Professional Documents
Culture Documents
Complete Task On Graded Unit
Complete Task On Graded Unit
CARE-GRADED UNIT
By: M.Dass
COMPLETE TASK
ON
HNC HEALTH CARE
GRADED UNIT
2008
By:
MOTILAL DASS
Scotland
1
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
PLANNING
My placement is in local residential care home in Ayr. For completion of graded unit project I
have selected a client who has a permanent colostomy and an attachment of colostomy bag at
the site. A colostomy means a surgical opening into the colon. This project includes three
stages called planning, development and evaluation of a practical activity where I will change a
colostomy bag.
This client is of 78 years old lady who has been cared for last six months and was transferred
from Ayr General Hospital. Due to permanent colostomy bag attachment at the site her normal
movement altered and as a result of this normal movement got a diversion. So she is required
to change the bag from time to time. This changing of bag will minimize the risk of infection and
tissue integrity. The constant moisture condition may aggravate the condition, so it’s important
While the bag is attached at the site an extra care has to be taken that the bag is well sealed
and not leaking at all. As due to leakage she may have low self esteem, so the social need
could be hindered. As a result of her existing condition she is totally confined to the specific area
around her .This affects her normal social life and she is emotionally depressed. In order to lift
her emotional need it is necessary to talk to her from time to time and to give her a brief history
of same types of clients and their prognosis.
While I went through the client’s medical notes I kept that information confidential as Nursing
and Midwifery Council states that you must treat information about patients and clients as
confidential and use it for the purpose for which it was given (NMC-2004).
I found that she had a poor educational background. As a result it took time for me to explain
the medical terminology but I found she was much interested to learn so I could state that her
cognitive need is moderate. By talking to number of relatives I came to know that she belongs to
2
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
Her educational background revealed that she discontinued studies at the earlier stages of her
life. Then she started working as a kitchen assistant in a nearby restaurant. She has her own
house and her family consists of five members including two sons and a daughter and a
husband. In the context of her socioeconomic background and her existing disease condition it
could probably be stated that the quality of food consumption and living standard might be the
contributing factor of the cancer of the colon and on the basis of the educational history she has
knowledge deficit. Donna Myers, (colon cancer 2008) states where you live; who's around you,
your occupation, and even when you work may all influence your risk of developing colon
cancer
In the perspective of the health and well being of this client it is quite clear that she had the
opportunity for early screening and detecting the disease process at the preliminary stages. She
should have gone for this in order to be treated at early stages and better prognosis. While
reviewing her history I could relate this with the conflict theory. The conflict theory states about
social stratification and inequality in provision of health care and Kenworthy et al (2002) states
that Conflict theory explains social structure and changes in it by arguing that actors pursue
their interests in conflict with others and according to their resources for social organization.
This client is totally confined to the care home due to the existing condition and henceforth she
is emotionally depressed. In the most of the cases her normal life is normally hindered. Her
mental state is badly affected and in the context of the psychological need it is found that she is
ideal client for whom the cognitive theory is applicable as Kenworthy et al (2002) states that
cognition is involved in recognition with the thought process. Her past background revealed that
her understanding level of disease process is poor. The client had undergone a colostomy
operation and it is as result of the carcinogenic condition of the large colon. Tortora et al (1996)
states that the large colon has three parts called ascending colon, transverse colon and
descending colon.
3
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
The risks factors of colon cancer are age, hereditary, genetic alcohol consumption, smoking,
diabetes, obesity, race and ethnic background, lack of exercise, personal cancer history,
medical conditions, family history of colon cancer, large intestinal polyps and diet. Carol (2003)
states Colon cancer arises from histopathology and molecular changes caused by complex
interactions between genetic susceptibility and environmental factors. These molecular changes
include multiple, acquired genetic alterations within colonocyte oncogenes (promoting malignant
transformation) and tumor suppressor genes (causing loss of the inhibition of cellular
proliferation). To resolve the normal elimination pattern this operation was necessary.
The activity I chose is changing of stoma a bag I realized that due to the patient’s condition it is
good enough to carry out this task. This will help the client to promote her independence and
intellectually she will be more knowledgeable and know the rationale for doing it from time to
time. Emotionally she will be more uplifted and socially she will be have more confidence as she
keeps on interacting with similar groups of clients, who underwent this procedure. I will be
carrying out this activity in a care home by demonstrating the activity of changing the stoma bag
from the site and connecting a new bag and in this activity the patient will be involved directly
and in the presence of a staff nurse who would be supervising the activity. This activity will be
carried in fortnight time from now. The time I have set for the activity is almost one and half hour
and overall time scale of this project is to be submitted by planning on March 3rd, development
on 1st April and evaluation on May 19th 2008.
The aim of the project is to achieve my HNC award. In order to complete this activity I would be
needing help from the staff nurse, stoma care nurse and also logging into various educational
web sites, magazines and health related books. The appropriate time scale for this planning is
in three weeks time from now. The resources needed for this activity are gloves, aprons, alcohol
gel, stoma bag, color coded yellow bin for clinical waste, gliding and sliding sheets. While
changing the bag the personal protective devices will be worn in order to minimize the risk of
infection.
4
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
The soiled bag will be discarded into the yellow bin as the yellow color coded bin is meant for
discarding clinical waste It will require turning the patient slightly to the opposite side of the bed,
so care must be taken to keep the bed side rails in order to prevent falls and also unnecessary
equipments should not be keeping within the area of demonstrating this activity since it may
require good space. The patient should be turn with the help of other staff and using the sliding
and gliding sheets as these position changing devices facilitates easy way of changing the
position and also I made sure that other objects are kept in orderly manner as dropping objects
on body parts can cause fractures, abrasions and cuts, etc (Kingston and Chelsea -2008).
During my plan I will make sure that the environment is quite safe and secure for my client in
order to avoid any further injuries on hazards as the health and safety regulation (Health and
Safety Regulation) states that the provision and maintenance of plant and systems of work that
are, so far as is reasonably practicable, safe and without risks to health. While I was making this
plan I made sure not to disclose any in formations concerning to the patient and even in my
planning process I did not mention patient’s name and relevant personal details. To abide by the
Data Protection Act 1998 I did it so.
Considering to the patient’s need and evaluating her existing condition and talking to the staff
nurse regarding this patient I could understand that it would be an appropriate activity to carry
out with the patient and it is of course a realistic plan which could be implemented.
5
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
DEVELOPMENT
As previously mentioned, I have chosen to change colostomy bag as a clinical activity for the
purpose of completing the graded unit project. After reviewing the medical record of the client I
found that she has been suffering from bowel cancer from last few years.
Colostomy means surgically opening at the colon and the attachment of a bag for the purpose
of collecting the faecal mater into the bag. This bag acts as a reservoir. The colon is divided into
three parts ascending, transverse and descending colon and this patient was suffering with
cancer of the descending portion of the colon. As a result it was necessary for her to have a
colostomy. There are manifold clinical manifestations associated with the colon cancer as
Tortora et al (1996) states that increasing age, family history of colon cancer, previous colon
cancer, and history of inflammatory bowel disease, high fat –high protein and low fibre diet are
closely linked with the colon cancer. So colostomy is done in order to provide palliative
treatment.As the client had undergone a colostomy operation and had a bag attached at the site
it may change the client’s physical image, and this also interferes with the hygiene needs. If the
bag is not changed frequently then there might be chance of developing infection at the site.
I have gone through the infection control policies and protocols of the care home and it states
that prior to giving any care to patients its mandatory to wash hands and when it comes to care
of surgical sites then the gloves and aprons must be worn. I have read the care plans of this
patient and found that every second day the bag needs to be changed. I also spoke to the other
members of the care team such as staff nurse, stoma care nurse and senior carers of the care
home. All of them were co-operative with me. I was told to observe the activity first as the staff
nurse carried out and she explained it to me as how to do it.
6
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
But the staff nurse demonstrated it on another patient, who has undergone the colostomy
operation. Then I was asked to carry out on the patient I selected. I gathered all the necessary
articles needed for carrying out this task. The articles included:
• disposable gloves
• plastic apron
• stoma bag
• alcohol gel
• yellow colour coded bin
• scissor
• cotton swab
I went to the patient and introduced myself to her and I also explained the procedure to the
patient to gain her confidence. I sought her permission to carry out the activity as NMC (2004)
states that you must obtain consent before you give any treatment or care. I ensured the
patient’s privacy and dignity by closing the door and keeping the curtains shut. Staff nurse was
there to supervise me. The client was initially anxious and kept on asking me questions, why I
was closing the door and keeping the curtains shut and I explained that others may not feel
good to see us carrying our the activity, moreover it may give some foul odour. After making
everything ready I put on the apron and washed my hands with antiseptic solution provided for
hand washing, dried the hands thoroughly and then put on the disposable gloves. I did it to
comply with the infection control policy and procedure. Hand washing is important the risk of
minimizing the risk of transference of organism.
The Postnote (2005) states that probably the single most effective way of combating health care
First, I took out the old colostomy bag from the site and cleaned the site with sterile water using
cotton swab, made the site dry with dry cotton swab and discarded the bag into the bin to send
it for incineration.
7
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
I then opened then clean bag, checked the stoma and its diameter so that it fitted into the mouth
of the bag and the stoma. I fixed it properly ensuring that it did not leak at all. During this
process I had to turn the patient to have the easy access to the site, which I found initially
difficult but finally I could do this with the help of other carers. I made the patient feel
comfortable and repositioned her back into the bed. Took all the articles back to the treatment
room and cleaned them. I replaced them back to the place they were. I took off the gloves and
aprons and discarded them properly, washed my hands and applied the alcohol gel. I came to
nursing station and took the patient’s file and recorded the activity which I carried out. I asked
the staff nurse on duty to countersign and so she did it. She was much impressed the way I
carried out then activity. Throughout the activity I communicated effectively with the patient
using verbal method of communication like keeping good eye contact. I cleared all the doubts
that the patient had regarding this procedure. Being the communicator in this case I delivered
accurate message to her. I was successful in interacting with her since she was able to respond
effectively. Kenworthy et al (2002) states that communication is judged as successful when the
As prior to carrying out the activity I discussed it with the staff nurse and she gave me
necessary information and I also read the policy and protocol of doing this activity. I gathered all
the things in accordance to it. There are many patients who have undergone a colostomy
operation and residing in the care home. It’s like a common procedure in the care home. For
this reason there were adequate supplies of things needed for this activity. I found all the things
needed to hand. The nurse in charge was very supportive for this activity.
During the activity I needed to change patient’s position, since the patient was quite heavy and it
was difficult for me to do it by myself. During the activity I found it hard to do it but the nurse
reminded me and then I got assistance from other carer to do it as Kenworthy et all (2002)
states that moving and handling patients within an acute hospital setting, with the availability of
other colleagues and lifting aids is more easily achieved safely than trying to move a patient in
their own home in a low bed and without the support of the staff and mechanical aids.
8
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
I summoned couple of carer who helped me to do it. It interfered a bit during the work. I adhered
to health and safety regulation as Health and safety at work place (2007) states that it safeguard
others, including members of the public, who may be exposed to risks from the way work is
carried out. Which I felt should have done prior to carrying out the activity. As I was being
supervised by the staff nurse I made sure all the used and soiled articles are disposed properly.
I promoted my patient’s independence and adhered to all the Health and Safety policies
9
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
EVALUATION:
As it has been already mentioned in planning and development stage that for the purpose of
completing the graded unit project the care of the stoma was selected as a clinical activity. I
have selected a patient assessed her needs on the basis Maslow’s hierarchy of need and a plan
was formulated. On the basis of the plan the care was implemented to this patient. Now I am
intending to evaluate the efficacy of the whole project work that I have undertaken. Evaluation
also helps in judging the overall out come of the patient but in this case I am much interested to
evaluate the planning and development stage as a whole.
The appropriateness of this project is assessed on the basis of patient’s outcome. The patient
was prone to develop skin infection at the site of the stoma and irritation or rash could be
aggravating so the care of the stoma was an important aspect to consider. In order to minimize
the risk of infection at the site this activity was chosen. Particular concentration was given on
hand hygiene as the Postnote (2005) states that probably the single most effective way of
particular hand hygiene. All the information regarding this patient kept confidential and it was
disclosed to the members of the multidisciplinary team only as NMC (2004) states that you must
protect confidential information. The Data Protection Act (1998) also declares that all the
records about client which are filled will be seen as data, whether electronic or paper and
individuals are given rights which include the right to confidentiality- that the information should
I planned and carried out this activity under the supervision of a staff nurse. Prior to carrying out
this activity I had to gather information from various sources such as I had to spent lot times with
the staff nurse, logged onto various educational and scientific websites, used library books and
leaflets and also consulted the stoma care nurses for adequate information.
During the activity I was told that there was a slight discrepancy in gathering articles which was
10
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
I was interested to look on the types of stoma bag, its specification, and colour, how often it
needs to be changed and also on the manufacturer’s guidance on how to use them. Since the
patient was vulnerable and could not follow the instruction while I was instructing on how to take
care of it by her but still she was happy to receive the instruction. The activity I planned was
Effective communication with the patient was one of the main strength that helped me to carry
out the activity smoothly. I preferred to use the non-verbal method of communication and I
mostly used actions to convey messages to this patient as Kenworthy et al (2002) states that
actions speak louder than words. The patient could easily understand me and co-operated well.
Some times this patient was restless and did not feel like talking with me but she showed
positive gestures.
The plan was made on the basis of the patient’s assessment. For this reason the activity I
planned well suited to her. The priorities of her needs were identified accordingly. On the other
hand I needed support from other carers which initially I could not realize but during the activity I
faced difficulty and then summoned assistance from them. Couple of the carers came and
helped in turning the position of the client which facilitated the easy access to the site. In the
planning stage it was quite difficult for me to gather information and assess the patient’s needs
and to select suitable client for carrying out the activity. I was in indecisive state in planning
stage. When I started planning the activity I made a rough description of the activity and showed
it to the nurse on duty for further guidance and to check the accuracy of it.
I was then asked by the nurse on duty to make some changes and to comply with the
assessment guidelines. I was also asked to formulate the plan which will promote the
independence of the client I chose. In the developing stage I was reminded by the nurse to use
sliding and gliding sheets properly. I had to reflect on this area and then made further changes.
In the future I will be able to carry out the any project work with much confidence. I will not
repeat the same errors I which made here. Initially, I failed to organize properly but gradually
with the assistance of my tutors and other staffs I could make it possible.
11
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
Now I am capable of working in a team. The way I have carried out this activity I could relate it
to the Belbin’s team role theory as Belbin (1994) stated that team workers make helpful
interventions to avert potential friction and enable difficult characters within the team to use their
skills to positive ends; they tend to keep team spirit up and allow other members to contribute
effectively. In order to collect the relevant information I had to revise all the units taught. I had to
universal precaution of infection control like proper hand hygiene, use of personal protective
equipments, disposal waste materials and also disinfecting the articles used. Due to existing
disease condition this patient had low self esteem. I had to provide her psychological support. I
talked with her and tried to divert her attention from monotonous feeling. I drew her attention
towards music and videos. By the time I finish this project work I found her self esteem
improved. Self-esteem is concerned with the person inner belief as Counseling service (2008)
states that self-esteem reflects the intrinsic belief in the self, i.e. the overall opinion and value of
a person. Low self esteem plays vital roles in person’s life. To find out the details of the disease
process and its clinical manifestation I referred anatomy and physiology handouts, notes and
many reference books from the library and this helped me to get the precise information
needed. By undertaking this project work for Graded unit I have learned manifold aspects of
Now I am confident enough to correlate theory into practice, do research work, find out data as
well as back up my work with sufficient evidence, going into in-depth of the work and taking
initiative steps and also working in an effective and well co-ordinated manner. I have evaluated
the continuity of the project as a whole. I could successfully adhere to the appropriate code of
practice. Through out this project I could maintain professional standards incompliance with the
code of conduct mentioned in Nursing and Midwifery Council guidelines 2004 which states that
you have a duty of care to your patients and clients who are entitled to receive safe and
competent care.
I was supervised by a nurse. The activity closely followed what was written in the plan. Indeed it
12
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
The supervision from the staff nurse helped me to gain confidence. In collaboration with her I
could follow meticulous technique. Always I respected my patient’s autonomy and involved her
in this activity. Since I am quite good in IT, word processing and browsing so I was benefited in
searching online information quickly. I had to negotiate with other carers to carry out my project
work within a given time in the placement areas. I also met the time scale of this project. I
submitted both planning and development stages on the specific dates mentioned by my
Graded unit lecturer. This shows that I am much aware of the times scale for this project. By
undertaking this project I have gained confidence and my self-esteem improved. I followed the
instruction of my lecturer while I intended to organize this project. I was positive, showed
willingness to learn from the carers and staff nurses and I also attended couple of training
conducted in this care home. Through this project one of the main pitfalls was initial organization
of the whole project. At the beginning of the project I was perplexed and I thought it was not
possible by me. I went on with perseverance and finally made it. The encouragement from my
Now I am capable of undertaking any project of this kind. I learned to organize the project work
properly, outline the plan and putting the plan into action. I could gather information in relation to
information. In this project at times I got drifted away but this will not happen in the future
project. I applied the knowledge gained in all the units and this project work gave me positive
feed back. I gained knowledge on many areas such as disease condition of this patient,
referencing accurately for research work and discussing with other members on issues requiring
improvement to make a good project work. In conclusion, an effective patient care strategy was
demonstrated by me while the care was being given to this patient. Working in collaboration with
the multidisciplinary team was the most interesting aspect of this project. I could take own
initiative to implement the care. Planning the brief overview of the project, discussing it with the
patient and interviewing her directly were another interesting aspect which I enjoyed.This project
helped me to acquire evidence based learning resources. It also required me to review all the
13
HNC HEALTH
CARE-GRADED UNIT By: M.Dass
Whole project was done on the basis of holistic approach, in turn which made all the needs of
this patient. It required integrity, the knowledge and understanding as a whole. Reflecting on this
project work I could state that I learned the skills to undertake such activity in future. I would be
mentally prepared to do it without excessive straining for gathering information. In few occasions
I missed out using sliding and gliding sheets, which I was not expected to do. In future when I
undertake this kind of projects I will not do the same mistakes I did here.
14
HNC HEALTH
CARE-GRADED UNIT
By: M.Dass
REFERENCES
Belbin’s Team Role Theory [online] 1994, London; available on: www.srds.co.uk and accessed
on April 23rd 2008.
Health and Safety Act 2008 London [online] available on www.healthandsafety.co.uk and
accessed on February 27th 2008.
NMC code of professional conduct: standards for conduct, performance and ethics (Nursing &
Midwifery Council) London, p.3, 15
Occupational Therapy Training [online] 2007, London; available on: www.otdirect.co.uk and
accessed on April 25th 2008.
Postnote (2005) Infection control in health care setting London. [Online]: available
www.parliament.uk [accessed on March 25th 2008]
The Royal Borough of Kingston and Chelsea 2008, London. [Online]: available on
www.rbkc.gov.ukand accessed on March 2nd 2008.
Tortora GJ, Grabowski SR (1996): Principles of Anatomy and Physiology 1st ed. Biological
Sciences Text Books, Inc. and Sandra Renolds Grabowski. p.793, 794, 1051
15
HNC HEALTH
CARE-GRADED UNIT
By: M.Dass
This task is entirely based on the Higher National Certificate in Health Care
Module. It is kindly requested to the readers to view it as a sample of assignment
only. Please do not copy any of its components. However, its materials can be used
for referencing other assignments.
Comments and suggestions are cordially welcomed.
A very special token of thanks to you all for going through this research work.
Motilal Dass
Registered Nurse (India)
HNC Health Care (Scotland)
E-mail:
motilald@hotmail.com
END
16