Applying Driscoll's Model

Introduction

I have undertaken a reflection on nursing skills that I pursued during my placement practice applying Driscoll's model reflective cycle. Driscoll's model is a recognized reflective framework that demonstrated my capability to reflect on diverse nursing skills. Driscoll model uses three processes to reflect individuals nursing practice. The three processes that I applied include what happened, what I was feeling and the good or bad experiences that I went through. The application of Driscoll's model enabled me to link theory with practice. The practice of reflection allowed me to examine, through experiment, development area in quality care provision, thus aligning with Nursing and Midwifery Council (NMC, 2004) (Chowthi-Williams, Curzio & Lerman, 2016, p.133). Reflection is a vital area in knowledge attainment and understanding to examine both positive and negative, thus allowing for self-criticism.

My first skill explores communication enhancement for patients with communication impairments to promote infection control during transitions of care. I raised the issue in one of the multidisciplinary team meeting (MDT). I will be drawing from experience and knowledge obtained from MDT meeting which incorporates speech and language therapist, social workers, mental health nurse, adult nurse and carer experience. I discovered that both nurses and support workers communication to service users fails the test of meeting the standards simply because the service users are impaired. This now prompts me to advance my research on the highlighted issues and I discovered that it has been estimated that 2.5 million people in the UK face communication impairment challenge (Chowthi-Williams, Curzio & Lerman, 2016,p.135). Statistics indicate that 50 to 90% of people living with intellectual disabilities also face communications challenges and approximate 60% of the population with intellectual disabilities possess symbolic communication skills which are simply the use of signs, pictures and symbols (Vissers, Gilissen &Veltman, 2016,p.9). Additionally, the World Health Organization classification of disability, impairment and handicap addressing communication disorders are impairment disruptions to the normal language speech production or processing systems for instance difficulty with reading sentences, finding the right words thus reduced ability to clearly pronounce the words as well as reduced spelling ability (Vissers, Gilissen &Veltman, 2016,p.9). This reduces efficiency in communication between nurses and service users. According to (Vissers, Gilissen &Veltman, 2016,p.9) communication is a process of meaningful conveyance of messages between two people to convey needs, facts, opinions, feelings, thoughts and diverse information through both non-verbal and verbal means that includes written words and face to face exchanges. After receiving the message it is interpreted to give a response. However, people with communication impairments may delay responding timely. This was a problem I discovered that coupled with an impaired man identified as Max and I sometimes felt frustrated because support workers/nurses lacked patience with the patient.

I would propose both nonverbal and verbal communication to be perceived as an important element when handling the impaired man as it is imperative to ensure that the message transmitted across is clear. Also, there is a necessity to devise communication strategy that would enhance empowerment, thus building on the existing strengths to prevent power imbalance and reinforcement of a sense of helplessness. According to Lorié et al (2017, p.412), both nonverbal and verbal communication techniques are ideal in helping nurses and families to communicate and promote communication of impaired people for instance in the case of Max. For instance, in the case of Max, a conducive environment should be created, listen carefully to what Max struggles to say, observe his body language, use positive body language to convey reassurance and warmth, speak slowly using simple and short words, give Max opportunities to express himself and talk in indirect ways. I attempted to emphasize the need for support workers/nurses to be skilful, adaptable and creative in avoidance of disempowering Max due to his communication impairment issue. According to Lorié et al (2017, p.416), an ideal approach to disempower communication for people suffering from dementia is the continuous outpacing them, having others speak and acting more quickly than they are capable of matching and understanding.

The MDT experience emphasizes on inter-professional working together significance to encourage holistic care delivery. The learning obtained from this experience will impact my future practice in diverse areas which includes empathy and communication. I'm careful of the challenges that coupled Max and this increased my clinical practice knowledge where I observed that mental illness impairs the patient capability to communicate for instance depression, dementia, schizophrenia and psychosis that causes cognitive impairment. This interferes with people's capability to think clearly, distinguishing reality from fantasy, relate to others, manage emotions, make decisions which often hinders therapeutic relationship development. I acquired wide knowledge on the Mental Capacity Act, 2005 that guides the factors that should be considered in decision making of best interest (Manthorpe & Samsi 2015, p.384)

As a qualified nurse, I would assume a role of ensuring decisions are made on behalf of the service users after much consultations with service users communication advocacy that is universally deemed as a nursing practice moral obligation that is considered as a vital foundation for nursing (Boles, Jessika & Dee Baddley, p.144). Effective advocacy transforms people's lives with learning disabilities thus enabling them to express their ideas and make ideal choices. Empowerment in mental health nursing represents the intention to ensure that conditions align with individuals self- advocate act. The experience highlights difficulties encountered in gaining and communication of valid consent awarded in future practice.

Conclusively, steps towards the achievement of better health care are made through the provision of encouragement and the support to enhance communication between support workers/nurses and careers with communication disabilities (Boles, Jessika & Dee Baddley, p.146). This is ideal for curbing restrictions for Max to access quality health care and maintain his well-being.

The 2nd skill examines the concept of dignity and its imperativeness about Dominic, an elderly patient, with difficulty in hearing, requires an assistant to walk, frail, his shoes and trousers wet with urine and a filthy smell of faeces. Support and actions based on Nursing and Midwifery Council (NMC, 2008) a Code of Professional Conduct as suggested to be applied in care rendering to Dominic (Newton, Taylor & Crighton, 2017.P.3057) in order to prevent him from contracting hygiene related infections within the care settings. Additionally, the Nursing action that maintains and promotes Dominic’s dignity during health care provision is described in this section.

How Dominic was treated by the nurses and staff raised my concern. This enhanced my interest in this topic as to acquit myself before escalating the matter. I was involved in the care for Dominic who was diagnosed with dementia. Deeken et al (2018, p.39) argue that dementia is a lifelong chronic condition that triggers communication problems, memory loss, neglect of personal hygiene and incontinence. The incontinence condition triggered the negligence of Dominic personal hygiene.

According to Newton, Taylor & Crighton (2017.P.3060) dignity is being treated like somebody. Relating dignity with Dominic’s care, dignity will be defined by the care given to Dominic that promotes and upholds his self -respect despite the current challenge that curbs him, that is the filthy smell of faeces and being wet with urine. In his present condition, Dominic should feel valued before, during and after his care. The dignity concept incorporates respect, privacy, identity, autonomy and self-worth, therefore, making life worth living. However, individual patients needs are unique, for instance, privacy that other service users need is different from what Dominic requires during his time of care. When dignity fails to be accorded during Dominic care, he will feel devalued, lack comfort, control, and feel ashamed and embarrassed.

In my observation the things that emerged for Dominic to be provided with dignified care, it involves delivering personal care to Dominic in such a manner that dignity is maintained, obtaining support from team members, up to date training in care delivering and supportive wards environment. I raised some issues with my mentor to address the gap that existed when attending to Dominic which included self-esteem, privacy, respect and autonomy.

Newton, Taylor & Crighton (2017.P.3066) argues that respect is a summary of taking time, good communication and courtesy. It is the unbiased consideration that is objective and regards for the right beliefs, values and everyone's property. Particularly, Dominic was vulnerable as he solely depended on staff for the provision of personal care due to his age, frail and necessary walk assistance. Dominic should be treated as an individual and should not be subject to discrimination. Much emphasis should be on Dominic's care procedures which should be explained to him and his care should be person-centered as opposed to task-oriented.

The dignity of Dominic must be protected and respected as a person who is equal in dignity, born free and has basic human rights (Harrison 2018,p 50). It is imperative for health services to recognize older people specific needs in their care, demonstrate respect for Dominic autonomy, privacy during Dominic's care and avoid a poor practice that deifies Dominic dignity such as scolding him and allowing him to remain soiled and wet.

Harrison (2018,p 50) argues that according to the NMC code of conduct the care of Dominic should be the first concern for nurses, treating him as an individual and respecting Dominic dignity. Dominic will be approached in a dignified way, he should be subjected to a choice to decide where or whether he needs his care carried out, demonstrating sensitivity, appropriate communication and inter-personal skills during interactions. Where there exists a negative interaction between nurses and Dominic dignity is defied and especially when Dominic freedom to make choices is curtailed. Dominic appearance is vital to his self –respect; therefore Dominic requires support in changing his soiled and wet clothes. Thus Dominic should be supported to maintain his standards as opposed to neglecting him because of his appearance

The NMC instructed the staff to protect and promote the dignity and interest of service users despite race, gender, age, economic status, ability sexuality, culture, lifestyle, political and religious beliefs (Harrison 2018,p. 50). Dominic who is an elderly man will not be problematic because the code outlines that care should be provided aligning with his culture preference, for instance, choosing a male staff to aid for his care. Fair treatment to Dominic forms part of the code, in essence, Dominic should not be discriminated against due to his status that is characterized with the filthy smell of faeces and trousers that are wet due to urine, instead, the caregivers and nurses should respect Dominic while attending to his needs.

Privacy is closely linked with respect. Dominic care should be delivered in a private area ensuring that he receives care in a dignified manner thus avoiding humiliating him. This implies that discussions regarding Dominic condition should be discussed and explained to him where others are unable to curtain and hear during Dominic care (Lorié, et al 2018, P.420). Failure to give Dominic the privacy he deserves would make him feel that he was treated as incontinent due to his situation. Musa et al (2019, np) define incontinent as an involuntary passage of urine or faeces impacting on the hygiene or the social function of the client. There are diverse types of incontinent such as urge incontinent, stress incontinent, mixed incontinent, and reflex incontinent. It was probable that Dominic may be a victim of any of the aforementioned incontinent.

Conclusively, my knowledge based on dignity concept and its importance to the benefits of service users and health care increased. NMC has enhanced clarity to dignity making it easier to understand through incorporating dignity among its codes. This section also outlines the different meanings of dignity among diverse people.

My mentor instructed me to assess a new patient who was referred to our service, during the one week into my placement at the community. As a strategy to prepare for this assessment I started reading the assessment note of other patients and researching on the ideal method that would help in obtaining the patient’s information. According to Edward et al (2018.np) deems mental health nursing as the decision-making process based on a collection of relevant information, applying a set of ethical criteria that is formalized, contributing to the overall evaluation of an individual and his circumstances. Assessment entails a continuous process that systematically includes a collection of information from diverse sources. The author further outlines that assessment can be outlined as a two-stage process of drawing and gathering inferences from the available decisions made and data regarding an individual need of care. The objective of the assessment incorporates understanding and judging need levels, planning care programmes and observing progress over time, conducting research and planning service provision, and preventing further infection within the hospital care setting.

Accurate and material assessment is imperative to an individual who has highly complex needs to streamline service user care requirement. Assessment of individuals needs and strengths in social functioning is a fundamental stage in planned care development that is conversant with practitioners. Preparation of social functioning accurate assessment provides valuable information about diverse activities that an individual undertakes as well as those activities that an individual requires support Edward et al (2018.np).

During the placement period, my mentor and I brainstormed to identify the major communication needs of the new service users based on the note that I was required to use open questions as this allowed the patient to express himself. I observed need perceptions between the two disciplines. This benefited the group as it facilitated the achievement of a holistic view of possible needs.

Bibliography

Boles, Jessika, and Dee Baddley. "Enhancing Effective Communication Among Non- Verbal Patients." Pediatric Nursing 44, no. 3 (2018): 144-147.

Chowthi-Williams, A., Curzio, J. and Lerman, S., 2016. Evaluation of how a curriculum change in nurse education was managed through the application of a business change management model: A qualitative case study. Nurse education today, 36, pp.133-138.

Deeken, F., Häusler, A., Nordheim, J., Rapp, M., Knoll, N. and Rieckmann, N., 2018. Psychometric properties of the Perceived Stress Scale in a sample of German dementia patients and their caregivers. International psychogeriatrics, 30(1), pp.39-47.

Harrison, P., 2018. NMC Code updated to cover delegation and associates. Gastrointestinal Nursing, 16(9), pp.50-50.

Lorié, Á., Reinero, D.A., Phillips, M., Zhang, L. and Riess, H., 2017. Culture and nonverbal expressions of empathy in clinical settings: A systematic review. Patient Education and Counseling, 100(3), pp.411-424.

Manthorpe, J. and Samsi, K., 2015. Care professionals' understanding of the new criminal offences created by the Mental Capacity Act 2005. International journal of geriatric psychiatry, 30(4), pp.384-392.

Musa, M.K., Saga, S., Blekken, L.E., Harris, R., Goodman, C. and Norton, C., 2019. The Prevalence, Incidence, and Correlates of Fecal Incontinence Among Older People Residing in Care Homes: A Systematic Review. Journal of the American Medical Directors Association.

Newton, J., Taylor, R.M. and Crighton, L., 2017. A mixed‐methods study exploring sign‐ off mentorship practices in relation to the Nursing and Midwifery Council standards. Journal of clinical nursing, 26(19-20), pp.3056-3066.

Vissers, L.E., Gilissen, C. and Veltman, J.A., 2016. Genetic studies in intellectual disability and related disorders. Nature Reviews Genetics, 17(1), p.9..

Institution

This section intends to demonstrate an understanding of my views based on scientific reflection and the issues surrounding reflective nursing practices. It is based on significant incidents from my nursing practice area as a student who is pursuing a Nursing professional in the US. The discussion appraises the concept of reflection in general and certainly in my nursing profession area. This is followed by an analysis of incidents using Driscoll's reflective model. The three processes presented helped in the reflection of individual performance relative to the group performance. The model was also insightful on how to make adjustments that will improve understanding throughout my nursing career.

The application of the model enabled me to reflect and explore diverse areas that will improve my nursing practice experience which is necessary for the development of necessary skills that contributes to improved healthy quality care and prevention of further infection within the care setting. For instance, the reflection on communication enhancement for a patient with communication impairment improved my understanding of medical practices consequently allowing self-criticism. The first skill that I learned is to ensure that improved communication between nurses and service users promotes health services. The issue I raised during one of the multidisciplinary team meeting (MDT) helped me to draw experience and knowledge from the MDT meeting that incorporated mental health nurse, speech and language therapist, carer experience, social workers and adult nurse. Therefore, I discovered that both support workers and nurses' communication is imperative to service users who experience impairment in communication Belkacemi et al (2019, p.108). Also, I learnt that people with intellectual disabilities often face impairment in communication challenge and they need special care and attention such as the use of pictures, signs and symbols to facilitate communication. The knowledge obtained from the MTD meeting enabled me to draw communication skills that enhance my understanding of the clients' needs within the health platform throughout my nursing career. Also increased my understanding of the patient needs and the colleagues which is necessary for the confidentiality creation and maintenance in the health practice.

Through my experience with an elderly patient, with difficulty in hearing, required an assistant to walk, frailed and his wet trousers and shoes due to both urine and faeces incontinence I was able to understand the concept of dignity. The concept requires that such individuals require a nursing action that promotes and maintains their dignity during health care provision ( Rejnö et.al, 2019).

Finally, I acquired my third skill in mental health nursing when my mentor instructed me to access a new patient who was referred to the hospital during my first week of placement. I was able to adopt a strategy to prepare for the assignment that involved reading the other patient’s assessment note and researching on the ideal method that would help in obtaining the patient’s information. I learnt how to apply mental health nursing as a decision-making process based on a collection of relevant information and applying a formalized ethical criteria enabling overall evaluation of an individual and the condition. The assessment entailed a continuous collection of information from diverse sources. Also, I learnt that assessment can be drawn from to stage process that incorporates drawing and gathering inferences from the available decision and data regarding an individual need for health care (Foster et.al 2019, p.79). The process of assessment is objected towards encouraging understanding and judging need levels, planning service provision and conducting research and planning care programs as well as observing progress over time.

My feeling about the experiences

Lack of proper nursing parameters and professional values contributes to the patients’ poor health care that leads to several death cases as well as deteriorated health conditions. I discovered that some patients with impaired communication die because are unable to express themselves to nurses and other staff due to low self-esteem and also inability to communicate. On the other hand, nurses and other social workers fail to accord such patients dignity and also fail to encourage them to express their views as well as lacking to use nonverbal communication to communicate with such patients (Foster et.al 2019, p.80). For instance, people with impaired communication who also suffers incontinences are the worst affected as they always develop low self-esteem when dignity is not appropriately accorded to them and as a result, they rarely express their opinions.

I feel that communication levels between communications impaired patients and nurses lack standardization. Leake (2019) argues that 80% of dementia patients suffering from Alzheimer are prone to communication impairment challenges. However, nurses and social workers fail to use nonverbal communication such as signs, pictures and signals which is ideal for such patients.

Through my observation, I realized that communication impaired patients should be treated with respect and dignity. Treating such patients with dignity and respect boosts their self-esteem and they can share their ideas, opinions as well as their fears. Nurses and social workers should embrace the concept of dignity first to ensure that the communication impaired individual autonomy is maintained. Simple efforts such as encouraging the patient to voice their opinions, letting them feel valuable, involving the patient in the decision making the process and listening to their concerns elaborates the patient treatment with dignity (Foster et.al 2019, p.81). The nurses and social workers should ensure that communication impaired patients enjoy their privacy when necessary, provide any support they need to be independent, ensure that autonomous among such patients is observed and treat them as equals.

My Reaction to the Team’s Perception

The contribution of the team members and mentors helped to improve my health care principles. On the other hand, the experiences have enabled me to re-examine my nursing skills to align them with health care principles. Although sometimes I differed with the practices of some nurses and health workers contribution, a more robust approach should be embraced to ensure that each nurse to research and contribute to the MTD meeting to make a comprehensive conclusion. Nurses and social workers need to focus on ensuring that health promotion principles align with the World Health Organization principles which always advocates for dignity and equality in health care provision.

I would propose material communication between nurses and communication impaired patients. This involves the sharing of material opinions, ideas and feelings with the communication impaired patients through nonverbal communication ensuring that the patients communicate what is ideal for incorporation for the health promotion principles. Inclusivity is key; the communication impaired patients deserve an equal opportunity to contribute.

As an emerging nurse, the experience that I have acquired will enable me to demonstrate the nursing skills that adhere to the nursing profession principles and also aligns with the World Health Organization principles. Driscoll's (2007) reflective model has enabled me to examine my experiences from diverse aspects of life. It has served as a platform for my ability discovery to identify different nursing skills that improve health promotion practices. Also, this platform has enabled me to identify how dignity concept controls all other levels of nursing practices. The model has laid a platform for me to acquit myself in terms of health practicing principles before the escalation of the whole issue. I believe that Driscoll's reflective model, through the theory and practice will help me become a professional nurse.

Bibliography

Belkacemi, Y., Colson-Durand, L., Fayolle-Campana, M., Pons, P., Rialland, A., Bastuji- Garin, S., Hoang, Q.N., Lerouge, D., Jaffré, F., Bollet, M. and Azria, D., 2019. A Wake-Up Call for Routine Morbidity and Mortality Review Meeting Procedures as Part of a Quality Governance Programs in Radiation Therapy Departments: Results of the PROUST Survey. Practical radiation oncology, 9(2), pp.108-114.

Foster, K., Roche, M., Delgado, C., Cuzzillo, C., Giandinoto, J.A. and Furness, T., 2019. Resilience and mental health nursing: An integrative review of international literature. International journal of mental health nursing, 28(1), pp.71-85.

Leake, I., 2019. Crosstalk in Alzheimer disease.

Rejnö, Å., Ternestedt, B.M., Nordenfelt, L., Silfverberg, G. and Godskesen, T.E., 2019. Dignity at stake: Caring for persons with impaired autonomy. Nursing ethics, p.0969733019845128.

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