptive in the Code and set out pages and pages of rules that might be inappropriate and might not arise in different circumstances, we felt it would be better to use this other approach which allows the profession to use their professional judgement, relevant to the situation they are in” (www.nmc-uk.org, 2008).

Considering the fact that Mary cannot verbally communicate her likes and dislikes, it is imperative that I understand what and when she likes to eat.  As the broader Code of Conduct document spells out, collaborating with Mary would entail making arrangements to meet her language and communication needs.  Moreover, I must share information with her in a way she can understand and the information that she seeks about her health is also duly provided her.  The limited mobility available to Mary would allow her to nod in approval or disapproval of the food I am feeding her.  Before I make preparations for her meal, I would intimate her of the items I have chosen for her meal.  I would observe her subtle reaction and understand what she is trying to communicate.  It is important that I do not force her to do something she does not want too.  While the food chosen by me might adhere to the recommendations made by the nutritionist, I can still exercise discretion in tailoring it to Mary’s preferences.  As the Code of Conduct documents indicate, “Patients who have had a stroke may have difficulty in communicating.  Nurses need to be alert to this, particularly if these patients are being treated fro and unrelated conditions as their communication need could be overlooked”. (www.nmc-uk.org, 2008)

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