POLICY AND GOVERNANCE IN NURSING AND HEALTHCARE

The name of the patient used in this review has been changed to maintain confidentiality, according to the Nursing and Midwifery Council code of conduct (Nursing and Midwifery Council, 2015). Healthcare delivery presently focus on delivery of care that is patient-centred. This implies according patients healthcare services that are not only responsive but also respectful of their needs, preferences and values. This care consists of every action that ensures the patient is respected, given emotional assistance, and that their comfort at the physical level assured. Additionally, such care ensures that there is coordination between healthcare professionals giving the care and the family of the patient through a collaborative framework. Case Summary Bob a 78-year-old man, who lives with his wife and their only son went to his local Accident & Emergency unit complaining of stinging pain in his lower abdomen.

After careful patient assessment, it was established that Bob had urinary retention. At its acute state, this condition presented with a sharp pain that the patient described as being stinging thus needed immediate attention of medical professionals whose first course of action would be to control the pain before admitting the patient to the medical ward. The following assessment and interventions were carried out. (a) Patient Assessment The nurses in this unit carried out an assessment on the patient to establish the potential problems that would have resulted in the condition. This then formed the basis for the physician to institute pharmacological management (Marshall, Haber, & Josephson, 2014). A record of the quantity of urine voided with each action of voiding was then kept.

Any time the patient presented a value that showed a decrease in the urine output, the quantity of the urine voided was recorded. The physician then ordered for the determination of the specific gravity of this urine. The rationale behind this was that increased urinary retention puts pressure on the ureters and this goes back to the kidney. These demonstrated a distended bladder that was felt in the suprapubic region. Urinalysis was then monitored, including urine cultures for sensitivity to establish urinary tract infection. Blood urea nitrogen (BUN) and levels of creatinine were also monitored through laboratory tests to distinguish urinary retention from urinary failure (Marshall, Haber, & Josephson, 2014). (b) Interventions Upon the establishment of the diagnosis as outlined above, and carrying out the aforementioned assessments, the interventions were initiated by the nurses under the guide of the physician that was assigned to this patient.

1,500 millilitres of fluids in every 24 hours were initiated on the patient. This was done to ensure that urine drained freely, chances for stasis reduced, and consequently a reduction in the risk for infections. The catheter was then secured to the abdomen of the patient to prevent it from being dislodged accidentally, and the patient from developing urethral fistula (NICE, 2014). Policy, Ethics, and Legal Framework The National Institute for Health and Care Excellence provided a guideline for the management of urinary retention. This protocol indicates that the first method of managing this condition is the use of self-management techniques like urethral milking in which the patient is taught how to empty their urethra such that they prevent urine drops from leaking when they complete urinating.

Additionally, these patients are taught bladder training, which entails increasing the duration it takes them to want to void urine and the actual act of voiding. However, before the catheter is removed, this patient should be started on alpha-blockers. These drugs help in relaxing the smooth muscles surrounding the prostate gland and those found at the base of the patient’s bladder to enable the patient void urine with little effort after catheter removal. Additionally, these drugs will prevent urinary retention from recurring through ease of urine passage. In the case of chronic urinary retention, which is the case with my patient, the guideline requires that they be put on catheterisation, with the possibility of surgery to correct the cause of this condition (NICE, 2015).

In this case, the patient was diagnosed with chronic urinary retention and the healthcare team that was attending to him found it necessary that he be put on a catheter to swiftly drain the retained urine that was causing severe pain. All these are done after considering the care protocols set by regulatory bodies and the hospital. Respecting the autonomy of the patient implies that the nurse and the healthcare professionals in the team according care understand that the patient has the right to self-determine. Catheterisation exposes the patient to numerous risks as outlined above. The patient should therefore be able to consider the benefits they intend to accrue from the intervention versus the risks that this intervention will potentially have on their well-being.

The decision they make should be respected. Because the healthcare team carried out this session properly prior to the initiation of intervention, they adhered to both the ethical code of conduct and the legal framework for healthcare practice. Nursing Contribution in Patient Experience Nurses play an important role in as far as the experience the patient gets through the process of patient care is concerned. They play a role in assessing the patient, administering various forms of intervention, advocating for the optimum possible quality of healthcare for their patient and carrying out both health education and health promotion in the process. In the case of a patient with urinary retention, it is the nurse’s duty to assess the patient the moment they arrive at the emergency unit and establish the nature of care that this patient needs.

If the condition of the patient is a threat to their life, the nurse should be able to initiate emergency protocols to save the life of such a patient and stabilize their condition before they can formulate a care plan. The necessary tests were ordered for following the sharing of this information and the healthcare team confirmed this diagnosis. It was then identified that the patient needed an immediate catheterisation to empty their bladder in order to prevent them from getting further complications that come with such urinary retention. The nurses swiftly and with care carried out the catheterisation process but only after obtaining an informed consent from the patient. Once the catheterisation had been done, and the patient’s condition stabilized, the nurses carried out a detailed patient education in order to not only ensure that they attained positive patient care outcomes but also that they avoided any form of complications that are often associated with catheterisation.

The patient was educated on the significance of meatal care that was to be carried out two times everyday using soap and water, and allowing the area to dry well in order to avoid infections. They do this by involving the patient through obtaining of informed consent while respecting their values and provision of both professional codes of conduct and legal frameworks. TOTAL WORDS: 3,192 References Bell, L. Patient-Centered Care. American Journal of Critical Care, 23(4). doi:10. 008 Marshall, J. R. , Haber, J. , & Josephson, a. E. Lower urinary tract symptoms in men: management: Clinical guideline [CG97]. Retrieved from National Institute for Health and Care Excellence : https://www. nice. org. uk/guidance/cg97/ifp/chapter/treating-urinary-symptoms#treating-urinary-retention Nursing and Midwifery Council. doi:http://dx. doi.