NMC DECISION ON PIN REGISTRATION

I am currently a nurse, and I live with my autistic son. An incident happened at my house, whereby I unintentionally locked my son inside the house. I quickly went to get a spare key from my minder, but unluckily police and social services got involved in the case. Following the investigation, I was required to go through a psychological evaluation, which indicated that I did not comprehend the diagnosis of autism. The occurrence was reported to the Nursing and Midwifery Council (NMC), and I was denied NMC PIN registration. According to the NMC, I was not refused the registration since I left my son inside the house, but because I did not understand my son’s condition. The clinical psychologist’s report revealed that I did not comprehend my son’s diagnosis, prognosis, and care requirements indicating that I had limited insight regarding how I should support him. The phenomenon created a concern to the NMC since to practice as a registered nurse, it is fundamental to comprehend patient’s requirements and offer suitable intervention and care. Consequently, my psychologist assessment did not give NMC the guarantee that I comprehensively understood the patient’s needs and care. 

Feelings

Now that I have researched on autism spectrum disorder, I am excited that the Nursing and Midwifery Council (NMC) is diligent in registering only candidates who are comprehensively qualified. Before this incident, I was overconfident about my practice as a nurse, but I have realized the need for practical use of nursing knowledge and skills in all situations. Also, I feel a sense of self-efficacy, which have come from delving into the case studies and practical approaches of a nurse to autism. I also feel passionate about my profession since I have learned the critical role that I should play in improving the wellness of people living with ASD, including my son. In my understanding of the broad range of ASD, and the interventions to improve the health outcome of people living with ASD, I feel adequate with the understanding of diagnosis, prognosis and care requirements for autism.

Evaluation

Before the MNC rejected my MNC PIN registration, I was overconfident in nursing practice. However, I have learned through the incident that a nurse ought to be effective in practice, or as Hughes puts it, “be at the sharp end of patient care” (Hughes, 2008). Through research, I understood that there are many things I knew about ASD, but I overlooked them in practice, including in raising my son. I am currently cautious not to be overconfident, but to keep on learning, to perfect my practical care proficiency. For instance, I understand that ASD may reveal through low or high functioning, it affects social interaction and communication skills, and the outcome is a recurring behavioural and activity patterns. Earlier on, I thought ASD did not quite affect communication and social skills since my son is an introvert like myself, which led to me overlooking symptoms and outcomes on him. I am committed to upholding trust and confidence in the professions from patients, people receiving care, other health, and care professionals and the public, by becoming a model of integrity and leadership in healthcare.

Analysis

The journey to learning about ASD through research began with my mistake. Now I understand that people living with ASD like my son may at times be tranquil (“Autism spectrum disorder,” 2020). Also, I was not a competent nurse since I should have considered looking for him and keeping regular checks about what he was doing.

I generally knew that ASD causes people to experience challenges with their social skills and that it is easy to manage. Nevertheless, I forgot one critical finding of many studies; that it is easy to overlook or forget the needs of people living with ASD (“Autism spectrum disorder,” 2020; Camm-Crosbie et al., 2018; Stagg and Belcher, 2019). I thought that my son was adapting well and that I was in control, helping him manage the condition. This lack of critical awareness about the competencies of nursing care led me to feel frustrated when the MNC could not offer a PIN registration.

I am now aware of the spectrum regarding the symptoms, diagnosis, prognosis, process, and outcomes. These will aid me in caring for my son and other people living with ASD. I have found senior nurses and specialists in ASD, and they have agreed to be my confidants in the nursing practice to improve my efficacy and competency on ASD, as suggested by Stanley (2012). Notably, having them may reduce my panic and bolster confidence in my practice, since lack of confidence may lead me to forget the things I knew and lose focus on critical care needs (Swift et al., 2014). The current lack of fear makes me confident about my professional standard of practice and behaviour for nurses.

Additionally, the MNC was correct and right to conclude that I did not comprehend my son’s diagnosis, prognosis, and care requirements. I ought to be competent and effective, being at the “sharp-end” of patient care (Hughes, 2008). I have to honour the Nursing and Midwifery Council (2018) by becoming a model of integrity and leadership in healthcare and upholding trust and confidence in the professions from patients, people receiving care, other health, and care professionals and the public.

Conclusion

The autism incident has become a journey for me to learn and improve my competency regarding nursing practice and ASD. It began with me unintentionally locking my son, who lives with ASD inside the house. The issues escalated, resulting in me failing to acquire licensure with the MNC. Although I felt discouraged and frustrated, I learned that I was overlooking many issues regarding patient care, as illustrated by the negligence in taking good care of my son. The MNC did the right thing to deny the PIN registration since it was an eye-opener to the need for evidence-based and nursing competency. They made me reflect and challenge myself to learning about ASD and improving my nursing competencies. I have researched and learned about ASD and found senior nurses and specialist practitioners to guide me through taking care of my son and other patients living with ASD. Now I am confident that I know much more about ASD, and that I am an improved nursing profession regarding effectiveness and competencies. I have also re-read the MNC codes, and I look forward to becoming a model of integrity and leadership in healthcare and upholding trust and confidence in the nursing profession.

Action Plan

Autism is a complex neurodevelopment disorder that appears during childhood to challenge individual social skills, communication, and self-regulation throughout their life (National Institute of Mental Health, 2018). The National Institute of Mental Health is a valuable source of information concerning autism, among other developmental disorders. Besides, there are groups and organizations such as the Autism Society, National Autistic Society, The Autism Group, Autimlinks, among others. They all contain incredible social support and are rich in recent information concerning autism. They have enabled me to overcome the previously limited insight into autism. For instance, I have heard many real experiences of parents and people living with autism, which can be overlooked in theory, but escalate health outcomes in real life.

Through the research and support from professional nursing and society contexts, I have gained valuable information about autism, which I intend to use effectively for the good of my son and other people living with ASD. I will teach my family and friends on appropriate home care and support for people living with ASD. Also, I will engage other professionals in ensuring professional efficacy and competency in nursing practice to honour the MNC and other codes of work ethics. Besides, I will inform professionals, allied members, patients, and home caregivers the necessary interventions, support strategies, the does and the avoids to caring for people living with ASD. This is important, as found by a recent study, concluding that the effectiveness of a healthcare system is rooted in systemic collaboration and functioning of highly effective teams (Buljac-Samardzic, Doekhie and van Wijngaarden, 2020). I would also explain the role of each stakeholder, for everyone to recognize the need for professional and allied help in combating autism ramifications. That way, I will be able to execute my knowledge and skills in autism management diligently, and “identify and manage any problems as they arise and before they present as ‘disasters’” (Barker, 2013). That includes being patient and realistic, consistent with care, aware of the environment, supportive of effective communication, rewarding, managing environmental transitions with patients and bolstering their social skills.

The basic sequential technique for managing autism may entail six steps within the SMART model. First, ask patients open-ended questions and take time to listen as they talk. Secondly, one may model coordination by retelling stories or events sequentially using transitional words such as first, second, last, and next. Thirdly, conduct a task analysis by aligning patients’ tasks such as planting a garden. Fourthly, observe their self-management such as taking dishes to the sink after eating, and celebrate them when they do it. The fifth step is video modelling, where patients view a film and are requested to redo as they have watched. Lastly, use cards or images to train the logic of a patient the sequence of events in the world.

References

Barker, M., 2013. Anaesthetic emergencies. Veterinary Nursing Journal, 28(7), pp.220-224.

Buljac-Samardzic, M., Doekhie, K. and van Wijngaarden, J., 2020. Interventions to improve team effectiveness within health care: a systematic review of the past decade. Human Resources for Health, 18(1).

Camm-Crosbie, L., Bradley, L., Shaw, R., Baron-Cohen, S. and Cassidy, S., 2018. ‘People like me don’t get support’: Autistic adults’ experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism, 23(6), pp.1431-1441.

Hughes RG. 2008. Nurses at the “Sharp End” of Patient Care. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US). Chapter 2. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2672/

National Institute of Mental Health, 2018. NIMH » Autism Spectrum Disorder. [online] Nimh.nih.gov. Available at: <https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml> [Accessed 20 July 2020].

Nhsinform.scot. 2020. Autism Spectrum Disorder. [online] Available at: <https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/autistic-spectrum-disorder-asd> [Accessed 20 July 2020].

Nursing and Midwifery Council, 2018. The Code. [online] Nmc.org.uk. Available at: <https://www.nmc.org.uk/standards/code/read-the-code-online/> [Accessed 20 July 2020].

Stagg, S. and Belcher, H., 2019. Living with autism without knowing: receiving a diagnosis in later life. Health Psychology and Behavioural Medicine, 7(1), pp.348-361.

Stanley, D., 2012. Clinical leadership characteristics confirmed. Journal of Research in Nursing, 19(2), pp.118-128.

Swift, P., Cyhlarova, E., Goldie, I., O’Sullivan, C., Bristow, P., Carson, J., Biggs, H. and Edwards, J., 2014. Living with anxiety: understanding the role and impact of anxiety in our lives. Mental Health Foundation.