NURSING: The Patient Experience and Partnering in Care S2 2019 Essay

This essay delves into the critical aspects of nursing practice, emphasizing the importance of the nursing professional code of conduct in delivering patient care. It utilizes a case study of an Aboriginal woman named Raelene Ward, who experienced gestational diabetes, to illustrate key concepts. The paper integrates theories related to person-centered care, family-centered care plans, and ethical conduct, alongside the National Safety and Quality Health Service Standards (NSQHSS) and Erikson's psychosocial theory. The essay highlights examples of both effective and ineffective care, emphasizing the significance of partnering with consumers in healthcare. The analysis underscores the importance of informed decision-making, patient education, and culturally competent care, while also addressing gaps in care planning, such as the lack of family involvement and mental health support. The essay concludes by stressing the positive impact of interventions like dietary management and the crucial role of healthcare professionals in fostering patient adherence to care plans.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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One of the important aspects of healthcare is proper application of the nursing
professionals’ standards and nursing code of conduct (Nursing and Midwifery Board of
Australia [NMBA] 2013). The following essay will elaborate the significance of the nursing
professional code of conduct while delivering care to the patient. In doing this, the essay will
take help of the case study of an Aboriginal women named Raelene Ward. Raelene Ward is
40 years old having three children and the case study is elaborated in the reflective phrase as
she is giving interview to Natasha Reedy. The paper will discuss theories that are associated
with the nursing based person-centred care, family centred care plan and nursing code of
ethical conduct. The paper will also focus on the National Safety and Quality Health Service
Standards (NSQHSS) and Erikson psychosocial theory of needs. At the end, the essay will
state few examples of the effective and in-effective care as elaborated in through the case
study along with the significance of “partnering with the consumers”.
The nursing professional standards that can be easily highlighted in the case study is
process of informed-decision making. According to the NMBA Standards (2013), a nurse
must incorporate the patients in the care plan by the process of informed decision making.
This helps to up-held the nursing ethics of autonomy. However, from the interview of
Raelene, it is clear that upon her diagnosis with gestational diabetes (GD) after the delivery of
the third baby, the endocrinologist in antenatal care prescribed her with the insulin therapy.
During that time she has no knowledge about the role of insulin therapy or why the insulin
injection was given to her suddenly. Thus it can be said that she received no support from the
nurses like education of the patients in order to take part in the informed decision making.
Buhse, Kuniss, Liethmann, Müller, Lehmann and Mühlhauser (2018) stated that education of
the patient about the disease prognosis and the therapy planning helps to increase the
patients’ support in the care plan and thus helping to improve the outcome of care. According
to the Erickson’s psychosocial theory of need, the people who are aged between 18 to 40

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years, the main needs are intimacy and isolation (Knight, 2017). Social and community level
participation or interacting with the family members promotes intimacy. This intimacy helps
to improve the mental well-being and this in turn facilitated the physical well-being (Kuiper,
Kirsh & Maiolino, 2016). Raelene reported that she is single working mother with no
financial and mental support coming from her husband. Sudden demise of her sister further
created a psychological void in her life and thus increasing social isolation. This is the reason
why she passed on to depression. However, during the process of care, she received no
mental health support from the nursing professionals. Counselling from the mental health
nurses for the older adults might help to avoid such complications (Mehta, Lo, Garshasb &
Jeffrey, 2017). Raelene was unable to manager her own medications and this is against her
aboriginal culture as they are well-equipped with the self-management and self-coping skills.
Proper mental health counselling and awareness about diabetes might help to increase her
self-coping skills.
The care-plan used for Raelene was in-effective as it did not followed the person-
centred care plan. When Raelene was developed gestational diabetes mellitus (GDM) no
prior consent was taken from her for injecting insulin in order to manage her blood glucose
level. Brown et al. (2017) stated that form the treatment of the gestational diabetes, the
injection of the fast acting insulin through subcutaneous injection is always not
comprehensive and might incur side effects. Depending on the physiological health condition
of the women in pre-natal care along with the blood glucose level, the selection of the therapy
must be done. Brown, Grzeskowiak, Williamson, Downie and Crowther (2017) state that the
proper analysis of the insulin management for GD is crucial for fostering effective care to
women in the pre-natal care. Proper implementation of the person-centred care approach
based on the clinical needs of the patient helps to chances of un-wanted complications.

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Lack of presence of the culturally competent nurse or the indigenous healthcare
professional is another example of the in-effective care for Raelene. Whitty-Rogers, Caine
and Cameron (2016) stated that pre and post pregnancy related care is defined by the
presence of the culturally competent or aboriginal midwives while dealing with the
indigenous healthcare service users. The presence of Aboriginal nurse helps the women
service users to discuss her concerns or problems in detail and thus helping in the easier
identification of the clinical priorities and designing proper person-centred care plan.
Presence of the Aboriginal healthcare workers help to bridge the communication gap among
the Aboriginal women (healthcare service users) and thus helping to proper health literacy
and increase in the patients’ participation in the care plan (Campbell et al., 2017). Not only
the patient, the presence of the family members are also important in order to develop person-
centred plan and for the implementation of the health-literacy among the clients. However, in
case of Raelene, none of her family members are involved and this goes against the
NSQHSS.
Effective care planning for GD in case of Raelene is presence of the dietician. The
dietician not only helped to design person-centred plan for Raelene but also helped to
promote education to Raelene about the importance of the anti-diabetic diet in the
management of the GD. Whitty-Rogers, Caine and Cameron (2016) stated that proper
regulation of the dietary intake is an effective non-pharmacological intervention for the
management of GD. The regulation of the sugar, carbohydrate and protein in-taken based on
the body mass index of the patients suffering from the GD helps to regulate the body weight
and at the same time helps to reduce the elevated blood glucose level.
According to the NSQHSS (2012), a nursing professional by the execution of
effective communication skills for the development of therapeutic relationship with the
patient and this is known as developing effective partnership with the client. Partnership with

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the client helps to increase his or her participation in the care plan and also helps to execute
person-centred care plan. Australian Commission on Safety and Quality in Healthcare
(ACSQH) (2012), clinical governance in the care plan is achieved by involving effective
partnership with the clients and their family members. Raelene use to inject insulin on her
own after she was diagnosed with. However, she was not aware of the reason why she is
taking insulin. Nevertheless, insulin functioned to reduce her BGL and thus helping to reduce
the severity of the GD. However, death of her sister devastated her leading to decrease in the
therapy adherence. Thus the case study showed that targeted insulin intervention is effective
for reducing the diabetes mellitus only when proper lifestyle interventions are taken and the
primary care givers are educated to help the patient to adhere with the care plan. Since there
was no adult member to support Raelene after demise of her sister, there occurred decrease in
the therapy adherence (NSQHSS, 2012).
The analysis of the intervention of the aboriginal women Raelene helped in the
identification of several gaps in the care plan like gap in the person-centred care approach,
lack of involvement of the family members and lack of informed decision making. This is the
reason why there occurred decease in the therapy adherence in Raelene after demise of her
sister. Raelene was a single mother with three children and thus lack of support coming from
the adult family members and lack of informed decision making in the care plan create a gap
in the therapy adherence. One of the best aspects of the care plans is presence of the dietician
who helped to draft anti-diabetic care plan and at the same time helped to increase her
knowledge about the dietary management of GD.

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References
Australian Commission on Safety and Quality in Healthcare (ACSQH) (2012). National
Safety and Quality Health Service Standards (NSQHSS). Access date: 4th October
2019. Retrieved from: https://www.safetyandquality.gov.au/standards/nsqhs-
standards
Brown, J., Alwan, N. A., West, J., Brown, S., McKinlay, C. J., Farrar, D., & Crowther, C. A.
(2017). Lifestyle interventions for the treatment of women with gestational
diabetes. Cochrane Database of Systematic Reviews, (5).
https://doi.org/10.1002/14651858.CD011970.pub2
Brown, J., Grzeskowiak, L., Williamson, K., Downie, M. R., & Crowther, C. A. (2017).
Insulin for the treatment of women with gestational diabetes. Cochrane Database of
Systematic Reviews, (11). https://doi.org/10.1002/14651858.CD012037.pub2
Buhse, S., Kuniss, N., Liethmann, K., Müller, U. A., Lehmann, T., & Mühlhauser, I. (2018).
Informed shared decision-making programme for patients with type 2 diabetes in
primary care: cluster randomised controlled trial. BMJ open, 8(12), e024004.
http://dx.doi.org/10.1136/bmjopen-2018-024004
Campbell, S., Roux, N., Preece, C., Rafter, E., Davis, B., Mein, J., ... & Chamberlain, C.
(2017). Paths to improving care of Australian Aboriginal and Torres Strait Islander
women following gestational diabetes. Primary health care research &
development, 18(6), 549-562.
DOI: https://doi.org/10.1017/S1463423617000305

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Knight, Z. G. (2017). A proposed model of psychodynamic psychotherapy linked to Erik
Erikson's eight stages of psychosocial development. Clinical psychology &
psychotherapy, 24(5), 1047-1058. https://doi.org/10.1002/cpp.2066
Kuiper, N., Kirsh, G., & Maiolino, N. (2016). Identity and intimacy development, humor
styles, and psychological well-being. Identity, 16(2), 115-125.
https://doi.org/10.1080/15283488.2016.1159964
Mehta, G., Lo, B., Garshasb, A., & Jeffrey, J. (2017). Diabetes and Mental Health: Exploring
the Effects of Diabetes Diagnoses in Patients with Mental Health
Conditions. Canadian Journal of Diabetes, 41(5), S80.
DOI: https://doi.org/10.1016/j.jcjd.2017.08.229
Nursing and Midwifery Board of Australia [NMBA] (2013). Regulating Australia's nurses
and midwives. Access date: 4th October 2019. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/
Whitty-Rogers, J., Caine, V., & Cameron, B. (2016). Aboriginal Women's Experiences With
Gestational Diabetes Mellitus. Advances in Nursing Science, 39(2), 181-198.
DOI: https://doi.org/10.1097/ANS.0000000000000115