In the late 2000s the healthcare commission began an investigation into the Mid Staffordshire Hospital, England. Concerns come to light because of the hospitals unusually high mortality rates. When the Mid Staffordshire NHS Foundation Trust failed to provide an adequate explanation, the Healthcare Commission began a full-scale investigation. Years of unsatisfactory investigation eventually led to a full public inquiry, led by Robert Francis in 2010.
The final report, published in 2013, is what has come to be known as The Francis Report. The Francis Report has become a driving force to promote change, lead, shape, fund and improve all aspects of health care, and make sure that people receive the support, care and treatment they require, with the compassion, respect and dignity that they deserve.
The result of the Francis Report means that the NHS is at a turning point in how all Health Care is delivered, as suggested by NHS employers “28 of Robert Francis' QC's recommendations are for changes to nursing regulation or delivery”.
Not only does The Francis Report call for more compassionate care, but it also states that stronger leadership is required of all ward nurse managers. It also insists on a change with regards to the appraisal and support system for nurses. This appraisal system is a means of assessing the performance of nurses so that any shortcomings can be corrected through methods such as training and transfer. On the other hand, a positive assessment is to be rewarded by promotion.
Due to an ageing population , The Francis Report recommends the introduction of a new status of nurse, the “registered older persons nurse”. One of the illnesses linked in with this is dementia, and multiple factors relating to dementia are having an impact on how nurses are trained and their deliverance of services. In 2013, the Royal College of Nursing (RCN) began a new development program to transform dementia care for hospitals. There aim is to develop skills and knowledge related to dementia, the roles of all those who are involved, understanding the development of action plans that identify key changes.
Another focus for change is that over the years the demand for home and community care over hospital care has continued to grow, as stated by the Queens nursing institute “Recent health policy points to the importance of improving and extending services to meet the health and care needs of an increasingly older population and provide services which may have previously been provided in hospital within community settings”.
Dementia is common among a large population of elderly people. The disease affects not only the individual diagnosed, but also the caregivers that work towards making their life comfortable in the end. Understanding and learning about the disease is crucial in helping those that experience or live with someone who has dementia. The services and support that are currently in affect for elderly people with dementia and the caregivers is poor, and ineffective because of the lack of research and information on the topic.
For the case study one considered the overall working environment of the organisation, with a particular client situation to apply the case study arguments around. This client was experiencing a catastrophic reaction to an event. One applied an integrated person-centred approach which considered meeting their needs by listening to the issue, and working with the person, and their family, as well as care staff, Registered Nurses (RN’s) and the Director of Nursing (DON). In order to find a resolution and meet the client’s needs. As well as, adding to their care plan strategies to assist with future behavioural and psychological symptoms of dementia (BPSD). This particular situation fit perfectly within the two questions of; does the organisation prevent me from providing person-centred care, and do we have formal team meetings to discuss residents’ care.
The government responded to the recommendations of the Francis Inquiry and voiced the recommendations for improving patient involvement in care, including changes to regulations and inspections (DOH, 2014). The NMC also responded to the Francis Inquiry in relation to the role of the nurse which was evaluated and criticised for ways in which it could be improved within the clinical setting, in order to improve nursing practice and knowledge towards patient-centred care. The NMC whole-heartedly agreed that there should be an increased focus in nurse training, education and professional development, in practical aspects in addition to theory (NMC, 2013).
Perspectives of service seekers- The individuals who seek the services of the Royal United Hospital Bath NHS Trust have their own perspective regarding the quality of the services. Quality of the home care must meet the essentials of the patients or service seekers. But it never means to fulfil the basic needs or requirements of the individuals who are seeking the service. On the other, hand if the home care is not able to meet the basic needs of the patients then this is important to analyze the certain reasons behind this (Janamian, et. al., 2014).
National Health Service (NHS) is the provider of healthcare to all citizens in England. At present many centres in the England are developing and conducting programmes to promote a multi-professional approach to working (Barr, 2002; Whittington, 2003). The NHS is steered by sequences of policies that are outlined by the Department of Health from time to time and has set up care trust which are partnerships with the NHS and the local council.
Llewellyn, S. (1993) Linking costs with quality in health and social care: new challenge for management accounting, Financial Accountability and Management, Vol 9 No 3, Aug 1993
In response the Francis Report (Francis, 2013), published in February 2013, which highlighted poor care and management at the Mid-Staffordshire NHS Trust, the Independent Cavendish Review made recommendations regarding the recruitment, training and regulation of HCAs. The Cavendish Review (DoH, 2013) concluded that HCA training varies greatly between NHS trusts. This is particularly concerning when the core of patient care is now being carried out by HCAs rather than Nurses (Kessler, 2012). There also exists ambiguity surrounding what tasks HCAs are allowed to carry out. This poses significant risks to patients, nursing staff and HCAs themselves. The Nursing and Midwifery Council state that;
...e crucial change needed in health services delivery, with the aim of transforming the current deteriorated system into a true “health care” system. (ANA, 2010)
This is further corroborated by Ingleton et al (2011), who believed that the need for community-based palliative and end of life care will increase rapidly over the course of the next 20 years because of increasing emphasis on shifting the delivery of care out of the hospital and into primary care which invariably leads to changes in the role of Community Nurses and in the demands on their time. Consequently, the above mentioned changes will place tremendous pressure on community nursing services and family carers (Department of Health, 2006a and Department of Health, 2006b)..
Sidebotham, P. (2012). What do serious case reviews achieve?. British Medical Journal . 97 (3), 189-192.
Yiu, L. (2012). Community care. In L. Stamler & L. Yiu (Eds.), Community health nursing: A Canadian perspective (3rd ed., p. 213, 219, 227). Toronto, Canada: Pearson Canada Inc.
Professionalisation of nurses is an ongoing complicated international debate.**** Hoeve et al …..find another one)
Globally it is estimated that there will be a “252% increase in people aged over 65 with one or more chronic condition by 2050” (Procter et al, 2013). The Department of Health’s 2013 Vision and Strategy for District Nurse detailed the increasingly important role that District Nurses have in the delivery and coordination of community healthcare. It described the District Nurse role as “Managing and accountability for an active caseload and providing population interventions to improve community health and wellbeing; Working with a range of health and social care partners in order to provide services for adults and their carers, at home”. A large part of the District Nurse caseload is managing patients with long term conditions and multi-morbidities.
In recent years, Australia’s population is aging due to increased life span and lowered reproduction rate (McMahon & Fleury, 2012). According to the Australian Bureau of Statistics (2012), there are three million adults aged 65 years and older residing in Australia. As a consequence, the focus of health care services and healthcare professionals, particularly nurses should be on addressing the physiological, functional and cognitive changes experienced by older adults (McMahon & Fleury, 2012). In line with this, the purpose of this assessment is to demonstrate how the provision of nursing care supports the elderly patient’s dignity. The direction of care will be based on the Functional Consequences Theory which roots patient’s care on understanding
Nurses are one of the most valuable resources in any healthcare organization (Longest, Rakich, & Darr, 2006). Nurses play an important role as members of the multidisciplinary healthcare teams. Nurses help organizations to achieve its mission and vision and meet its goals and objectives. Nursing care is vital to the provision of the healthcare delivery system in promoting health and wellness, preventing illness, restoring health, caring for disabled, and helping dying patients and their families (Catalano, 2006). The promotion of quality of nursing care and the safety of nursing practice takes place through nursing education and ensuring clinical practices meet evidence-based practice, accreditation, and certification requirements (Ironside,