ORGANISATIONAL ASPECTS OF CARE

NS421 Professional and Academic Skills for Nursing.

By May, Georgina, Gareth, Sonia.
CONTENTS

1. Front Cover
2. Contents
3. Introduction
4. Organisational aspects of care
5. Management of risk
6. Safeguarding, supporting and protecting
7. Responding to feedback and using a range of sources to learn and improve services.
8. Holistic care and systematic assessment.
9. Conclusion
10. References
INTRODUCTION

Organisational aspects of care is a very huge topic to be covering everything in it.

We will be focusing mainly on
• Management of risk
• Safeguarding, supporting and protecting.
• Responding to feedback and using a range of sources to learn and improve
services.
• Holistic care and systematic assessment.
ORGANISATIONAL ASPECTS OF CARE

Reflecting,
Assessing
feedback & care NMC Code
patients
plans

Understand
Safeguarding & Leadership &
public health:
protecting managing care
health lifestyle

Response when
Individual needs faced with an Holistic care
emergency

Maintaining Interventions &

Apply research
safe evaluating care Care Act 2014
based evidence
environment plans
MANAGEMENT OF RISK
WHAT IS MANAGEMENT OF RISK?

• “Across a diverse range of high risk environments, the promotion of

safety generally proceeds through the identification, and control of risk.” (Parker,
2009)
• "...continued existence of shortcomings in professional competence clearly
undermines the capacity to care for patients (Learning from Bristol, 2001, pp.
322–323, cited in Alazewski 2002)."
• Be aware of, and reduce as far as possible, any potential for harm associated
with your practice (NMC Code 2018)
WHY MANAGE RISK?

• Protect staff
• Protect patients
• Legal requirement
• Preserve organisational/ occupational reputation
• Prevent litigation
• Reduce costs
WHAT RISKS NEED TO BE MANAGED?

• Medications
• Environment
• Waste
• Sharps
• Manual handling
LEGISLATION

• Health and Safety at Work Act 1974

• Control of Substances Hazardous to Health
• Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013
• Health Act 2006
SAFEGUARDING AND PROTECTING
VULNERABLE ADULTS
WHAT IS SAFEGUARDING?

• Safeguarding is about protecting certain people who may be in vulnerable

circumstances. These people may be at risk of abuse or neglect due to actions(or
lack of action) of another person. (Gov,2017)
• Safeguarding adults means protecting a person’s right to live in safety, free from
abuse and neglect. (DH,2014)
• A nurses role is to ‘Raise concerns immediately if you believe a person is
vulnerable or at risk and needs extra support and protection’’(NMC, 2018)
 WHO IS VULNERABLE?

When the care act 2014 came into replace the no secrets policy 2000 the
terminology ‘vulnerable adults’ was no longer used and became those at risk.
The concept of vulnerability still remains an important part of
safeguarding.(Northway etal, 2017)
Defining ‘those at risk’
• An adult at risk of abuse or neglect is defined as someone who has needs for
care and support, who is experiencing, or at risk of, abuse or neglect and as a
result of their care needs - is unable to protect themselves. (Care act, 2014)
• A child is anyone who has not yet reached their 18th birthday. (HM Government,
2015)
TYPES OF ABUSE?

(Gov,2017)

sexual
Physical psychological

Environment financial
Abuse
Neglect
&acts of Discrimination
omission

organisational domestic
NATIONAL AND LOCAL POLICIES FOR
SAFEGUARDING ADULTS/CHILDREN
• Government policy on safeguarding 2017

• Care act 2014

• NMC Code 2018

• The human rights act 1998

• Mental capacity act 2005

• Child Act 1989-2004

• Gillick

• Multi-agency adult safeguarding policy and procedures (2016)

 NURSES ROLE IN SAFEGUARDING

The nurses role requires us to advocate for the ‘vulnerable’ (Nmc,2018) therefore the nurses should:

• Recognize the signs

• Use evidence based-practice (nice guidelines)

• Raising awareness/reporting

• By implementing and following use of acts and six principles that underpin all safeguarding work (empowerment, protection, prevention,
proportionality, partnership and accountability)

• Assessing capacity chart

• recording/ evidence with written evidence (forms)

• Making Safeguarding Personal” (Care Act 2014)

• Care plan

• Following up/ handovers to other agencies

• Referrals

• reflection
RESPONDING TO FEEDBACK AND USING A
RANGE OF SOURCES TO LEARN AND
IMPROVE SERVICES.
USING A WIDE RANGE OF SOURCES TO LEARN,
DEVELOP AND IMPROVE SERVICES
• Reading relevant literature
• Attending short courses and study days
• Attendance at conferences
• Participation in journal clubs
• Completion of tertiary qualifications
(Bloomfield and Pegram, 2015)
RECEIVING FEEDBACK

• Verbal feedback from

patients or their friends family
Colleagues
Other Professionals
(Bloomfield and Pegram, 2015)
• Other Sources available
questionnaires
Surveys
Public Enquiry
SURVEYS PROVIDED BY NHS

• National Patient and Staff Surveys

• Primary Care
GP Patient Survey
• Secondary Care Surveys’
Outpatients
Inpatients
Accident and Emergency
Maternity
Community and mental health
Children and young people
(England.nhs.uk, 2018)
THE FRANCIS REPORT 2013

• Following failures in care at the Mid

Staffordshire NHS Foundation Trust, Sir
Robert Francis QC was selected to chair
an independent public inquiry into those
failings. The report from that enquiry (‘the
Francis Report’) on 6 February 2013 made
a number of wide ranging
recommendations for change.

(Nmc, 2018)
EXAMPLES OF MID STAFF NHS FOUNDATION
TRUST FAILINGS
• A culture concentrated more on frameworks than patient care
• More credit given to positive data than data fit for suggesting cause for concern
• Guidelines and techniques for consistency that did not concentrate on the impact of an administration
on patients
• Continued culture of ignorance towards professional standards and risk to patients
• Poor multi-organisational correspondence
• Failure to assume liability for observing, performance management and intervention
• Inability to tackle issues in the development of a positive culture
• An inability to judge the hazards of disruptive loss of corporate memory and centre deriving from
repeated, multi-level re-organisation (RCM.org.uk, 2018)
HOLISTIC CARE AND SYSTEMATIC
ASSESSMENT
WHAT IS HOLISTIC CARE?

• Holistic nursing involves healing the mind, body and soul. Its concerned with every part of
the patient. It’s a model of caring which is believed to be at the heart of nursing.
(Practicalnursing.org)
INDIVIDUAL NEEDS AND IMPORTANCE OF TRUST,
PARTNERSHIP AND RESPECT.
• Making Every Contact Count (MECC) helps meet individual need and to
encourage changes in behaviour that have a positive effect on health and
wellbeing of individuals. (Makingeverycontactcount.co.uk, 2018).
• Build relationships through showing respect thus gaining trust
• Individualise care plans
SYSTEMATIC ASSESSMENT

Systematic assessment is where all the patients information is put in order for the
service provider to meet the individuals needs by creating a care plan. This is
done in two ways, subjective data and objective data.
Subjective data:
Subjective being what the patient is referred in by such as pain.
Objective data:
Is when measurements or assessments happen followed by the
subjective(Bloomfield and Pegram, 2015).
SUBJECTIVE AND OBJECTIVE DATA

DuPont,S.
(2018).
NURSE’S ROLE

The NMC code states that nurses have various roles and as I have discussed in
previous slides but the NMC has put these roles in practice in order to meet
customer needs.
• practise in a holistic, non-judgmental, caring and sensitive manner that avoids
assumptions, supports social inclusion; recognises and respects individual
choice; and acknowledges diversity. Where necessary, they must challenge
inequality, discrimination and exclusion from access to care.
CONCLUSION

• Risk needs to be managed to protect staff and patients, this can be met through complying with
legislations so that no harm can come from a nurses practice or misconduct.
• The nurse must be able to raise concerns where there are safeguarding issues to protect those who are
at risk and are unable to do so for themselves. She should be able to recognize the types of abuse and
have an understanding of legislations and policies regarding safeguarding so the right measures can be
taken.
• Learning/reflection from information such as surveys and feedback so that services can be improved,
Taking into consideration the failings from the Frances report, along with further development from
learning and reading literature.
• Using holistic care which is objective/subjective data and Make every count (Mecc) can result in better
patient- centered care, which will in turn build better trust between the nurse and patient.
REFERENCES

• ALASZEWSKI, A. (2002) The impact of the Bristol Royal Infirmary disaster and inquiry on public services in the UK -JOURNAL OF INTERPROFESSIONAL CARE, VOL. 16, NO. 4, available at:
http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=2&sid=3dfdc19f-b8b3-4018-8f47-52e509848965%40sessionmgr4009

• Bloomfield, J. and Pegram, A. (2015). Organisational aspects of care. Nursing Standard, 29(27), p.36.

• Care Act 2014, c.43. Available at: http://www.legislation.gov.uk/ukpga/2014/23/part/1/enacted: (Accessed: 23 October 2018).

• Department of Health(2011) Safeguarding Adults:the role of health service practitioners. Available at:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/215714/dh_125233.pdf (Accessed:15 october 2018).

• England.nhs.uk. (2018). [online] Available at: https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/05/clncl-waste-factsht.pdf [Accessed 29 Nov. 2018].

• England.nhs.uk. (2018). Statistics » Statistical work areas. [online] Available at: https://www.england.nhs.uk/statistics/statistical-work-areas/ [Accessed 27 Nov. 2018].

• Nursing, DuPont,S. (2018). Objective Vs. Subjective Data: How to tell the difference in Nursing | NRSNG. [online] NRSNG. Available at: /https://www.nrsng.com/objective-vs-subjective-data/ [Accessed
25 Nov. 2018].

• Gov UK (2017) SD8:office of the public guardian safeguarding policy. Available at: https://www.gov.uk/government/publications/safeguarding-policy-protecting-vulnerable-adults/sd8-opgs-safeguarding-
policy (Accessed: 18 October 2018).

• Gosh.nhs.uk. (2018). Sharps: disposal of used sharps. [online] Available at: https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/sharps-disposal-used-sharps [Accessed 29 Nov. 2018].

• Griffith,R. (2015) 'Understanding the code: safeguarding vulnerable adults', British journal community nursing. volume 20, issue 11, Page 2. doi:10.12968/bjcn.2015.20.11.564.
REFERENCES

• HM Government (2015) Working together to safeguard children.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachmentdata/file/592101/Working_Together_to_Safeguard_Children_20170213.pdf(Accessed: 25 October 2018).

• Hse.gov.uk. (2018). Control of Substances Hazardous to Health (COSHH) - COSHH. [online] Available at: http://www.hse.gov.uk/coshh/ [Accessed 29 Nov. 2018].

• Hse.gov.uk. (2018). Health and Safety at Work etc Act 1974 – legislation explained. [online] Available at: http://www.hse.gov.uk/legislation/hswa.htm [Accessed 29 Nov. 2018].

• Health Act 2006. [online] Available at: https://www.legislation.gov.uk/ukpga/2006/28/contents [Accessed 29 Nov. 2018].

• Health Act 2009. [online] Available at: https://www.legislation.gov.uk/ukpga/2009/21/contents [Accessed 29 Nov. 2018].

• London adass (2015) London multi-agency adult safeguarding policy and procedure. Available at: http://londonadass.org.uk/wp-content/uploads/2015/02/Pan-London-Updated-August-
2016.pdf (Accessed:19 october 2018).

• Makingeverycontactcount.co.uk. (2018). Making Every Contact Count (MECC). [online] Available at: http://www.makingeverycontactcount.co.uk/ [Accessed 25 Nov. 2018].

• NHS England(2015) Safeguarding Policy. Available at: https://www.england.nhs.uk/wp-content/uploads/2015/07/safeguard-policy.pdf (Accessed: 15 october 2018).

• NHS ENGLAND (2017) Safeguarding adults. Available at: https://www.england.nhs.uk/wp-content/uploads/2017/02/adult-pocket-guide.pdf (Accessed: 28 October 2018).

• Nmc.org.uk. (2018). [online] Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-competence-for-registered-nurses.pdf [Accessed 25 Nov. 2018].

REFERENCES

• Nmc.org.uk. (2018). Francis report. [online] Available at: https://www.nmc.org.uk/about-us/policy/position-statements/francis-report/ [Accessed 27 Nov. 2018].

• North way, R. and Jenkins, J. (2017) Safeguarding Adults in Nursing Practice. Croydon: Sage. Second edition.

• Nursing & Midwifery Council. (2018). The code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Available
at: http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf

• Parker, D. (2009) - Managing risk in healthcare: understanding your safety culture using the Manchester Patient Safety Framework (MaPSaF) - Journal of Nursing
Management, Vol 17, issue 2, pg 218-222 - https://doi.org/10.1111/j.1365-2834.2009.00993.x

• Practicalnursing.org. (2018). [online] Available at: https://www.practicalnursing.org/importance-holistic-nursing-care-how-completely-care-patients [Accessed 29 Nov. 2018].

• Rcm.org.uk. (2018). RCM briefing on the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. [online] Available at:
https://www.rcm.org.uk/sites/default/files/RCM%20briefing%20on%20the%20Francis%20Report.pdf [Accessed 27 Nov. 2018].

• The child act 2004, c.31. Available at: https://www.legislation.gov.uk/ukpga/2004/31/section/9A (Accessed: 28 october 2018).

• The human rights act 1998, c.42. Available at: https://www.legislation.gov.uk/ukpga/1998/42/introduction (Accessed: 28 october 2015).

• The mental capacity act 2005, c.9. Available at: https://www.legislation.gov.uk/ukpga/2005/9/part/1/crossheading/the-principles (Accessed: 28 october 2015).