Putting the nursing Principles into practice

Published: 17 August 2011

The RCN’s Adviser for HCA and AP members, Tanis Hand, provides an example of how the Principles of Nursing Practice can be used to improve the quality of care you provide to patients   

So let’s take the example of a typical patient you might see any day in a GP practice anywhere. Mrs Smith is 82 years old, sprightly but frail and has a BMI of 18. She lives alone with her cat and her family live about 50 miles away and visit once a month. Mrs Smith is attending the surgery to have her leg dressed because she banged it when dusting. She has a skin flap on her shin that is healing very slowly. She does not smoke or drink. You are dressing her wound weekly under delegation by the practice nurse who sees Mrs Smith on one other occasion each week.

As the weeks go by, Mrs Smith starts to open up and tells you that she has started to lose her appetite recently. She has always been slight and food has never been a high priority for her, but lately she has felt that she has to force herself to eat anything. As a result she tends to live on tinned soup and jam sandwiches as these are easy to make and eat. But she has noticed that her clothes are starting to feel loose and also her bowels have become much more irregular lately. She is sometimes constipated for days but then can suffer with diarrhoea for no apparent reason.

These symptoms could be caused by a number of issues and certainly you would be passing this information on to the practice nurse with Mrs Smith’s permission. But what if you hadn’t been someone that she felt she could speak with? What if you hadn’t shown her that you respect and value her? You may not have noticed for a good while that she was losing weight, but more importantly you may not have passed on information that could lead to further investigations. And this is before you consider the importance of good nutrition for wound healing.

Just by being attentive, by listening and by caring, you may have given Mrs Smith the chance to have her symptoms investigated, or simply assisted her to supplement her diet in order to aid the wound healing. But the most important point in all of this is that Mrs Smith felt safe to open up to you and felt that you cared enough to listen to her.

This is what Principle A is all about. You may say it is just about doing our jobs properly – but never underestimate how important that is to the people in your care.

To see videos of the Principles in action, go to www.rcn.org.uk/hcafirststeps and look under the “Quality” section.