Nursing Reflective Model

Introduction

I have undertaken a reflection of professional values and parameters of practice. Professional nursing values are characterized by integrity, human dignity, professional practice and evaluation, justice that serves as a framework for standards and altruism. However, it is often linked with altruism, empathy and compassion. Professional nursing values are essential standards in the provision of safe and high-quality ethical care. The nurse’s perspective on professional values influences patient care and decision making. On the other hand, the parameters of practice in nursing provide guidelines and define the provision of competent care. Therefore, the provision of high-quality care aligning with established standards is vital. The purpose of nursing professional values and parameters of practice reflection is to emphasize that nurses should acquire knowledge and awareness concerning professional values such as standards that provide high quality and safe ethical care through examining own experiences and actions as a nurse to develop practice and enhance clinical knowledge.

Application of Driscoll’s (2007) reflective model

The application of the model enables me to examine diverse areas that help in improving my nursing practices, thus facilitating the development of essential skills that aid in quality care improvement within the limits of nursing ethical standards. Here, I will reflect on an observation I made about the difficulty of communication with Mr. Lee (not his real name), a patient that had communication problems due to his dementia condition. I shared some of my skills and knowledge to a multidisciplinary team (MDT) group meeting with hopes that it would help any other team member to effectively communicate with Mr. Lee.

Nonetheless, the reflection on personal experiences helps me to allow self-criticism that is necessary for improving my understanding of the medical practices. Improvement of communication with the patients is a skill that helps facilitate improvement in health services within the nursing profession (Stonehouse 2019, p.183).

Good communication between nurses and patients is vital for successful individualized nursing care for each patient outcome. The knowledge shared in the group will enable me to draw the communication skills that will enable me to understand the patient's needs within the healthcare platform. For instance, I learnt that nurses must help and understand their patients demonstrating kindness, courtesy and sincerity. Good communication helps in understanding both the patients’ needs and the colleague’s aid in confidentiality creation and maintenance in the health practice. Additionally, besides the provision of individualized quality care, the good communication between nurses and patients makes the patient's feel loved, secure and confident which are all essential needs during a patient's treatment and recovery. To this end, learning nursing ethics such as good communication is instrumental to my career life as it will enable me to offer individualized quality care to the patients.

My feeling about the experience

Lack of proper professional values and parameters of practice in nursing accounts for more than half death incidents and emergency cases reported in the National Patient Safety Agency. I discovered that some patients die because they fear to inform nurses about their progress and predicaments. These instances happen where nurses fail to communicate to the patient demonstrating kindness, sincerity and courtesy. To this end the patient feels hated, insecure and timid which is a dangerous path in their treatment and recovery, thus succumbing to death. On the other hand, other patients who were not critical at the initial stages of securing treatment end up in emergency wards due to poor communication between the nurses and patients and colleagues. Batista, Miranda & Teixeira (2019 ,p.150) discovered that hospital dispensing schedules causes delays for reasons such as nurses are dispensing from a pharmacy or are busy elsewhere. This exposes patients to emergency cases because their issues fail to be attended timely due to poor communication between nurses and patients and colleagues.

I learnt that communication levels between nurses and patients become impaired when it lacks standardization. The group research will enable me to execute independent research that helps in the discovery of the effects of negative health promotion practices that prompt communication process impairment in the nursing profession. However, from the group interim findings on the health promotion project, it is clear that 80% of patients suffering from Alzheimer and dementia have high chances of succumbing to communication difficulties (Butterfield & Halliwell 2019, p.1). Therefore nurses must focus on media forms such as pictures and signs to enhance communication.

Through observation, I was able to provide dignified care to the patients. Some of the issues I raised in the group have enabled me to examine the nursing profession on a different perspective other than the normal health practice. I realized that patients should be treated with respect and dignity. Furthermore, treating the team members with respect helps in maintaining good communication between the group members and other people within the healthcare set up. Nursing services first should be the concept of health practices to ensure that individuals’ autonomy is respected. Simple efforts such as listening to patient concerns, asking patients opinions and letting them feel important to nurses, involving patients in many decisions as possible, including patients in the conversation and addressing patients as adults go a long way in treating the patient with dignity. Berg & Ruppert (2019, p.4) argues that regulation of dignity and respect demands service users be treated with dignity and respect in all times while receiving treatment and care. As an approach to meeting the regulation, the providers are obliged to provide treatment and care in a manner that ensures peoples dignity and accords them respect all time. This incorporates ensuring privacy when they need and want it, providing any support they need to be independent, autonomous and involved in the local community as well as treating them as equals.

My reaction to the team perception

There are instances when my input in the team perception differed due to the diverse ideologies that members presented. However, the team contributions enhanced my understanding on health promotion principles which include participation and involvement, a broad and positive health concept, equity in health, a settings perspective and Action and action competence (Christensen et. al 2019, p.220). On the other hand, the experience I learnt from my colleagues as an emerging nurse has enabled me to reexamine my skills of nursing aligning them with the aforementioned health promotion principles. Although sometimes I differed with the team members I realized that a more robust approach that encourages the individual team member to execute independent research for the group to be able to make a comprehensive conclusion from the group summed up findings. The other improvement that the group needs to focus on is to ensure that the health promotion principles align with the World Health Organization principles.

What to do differently

I would propose material communication between the team members. This involves the sharing of material opinions, ideas and feelings of the team members before the group concludes what is ideal for incorporation for the health promotion principles. Inclusivity is key in a group and all members deserve an equal opportunity to contribute. There are instances where I felt demoralized and frustrated when team members were denied an opportunity to contribute to the team. As a nurse, I strongly believe in team members' equality in contribution and participation. In future, communication in the nursing profession should be both nonverbal and verbal. There are team members who have valid contributions but due to communications limitations that pose a challenge to express themselves they never get to voice their ideas. The inclusion of both nonverbal and verbal communication in health care contributes significantly. The ability of nursing professionals to understand nonverbal communications is a vital tool that helps the healthcare providers to connect positively with the patient and reinforces mutual respect and understanding (Clucas, Chapman & Lovell 2019, np). The nonverbal communication is expressed by gestures, physical barriers such as distance from the interlocutor, and facial expression and posture. Also, it is crucial for non-verbal and verbal communication to align with each other.

Promotion of Health Promotion Practices

Based on the group findings, it is evident that the care providers and the nurses in the health sector should focus on creating a healthy work environment. I would recommend that health professionals should be both creative and adaptable to enable them to understand patients who come from diverse backgrounds. The health practitioners’ ability to be accommodative eliminates chances of disempowering the patients and other health providers workers coupled with communication challenges. For instance, people suffering from dementia always feel outpaced when they see others speaking and moving. Therefore, nurses must create a friendly and accommodative environment to all during health care services provision (Golaghaie et. al 2019, p.45). Additionally, I have realized the benefits of interprofessional working as a team during the creation of regulations that are subject to all people in the same field. Notably, it is imperative to promote holistic adherence to the principles of health promotion at diverse levels. The learning I have acquired through group interactions will positively impact my nursing profession in future. I believe nursing professionals need to formulate and abide by principles that accommodate the society needs.

conclusion

From the theory and the literature above, as an emerging nurse, the experience that I have acquired will enable me to demonstrate the nursing skills that adhere to health promotion 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.

References

Abou Hashish, E.A. and Ali Awad, N.H., 2019. Relationship between ethical ideology and moral judgment: Academic nurse educators’ perception. Nursing Ethics, 26(3), pp.845-858.

Batista, A., de Miranda, J.L. and Teixeira, A.P., 2019. The needs and barriers within the supply chain actors—Hospital pharmacy needs. In Pharmaceutical Supply Chains-Medicines Shortages (pp. 147-153). Springer, Cham.

Berg, J.A. and Ruppert, S.D., 2019. Fostering promotion and protection of the professional nurse practitioner role: A call to action. Journal of the American Association of Nurse Practitioners, 31(1), pp.3-5.

Butterfield, D.A. and Halliwell, B., 2019. Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease. Nature Reviews Neuroscience, p.1.

Butts, J.B. and Rich, K.L., 2019. Nursing ethics. Jones & Bartlett Learning.

Christensen, J.H., Bloch, P., Møller, S.R., Søgaard, C.P., Klinker, C.D., Aagaard‐ Hansen, J. and Bentsen, P., 2019. Health in All local Policies: Lessons learned on intersectoral collaboration in a community‐based health promotion network in Denmark. The International journal of health planning and management, 34(1), pp.216-231.

Clucas, C., Chapman, H. and Lovell, A., 2019. Nurses’ experiences of communicating respect to patients: Influences and challenges. Nursing Ethics, p.0969733019834974.

Feller, L.M., Fisher, M., Larson, J. and Schweinle, W., 2019. Nursing Students’ Professional Value Development: Can We Do Better?. Nursing Education Perspectives.

What was the event/incident that influenced your learning objective

During the placement, I interacted with one patient whose dementia condition made it difficult for him to effectively communicate with both the healthcare team and family. In one incident, I observed her try to point at the door an before I could move closer to enquire what she wanted, I realised she had peed on herself. I therefore concluded that she might have been trying to express her needs to go to the toilet, but her poor communication abilities could not enable him express his need.

What have you learnt so far

From this incident, I learned that both verbal and non-verbal communication is important when handling patients with mental health issues such as Mr Lee who cannot clearly put across what they are trying to communicate.

There is a need to develop an effective communication strategy that would help empower such patients by capitalising on their strengths and eliminating a sense of helplessness among patients with communication problems.

What steps will you take to achieve this

Studies by Heath (2019) show that an appropriate use of verbal and non-verbal communication can help nurses and families to effectively communicate with Mr Lee and enhance his ability to communicate. This can be achieved through careful listening; careful observation of Mr Lee’s body language, conveying reassurance and warmth to him and giving him opportunity to express himself in indirect ways can assist in developing an effective communication and interaction with him. Hwang et al (2009) also emphasises that nurses should be develop skills and be creative enough to avoid disempowering patients such like Mr Lee with communication impairment. In fact according to Safdar & Aqeel (2019), one way in which people with communication impairment are disempowered during communication is by outpacing them, acting quickly that they are able to match, or speaking on their behalf. These skills are to be developed through professional training workshops that I intend to attend in the next few weeks.

How do you know if you have been successful

To measure the adoption of effective communication with Mr Lee and the effectiveness of the training workshop, I will observe Mr Lee’s engagement levels by asking him to repeat verbal instructions after me. This will indicate whether my communication was good enough for him to understand.

What is your Timeline for these steps

I intend to attend an upcoming professional workshop in verbal and non-verbal communication by end of September 2019. The workshop will begin on 30/9/2019 and will run for two weeks (15/9/2019). After the workshop, I will be back to the field of practice to evaluate my communication skills with patients with communication impairment.

During my placement, I also had an opportunity to work as part of a multidisciplinary team that held frequent group meetings to reflect on various aspects of care. However, as aforementioned, there were instances that I did not agree with the ideologies of some team members. This contributed to hours of debate before we could achieve a consensus on certain issues of care. Consequently, we wasted time on debating at the expense of caring for patients. Moreover, the debates and arguments during the multidisciplinary group meetings threatened the team cohesion. It emerged from the group meetings that whereas nurses’ contribution were focused on information about patients’ choice, psychosocial elements of care, most medical personnel based their discussions and decision on biomedical aspects of care.

I have learnt the importance of personal and team skills in multidisciplinary teamwork - member of the multidisciplinary team should harness effective non-technical skills e.g. communication and leadership to enhance the level of team collaboration. This implies that members of the multidisciplinary team should learn how to effectively communicate with their colleagues at different organizational hierarchy (Lamb et al, 2011). Besides, I now agree with National Cancer Action Team (2010) that effective management of team conflict is a significant enabler of quality care delivery across different specialties. Furthermore, I have learned that unequal participation between nurses and medical personnel may endanger the patient’s well-being because it deviates from person-centered approach of care (Lamb et al, 2013).

My aim is to achieve an effective multidisciplinary teamwork through equal participation of nurses and medical personnel in multidisciplinary teams. I envision a situation whereby as a nurse, I can make my contributions to the team by providing patient-centered information while respecting the medical personnel’s biomedical perspectives and contribution to the team. I intend to develop a team player attitude where I do not feel excluded nor oppose the views and opinions of other members of the team.

What steps will you take to achieve this

I intend to improve my team player skills by evaluating my skills and knowing my importance to the team, then finding a role within the team that will enhance my ability to make meaningful contribution to the team. To conduct a personal evaluation, I will make use of the DISC Assessment Test tool, which is a personality evaluation tool useful in team building and employment (FMLibrary.com) also intend to conduct a proper understanding of team objectives so that my contributions are more focused bon such objectives.

How do you know if you have been successful

I will measure success by evaluating my ability to accommodate the views and opinions of other team players. Besides, I will measure my achievement by evaluating my feelings about the team, whereby a feeling of being excluded in a team decision will indicate failure while a feeling of being part of the decision will indicate achievement.

What is your Timeline for these steps

I will conduct personal evaluation after every multidisciplinary group meeting. Meanwhile, I intend to begin my personal evaluation with the DISC Assessment Test tool on 1/9/2019 and finish on 7/9/2019.

As I further interacted with Mr Lee, I noticed the important need for maintaining patient dignity as part of the requirements of nursing professional ethical standards (The Code, 2015). Mr Lee had peed on himself and this created the need for new clothes and bedding as part of the ethical efforts to restore and keep his personal dignity.

What have you learnt so far

My involvement with Mr Lee enabled me to reflect on dignity as a basic and ethical element of care which involves upholding and maintaining the patient’s self-respect regardless of their situation (Morrell et al, 2019). Hence, despite being wet with urine and being frail due to old age, Mr Lee should feel valuable before, during and after receiving care. While the concept of dignity entails autonomy, respect, self-worth and identity Tiruneh & Ayele (2018), each patient has their unique needs and therefore the levels of dignity required by Mr Lee would differ with the level of dignity required by a different patient. Nonetheless, the absence of dignity in his care would make Mr Lee feel devalued disempowered and embarrassed.

What is your learning objective

I intend to enhance my abilities of delivering supportive care and upholding patient dignity for purposes of delivering quality care to them.

What steps will you take to achieve this

I intend to make basic considerations in upholding patient dignity while serving them. First, as recommended by Morrell et al (2019), I intend to always listen to their concerns, and in cases whereby the patient is not able to effectively communicate, I will make observations to understand their concerns. After listening to or observing their concerns, I intend to involve them in any decisions that address their concerns (Tiruneh & Ayele, 2018). Lastly I intend to speak to the patient as adults even if I am not sure of how much they understand.

How do you know if you have been successful

I will measure my success by being able to assist the patients in very instance of need and by observing the patient’s gestures of contentment after involving them in decision making.

What is your Timeline for these steps

I intend to immediately implement these steps in my interaction with the next patient.

References

Safdar, S. A. and Aqeel, L. 2019. Grooming and etiquette as part of nurse’s professionalism: An essential curricular competency, Pakistan Journal Of Medical Sciences, 35(2), pp. 404–408. doi: 10.12669/pjms.35.2.647.

Lamb BW, Brown KF, Nagpal K, Vincent C, Green JSA, Sevdalis N. 2011. Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Ann Surg Oncol.;18:2116–2125.

Lamb BW, Taylor C, Lamb JN, et al. 2013. Facilitators and barriers to team-working and patient centeredness in multidisciplinary cancer teams: findings from a national study. Ann Surg Oncol;20:1408–1416.

Morrell, J., Konda, S., Grant-Kels, M. 2019. Response to a letter to the editor regarding "The ethical issue of cherry picking patients". J. Am. Acad. Dermatol;80(5):e127.

National Cancer Action Team 2010. The Characteristics of an Effective Multidisciplinary team (MDT) London: National Cancer Action Team; 2010.

The Code. 2015. Professional Standards of practice and behavior for nurses, midwives and nursing associates. Nursing and Midwifery Council.

Tiruneh, A., & Ayele T. 2018. Practice of code of ethics and associated factors among medical doctors in Addis Ababa, Ethiopia. PLoS ONE;13(8):e0201020.

Continue your journey with our comprehensive guide to Nursing Reflection on Complex Care in Mental Health.