Experience Of A Student In A Clinical Placement

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The aim of this essay is to describe and discuss an experience from a clinical placement in a Local hospital of a patient whom I have cared for. This reflection will be written in the first person using "I" as it will help the author to describe an episode of care; whereby she examined her own values and beliefs in the provision of care for the client. According to Webb (1992) it is acceptable to use the first person when giving a reasoned opinion that is grounded in firm evidence. I will reflect on how these beliefs and values underpin the practice for this particular individual.  Recommendations will be given and then a conclusion.

I will use the Gibbs (1988) reflective model to highlight the learning outcomes achieved mentioning how knowledge gained will be incorporated into future practice.  Reflection as defined by Mullally (2002), is a consciously and systematic thinking about personal thinking and personal actions. For nurses, reflection is the also the ability to review, analyse and evaluate situations, during or after event this means looking back at an experience analysing the events and learning from this experience.


According to the NMC (2008) and the Data Protection Act (1998) every name in this reflective assignment has been changed in order to maintain confidentiality.   Mr. Karim, a 54 year old Asian man, is a Hindu priest who was admitted on the ward and diagnosed with a chest infection. As a result of this, he was prescribed a course of antibiotic to be administered to him four times daily.  Due to his religious values and beliefs, Mr. Karim prayed and meditated several times a day which coincided with his 14.00 hours (hrs) medication.  How can this issue be resolved as both the antibiotic therapy and his religion are important to Mr. Karim's values and beliefs and the values and beliefs of both the nursing and medical staff?

Values can be fundamental to all cultures as ideas which are defined as something that is considered important.  Culture refers to the ways of life of the members of a society, or of groups within a society. It includes how they dress, their marriage customs, their family life; their patterns of work, religion ceremonies and leisure pursuits (Walsh et al 2000).  Therefore, with these aspects of human societies they are learned by many people from a young age, rather than inherited. These elements of culture are shared by members of society and allow cooperation and communication to take place among them.   Considerably, values and norms are the rules of behaviour which reflects cultural values of many today. Norms work together with values to shape how members of a culture behave within their surroundings. Many norms are taken by people for granted such as premarital sexual relations and unmarried couples living together (Giddens 2002).  Therefore, many of our everyday behaviours and habits are grounded in cultural norms such as movements, gestures and expressions are strongly influenced by cultural factors



After finding out that Mr. Karim prays at 14.00 hrs each day, the staff had a meeting to discuss the client's care plan. Good communication skills are paramount to the delivery of good quality nursing care today (Pied 2000; Bulman et al 2004). Furthermore, Schuster (2000) also stated that good communication skills are the key to the therapeutic relationship.  During this meeting, plans were put in place as to how to approach the client.  Mr. Karim who spoke fluent English did not need an interpreter for the meeting.  He was informed by the ward manager during his breakfast medication round.  However, he requested for his son to be present during the meeting. The manager asked me to telephone his son immediately as I was assigned to provide care Mr Karin during this shift.  On contacting his son, he agreed to visit the hospital at 11.00 hrs as the meeting was scheduled at 12.00 hrs; just before Mr. Karim's lunch break.  As the National Health Service (NHS) (2003) has now encouraged diversity, equal opportunity and anti-discriminatory legislations due to multi-cultural patients and clients in the United Kingdom (UK), it is vital for health professionals to adhere to these laws and put aside their own values and beliefs in order to provide equity and quality care for all clients.


 Diversity is seen as the recognition and valuing of difference. (DOH 2003). This is often related to different groups of people from various ethnic backgrounds and cultures.  Also, the encouragement of equal opportunity, which means ensuring that no one receives less favourable treatment because of their ethnicity, colour, creed, national origin, gender, marital status, class, disability or sexuality (Kroll 1994) has been diverged into the mission statement.  Therefore, equality in within the NHS and The Social Care Settings have helped in offering flexible, responsive services in which differing needs are identified and accommodated so that each person benefits equally.


Henley and Schott (2000) stated that Hinduism is generally considered to be the oldest major world religion still practised today.  It is a social and cultural system and a way of life as well as a set of beliefs, values and religious practices.  This religion for Mr. Karim believes in care and respect for other people, obedience to parents, and hospitality to visitors. Therefore, health care professionals in both hospitals and in the social care settings have to set aside their own cultural values and beliefs to respect this religion when providing care for clients or patients as they believe in various holy articles such as 'the Gita', holy water and 'Prasad, prayer at home three times daily, the temple; 'Mandir' and the priest; 'Pandit or Pujari'.  Mr Karim brought most of these articles to the ward which I helped to assemble on the shelf, though, I don't believe in his religion; as I am a devout Christian. Whilst Mr. Karim was admitted on the ward, he believed in astrology for good and bad events, special festivals , depending on the size of the moon (quarter, half and full), sacred marriages, the Caste systems (division of groups), special dietary requirements , which he discussed with me as one of his carer's.  He often stressed on the fact that many Hindus will refuse medications due to their cultural and religious values and beliefs.


Diversity within cultures is far more important in the UK nowadays to enable people in understanding various beliefs and cultures that can help in promoting greater tolerance in society.  According to (Trompenaars 1993), within every culture, there is a range of norms, values and assumptions.  Also, people are not the same and therefore, do not live in the same way.  Thus, it is essential for health care providers to set aside their own values and beliefs in order to respect individuals, their religious and cultural beliefs and in the provision of care for their patients and clients.  Conversely, within every culture, there are 'micro-cultures', influenced by, social class and religion of origin.  Therefore, families as well as social, religious, professionals and occupational groups can influence a better understanding of other people's religious and cultural beliefs.


Also, Mr. Karim's culture vitally affects every aspect of his daily life such as how he thinks, behaves, and the judgements and decisions he makes while he was in our care.  This seems like a set of lenses through which we look at the world and which defines both what we see and how we interpret it (Henley and Schott 1996; Hofstede 1997).  Therefore, people are to set aside these values and norms in a multi-cultural society in order to promote greater tolerance between one and other.  According to (Rack 1998), it is essential for people to set aside their own values and beliefs in order to respect other individuals, their religious and cultural beliefs.


The meeting took place in a quiet room away from all interventions in order to ensure privacy and respect as he is an elderly man. According to NMC (2008) nurses must respect the patient and client as individual and personally accountable for ensuring that you promote and protect the patient/client interest and dignity. His son was present during the meeting.  The manager informed him about the importance of his antibiotic therapy which was prescribed and ought to be taken at certain times over a number of days. Furthermore, the manager told him that he found out that he was missing his 14.00 hrs medications due to his prayers.  Mr. Karim explained that his religion was very important to him, especially at the time that he was not feeling well.  Also, people believed in sanctity of life and that life has a spiritual dimension and a greater purpose (Culley 1996; Donovan 1995).  According to (CRE 1991), 'for many members of the ethnic minorities, their faith, and their personal identity through their faith, and reactions of the rest of the society to that faith and to them as belonging to it are of utmost importance.  Therefore, careful considerations were undertaken by health professionals to amend the previous prescribing times for the client.  The influence of religion on his life varies a good deal and cannot be predicted.  Mr. Karim's needs were listened to supportively by all members of his care team. 


The medical team were contacted regarding the meeting and afterwards made a decision to change the times in order to meet his religious beliefs.   The times were changed to 06.00hrs, 12.00hrs, 18.00hrs and 24.00hrs respectively.  This meeting led to a satisfactory decision for both Mr. Karim and the care staff. 


I was nervous initially because of my own values and beliefs but my mentor and the other members of the team helped me to accept and understand cultural diversity, values and beliefs of Mr. Karim's religion. Also, reading policies at work on anti-discriminatory legislations helped to give me a wealth of knowledge on this subject. I went home and explored a wider reading on Hinduism and how they live in order for me; a devout Christian to be able to set aside my own values and beliefs and embrace his own in order to provide equity and quality care for him.  Reflecting in action involves being alert to changing circumstances as they occur, revising decisions and taking new course of action in the light of new information (Palmer and Kaur 2005).  Similarly, Baron (2000) states, that to every reflective process, we bring the "self critical thought and action. Therefore, by implementing all these knowledge gained, I was able to provide the appropriate care Mr Karim.



On evaluation, the other members of the multidisciplinary team and I were able to communicate among ourselves and Mr.Karim through the meeting in order to achieve the understanding of his cultural and religious values and beliefs; whilst setting aside our own values and beliefs as his health providers.   Newell (1998) defines evaluation as an ongoing process that entails the ability to make judgement about the value of something that occurs after a healthcare professional has had contact with clients or patients in aspects of the health care profession.  Therefore, effective reading of nursing journals, textbooks with relevance to this and on practice had enabled me to gain a wider knowledge and skills on cultural diversity, values and beliefs. 



On analysis, there were positive and negative aspects of meeting the needs of Mr.Karim.  Initially, he missed his antibiotic therapy, which was important for us as health care professionals and the prayers and meditation times for the clients was utmost to him during his illness.  However, if we were able to read a bit or discuss in details of his needs during his initial assessment, these problems would have been avoided. According to Bates (1995), Assessment is the observation and recording of facts relevant to the individual's life before and after seeking healthcare where physical as well as social aspects are all considered. The positive aspect was that my mentor assisted in guiding me to understand the values and beliefs of the client.  Furthermore, the stress would have been less if I had planned his care in details when he first came to us. Potter and Perry (2002) explained that the completeness and correctness of the information obtained during assessment are directly related to the accuracy of the skills that was used by the nurse.


As part of my professional development, I have now learnt to explore around the subjects and understanding of cultural and religious beliefs in order to provide quality care for my patients and clients.  Also, the use of evidence-based knowledge and exploring on subjects of cultural diversity, values and beliefs has enhanced me with wealth of knowledge.

Reflections of nursing students are important to help them to reshape their understanding on various aspects of their professional development as well as nuances and complexities of their roles in a given situation (Hunt 1994).   Therefore, most therapeutic tool that a nurse possesses is by making accurate decisions in order to gain client-nurse relationship until a favourable outcome is achieved in care.  On the basis of the aforementioned statement, I will suggest that this quality of a nurse does have vital effect on clients' wellbeing and to achieve this, autonomy is paramount among members of the multidisciplinary team.



The action plan for me is to read more on other cultural and religious beliefs and values, other than that of Mr.Karim in order to understand how to assess, plan, implement and evaluate the care of individual clients and patients that may be within my care groups and to prevent this same misunderstanding.   Benner (1984) cited in Baron (2000) captured the significance of reflection by stating that to examine what is worth preserving, one must study everyday expertise and narratives embedded in their practice as a nurse.  There was a respectful discussion between Mr. Karim and the staff with regards to his religious beliefs and times of his antibiotic therapy. Considerably, it is important for health professionals to demonstrate the willingness to learn about each patient's beliefs and needs (Henley and Schott 2002). Therefore, religious and cultural beliefs should be respected in the work place for the well-being of patients and clients.

Through reflection, I have used the knowledge that already existed within me and discovered new knowledge, which together will be combined to my practice in the future, a skill I believe, is crucial to the development of practice of a qualified practitioner.


It is vital for health care professionals to understand the multi-cultural society that exist in the UK and how to plan and implement quality care for individual patients and clients.



In this reflection, I have defined values, cultural diversity and equal opportunities, which exists within the NHS and the social care setting. Also, I have explored Mr. Karim's religion: Hinduism and the need for a comprehensive initial assessment for such clients in order to avoid misunderstanding and to also be able to set aside one's own values and beliefs in order to embrace the values and beliefs of others within your care. In addition, I used the Gibbs (1988) cycle to reflect on my knowledge and skills in and on practice. To conclude, it is important as a nurse to encompass the understanding of others' cultural and religious values and beliefs as an integral part of nursing education.