Physical and social barriers

Section 2. 2 of the Nursing and Midwifery Council Code of Professional Conduct (2002) states that as a registered nurse ‘you are personally accountable for ensuring that you promote and protect the interests and dignity of patients and clients, irrespective of gender, age, race, ability, sexuality, economic status, lifestyle, culture and religious or political beliefs. It was acknowledged by staff nurses that this incident should not have happened as Chris’s physical needs should have been met. The Disability Discriminations Act part 3 is concerned with access to goods and services.

The act makes it unlawful for a service provider to discriminate against a disabled person in the standard of service which it provides to the disabled person or in the manner in which it provides a service to a disabled person. Helen’s decision to put Chris in a cubicle and her attitude that he did not need immediate assistance to the toilet directly influenced the care Chris received. When admitting him by automatically placing him in a cubicle this cut off interaction with other patients therefore his emotional and social needs we’re not being met.

As Chris; mother had gone out and he was physically disabled he could not summon a nurse himself to tell them his needs we’re urgent. As he had been placed in a cubicle at the end of the corridor he could not be seen on the bay and therefore his more demanding physical needs had not been met. According to Hughes B, and Paterson K, the Social Model of Disability indicates that Chris’ disability is exacerbated by environmental factors so that the context of disability extends beyond his impairment.

Therefore it is the presence of physical and social barriers that disable children by the lack of provision for their needs. (Swam et al 1997) This can be applied to that ward setting that was not fully adapted to meet Chris’ physical needs as he could not summon for assistance in the cubicle by himself therefore it would have been more appropriate for him in the bay. As a student nurse my immediate personal feelings were of guilt that I had not gone to help Chris as I had offered and I felt embarrassment and loss of dignity for Chris.

The Royal College of Nursing (2008) ‘Dignity: at the heart of everything we do’ campaign states that as a registered nurse we have the responsibility to respect the patients dignity and privacy while being compassionate when emotional support is needed. The Royal College of Nursing (2000) is committed to a view of patients as equal partners in their own health care. It states that professionals need to ‘modify their position to ensure that power balance is effectively achieved. ‘

This indicates that Chris should have been given the choice between a cubicle or the bay thus empowering him and giving him choice and control in his care. The Nursing and Midwifery Councils Code of Professional Conduct 2002, section 2. 1, states that ‘you must recognise and respect the role of patients and clients as partners in their care and the contribution they can make to it. This involves identifying their preferences regarding care and respecting these within the limits of professional practice, existing legislation, resources and the goals of the therapeutic relationship’.

A patient’s ability to chose for themselves and determine their own lifestyle is an important aspect of physical and psychological wellbeing. Empowerment aims to encourage personal growth by developing assertiveness and self-esteem. People who feel they have little or no control over their circumstances or events in their lives have higher rates of illness and mortality, (Kenworthy, Snowley and Gilling, 2002). This emphasises the responsibility on nurses to promote and encourage patient independence by recognising and respecting their involvement in the planning and delivery of care.

It is important that nurses also recognise that empowering care optimises patient independence and disempowering care leads to increased patient dependence, (Faulkner, 2001). As a student nurse this experience forced the question as the why Chris has automatically been admitted to a cubicle thus opposed to the ward bay when he was physically disabled therefore having special needs and it was apparent his parents we’re not going to be with him all the time.

By asking my mentor and staff nurses it became apparent that usually disabled patients and their families are given the choice, if appropriate between a cubicle and the bay but on this particular day as it was so busy the choice was not offered. This highlighted the importance of empowering the patient by making choices, patient partnership, communication and advocacy when child is without parents. According to Kenyon, E (2003) Partnership in care is the ability to develop a relationship that co-exists to form a collaborative approach to care.

Negative partnership consists of poor communication and poor negotiating skills. If Chris had have been in the ward bay communication would have been easier thus he would have been able to go to the toilet, promoting partnership. The RCN Children and Young People’s Nursing Philosophy of Care (2003) states that nurse’s caring for children should listen to young people providing a means for them to convey their opinions and feeling and using these to guide decisions about they way their care is delivered.

As a registered nurse you have the responsibility of recognising each child as a unique individual whose best interest must be paramount, whilst considering their physical, psychological, social, cultural and spiritual needs as well as those of their family. As a student nurse this emphasises the importance of assessing the needs of a disabled child thoroughly as their needs may be more complex and care planning appropriately.

This situation has given the student nurse the confidence to question why things are done as they are in practice placement and highlighted the importance and relevance of the NMC Code of Professional Conduct within nursing practice and how it protects client’s dignity rights.


Contact a Family (2007) available at: http://www. cafamily. org. uk/students. html (accessed 11/-7/2008) The Disability Discrimination act 1995 Equality and Human Rights Commission (2007) assessed at: http://www. equalityhumanrights. com/en/forbusinessesandorganisation/employers/pages/whatthelawsays. aspx Every Disabled Child Matters (2006).

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