HNC HEALTH

  CARE-GRADED UNIT   
By: M.Dass

COMPLETE TASK 
 
ON 

HNC HEALTH CARE 
GRADED UNIT 
2008 

 
 
By: 
MOTILAL DASS
Scotland

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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

to maintain her hygiene and promote independence.

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

a middle class family.

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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.

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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.

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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.

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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.

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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

associated infections is to improve hygiene in healthcare settings, in particular hand hygiene.

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.

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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

received message in close enough to that of the sender.

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.

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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

mentioned in the planning stage.

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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

combating health care associated infections is to improve hygiene in healthcare settings, in

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

not be accessible to unauthorized people.

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

pointed out by the nurse on duty. In later stages I rectified it.

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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 and it did work well.

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.

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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

integrate information appropriately. I demonstrated evidence based practice by maintaining

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

making the project works done within a given time.

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

was a safe practice done by me so no detrimental situation noted.

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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

mentor and nurses where of great help for me.

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

the projects. In future if I am required to do a project I would probably gather precise

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

units of health care topics I was taught.

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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.

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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.

Burke CA (2003) Colon Cancer, London [online] available on:www.coloncancer.about.com

accessed on March 3rd 2008

Health and Safety Act 2008 London [online] available on www.healthandsafety.co.uk and
accessed on February 27th 2008.

Kenworthy N, Snowley G, Gilling C (2002): Common Foundation Studies in Nursing 3rd

ed.Edinburugh: Churchill Livingstone. p. 207,258,260,411, 453,

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

Warwick Counseling Service, London (Online): available on www.warwick.ac.uk

[accessed on May 19th, 2008]

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HNC HEALTH
  CARE-GRADED UNIT   
By: M.Dass

Special Note from the desk of the Writer:

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

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