Sample 2:1 Undergraduate Nursing Reflective Practice Essay
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Critically reflect on an encounter with a service user in a health care setting
This essay aims to critically reflect on an encounter with a service user in a health care setting. The Gibbs’ Reflective Cycle will be used as this is a popular model of reflection. Reflection is associated with learning from experience. It is viewed as an important approach for professionals who embrace lifelong learning (Jasper, 2013). In general terms, reflective practice is the process of learning through and from an experience or activity to gain new understandings of self and/or practice (Bout et al., 1985; Jasper, 2013). This method is viewed as a way of promoting the personal and professional development of qualified and independent professionals, eventually stimulating both personal and professional growth (Jasper, 2013). Dating back to 1988, the Gibbs’ Reflective Cycle encompasses six stages of reflection which enable the reflector to think through all the phases of an activity or experience (Gibbs, 1998). The model is unique because it includes knowledge, actions, emotions and suggests that experiences are repeated, which is different from Kolb’s reflective model (Kolb, 1984) and thus, the model is wider and a more flexible approach in examining a situation in a critical light to enable future changes (Zeichner and Liston, 1996).
The incident I will be reflecting on occurred whilst I was placed on the oncology ward during my first year of qualified nursing. We had an elderly service user on the ward, who had been admitted due to stomach cancer. Upon his arrival, we read his notes which highlighted that he had significant learning difficulties, meaning that he also had problems with verbal communication. The main areas of reflection are how both myself and the other nurses used communication to calm the patient and show compassion, as well as how we adapted our care to address their individual needs. A nurse came onto the ward with three members of the public, who were viewing the ward as part of a job advertising process. When the nurse entered the patients bay, she informed the members of the public that the service users in that bay were currently receiving radiotherapy treatment. Upon hearing the nurse’s words, the service user became overtly distressed and began crying, shrieking and hitting his head backwards against his pillow –it took time; however, another nurse managed to calm him down by talking in a soothing manner.
Prior to the incident occurring, I was mindful that the nurse was showing the three members of the public around the oncology ward, as part of a job advertising process. At the time of the incident, I had only been working on the oncology ward for six months so still felt slightly unsure of my position within the team. Ultimately, I did not feel confident or experienced enough to deal with this situation independently. I think that my increased level of anxiety meant that I struggled to intervene, however it is still clear that both my colleagues and myself should have intervened more quickly to ensure that the patient was dealt with effectively. Moreover, I was very surprised when the nurse failed to take into consideration the individual needs of the service user during the visit of the ward, as the distress caused to both the service user and the members of the public was very unnecessary.
In hindsight, the experience had both good and bad elements which have led to an increased understanding of the service user experience and my role as a nurse practitioner within the oncology team. My role was to give physical examinations and evaluate the service user’s health, prescribe and administer medication, recommend diagnostic and laboratory tests/read the results, manage treatment side effects, and provide support to patients – this includes acting in their best interests. I feel that I did not fulfil the latter responsibility completely. This duty to protect service user’s full confidentiality and ensuring that the nurse who was showing the members of the public around the ward was aware of the service user’s communication difficulties and resulting anxiety was not fulfilled. Our failure to act as a team, by sharing information and stepping in before a situation escalated, shows that there was a low level of group cohesiveness (Rutkowski, Gruder and Romer, 1983).
According to the Nursing Times Clinical (2004), people with learning difficulties often have a struggle with adapting to new situations, which means that there is a potential for problematic behaviour when dealing with something outside of their comfort zone. Nevertheless, as suggested by the Nursing Times Clinical (2004), healthcare staff should be aware of how to effectively interact with people who have a learning disability and this can be aided through regular and valuable reflection. Prior to admission into the hospital, it is advised that professionals find out about the patient's communication and their likes and dislikes; address any potential fears either through discussion or by allowing the patient to visit the ward to meet the nursing staff (Nursing Times Clinical, 2004). Moreover, the day to day communication towards patients with learning difficulties should involve patient-centred/holistic care in addressing patient needs, which incorporates both verbal and non-verbal forms of communication. Therefore, professionals should make eye contact, look and listen, allocate more time for the patient, be interactive and communicative, remain patient and in some cases, enable any professionals who may have had experience with people with a learning difficulty to care for the patient (Nursing Times Clinical, 2004).
MENCAP states that one of the most common problems when accessing healthcare for people with learning disabilities is poor communication (n.d). This can be aided by offering the service user an advocate to communicate on their behalf and by providing information in a variety of ways including visual. They further this with the notion that healthcare professionals should equally value all people, adapt their service so that it meets different needs and understand that each individual will have different needs (MENCAP, n.d). The Nursing and Midwifery Council (NMC) (2015) further this in 'The Code', which states that all registered nurses and midwives must abide by the professional standards which are to: prioritise people, practise effectively, preserve safety and promote professionalism and trust. Therefore, the incident whereby another nurse did not take into consideration the individual needs of the patient does not abide by the professional code of conduct; ultimately, they did not recognise when the patient was anxious or in distress and respond compassionately, paying attention to promoting the wellbeing of the service user and making use of a range of verbal and non-verbal communication methods (NMC, 2015). Compassion is one of the '6cs' introduced in 2012 - which are the values and behaviours that are viewed as the quality markers of a health and care service - these being: care, compassion, competence, communication, courage and commitment (Department of Health, 2012). The 6Cs carry equal weight and should be a part of all service delivery - ensuring that patients are always placed at the heart of the provision (DoH, 2012).
From this experience, I am now more mindful of the importance of being assertive and exert professionalism in practice (and not feel as though I cannot do something because of my position within the team or length of experience) if similar situations were to arise in the future. The insight I have gained from this experience means that I am now more aware of the implications of not acting immediately and the importance of acting in the best interests of the patient, even when this may take courage. Strong working relationships between healthcare professionals should also be given a greater emphasis within the oncology ward, so to increase levels of group cohesiveness (Rutkowski, Gruder and Romer, 1983).
In the future, I aim to be more proactive in dealing with a situation face on regardless of my role within the team or level of experience; this includes dealing with a stressed service user, ensuring that information is passed on to the relevant staff and intervening when I believe that is a risk to a service user’s health or mental wellbeing. Moreover, I will address the needs and alter how I approach a patient with learning difficulties in the future by ensuring that I use the different methods of communication and undertake some independent research on their specific needs; the information of which I can use in my nursing practice.
I will not assume that other members of staff will always be aware or mindful of the individual needs and/or triggers of a service user, and I will not presume that other members of staff will always act in a wholly professional way. I will continue to undertake regular professional reflective practice, using the on-going model proposed by Gibbs (1988). I also aim to consistently and confidently implement the principles and values as set out by the National League for Nursing, relating to the individual needs of service users, these being:
- To respect the dignity and moral wholeness of every person without conditions or limitation.
- To affirm the uniqueness of and differences among people, their ideas, values and ethnicities. (National League for Nursing, 2017, n.d).
These are furthered by the National Health Service (NHS), which was created out of the ideal that quality healthcare should be available to all and should meet the individual needs of everyone.
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MENCAP. (n.d) Communicating with people with a learning disability. Online. Available at: https://www.mencap.org.uk/sites/default/files/2016-12/Communicating%20with%20people_updated%20(1).pdf
National Health Service (NHS). (2015) Principles and values that guide the NHS. Online. Available at: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx
National League for Nursing. (2017) Core Values. Online. Available at: http://www.nln.org/about/core-values
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Nursing Times Clinical. (2004) Managing the needs of people who have a learning disability, Nursing Times 100 (10) pp. 28-29.
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Rutkowski, G. K., Gruder, C. L., & Romer, D. (1983). Group cohesiveness, social norms, and bystander intervention, Journal of Personality and Social Psychology, 44(3), pp.545-552.
Zeichner, K. and Liston, D. (1996) Reflective Teaching: an introduction. New Jersey: Lawrence Erlbaum Associates.