Healthcare Practice (HNC) Joint Assignment. Name: Eimear O Donnell Student Number: 30014816 Name of Booklet: Handbook for Student Nurses on placement. Units: Unit 2- Demonstrating Professional Principles and Values in Health and Social Care. Unit 3- Supporting the Individual Journey through Integrated Health and Social Care. Unit 17- Effective Record keeping in Health and Social Care. Unit Tutors: Karen Roarty, Nicola King, Ellen McCurdy. Course Coordinator: Kate Kilfeather. Word Count: 8703 Hand in date: 13th December 2021.

Contents.



How health and social care are structed and delivered in Northern Ireland



The current unmet needs in Northern Ireland within Health and social care services.



Frameworks that are available in Northern to support integrated care working



The Role of Health and Social Care professionals in supporting person-centred care.



The Statutory, regulatory, and inspecting body requirements when recording and reporting information within a care setting.



The implications of non-compliance with these requirements.



Impact of non-compliance within the care setting referring to the media, service user safely and the credibility of the healthcare setting.



The process of storing and recording records in a care setting (paper/electronic)



Current processes used in a care setting to store records and the policy and procedures to guide this process.



The reasons why information is shared in a care setting (internal/external)



How to improve storing and recording records.



How technology is used in a care to record and report service users' information.



What are the responsibilities of information sharing between multidisciplinary teams?



What are the purposes of reflection?



Two models of reflection and two tools used to reflect.



How reflective practice is applied to healthcare practice.



The impact of experiences on my own personal and professional reflection and how these impacts individuals using the health care services.

Introduction to the handbook. My name is Eimear O Donnell, and I am a nurse in Summerville Care Home. I have been asked to create a handbook for student nurses that will help guide them while on their placement with us. I will outline matters of how care is structed here in Northern Ireland, the different frameworks of care, the statutory, regulatory, and inspecting bodies requirements,

impact of non-compliance, how records are stored and used, and different models and tools of reflection used in healthcare. These issues are very important and should be implemented while on placement with us. I hope this handbook comes in useful to you during your placement and that you take the time to read it carefully.

How Health and Social Care is structed and delivered in Northern Ireland. Health and Social care is structed and delivered in Northern Ireland by the Department of Health. They are a body under the central government who guide and support the NHS to provide health and social care for the United Kingdom. The Dept. Health has umbrella organisations like, the health and social care board, the Public Health Agency and health and social care trusts, which work

together to provide integrated healthcare in NI. The Health and Social care board (HSCB) is a statutory organisation that organises health and social care services for patients in Northern Ireland. It works in conjunction with the Public Health Agency (PHA) to ensure needs of individuals are met throughout Northern Ireland. The Public health Agency was established to try to improve Northern Ireland’s health and wellbeing and reduce health discriminations. An example of this joint working is the vaccination programme in Northern Ireland. A document published by the Department of health, states that the vaccine will be rolled out in five phases in centres provided by HSC trusts such as walk-in vaccination centres,

GP’s

and

local

pharmacies.

(Department

of

Health:

COVID-19

Vaccination Programme Phased plan, 15th March 2021). There are six trusts that provide health and social care throughout Northern Ireland: Belfast Health and social care trust, Western Health and social care trust, Southern Health and social care trust, Northern Health and social care trust, South-eastern Health and social care trust and the Ambulance trust. They were created to deliver high quality care services including hospitals, care homes, day centres and other health and social care services. (Health and Social Care Online, 2021). Healthcare is organised into four groups in Northern Ireland: Primary, secondary, tertiary, and quaternary healthcare. Primary healthcare is the usually the first contact for individuals in need of healthcare. Examples include General Practitioner's (GPS), community nurses, dentists, and pharmacists. These organisations are designed to be easily accessed and to be able to deal with most health problems including physical health such as a broken arm or leg and mental health such as depression or anxiety. Primary care can be continued overtime by the management of a long-term diseases like diabetes. For example, In Northern Ireland Diabetes Specialists nurses (DSNs) assist people in managing their diabetes and can be employed in care settings such as GP’s. They become the first point of contact for people with diabetes and help to reduce the number of A&E admissions. These nurses help the service user independently manage their diabetes along with supporting their family members. (Royal Collage of Nursing, Diabetes Specialist Nurses: Improving Patient Outcomes and Reducing cost, February 2014). Secondary Healthcare is accessed through a referral form primary healthcare. Secondary healthcare deals with more challenging problems that can’t be

resolved in GP’S. These would include treatment for a broken leg, or a patient who has speech problems, may be referred by their doctor onto a speech therapist for further support. This type of care is usually caried out in hospitals where there are more staff and specialists are available. Tertiary healthcare is similar to secondary healthcare and is carried out in hospitals. It requires a referral from primary or secondary care. It deals with more complex problems including treating cancer patients or a major heart surgery. This isn’t available in every hospital as many don’t have the specialists available to carry out complicated procedures. Quaternary healthcare is the final level of care, and it deals with even more complicated cases such as an experimental drug for a rare disease, for example acute myeloid leukaemia. (e-INSURE, 2018). This is a rare cancer that is caused by an overproduction of cells in bone marrow that effects the production of normal blood cells. Treatment for this disease would be classed as Quaternary care as treatment involves chemotherapy and a possible stem cell transplant which is carried out by haematologist or a medical oncologist. These specialists and treatments wouldn’t be offered in local hospitals as are more complex and expensive. (American Cancer Society, Treating Acute Myeloid Leukaemia, 2021). Healthcare in Northern Ireland is also provided through voluntary and informal services. Voluntary services are non-profit organisations. An example of a voluntary service is Maire Curie. The nurses in Marie Curie provide round the clock in home care for individuals living with long term illnesses. They try to make end of life more comfortable for patients and their families while providing the patients with dignity and respect. (WHS Blog, 2019) Informal services include families, friends, neighbours, or the community who provide the patient with care and support without leaving their home. This type of service allows patients to be more independent and feel safe and secure knowing who is coming into their home. While there are positives to informal services there are also negatives. These services are under huge stress as they are usually done without any help from outside organisations. This can result in social isolation for the caregiver and lead to a strain on their family life. If the care giver is still working full time, caring for the individual can result in a drop in their work performance due to lack of sleep and time dedicated to their work. (Informal Caregiving: The Consequences Of providing Informal Care, 2021).

Current unmet needs in Northern Ireland within Health and Social Care Services. An article on BBC News by Janye McCormack declares that the Stormont government collapsed in 2017 when the Democratic Unionist Party (DUP) and Sinn Fein had a disagreement over the green party. This in turn paved the way for Direct Rule in Northern Ireland. This had great impact on the healthcare system in Northern Ireland and with no clear political leadership, civil servants were left to rule, and they didn’t have the power to make the big decisions needed such as reducing waiting list times for operations. (BBC News, Stormont; What it is and why did power-sharing collapse in Northern Ireland, 10 th January 2020). It became clear that the Northern Ireland Health system needed to change to keep up with the growing and ageing population. The Transforming your Care Document (TYC) 2011 stated the system in place was not fit for purpose in Northern Ireland. A review by John Compton chief executive of the Health and Social care board (HSCB) was taken and a new model of health and social care was found which would put the healthcare system in the right direction. The review had 12 points which were essential for the new model of healthcare including, putting the patient at the centre of care, safeguarding at risk patients, promoting independence and integrated care for patients. The TYC was created to help improve patient care and help individuals live longer independently. The document allows individuals to make their own decisions and have a greater input in their care. (Transforming your care document: A review of health and social care in Northern Ireland, 2011). However, this document was not implemented into Northern Ireland straight away. Initially the document was to be rolled out over a 5-year period but due to financial and budget restraints it was prolonged. Investment was then turned to other areas of healthcare such as stop smoking services, support for mental health problems and the continued access to new drugs. This saw a decrease in high quality care in Northern Ireland. Waiting’s list numbers began to grow, and it was reported by BBC News, that the Royal Victoria hospital in Belfast’s A&E department was ‘at breaking point’. With lack of informal services for the elderly, many hospitals and respite facilities found it hard to free up beds for new patients. (BBC News: Northern Irelands health challenges, Hugh Pym, 16 th December 2015).

With Northern Irelands ageing population more strain is being put on the NHS to provide high quality independent care. It was estimated that the average life expectancy of a man in Northern Ireland is 78.7 years and 82.4 years for a woman. Along with a lack of healthy lifestyle, nicotine uses and access to care by the government more and more of these people with develop an illness such as diabetes, coronary heart disease, obesity and cancer. With Northern Irelands waiting list blockage being 100 times larger than England’s in 2019, the government still have no forward plans to change. (Institute of Public Health- an overview of key statistics in Ireland and Northern Ireland, 2020). The lack of funding for the NHS is another unmet need. Northern Irelands spending on healthcare is more than the whole of England’s and the results are not the same. Northern Irelands Health Departments Finance director Brigitte Worth explained how the current health budget would not address the issues that needed to be dealt with. She estimated that £750 million to £1 billion would be needed to make a difference in the next ten years. The access to health services is also a need for patients living in rural areas and the lack of funding for transport to these services means many patients do without and their conditions can worsen overtime. To avoid this happening, the government should implement community health hubs in rural areas where elderly can visit instead of travelling into cities. An example of this can be seen in Hertfordshire. The local county council set up ‘public health partnership’ which see the local districts providing health services for individuals under the council’s leadership. Each district has its specific rules and services they want to provide. This eliminates the need for elderly to be visiting hospitals and ensures that high quality personcentred care is maintained. (Public Health England, Health and Wellbeing in Rural areas, 2017). Along with the refusal of the political parties to come to an agreement, the healthcare system was made worse by the COVID-19 pandemic. Waiting lists for major operations were put on hold and the general public’s health was cast aside to deal with the bigger problem: corona virus. This put huge strain on the already understaffed National Health Service (NHS) and they were faced with unrealistic demands of caring for more patients than ever before. With more nurses contracting COVID-19, establishments that where already understaffed saw nurses under more pressure. An article by Mimi Launder published in nursing practice, states that eight in ten nurses feel that the pressure of the pandemic

will linger for years to come. Many nurses fear for the number of people on waiting lists for operations increasing and more people becoming sick due to untreated individuals during the pandemic. (Nursing in Practice, NHS Staff as worried about pressures as peak of COVID-19 pandemic, Mimi Launder, 11 October 2021) The pandemic had a knock-on effect for residents in nursing homes as they weren’t allowed to see their families and friends. With the already drop of informal services due to younger populations moving away and families not having the manpower to look after relatives, this isolated elderly patients even more. A study done on long-term nursing home residents between March and July 2020, saw that 15% of individuals showed signs of depressive symptoms along with other issues including weight loss and loss of cognitive function. Most of these issues happened as a result of loneliness and isolation. (The Society for Post-Acute and Long-term Care Medicine, published by Elsevier Inc, 2021).

Frameworks available in Northern Ireland to support Integrated care working. Integrated care is when all members of the multidisciplinary team work together to improve patients care. The focus is to provide more person-centred care for each individual and tailor the care towards their needs. This is done through Integrated care Partnerships (ICPs). These are groups of services that range from doctors and nurses to voluntary and informal services. ICPs help to improve local services for patients and make their care more community based. For example, holding a diabetes clinic at the local GP once a week so that patients with diabetes don’t have to travel into hospital for check-ups.

They help to cut down

hospital admissions so that when a patient with a long-term illness like diabetes, becomes unwell they can be treated at home. (Health and Social care board, 2021). The introduction of the discharge to access model and the governments discharge fund has increased the number of patients being discharged from hospital earlier. These patients are then released back into the care of their General Practitioner and health discharge teams. These teams ensure that patients recovery plans are implemented efficiently so that their care is continued after they leave hospital.

This in turn would improve the patient with diabetes health. Instead of being in hospital for days they can be treated in the comfort of their home and receive the care they deserve. (GOV.UK, Hospital Discharge and community support: policy and operating model, updated 19th October 2021).

Integrated care also means caring for the patient holistically. This involves not only caring for their physical needs but also their mental, spiritual and social needs. It looks at the ‘whole person’ rather than just their illness. Providing holistic care can improve patients’ overall health to ensure they live a long healthy life. To ensure holistic care is received multidisciplinary teams need to work together. Co-Production is a way in which patients their families and healthcare professionals work together to create a care plan that improves quality of life for service user and ensures care is person-centred. It maintains the service user’s independence as they have input in their own care. It builds trusts among individuals and puts them at ease knowing what is happening with their care. An example of integrated care practice can be seen in Doncaster England where the borough council developed the already existing intermediate care services A survey highlighted how there was a lack of home-based services to help vulnerable individuals that lived at home. The service created named ‘Home-First’, aims to treat service users at home decreasing their need for hospital admission. The service provides care for early discharge from hospital and works closely with primary care providers such as GP’s and practice nurses. This service involves the patent and their families in decisions and allows the patient to feel more in control of their care. (Social care institute for excellence, Transforming Intermediate care services in Doncaster, July 2019). Partnership working in integrated care is about people working together to ensure patients get the most out of the services around them to benefit their care. A multidisciplinary team is an example of partnership working. It requires all members of the team such as doctors, nurses, physios, speech and language therapists working together through communication and co-ordination to ensure patients receive the care they require. The benefits of partnership working are allowing patients to be treated at home, developing healthcare professionals to deal with specific areas and a decrease of hospital admissions. (Locus Assignments, 2021). These benefits can only be achieved by agreed ways of working between healthcare professionals. Agreed ways of working can be

policies, procedures and personal care tailored to the service user. If these are not followed correctly the carer could cause harm to themselves and their patient. For example, an agreed way of working in a healthcare setting new for 2021, could be each employee must take a COVID-19 test every week. If a professional failed to take a test and ended up testing positive serious harm could be done to service users and service providers within the establishment. (DSDWEB, 2021)

Role of Health and Social Care Professionals in supporting personcentred care. Health and social care Professionals involved in person-centred care must demonstrate the 6Cs throughout their work. After several reports of poor-quality care being provided in England, Robert Francis QC held an inquiry into these reports. On the 6th of February 2013 the Francis report was published with recommendations for change including the introduction of the 6C’s. The 6Cs, were created to ensure all healthcare professionals provide patients with highquality person-centred care every day. (NMC, 2021). The 6Cs are. 1. Care: means putting the patient first. It requires being understanding, respectful and caring towards the service users’ needs at whatever stage of life they are at. 2. Compassion: involves treating the person beyond their illness. It demands you to be empathetic towards the patient and what they are experiencing. 3. Communication: involves every member of the multidisciplinary team knowing what is happening with the patient's care. It also makes sure that the patient knows what is happening in their care and can make decisions about it. 4. Courage: involves not being afraid to stand up for your beliefs. If you think something is wrong with a patients care or have a different strategy to the one in place have courage to say what you think. It also involves putting the patient first to ensure they receive high quality care. 5. Competence: means understanding and respecting the needs of the patient. Every patient is different and has different needs and will need different types of care best suited for them.

6. Commitment: involves giving 100% to your patients every day. It involves putting the patient first to ensure they receive the best quality care. (Nursing notes, 28th Oct 2021). By following the 6C’s and implementing them in everyday practice nurses and midwifes are adhering the Nursing and Midwifery Council (NMC) code. This code highlights the standards that nurses and midwifes must follow and uphold to maintain registered in the UK. (NMC, 2021) To ensure person-centred care is maintained health and social care professionals must understand the patient. They should find out what is important to the patient, their likes and dislikes and be able to relate with them. This builds a relationship between the patient and healthcare professional and enables the patient to trust their carer more. If a person is admitted to hospital and feeling lonely, the relationship with the healthcare professional can make their stay more bearable knowing that their service providers are friendly. The Care Act 2014 ensures this is happening in healthcare. It is centred around safeguarding vulnerable patients and their needs. The six principles of the Act are, empowerment,

protection,

prevention,

partnership,

accountability,

proportionality. These principles make sure that patients have their say and that they feel in power of their care. Accountability ensures that the healthcare professional keeps the patient and their families informed of every action and change in their care. This makes sure the care provided is patient centred. (High speed training, 2021). The Nursing and Midwifery Council (NMC) and Regulation and Quality Improvement Authority work in line with the Care Act to ensure patient-centred care is being delivered. Sanctions and fines can be imposed by both authorities if standards are not being upheld and in some cases nurses and midwifes can be struck off the register. (NMC, 2021).

The Statutory, Regulatory and inspecting body requirements when recording and reporting information within a care setting. When recording information, healthcare professionals must comply with the statutory, regulatory and inspecting body requirements. This protects the service user and the professional from the risk of a data breach and

ensures that a high standard of healthcare is maintained. A statutory body in healthcare is the Public Health Agency (PHA). Their record keeping requirements include:



That records should be easy to access being in electronic or in paper form.



That they are stored correctly and efficiently so they can be sourced quickly when needed



That records should be maintained for specific length of time and destroyed correctly to protect patient confidentiality and that records comply with the Data Protection Act 2018. (Public Health Agency, Records Management Policy, February 2011). When recording information, healthcare professionals must adhere the General Data Protection Regulation (GDPR). This law includes 6 principles that must be followed to avoid data breaches. These consist of consent from individuals for using data, informing individuals of data being used, avoiding the overcollection of unnecessary data, disposing of data when retention period is over. If this law is not adhered to, organisations could face fines of up to 20 million or 4% of their annual global turnover. (GDPR.EU, What are GDPR Fines, 2021). The Northern Ireland Social Care Council (NISSC) is another regulatory body for health and social care in Northern Ireland. Their standards include, respect the privacy of service users, gain and maintain the trust of service users, keep clear and concise records, and be accountable for the decisions they make. Non-compliance with

these

standards

can

result

in

sanctions

for

the

cate

professional. (NISCC, 2021). The Nursing and Midwifery Council (NMC) is a regulatory body for nurses and midwives in the UK. Their requirements for record keeping are. 

Records should be legible (easy to read and understand).



No records should be tampered with or destroyed unless given direction to do so.



Records should include all relevant facts and avoid including meaningless facts.



Records should be stored in a safe place and not left out in the open for unlicensed people to see.

(Nursing and Midwifery Council,

Record keeping – Guidance for nurses and midwives, 2010). Other requirements for record keeping by the NMC is, service providers must respect the service users right to privacy, not sharing confidential information with colleagues and other health professionals and take all necessary steps to ensure record are stored correctly and safely. The Regulation Quality and Improvement Authority (RQIA) is an inspecting body that ensures healthcare settings are meeting their standards of care. The record keeping requirements for RQIA include.



Records are clearly written so that patients can keep up to date on and be involved in their care.



All aspects of the patient’s care should be clearly legible in the individual’s records.



The Data Protection Act 2018 allows patients to have full access to their records.



That staff know the requirements for record keeping in line with statutory body requirements. (Health, Social Services and Public Safety,

Minimum

Standards

for

Independent

Healthcare

establishments, July 2014)

The

implications

of

non-compliance

with

these

requirements. Non-compliance means not adhering to the rules and guidelines put in place by the statutory, regulatory, and inspecting bodies. If organisations do not comply this can result in enforcement action.

Non-compliance with the Nursing and midwifery council (NMC) can result in sanctions such as. 

Suspension Order: Stops nurse or midwife from practising nursing for an agreed length of time.



Striking-off order: Professional is struck off the register, and not prohibited to work as a nurse or midwife in the UK.



Caution Order: individual cautioned for their actions but allowed to practice. This can last up to 5 years.



Conditions of practice prevents nurse or midwife to practice for up to 3 years and they need to be assessed by a fitness panel before they can practice again. (NMC, 2021) The Regulation and Quality Improvement Authority (RQIA) deals with no-compliance by issuing penalties. A Failure to comply (FTC) notice is issued where for example, an organisation has breached regulations and are placing the health and welfare of individuals at risk. Or they have failed to comply with guidelines after warnings and after a Quality Improvement Plan (QIP) has been issued. A meeting will take place to discuss risks, but if no meetings take place and an enforcement action will take place if the health and welfare of individuals are at risk. If compliance is not achieved within 90 days of notice another enforcement action will take place. An example of an enforcement action in a healthcare setting is in Camlo Homes, Belfast. The RQIA issued a notice of proposal when they inspected the care home on the 19 th January 2021. They found that the manager in the home was no longer registered with the Nursing Midwifery Council (NMC). This was a breach of the Residential Care Home Minimum Standards (2011). The RQIA held a meeting on the 27th January 2021 and put a plan in place that they deputy manager would now take over as acting manager until the former manager gains necessary qualification. Camlo Homes have 28 days to respond to notice or further enforcement action will take place i.e., shutting down of establishment. (Regulation and Quality improvement Authority, 2021).

The Information Commissioners Office is another inspecting body that maintains information rights and data privacy for the public. They aim to ensure that organisations adhere to their information rights and responsibilities. If organisations do not comply, they could face sanctions. An example of enforcement action taken by the ICO is when a pharmacy Doorstep Dispensaries Ltd, in London was fined £275,000 for leaving documents that contained patient’s names, addresses and date of births in an unlocked cabinet at the back of their grounds. This would be classed as an extreme data breach and a breach of ICO standards. (ICO, 20 TH December 2019).

Impact of non-compliance within the care setting referring to the media, service user safely and the credibility of the healthcare setting. The media now more than ever plays a huge role in the healthcare. We have various new ways to communicate with patients and colleagues. Although this is a good thing it can also have harmful effects to patients, healthcare professionals and organisations if not used in the appropriate way. Most hospitals and healthcare settings use social as a way of communicating with patients. It's a fast and easy way to get in contact with patients and can be easily accessed at any time. Social media is a great way for patients to gain knowledge about topics they are not familiar with. It also allows people undergoing the same illness to meet people the same as them and share stories of their experiences. Along with this, it allows healthcare professionals to share their knowledge with the wider world. Even though social media increases patient engagement it comes with its negative aspects as well. The media can spread false and misleading information to patients and make them believe information that is not true. Social media can also violate individuals' privacy. Individual’s data can be breached and confidential information like their name, date of birth and address can be share on the internet for people for to see. To ensure patient confidentially, service providers should adhere to standards issued by NMC and the ICO on recording keeping and preventing data breaches. Social media can also harm a person's employment status. Uploading an inappropriate picture or commenting

something unprofessional online can be seen your employer and can result in you being fired from your job. (Hospital Careers, The Pros and Cons of social media for Healthcare Professionals, 11 September 2018). The Nursing and Midwifery Council (NMC), has a document of guidance published on the appropriate use of social media for nurses and midwifes. It includes, not sharing information on social media about patients, posting inappropriate photos, discriminating against patients on social media and developing unprofessional relationships with patients online. Participating in any of these actions is going against the NMC code and can have serious consequences for the healthcare professional. (NMC, Guidance on using social media responsibly, 2021). An example of a non-compliance that was published on the media was when Derriford Hospital dumped 37 patients records into a charity bin. It was understood that a hospital employee had disposed of the records. Many of the records included confidential information like service users name, NHS number and previous medical history. Patients were left feeling vulnerable and betrayed by the hospital and they were left not trusting the healthcare professionals around them. As this was published on the media, it had an increased effect on the general public This tarnished the credibility of Derriford Hospital as patients didn’t have trust in the organisation which affected the creation of professional relationships and effected person-centred care. (BBC News, 2 nd March 2016).

Process of storing and recording in a care setting (paper and electronic). Records are kept on patients during their treatment so that every professional involved in their care has their information at hand. It also is a way of ensuring no information is left out about the patient as it is written down or stored online after every appointment. The most common ways of storing records are paper based or electronic records. Paper-based records are records written down by hand by doctors, nurses, physios and other healthcare professionals. They include records like, patient fluid charts, risk assessments, rotas for staff or notes of a meeting. Paper records are more liked by the older generation as you can see all your

information written down. They are more personal as they are written down by the people in charge of your care. They are also quicker to access on a busy day as they are on hand rather than trying to log into a computer as its more time consuming. Although paper records have advantages, they also have disadvantages. They can be lost or destroyed easily by water or ripped accidently by a healthcare professional. If records must be sent to a different hospital, they can take up to 2-3 days and this impacts the patients care. Similarly, the handwriting on written records can be harder to understand as you might not be able to read other peoples handwriting. Another way of storing records is electronic. These can be stored on computers, laptops or iPad. They include databases with patients’ information, emails between doctors and other professionals and documents scanned into computers. Electronic records take up no storage place and can be quickly sent to other hospitals or members of the multidisciplinary team. They promote more joined up working as everyone can quickly access the information. The downside of electronic records is that they can be easily leaked online for the public to see. If the wi-fi is down records cant be accessed online and this could affect the service users care for example, giving the patient something, they are allergic to. (Dr. Chrono, Paper vs Electrical medical records, September 20th, 2015). Current processes used in care settings to store records and the policy and procedures to guide these processes. Electronic and paper records although similar are stored very differently. In a nursing home paper records are usually stored in a locked filing cabinet at the nurse’s station. Only the nurses or doctors have access to the records. Paper records are stored in chronological order (a-z) and each patients record includes information like, care plan, risk assessments, fluid and eating charts and health prior to admission. This system ensures nurses can find records easily and less time is wasted. Electronic records are stored on a computer database called, The Northern Ireland Electronic Care Record (NIECR). This system contains patient information like appointments, previous care, lab reports and referrals to hospital. This system has great benefits for patients and healthcare professionals as the doctors have quicker access to lab results and tests so that the patient

can begin treatment as soon as possible. To ensure that electronic records are stored safely healthcare professionals should: 

Not share passwords with people not involved in the service user’s care.



Not leave computers or iPad open with confidential information for members of the public to see.



If information is saved on a USB only use in your computer as information can accidentally save on to another computer. Care Records on patients should only be maintained for a certain length of time and all records have different retention periods. Mental Health records should be kept for 20 years, Sexual Assault records for 30 years, General Partitioner (GP) records for 15 years and records; like the staff rotas should only be maintained for 2 years. The disposal of records should only be done when given order to. Records should be destroyed in the correct manner to ensure the safety of the patient so that nobody a can find them and read them. Records should be shredded, destroyed by fire and electronic should be deleted off USB and computer databases. (CPSO, Medical Records Management, updated March 2020).

Reasons why information is shared in a care setting internally and externally. In health and social care, information can be shared internally and externally. Information shared internally is between different members of a multidisciplinary team. For example, if a patient has started a new tablet, it should be recorded in their records so that all members of the multidisciplinary team are aware. Sharing internal information also allows the service user to know how their information is being shared, and with who it is being shared. Internal information is usually confidential information which is only shared between the service user, their families and the healthcare professionals involved in their care. External information is information shared to people outside the care organisation. People like social services, the PNSI, organisations like the Nursing and Midwifery Council (NMC) or Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR). RIDDOR, is an organisation that deals with the reporting of deaths, and accidents in a care institution. Reporting these incidents ensures

that they are taken care of and that in the future risks can be kept it a minimum. (High Speed Training Hub Kristin Guzder, Feb 22 nd, 2019). Sometimes external information is shared for the welfare of the patient. Information might be shared to the PSNI if the patient has been abused or assaulted. This information is usually private and personal and only shared in confidence when needed. External information may also be shared to the Nursing and Midwifery Council (NMC). This could include if a nurse is not following proper procedure under the NMC laws they can be named on the NMC website after a fair trial into the compliant. This information is public and can be found online by anybody. How to improve storing and recording records. Records in a care facility need to be recorded and stored correctly to ensure that none get damaged or accidentally destroyed. Healthcare Professionals should be educated and on how to keep good records by their supervisors and given training on the importance of keeping good records. Paper records should be easy to access in chronological order so that when nurses, midwives and other professionals are looking for them they can be accessed easily. Records should be kept until there retention period is up so that records don’t build up overtime. Audits should be kept of the record keeping process and this can help the organisation see what they are doing right or wrong and help them to improve. Organisations should use computer databases like the Northern Ireland Electronic Care Record (NICER) so that all electronic records are easy to access, and area l stored in one place, with exemption to patient progress charts. This allow the records to also be confidential as only individuals with the passwords for the database can enter. (RACGP, Improving Health record quality in general practice).

How technology is used in a care setting, to record and report service users' information. The use of technology in healthcare has many benefits to the service users and the individuals providing their care. There are two types of ways electronic records are stored, Electronic Medical Record (EMR) and Electronic Health Record (EHR). Electronic medical records are an online version of the patients record. It includes information like the patient’s medical history, their likes and dislikes and

treatment they are undergoing now. EMR allows doctors to keep up the date with specific areas like blood pressure or blood tests, identify if patients need to be set for tests or screenings. All this information remains in the one organisation and multidisciplinary team and is not sent if the patient moves care settings. Electronic Health Records (EHR), focus on the patient’s overall health including their physical, mental and social health. EHR contains the whole history of the patient and moves wherever the patient does. The benefits of EHRS are, when the patient moves to a different care setting, all their information is in one place, the patient can monitor and track the progress of their health, so they are kept informed. EHR results in the patient’s care being faster and more effective this in turn provides more person-centred care for the individual. (HealthITBuzz, EMR vs EHR- What is the difference? Garret n Seidman, 4 th January 2011). Other forms of technology used in care homes is emails and faxes. These are used to send information between different care settings for example if a patient is being moved into a new care home their records will be faxed over. This is a quick and easy way to send information and doesn’t take long. Another useful form of technology is the Telehealth app. This app allows you to visit and talk to healthcare professionals without leaving your home. You can chat to your doctor through video calls, emails and text message. This is a way of keeping all your health records together and safe. This app is useful if you are admitted to hospital or a healthcare facility, you have your records all in one place and can be easily accessed. (Telehealth.HHS.GOV, What is telehealth?16 th August 2021).

What are the responsibilities of information sharing between multidisciplinary teams? Information is shared between multidisciplinary teams, so that every member knows what is going on with the patients care. Healthcare Professionals have a duty to ensure that patient’s information is shared safely. Professionals should let the patient know what information is being shared and who it is being shared with, they should apply the knowledge they already know about sharing information when talking with other professionals and they should not share confidential information with people outside the multidisciplinary team without the patients consent. The service user must give their consent before any care or treatment is provided. Informed consent is needed for most treatments. It is when the medical provider explains to the patient what is involved in the

procedure, and they agree to it. Exceptions can be made if the patient is unable to give consent and is needed for an emergency. An example would be if a patient was admitted to hospital from an accident and needed a blood transfusion straight away to stay alive, they would not be in the mental capacity to give proper consent. Written consent is needed for bigger treatments such as surgery. When you sign the form, it means that you understand what is happening and are satisfied to undergo your procedure. Without proper consent the treatment that was provided would be unlawful. Patients must have the mental capacity to give consent and they cannot be under pressure by other persons to give it. This comes under the Human Rights Act 1998, Article 3, Freedom from torture, and inhuman or degrading treatment. The article protects individuals from torture and being forced into something they don’t want to do. It also protects the service user from being degraded and embarrassed when they are most vulnerable by the people caring for them. (Equality and Human Rights Commission). What are the purposes of Reflection? Reflection is a way in which we can learn from our past experiences. It allows us to evaluate what happened the right and wrong and what we can do differently next time. By reflecting we can think about what happened and why we took that course of action. Reflection helps professionals in difficult situations and in turn helps to develop their personal and professional relationships, relationships with patients and how to effectively work as part of a team. If professionals do not reflect on past experiences, things they might have done wrong will be kept inside of them. This will affect them mentally and could impact their job as they might not be able to progress into higher more authoritative roles. There are two types of reflection, reflection-in-action and reflection-on-action. In action takes place when preforming tasks that are difficult and need more thinking, while at work. On action means after the task has been completed. It involves looking back on situations and evaluating what they did good or bad and what they would do differently next time. Reflection allows the individual to gain knowledge about the situation and if they are faced with the problem in the future, they have the knowledge to deal with it effectively. (Nursinganswers.net- Why is reflective practice important in healthcare? 17th February 2021).

Two models of reflection and two tools used in reflection.

A model of reflection used in healthcare is The Gibbs Cycle, created by Graham Gibbs in 1998. It has six stages in the reflective cycle, Description- describing the event that took place, Feelings- How you felt during it, Evaluation- How the event was carried out, good/ bad, Analysis- understanding the event and what happened, Conclusion- what the event taught you and what would you do differently next time. Action Plan- what you would do if you were in the same situation in the future. The Gibbs cycle is one of the most used reflective cycles in the world. It allows professionals to easily reflect on past situations and highlight where they went right and wrong and what they could do better. Can be used for an individual experience or an experience you go through every day. (Mind Tools, Gibbs reflective cycle) Another reflective cycle is Rolfe 2001. It answers three questions, what, so what, what’s next? It is used in team situations so that teams can share experiences and try to find ways to improve their profession. What- what happened? How were you feeling? What did you do? So what? – what actions did you take? What have you learnt from experience? What’s next? – What would you do differently next time? This method of reflection is easy to use and understand which works well in a group of professional with different abilities. Two tools used in the reflection process are self-assessment and reflective discussions. Self- assessment means examining yourself and seeing how far you can go and what your boundaries are. Self- assessment ensures you are able and competent about the job you must undertake, it ensures that you are able to correct yourself when you make a mistake quickly and it also helps to identify strengths and weakness and ways to use them. This in turn can help you develop as you learn from your mistakes and know what areas you are strong in. Reflective Discussions allows the individual to discuss an event with another peer or colleague. It enables you to share past experiences and

discuss how this improved your own professional development. These discussions can be written down or had verbally. It lets you learn from others and help peers improve on their jobs as healthcare professionals. An example of this can be a formative and summative submission for an assignment. The formative submission allows the teacher to give their feedback and highlight areas where the student has done well and other areas that need work. This will allow the student to build from their mistakes. How reflective practice is applied in healthcare practice. Reflective practice can be applied in all areas of healthcare. It allows you to look back on events that happen and evaluate what you did right and wrong and what you could do differently the next time. Reflecting involves stopping and thinking about the situation. How did you feel at the time? Sad, happy, confused? How did the situation come around? What were the actions leading up to this scenario happening? Now think of how you handled the situation. Good, bad? What could you have done differently? What could have made the situation better? Reflecting on important situations like a person taking a heart attack or having a stroke in your care, allows you to destress about the situation. If we don’t reflect these feelings can be locked inside of us and affect our ability to perform the best quality care for our patients. Reflecting on situations with other colleagues can help bring new ideas of how to deal with situations and help each other improve their professional development. Reflection can also help us progress in our jobs and build trustworthy relationships with patients and colleagues. Reflecting can highlight areas where we are strongest and help us move up the career ladder. We become more confident about situations and reflection enhances our ability to deal with these situations. (International Journal Surgery: Oncology, Reflective Practice in Healthcare and how to Reflect Effectively, July 2017).

The impact of experiences on my own personal and professional reflection and how these impacts individuals using the health care services.

Reflecting on personal experiences can help impact you professionally. It enables you to learn from past experiences and makes you more comfortable in situations in the future. It helps you develop skills like time management, effective communication and working together as part of a team. This in turn will build your confidence and improve service user’s care. It also keeps you up to date in new policies and procedures in health care and ensures you can implement them efficiently. For example, A man on your ward is Muslim and doesn’t eat meat or poultry. You are extremely busy and when serving the meals at dinnertime you give him chicken. You ask him why he is not eating, and he angrily explains how he doesn’t eat meat or poultry and asks to speak to the ward manager. Reflecting on this situation can help improve the man’s experience in the future. You could ask yourself why you were so busy? Why didn’t you read his care pan beforehand? Why was there no vegetarian option on the menu? While reflecting, look at your own beliefs. Do you eat poultry? Would you have acted the same way if this event happened to you? If you knew and understood the importance of the man’s beliefs, would you have reacted different? When reflecting on this situation you could explore why Muslims don’t eat meat and try to comprehend. Reflecting on this situation is a pro for the service user, as after reflecting you have the gained the knowledge to not serve meat to the patient again. A con for the service provider is that they may feel guilty for not paying more attention to their patient. Therefore, reflecting on the situation will ensure the service provider becomes more competent in their role. Additionally, this builds trust between the patient and carers and the man can ensure the professionals around him are providing the best quality, personcentred care.

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