This essay is composed of four domains. The four domains I will be reflecting on are our professional and ethical practices, care delivery, care management and personal/professional development. I will also demonstrate the learning I gained during my six-week clinical placement in the Acute Mental Ward. Finally, I will demonstrate the relationship between practice and the competencies observed in the ward and relate this to theory such as the importance of communication, dignity, respect and safety and how this affects patient care. (Nicol et al. 2004).
Definition. Dewey (1933) defined reflection as the process of internally examining and exploring an issue of concern triggered by an experience that creates and clarifies meaning in terms of self and results in a changed conceptual perspective. (Burnard Philip., 1995). Reflection is described as noticing or becoming aware of what you are doing as you are doing it. Reflection can also be seen as the idea of learning through experience. Burnard (1995) referred to reflection as a process that involves the practitioner being aware of their own psychological, cognitive and behavioural state.
Jarvis (1991) mentioned that reflective practice is an essential part of nursing as a professional activity. He also points out that although nursing tends to be a highly structured and ritualized activity, mentors and supervisors can help neophyte nurses develop reflective skills. He also suggests that reflective practise can help nurses grow both professionally and personally. In nursing, reflection tries to identify the true value and meaning of our actions to qualify, enhance or discard them and enable us to replicate them appropriately to their best effect in future interactions. Each situation reflected on must be treated as a unique event if maximum learning is gained. Hogston and Simpson (2002).
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On the first day of my six-week placement, my mentor introduced me to the acute ward. She showed me the emergency cardiac arrest and rapid response phone numbers. I was shown the fire exits and was told what to do in case of fire. I followed registered nurses around and participated in caring for the patients. A patient was allocated to me to care for, my mentor and other team member supervised me to ensure adequate care was given to the patient. I have the opportunity to learning advantages and experiences in sharing with others. The knowledge gained in my placement has given me the experience to improve my skills and standard of care.
PROFESSIONAL/ETHICAL PRACTICE. Professional practice is define as the knowledge that people have their professional qualifications or evidence of belonging to a professional body or organization that licenses or registers them to practise. The skills they exhibit in their practice, their conduct, for example, how they dress, how they treat one, the respect they show, and their confidence in their ability to help. (Hogston and Simpson 2002). The Code of Conduct states that, as a registered nurse or midwife, one must protect and support individual patients and clients and the health of the wider community. To act in such a way that justifies the trust and confidence the public has in them and uphold and enhance the good reputation of the professions. (NMC (2002). For example, a nurse must not do anything to destroy the public’s trust in the NHS.
A nurse’s duty is to promote, advocate, make every effort to protect the health, safety, and rights of the patient receiving care. The individual nurse is responsible and accountable for their practice. It is the duty of the nurse to be responsible for professional relationships, practice compassion and respect for the inherent dignity, value and uniqueness of every individual client, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. Kenworthy et al. (2003). Professional practice involves abiding by regulations that have been established to avoid misconduct and unprofessional practice. This conduct states that a nurse must act in a manner that will maintain the profession’s profession’s good reputation, that a nurse is accountable for their individual actions and omissions (NMC 2002). The (NMC 2002) states that a nurse must practice according to a topical and legal framework that ensures patient interest and well-being and respects patient confidentiality.
Throughout the placement, the patient’s confidentiality, dignity, privacy, and wishes were respected by staff and the student. For example, the patient’s autonomy was respected. Patients were informed that I was a student, and I asked for their consent before any procedure. I acted according to the code of practice which informs the general public of the professional conduct they can expect from us (students) when we become registered nurses (NMC 2002). The NMC Code of Professional Conduct (2002), place responsibility on registered nurses to act always in the best interests of their patients or client and respect information as confidentiality. The individuals are responsible for their safety to safeguard themselves. It is the employer’s duty to take all reasonable steps to provide an environment in which staff can work safely. Hinchliff et al. (2003).
Ethical practice is concerned with using our knowledge to decide whether our personal judgments will interfere with the care we will deliver. Although each of us has our ethical beliefs, as nurses, we must provide care equally and non-judgmentally to all the patients we come across. Our prime responsibility is to respect confidentiality and the care and well-being of our patients regardless of race, culture or religion, Hogston and Simpson (2002). Hinchliff et al. (2003) state that conscience should not be used to abdicate professional responsibility to give care to individual patients or groups whose lifestyle, personal habits or diagnosis are offensive to the practitioner. Nurses provide appropriate treatment and support in an emergency; ethics refer to values, beliefs, human rights, justice, confidentiality, personal viewpoints, and respect for patients. Nurses must provide caring qualities, be non-judgemental, not discriminate, accept patients, empathise, and have a therapeutically close relationship with patients. (Hogston and Simpson, 2002).
Discrimination refers to activities that serve to disqualify the members of one grouping from opportunities open to others. As when a patient is discriminated against because of his illness. Hogston and Simpson (2002) state that practising in an antidiscriminatory way means acknowledging the sources of oppression in people’s lives and actively reducing them. Ethical issues often arise to question the principle of confidentiality and create conflicts. Examples will be from my placement experience where I worked with patients experiencing mental health illnesses. I will look into the client’s right to confidentiality. A patient with a mental health condition, a schizophrenic patient, turns aggressive toward the nurses and other patients and clients. He is on daily medication to manage his aggression. He attended Occupational Therapy, and being in charge of him; he has been talking to me in confidence about his isolation from his family. He further said that due to the side effect of the medicine, he occasionally doesn’t bother to take it.
In my first placement, one of the patients in the ward, a white lady, had paranoid schizophrenia; she was abusive and called nurses racial names; she shouted abuses and told them to go back to Africa. Even though she had never abused me, some staff told me to stay away from her. I overlooked this patient for the first two weeks, and then I realized that I had neglected her, which was unprofessional. I was discriminating against this patient and was not giving her the holistic care she needed. Kenworthy et al. (2003) state that mental health nurses regard the creation of relationships with their clients or patients as the centre of their work. I changed my attitude toward her and built a therapeutic relationship with this patient base on trust, respect and understanding.
I was surprised how this patient opened up to me and was friendly with me. Even though she continued with the verbal abuses against other staff, I communicated with her and calmed her down when she showed bizarre behaviour and violence toward others. Upon reflection, I recognized my own strength and weakness; I realized that whenever a patient became aggressive, I failed to attend to him and could not deliver the therapeutic care they needed. As a student, I am allowed to make a mistake; I acknowledge the importance of seeking supervision to develop safe nursing practice. As my course progress, I shall continue to learn more personal and professional knowledge and experience to develop more skills.
CARE DELIVERY. rson (1969) defines nurses’ role as assisting individuals sick or well in the performance of those activities contributing to health or its discovery that he would perform unaided if he has the nec, necessary strength, will or will k, knowledge. It is important to promote the well-being and health of the patient. Hinchliff et al. (2003). Care delivery is an integrated approach or pathway, which determines and utilizes locally agreed multidisciplinary practice based on guidelines and evidence for a specific patient or client group. It may form part or all of the clinical record; it documents the care given and facilitates the evaluation of outcome Barbara, Weller. (2002). This is also base on the specific numbers, proportions, or ratios of nurses to patients; nurse availability variables generally characterize the number of hours nurses spend with patients.
The assessment state is the first phase basic of the nursing process, and it forms the basis of the nursing diagnosis. It sets the basics for the remaining steps of the nursing process Bradley et al. (1990). Activities of daily living frame lists of client’s activities such as maintaining a safe environment, communication, breathing, eating a balanced diet, drinking, eliminating, mobility, controlling body temperature, sleeping, working and playing, expressing sexuality, dying, Hogston and Simpson (1999). Nursing assessments are used as interventions, such as risk assessment, pressure ulcer risk assessment, or identifying patients at high risk for malnutrition, to reduce adverse events. In the multidisciplinary procedure, the nursing activity is often assessment rather than a nursing process or procedure. Kenworthy et al. (2003).
Hinchliff et al. 2003 state that the nursing assessment includes developing and documenting nursing assessments and participating in comprehensive, systematic nursing assessment of the patient’s physical, psychological, social, and spiritual needs. In care delivery, a nurse is to demonstrate a range of important nursing skills, under the supervision of a registered nurse, to meet individuals’ needs, which include maintaining dignity, privacy, and confidentiality and effective communication and observation and listening skills. Kenworthy et al. (2003). Health and safety, including moving and handling, are an essential part of care to prevent nurses from causing harm to themselves and their colleagues and patients. Care also includes controlling infection in the ward, such as washing hands using protective clothes such as gloves and aprons, administering medicine, giving the correct dose, and being aware of the patient’s emotional and physical personal care.
There is a need to develop a therapeutic relationship and promote the patient’s wellbeing in delivering care. This involves giving the patient a choice and empowering them by providing them with the necessary information. Data collection is an essential part of the assessment process, and this, in turn, helps the planning implementing and evaluating the care process. Maintaining the patient’s privacy and dignity and respecting and protecting their confidentiality is part of the nurse’s duty of care (Hogston and Sampson 2000). According to (NMC 2002) code of professional conduct, Information about the patient must be treated as confidential and used only for the purposes for which it was given. The nurse should not disclose patient information with other patients or talk on the phone with an unknown caller.
Nurses are to discuss with patients and clients to identify their needs and wishes for health promotion advice and provide relevant and current health information to the patients. Which will be easy for the patient to understand and acknowledge individual choice and provide support and education in the development of independent living? Hinchliff et al. (2003). For example, if the patient wants to give up smoking because it is bad for his health or not bother. Communication forms a vital and essential part of good practice NMC guidelines for professional practise (2002). Arnold and Boggs (1999) also state that communication with colleagues and patients is an important fundamental requirement for improving patient care.
Walsh (1991) states that high priorities occur in physiological and psychological needs, intermediate priorities involve non-emergency, non-life-threatening needs, and low priorities may not be directly related to a specific illness or prognosis. The short-term therapeutic aims for patients were to minimize the extent of any harm and distress, help them safely overcome any dependency on the drugs they were taking, and facilitate the development of their coping skills. Due to my concern, I asked him if he is aware of the implication of not having the proper amount of medicine. Being very clear about the consequences, I further reinforce this and explain that other patients are afraid to hurt them because of his aggression. He told me the medicine has made him impotent, and he does not want to take it continually. I have advised him to tell the doctor about the side effect, but he declined. According to his culture, he fined it very difficult to talk about his private life. The client believes that I would not reveal his information; he told me not to tell anyone, he will tell the doctor in his own time.
I reported this to my mentor as I think there is a risk that he may harm others or endanger himself. I felt it would be better for the registered nurse to persuade him to tell his doctor to review his medication to protect others. The Code of Professional Conduct NMC (2002) supports the practising and registered nurses and argues that confidentiality can be overridden if it is in the public interest. Even though confidentiality is not a guarantee, it can be seen as a cal issue and guideline to good practice. All nursing codes of ethics have a clause regarding confidentiality. In reflecting, I realized that I did not spend enough time with the patients. I did not ask them how they felt after taking their medication and did not observe him for any side effects. After spending four weeks in the ward, I was able to talk to patients about their medication and asked them how they felt after taking their medication.
PERSONAL/PROFESSIONAL DEVELOPMENT. For professional development, the NMC (NMC 2002) states that nurses must keep their knowledge and skills up to date throughout their working life. It is, therefore, the responsibility of the individual nurse for their own learning through the development of practice. Such as identifying additional knowledge and skills needed to manage unfamiliar or professionally challenging situations (Kenworthy et al., 2003). This also demonstrates one’s commitment to continuing professional development and personal supervision activities to enhance knowledge, skill, values, and attitude of safe and effective nursing practice. The need for continuing professional development is vital for all staff in health care delivery. Registered Nurses, Midwives and Health Visitors are the key professional people who have the skills, knowledge and ability to make a difference in the delivery of health care. Personal career development can be at a pace to meet both one’s professional and circumstances.
The gaining of new knowledge and skills is vital to nurses and making a difference to the type of health care they deliver Hinchliff et al. (2003). It also contributes to creating a climate conducive to learning experiences and the development of others by facilitating the mutual sharing of knowledge and experience. When practitioners do not comply with the UKCC (1995) standard and maintain a personal, professional profile, they will be considered to have allowed their own registration to lapse. All Learning activity needs to be recorded in a personal, professional portfolio. This enables the individual to demonstrate to the NMC all learning activity that has been undertaken. Kenworthy et al. (2003).
Kenworthy states that one has to identify their own professional development needs by engaging in activities such as reflection, practice, and lifelong learning and developing a personal development plan that considers personal, professional, and organizational needs. In addition, one’s experience should be shared with colleagues and patients to identify additional knowledge and skills needed to manage unfamiliar or professionally challenging situations. UKCC (1992) emphasis that the pre-registration curriculum will continue to change over time to absorb relevant changes in care as advances are made. Therefore, pre-registration education is a foundation for professional practice and a means of equipping nurses, midwives, and health visitors with the necessary knowledge and skills to assume responsibility as registered practitioners. Further education will equip practitioners with additional and more specialist skills necessary to meet the special needs of patients and clients.
Hogston and Simpson mention that nurses need to access their own thoughts, feelings, and motivation for behaviour to be aware of how they may respond to the thoughts, feelings, and behaviour. There is an acknowledgement within the field of health care that nurses need to demonstrate positive regard. Nurse aim is to promote a sense of value in their patients. Still, to be successful, they need to understand themselves in terms of their values, attitudes, thoughts, and feelings and be comfortable with themselves before understanding others. NMC (2002) code of professional conduct states that one must keep their knowledge and skills up to date throughout their working life. One needs to take part in learning activities that develop one’s competence and performance. One must possess the knowledge, skills and abilities required for lawful, safe and effective practice without direct supervision.
Hinchliff et al. (2003) emphasize that a nurse must acknowledge their limitation of professional competence, for example, if one is asked to take a task beyond their level of competence or outside their limitation. They should obtain help and supervision from a competent practitioner. A registered nurse is to assist student nurses in developing their skills. A registered nurse’s responsibility is to deliver care based on current evidence, best practice and, where applicable, and available validated research. Peplau’s model maintains that individuals have the right to autonomy, self-direction and decision-making within their capabilities. I used this model to relate to James’ physiological needs, psychological support and care. Peplau’s model is that the patient should be moving towards health and that the nurse has the role in educating and empowering the patient. Hinchliff (2003).
I have identified the needs for my personal development by working with my mentor and other trained nurses by engaging in activities such as observation, communication and working in a team. This has highlighted the need to develop skills and gain knowledge and confidence to provide quality care to patients. My mentor explained the (UKCC) code of conduct to me and how the code of regulation was set up to protect the public and maintain standards through reflection and appraisal. During my placement in Newham hospital, I was given a task to observe Adam (pseudonym), who was 30 years old and had Multiple Sclerosis (MS). He was in a terrible emotional state and refusing to eat or maintain his personal hygiene. I build a therapeutic relationship with Adam based on trust, empathy and understanding and listening. I went to his bedside and asked him if I could talk to him; I asked him the reason for his depressing. He told me his fiancï¿½e visited him the day before and told him she has broken up with him; he said he felt abandoned and depressed.
He told me he would prefer to be transferred to Walsh hospital to be closer to his parent. I reassured him, and prompted him to eat and gave him adequate fluid intake. I encouraged and supported him to take his bath; I changed his bed with clean sheets, gave him clean clothes, and made sure he was comfortable. I told my mentor what happened to Adam, and she went and had a chat with him. Before I left the ward that evening, Adam felt much better and was cheerfully chatting with another patient. Upon reflection, I used my communication skills to listen carefully whilst Adam told me about his problems. I realized that I did not get the patient’s consent before informing my mentor about his problems. I have not spent enough time with him due to other tasks I was given. As a student, I am allowed to make mistakes and learn from them. Next time, I will make sure to spend enough time with a patient who has emotional problems and ask his permission before I give any information concerning him.
CARE MANAGEMENT. The duty A nurse’s duty is to promote, advocate every effort to protect the health, safety, and rights of the patient receiving care. In the ward, the nurses ensure that the environment is safe for the patients and clients; for example, the patient paths are not blocked with chairs, boxes, or any electrical wire left around .and to ensure that floor was not wet. I observed how nurses deal with ethical issues every day with patients, families and other health care providers. Regarding professional and ethical practice, registered nurses must manage themselves and their practice and that of others, according to the code of professional conduct of UKCC (1995). Care management contributes to identifying actual and potential risks to patients, clients, and their carers, to oneself and others and participates in measures to promote and ensure health and safety.
Als,o to under, stand, and put into practice health and safety principles and policies andize and report potentially unsafe situations for patients, clients, and oneself, hers Kenworthy et al. (2003). One must ensure that relevant principles were applied to ensure safe administration of therapeutic substances and to use appropriate risk assessment tools to identify actual and possible risks such as environmental hazards and prevent them. This involves the need to identify how to utilize risk management tools in assessment, for example, the Waterlow score. To demonstrate the key skills of effective communication, maintaining a safe working environment byusingurance and appropriate risks assessment, such as idenidentifying hazards and eliminating or preventing them. NMC (2002) code of professional conduct states that a nurse must work with other team members to promote health care environments that are conducive to safe, therapeutic and ethical practice.
A manager must have a duty toward patients, clients, colleagues and the wider community and the organization in which one works. NMC also states that whether one has a professional duty to provide care n with an emergency or outside work setting, one student, I established and maintained collaborative working relationships with members of the multidisciplinary team and took part in assessing the patients. Kenworthy et al. (2003). Hinchliff et al. (2003) state that teamwork introduced in the 1980s was a way of ensuring more holistic care. According to the NMC (2002), teamwork includes the patient, their family and their carers; I worked as part of a team by reporting issues observed to the nurse in charge and respected the skills, knowledge and expertise of other team members. I listened carefully to discuss and solve difficult situations, such as controlling violence and abusive patients. I also asked questions and discussed patients’ conditions with registered nurses.
It is the duty of the ward manager to demonstrate the ability to coordinate the delivery of nursing and health care, delegate duties to other staff as appropriate, and ensure that they are supervised and monitored. Also, the staff nurses are to be computer skills to record patients’ information on the computer and retrieve it, and accurate numeracy, Hinchliff et al. (2003). During my placement in Kings Square Nursery, the manager in charge of the nursery make sure that we care for the children and try and create a good environment for them. This means I made sure that the place is safe, hygienic and that the equipment and activities provided are suitable for the needs of the children being cared for. I was asked to check to ensure there were no potential hazards; I supervised the children and ensured that equipment and materials were right for their age. In addition, I was asked to take responsibility for tidying away equipment so that accidents are prevented and the environment is kept clean.
All the staff were involved in wiping spillage and cleaned up surfaces to prevent the children from being sick. I asked my supervisor or management anything I wanted to know about the children and keep it confidential. NMC (2002). The staffs also establish a good relationship with the parents, this he; these children to settle in more quickly, I get o; Tell with the children by spending much time with each patient to build relationships and trust. I also supported the need of the individual children. For example, when a child wants to go to the toilet, I help them and tar clothes, and after they have finished, I help them watch ir hands. I also helped them to do their act works as well as help them in the playground. I also played a part as a team member and was able to work with the staff. As a good team member, I respected the members of the team and supported them.
I reflected upon, as a mother, I was able to use my skills of observation to prevent the children from injuring themselves. Used motherly love experience to provide for the children’s needs. I identified the roles of each care team member and how the nursery identifies environmental hazards and eliminates and prevents possible. I also observed how the nursery applies appropriate rules to ensure the safe administration of therapeutic substances. As a student, I need to learn more about child care and continue to practice and experience under the supervision of a registered nurse.
- Hinchliff, S., Norman, S. and Schober, J. (2003). Nursing practice and health care 4th ed. London: Arnold. –
- Jarvis, P. (1991) Reflective practice and nursing. Nurse Education Today, 12,174-181.
- Kenworthy, N., Snowley, G. and Gilling, C. (2003) Common Foundation, Studies in Nursing 3rd ed. Edinburgh: Churchill Livingstone.
- Nicol, M., Bavin, C., Bedford-Turner, C., Cronin, P. and Rawlings Anderson, K. (2004) Essential Nursing Skills. London: Mosby.
- Hogston, S. and Simpson, P. M. (2002) Foundation of Nursing Practice. London: Macmillan.
- Burnard, P. (1995) Learning Human Skills 3rd ed. London: Guildford
- NMC code of professional conduct (2002). London: NMC
- UKCC code of professional conduct (1995) London: UKCC
- Walsh, Catherine (1991). Literacy as praxis: Culture, language and pedagogy: Norwood, NJ.