The NMC Code of Conduct: A Reflective Account of Patient-Centred Care

Desklib provides past papers and solved assignments for students. This report reflects on the NMC code in nursing practice.

Contents
INTRODUCTION...........................................................................................................................................1
Incidence 1..............................................................................................................................................4
Incidence 2..............................................................................................................................................6
CONCLUSION...............................................................................................................................................9
REFERENCES..............................................................................................................................................10
1

INTRODUCTION
Nursing profession is all about social care and health care where a person seeks
education and qualifies to treat patients as well as promotes health and prevention from
diseases by fostering wellbeing. NMC code stands for Nursing and Midwifery Code of
Ethics that are set of regulations created to be followed by every nursing professional in
UK to maintain proper standard of care and conduct (Levati, 2014). The aim of NMC
code is to support and help the nurses and midwives to play their desired role in
suitable manner. These clauses of NMC code guides the individual to act wisely in
every situation and should be able to make informed decisions including patient
centered care view. NMC code of nursing conduct are the rules that revolves around
achieving four main aspects that is prioritizing people, practice effectively, preserve
2

safety and promote trust and professionalism (Chadwick and Gallagher, 2016). These
professional standards are must for every nursing professional and associate to follow
in order to practice as a registered nurse in UK. The brief explanation of these codes
includes prioritizing people that aims to prioritize patient as a person and human being
first and foremost in the nursing care than any other issues. Practice effectively focuses
on delivery of services that are in best interest of the patient and has positive and good
effects on the recovery of the patient (Griffith, 2015). Preserve safety is the third goal in
NMC codes that means the nursing professional has great duty to preserve the patient’s
safety and protect him from any kind of harm (Barrett, Wilson and Woodlands, 2014). It
also includes providing better health and safe environment in health and community
care settings. The last goal is to promote professionalism and trust that is ensuring
patient’s needs are met and to foster the dignity and respect of the patient while
delivering care. NMC code is introduced in order to provide the nurses and midwives
better set of guidance and this code enables the other regulations and rules from NMC
to be guided accordingly (Holt and Convey, 2012). The goals of NMC codes include
safeguard public health and well-being, set standards for education and research, and
conduct training and sessions to train the nurses and healthcare professionals to
perform as per the nursing standards (Holt and Convey, 2012).
NMC code is defined as a professional duty that is to be followed by all the registered
nurses and midwives in UK in order to deliver their roles (Clarke, 2014). NMC was
established in the year 2002 since then it has worked in order to provide better
standards and quality care to the individual via nursing and midwifery staff. Previously
UKCC was the initial body that was replaced by NMC in 2002 (NMC, 2015). Previously
the nursing codes were regulated y UKCC but in 2008 the NMC code were first revised
and modified for better outcomes. Lastly the NMC code was revised in the year 2015
(Clarke, 2014). On 31 March 2015 the council revised the NMC code of professional
standards that ensure the universal standard of nurses in order to follow the
professional requirements. The aim of this code was to incorporate one code and four
themes with both professional as well as organizational priorities. Four main themes
introduced were people, effective, safety and trust and clause were formulated
encircling these themes. Three new domains were added to revised codes including
3

Duty of Candour, social media, and maintenance of medicine, end of life care and
fundamentals of care (Garside and Nhemachena, 2013.). In 2013 the NHS Stanford
foundation was inspected by Sir Francis for quality and management. The report
highlighted various areas of care being not guided as her the NMC code of conduct and
quality is not adequate. The Francis report made 290 recommendations for the
foundation and the nationwide nursing practice and care being implemented. After
publication of the Francis report the NHS foundation made changes in their policy and
framework in order to provide better services as per the code. The code also mentioned
the duty of candour and fundamentals of care that is now followed by the health and
social care organizations in UK (Thorlby, Smith, Williams and Dayan, 2014).
This assignment deals with introducing the important of NMC code in nursing practice
and how I developed my professional practice by following these codes. It will also
discuss the different domains of NMC code and ethics and elaborate the discussion on
one of the code that is “Prioritizing people” (Snelling, 2017). The assignment uses a
reflective approach to achieve better understanding of NMC code in own practice. I
have used Gibbs reflective model to explain the incidence that occurred with me during
my placement year and how that was accompanied by the NMC code and prioritizing
patient clause in it (Oluwatoyin, 2015). Reflection is a tool that involves self-evaluation
of the incidence or own practice for improvement and better future clinical practice
(Thompson and Pascal, 2012). It is a widely advised tool that is used by health care
professionals and students worldwide. It enables individual to identify own strengths and
weaknesses and work on the areas of improvement to ensure continuous professional
development in the field. There are various models of reflection that can be utilized to
reflect on an incidence from own practice and learn through it. Some of the models are
O’Driscoll model, Gibbs reflection cycle, Kolb’s reflective cycle, Rolfe et al framework for
reflection etc. (Bulman, Lathlean and Gobbi, 2012) I have chosen Gibbs reflective
model to reflect upon my incidences from placement practices, it is the cycle that uses
five stages to describe and evaluate the incidence in practice. The five stages are as
follows description, feeling, evaluation, conclusion and action. The five stages model
helps the individual to reflect on own practice and learn from it by evaluating it critically
(Bulman, Lathlean and Gobbi, 2012). It is useful in making individual learn from the
4

experiences that happened with them in the past during their practice to be more
competent for the future practices. This model is easy to use and provides in depth
review and understanding of the incidence that can be concluded ad evaluated for
future practice effectively (Williams, Woolliams and Spiro, 2012). This assignment aims
at reflecting an incidence from own placement through Gibbs reflective model and
explain its relevance toward the NMC code of conduct involving the clause “prioritizing
patient.”
I personally have tried to incorporate the first code in my practice that includes
prioritizing the patient over anything else in the practice. The foremost code of practice
implies to the patient’s care and priority of health care professionals to be concentrated
around the patient they caring for. In order to provide better care to the service seeker it
is essential for us health care professionals to first understand how to deliver the care
as per their requirements and in order to do that first we should identify the needs of the
patient (Snelling, 2017). Accessibility to care, quality of care, and requirements of care
provide and aspects addressed by the care all are domains of patient priority in NMC
code. During my practice I have indulged in various procedures and have seen different
kinds of cases where these codes are applied by different professionals as well by me
to ensure patient safety, quality of care and patient satisfaction. Prioritizing patient is the
code that I have chosen to reflect upon through my own experience. This clause has
five sub principles that are to be considered while delivering nursing care. It involves 1)
treating people with kindness, compassion and respect, 2) making sure that the
fundamentals of care are delivered adequately, 3) avoid making assumptions and
accept diversity and different choices, 4) respect human right’s f an individual, 5)
making sure that all the treatment, procedures and care is delivered without delay.
These five principles of care when addressed adequately results in achievement of
patient priority and care as per the standard of NMC code one (Snelling, 2017).
The two incidences from my placement experience have been described below using
Gibbs reflection model. These two incidences clearly depicts how my knowledge
regarding the NMC code of practice and prioritizing patient was not adequate that led
me to deliver low quality care and with end of third year in my placement I steadily
5

learned all the policies and code of conduct and how it changed my learning
experiences as well as service delivery.
Incidence 1
Description
During my placement in second year I was appointed as the trainee professional in
CCU. The critical care unit that time comprised of accidental and advance stage limiting
cases. I was new to the setting and was not aware of the protocols nicely. I was
appointed to take care of the patient with end stage liver cirrhosis. The patient was a 64
years old male who was under critical care due to his condition and deteriorating liver
function. I was given the responsibility to monitor his vitals every two hours and report it
to my mentor. During the day when one time I went to the patient to measure his pulse
and blood pressure, he was feeling little anxious and asked me to not monitor his vitals.
I was not aware of the codes adequately and I anyhow talked him out and measured his
vitals. Later when I reported this incident to my mentor he asked me to follow the NMC
code of conduct and never force a patient to perform anything specially when there is
no consent from the patient. Priority of patient’s requirement is the first policy to be
followed by the nursing staff. In this case I did not bother to take consent of the patient
before the procedure nor did I manage to communicate well to lower the anxiety of the
patient (Mellor and Greenhill, 2014).
Feeling
Before I was going to perform the procedure I was feeling little nervous but later when I
approached the patient I felt I can do this process confidently. During the incidence
when the patient asked me not to monitor him I still urged to do the process to complete
my task without acknowledging patient’s priorities, first I felt I did right as I was asked to
perform it. Later when my mentor briefed me about the codes and laws I felt really bad
that I could not keep my patient in center of care and still performed the procedure
without his consent. I felt that my knowledge regarding nursing and codes of nursing
conduct was inadequate.
Evaluation
6

The incidence made me rethink over my education regarding the conduct of services in
nursing and it was evident that I require more training and more skill build up in order to
enhance my services. The overall incidence that took place taught me how to interact
with the patient as well how to achieve consent prior to any procedure or intervention.
This incident if present same circumstances again in future I can now manage to ask for
consent and prioritizing the need of the patent before any medical interventions.
I evaluated the whole incidence by using the Benner’s stages of clinical competence.
The stages describes how the individual in clinical practice has no knowledge and
experience initially but grasp and learn from his practice and such incidences to master
the art of nursing. The evaluation resulted that during second year of my placement
when this incident took place I was a novice and beginner that had improper knowledge
regarding the protocol and conduct legislations. Later by reflecting and learning form
such incidence till I reached third year of my placement I was able to perform the
practices adequately as per the code of conduct and guidelines of nursing framework.
Conclusion
This incidence helped me learn major two skills that is creating a therapeutic
relationship with the patient and secondly following the NMC code of nursing conduct in
any and every scenario. It also taught me how the consent has its own importance and
any procedure without consent of the patient will directly imply on legal non compliances
with my practice. Since then I followed an action plan to develop my interpersonal skills
to perform better and suitable to the nursing guidelines.
Action
The action that it took after this incidence was to develop my skills for proper
communication and listening. Major factor that I felt went wrong during this incidence
was I was not listening to what patient wanted and only concentrated on what I was
supposed to complete as a task rather as a process of human care. I developed my
interpersonal skills and always listened to the patient before akin any decisions that
helped me follow the first clause of NMC code that is prioritizing patient.
7

Incidence 2
Description
Another incident that helped me relate to my developing skills during my placement took
place when I was in second year posted in the pediatric recovery ward. The recovery
ward used to be always full with children of different age with different post-surgical care
or other cases. I was appointed as the nurse to the 10 years old child who has a
surgery recently for his appendix and was in recovery after that. The kid was 10 years
old and very talkative. I used to get along with him and always had good rapport with
him. One day while monitoring his recovery and filling his charts he mentioned it to me
that he wants to have some good food but the food down the cafeteria was not liked by
him much. I heard him but as I was busy filling the charts I ignored his statement and
went on with my work. Three days later his condition started to deteriorate and when
analyzed we found out that he was not taking up is food properly. Seeing this mentor
asked me various questions as the feeding of the child was my responsibility. I was not
having any answers because due to hectic schedule and workload I was not adequate
in performing my duties toward him properly.
Feeling
When the kid told me regarding his dislikes for the food provided to him I felt he is just
making excuses for not eating and didn’t bother to communicate with him on this topic.
Later when his condition got worse due to inadequate nutritional supply I was held
accountable and as I was a novice y mentor took care of it but I felt very bad and
embarrassing. I started doubting my skills to be a competent professional and could not
work properly for that entire day. I had negative thoughts seep in when this incidence
took place and found myself responsible for my patient’s health.
Evaluation
The whole incident when reviewed I felt that it was due to irresponsible nature towards
the codes of practice and taking the work load over competent care. It was identified
that my core duties included taking care of activities of daily living for the child but I
focused more over doing the paper work and monitoring the results rather than aiming
8

at producing better services for better results. Again according to the Benner’s stages of
clinical competence I evaluated my skills that time to be as an early beginner when the
individual perform duties allotted to an average level but not to the adequate level
required by the nature of the case (Turrill, 2014). Later in third year again I came along
such a situation when I was appointed to be nurse in the pediatric recovery ward. While
my practice I faced a challenge to look after a child with autism. As it was difficult to
communicate with the patient still I managed to build a rapport with her and prioritized
her in every sense during the care. I took care of her daily activities, social environment,
interactions ad also managed to avoid any triggers that could make her anxious. This
made me reach stage 4 of the staging by Brenner’s that is proficient to perform. Si build
my experience through reflecting on own practice and learning and putting my work into
action for better development.
Conclusion
The incident taught me the patient resides to be the center of the care and no matter
what the chief priority I care planning should be the decision taken as per the patient’s
requirement and the focus of planning is kept as per the patient’s wellbeing. The NMC
code was well incorporated in my learning at this stage and it helped me develop my
skills throughout the years.
Action
I developed an action plan to enhance my skills for communicating well, and reporting
the incidence or the feedbacks from the patient to the management. I took some
meditation and yoga hours routinely to have a clear and composed attitude that would
help me concentrate better and take better decisions for my patients. I also developed
my skills of involving the patient during care planning so as to improve the efficacy of
care provided and provide patient centered care (Redmond, 2017).
9

CONCLUSION
Reflecting on own practice is a very effective tool that helps us to develop and improve
our practice throughout the career. Using different tools for reflection helps identify
different areas of scope and improvement that can be planned to achieve better
success and quality in care delivery. NMC code of practice in nursing is an important
law to be followed by all the registered nurses and midwives in UK to ensure quality of
care and proper service delivery (Moon, 2013). The four clauses are basically built to
enhance the patient satisfaction and create gold standards for nursing care. Prioritizing
patient being very first and crucial clause enables practitioner to perform well and
provide patient centered care. This assignment helped me reflect on two incidences
from my placement that I reflected upon to learn better and achieve more quality skills
for the delivery of future services. Hence it can be concluded that reflection is an
essential tool to continuously develop in own profession and achieve the best
parameters of care quality and delivery.
10

REFERENCES
Barrett, D., Wilson, B. and Woodlands, A., 2014. Care planning: a guide for nurses.
Routledge.
Brooker, C. and Waugh, A., 2013. Foundations of Nursing Practice E-Book:
Fundamentals of Holistic Care. Elsevier Health Sciences.
Bulman, C., Lathlean, J. and Gobbi, M., 2012. The concept of reflection in nursing:
Qualitative findings on student and teacher perspectives. Nurse education today, 32(5),
pp.e8-e13.
Chadwick, R. and Gallagher, A., 2016. Ethics and nursing practice. Macmillan
International Higher Education.
Clarke, C., 2014. Promoting the 6Cs of nursing in patient assessment. Nursing
Standard, 28(44), pp.52-59.
Garside, J.R. and Nhemachena, J.Z., 2013. A concept analysis of competence and its
transition in nursing. Nurse Education Today, 33(5), pp.541-545.
Griffith, R., 2015. Understanding the Code: Keeping accurate records. British journal of
community nursing, 20(10), pp.511-514.
Holt, J. and Convey, H., 2012. Ethical practice in nursing care. Nursing
standard, 27(13).
Ion, R., Smith, K., Nimmo, S., Rice, A.M. and McMillan, L., 2015. Factors influencing
student nurse decisions to report poor practice witnessed while on placement. Nurse
education today, 35(7), pp.900-905.
Levati, S., 2014. Professional conduct among registered nurses in the use of online
social networking sites. Journal of advanced nursing, 70(10), pp.2284-2292.
Mellor, P. and Greenhill, J., 2014. A patient safety focused registered nurse transition to
practice program. Contemporary nurse, 47(1-2), pp.51-60.
11

Moon, J.A., 2013. Reflection in learning and professional development: Theory and
practice. Routledge.
Oluwatoyin, F.E., 2015. Reflective practice: Implication for nurses. Journal of nursing
and health science, 4(4), pp.28-33.
Redmond, B., 2017. Reflection in action: Developing reflective practice in health and
social services. Routledge.
Snelling, P.C., 2016. The metaethics of nursing codes of ethics and conduct. Nursing
Philosophy, 17(4), pp.229-249.
Snelling, P.C., 2017. Can the revised UK code direct practice?. Nursing ethics, 24(4),
pp.392-407.
Thompson, N. and Pascal, J., 2012. Developing critically reflective practice. Reflective
practice, 13(2), pp.311-325.
Thorlby, R., Smith, J., Williams, S. and Dayan, M., 2014. The Francis Report: one year
on. London: Nuffield Trust.
Turrill, S., 2014. The education of UK specialised neonatal nurses: Reviewing the
rationale for creating a standard competency framework. Nurse education in
practice, 14(5), pp.504-511. Turrill, S., 2014. The education of UK specialised neonatal
nurses: Reviewing the rationale for creating a standard competency framework. Nurse
education in practice, 14(5), pp.504-511.
Williams, K., Woolliams, M. and Spiro, J., 2012. Reflective writing. Macmillan
International Higher Education.
12