“recent changes in the delivery of healthcare demonstrate that a great deal of care now takes place outside of traditional settings. This strategic shift for nursing – from hospital to community – focuses on prevention, and sees patients and the public as the drivers of their care. Nurses and midwives must be aware of the changing needs of the health care settings and the communities they serve, responding to both current and future need.” (www.nmc-uk.org, 2008)
Mary’s life limiting condition might mean that she is also on medication everyday. While preparing to feed her, it is important to check for drug interactions of certain food items. For example, some food items will lead to adverse reactions when taken with certain medicines. While the NMC code of conduct document does not elaborate on these nuances, it is expected of a nurse to check for potential drug interactions before deciding on the meal. The Code of Conduct does not explicitly talk about food intake and the attendant precautionary measures, but it describes in length what is required of a nurse when administering medications to the patient. For example, standard 8 of medicines management says the following:
“You must contact the prescribing doctor or another authorized physician without delay where contra-indications to the prescribed medicine are discovered, where the patient develops a reaction to the medicine, or where assessment of the patient indicates that the medicine is no longer suitable. You must make a clear, accurate and immediate record of all medicine administered, intentionally withheld or refused by the patient, ensuring the signature is clear and legible; it is also your responsibility to ensure that a record is made when delegating the task of administering medicine.” (Hawley, 2007)
Mary has a fully functioning cognitive system, which might lead one to assume that the Mental Capacity Act of 2005 is not applicable in her case. But since she has shown signs of depression, Mary should be treated from the framework set by the Mental Capacity Act. In its introduction to the Act, the NMC website states “the Act provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. It makes it clear who can take decisions, in which situations, and how they should go about this. It also enables people to plan ahead for a time when they may lose capacity. The Act is effective in England and Wales and came fully into force in April 2007. It applies to those aged 16 and over with potentially 1.2 million people directly affected and will include those with dementia, learning disability, brain injury, mental health problems and autism.” (www.nmc-uk.org, 2008)
Mary’s mental illness is not as obvious some other illnesses such as dementia, brain injury, etc, for which there are telltale signs and symptoms. The evidence for clinical depression is not always clear cut and often a matter of subjective assessment. The fact that she is tearful most of the time is a serious indicator of underlying mental turmoil. There are a few measuring scales that could be used to ascertain the magnitude of Mary’s depression. Something like the DSM-IV standard, which is widely adopted in psychiatric clinics in theUnited States, could be used for testing Mary (Jones & Symon, 2000). It is important to keep the questionnaire simple and objective, rather than descriptive and elaborate. I will instruct Mary to nod in approval or disapproval for the true/false questions that I would put before her. Based on her answers, I can gain insight into the distressing thought patterns that underlie her depression.
Hence, taking care of Mary is not an easy task even for seasoned nursing professionals. Her limited movement and speech adds additional challenges to the task. Yet, the NMC Code of Conduct is a very helpful guideline in dealing with the task at hand. Rather than simply deal with issues of professional ethics, the code also touches upon finer aspects of the nursing profession. It also makes it clear that nursing is much more than a money-earning enterprise, for success as a nurse requires one to display compassion and kindness toward his/her charges. In other words, while the NMC Code of Conduct document should be practiced and implemented in spirit in which it was meant. This way I can make sure that Mary’s dignity is maintained and their self-esteem bolstered in the period of recuperation. The guidelines set out by the code will also keep me in good stead in the years to come.