Reflective practice is associated with exceptional benefits in improving the care practices, especially for the health care professionals. It has to be mentioned in this context that the importance of the reflective essay is extreme for the health care professionals as they have to adhere to a variety of different legislative frameworks and different practice protocols (Redmond, 2017). It is very important for the nursing professionals to continue to improve their practice standards in accordance with the different factors associated with improving the practice. Hence, it is very important for the nurses to continue to provide adequate patient centred care to the patients. As mentioned by Howatson-Jones (2016) that reflection is a way of thinking and practicing for the registered nurses that helps the nurses enhance their level of conscious awareness in enhancing the scope of practice. In this essay I will attempt to reflect on the experience of a patient with the age of 75 years and the care experience that he had had while availing care taking the assistance of Gibbs reflection.
The description is the section in the Gibbs reflection cycle that helps in the exploring the exact experience that the individual has had. In this case, the patient in the case study is William Taylor who had been enquired for the experience that he have had and some insight on how nurses can improve their practice (Dubé & Ducharme, 2015). Bill, as William wanted to be addressed as, explained that he had visited the facility due to the fall he experienced that caused him to immediately lose the use of the right arm, which basically shocked and terrified the patient by this point. He also explained that he had had a very bad hospitalization experience where he had suffered 11 hours of pain where the care providers neglected in the emergency department. The patient explained although it had been agonizing and embarrassing he still had not been angered by the event. The patient expressed that it had been an extremely disrespectful and stressful experience for him which reduced his inclination to taking hospital based support in the future and affected his future experiences as well.
The feelings and thoughts is the section of the reflective cycle which allows the individual to explore the thoughts and feelings while recollecting the experience (Johns, 2017). In this case, I would like to mention that Bill, with respect to the response that William had given, it can be mentioned that he had been a very Jolly older man who had been very forthcoming and co-operative in the entire experience. Although, after exploring the experience that he has had I felt extremely sad and aghast for the horrible experience he had had of waiting in the chaotic and uncomfortable environment of the emergency department environment with agonizing pain in the waiting room for hours and even with that going to the counter to ask from medications and no care providers seeing to him.
In this case, I would like to discuss my personal values and beliefs regarding the patient centred care and respecting the patient and his identity while providing care to the patient. I would like to mention, that I completely agree with the fact that the emergency department scenario is associated with various different urgencies and attending to each and every patient in the case scenario in this context proactively is not remotely possible in any case. However, when a patient in writhing in pain for 11 hours, even with moral grounds providing him a comfortable and secure environment is a necessity of patient centred care. Along with that, Bill also mentioned having to go to the counter to ask for more codeine to the pain he had been in which he described to be an 8 in the pain score which is undoubtedly a severe to chronic pain, this had been violating patient safety and patient centred care principles. In my belief, providing periodic visits to the patient with both pharmacological and non-pharmacological pain management measures to help him feel better (Vincent et al., 2016).
In the analysis section, which mainly is aimed at discovering the strengths and weaknesses of the experience that he has had in the experience. It has to be mentioned in this context, that the first and foremost aspect which needs to be compared and contrasted with the experience that has been highlighted in the case study is the aspect of patient centred care. There are 8 principles of patient centred care, among which each of the principles are needed to be adhered to in order for the care provided to the patient under any circumstances bee safe and effective (Feo & Kitson, 2016). These principles include respecting patient choices and preferences, co-coordinating and integrating care, informing and educating the patient proactively, providing physical and mental comfort, providing emotional support, involving the family and friends, continuity and transition of care, and lastly, access to care (Chaboyer et al., 2016).
The experience of the patient in the hospital while in the emergency department had been extremely bad and it had violated almost all of the principles of the patient centred care. Elaborating more on the case, providing physical and mental comfort is a very important standard principles of the patient centred care practices, which had been violated outright for William while he had been writhing in pain while in the emergency care department for 11 hours with a pain score of 8 out of 10. Neither was he provided adequate medication proactively rather than him having to personally go to the counter and fetch medication for himself, nor was he provided a safe and comfortable environment to wait while in the scenario. As discussed by Eaton, Roberts and Turner (2015), help seeking behaviour is intricately associated with the past experiences that the patients have had. Most of the key principles of patient centred care had been violated for him and it continued to worsen hospitalization experiences he had for his nose surgery and other health care needs. In this context, it has to be mentioned that a proper EHR or Electronic health record was not maintained properly for William, neither was he ever properly educated regarding how to use EHRs or personal health records for keeping track of his illnesses and recovery progress. Similarly, the patient experienced two consecutive falls, and the second fall in this case had been in his home after 4 weeks of being seen by the GP or his first fall. In this case, the GP had not followed the standard 10 preventing falls and harm from falls by NSQHS even after the patient exhibiting several falls risks which have been violation of patient safety and clinical governance (Safetyandquality.gov.au, 2018). It can be stated that in case these two factors have been taken into consideration while caring for William, his experience could have been better propelling his help seeking behaviour.
Conclusion drawn:
Lastly in the interview, while summarizing his experience and the advice to improve the practice essentials for the patients, Bill mentioned that building therapeutic relationship, effective communication and prioritizing patient interests visibly so that the patent can easily interpret it while availing care are the key requirements of adequate patient centred care. The main concern had been the two falls he sustained which resulted in severe consequences for him. The negligence and unsafe practice carried out by the GP and not adhering to the NSQHS standards resulted in enhancing the health risk of the patient. Along with that, the lack of nursing governance and nursing philosophies such as compassion, empathy, respect and accountability, had not been taken into consideration at all (Joseph & Bogue, 2016). The painful experience during his kidney stone removal attests to the fact that his hospitalization experience had been devoid of clinical governance principles and nursing philosophies. I believe in case the care proviedrs had adhered to the practice standards such as NMBA guidelines, NSQHS standards and practice governance, philosophies, and ethical principles, the care experience of William had been with accordance to patient centred and ethical care experience. I would like to mention while concluding the experience, that even though William had only provided a patient or consumer perspective on the scenario, his suggestion of improving therapeutic relationship, communication and prioritizing interest on patient by the nurses has captured the exact need of the hour for the health care delivery scenario (Fox & Reeves, 2015).
In this context, the action plan that I will be needing to complete includes soft skill enhancement and professional competence building for better therapeutic alliance establishment and communication. I would be taking the assistance of my supervisors and taking their suggestion in how to incorporate continuous professional development for myself. Along with that, I would also be enrolling in professional; development courses and workshop to build my soft skills and competence as a nurse along with continuing reflective journal to keep track of my progress (Pulvirenti, McMillan & Lawn, 2014).
Conclusion:
On a concluding note, Nurses are the primary point of contact for the patients and hence, it is very important for the nurses to develop a care approach that addresses each of the needs of the patient while providing therapeutic relationship, effective communication and prioritizing the patient interest over anything else is very important. Hence, there is need for reform in the care scenario to incorporate these values to improve the care experience for patients and enhance health care help seeking behaviour.
References:
Chaboyer, W., Bucknall, T., Webster, J., McInnes, E., Gillespie, B. M., Banks, M., … & Cullum, N. (2016). The effect of a patient centred care bundle intervention on pressure ulcer incidence (INTACT): a cluster randomised trial. International journal of nursing studies, 64, 63-71. Doi: 10.1016/j.ijnurstu.2016.09.015
Dubé, V., & Ducharme, F. (2015). Nursing reflective practice: An empirical literature review. Journal of Nursing Education and Practice, 5(7), 91. Doi: 10.5430/jnep.v5n7p91
Eaton, S., Roberts, S., & Turner, B. (2015). Delivering person centred care in long term conditions. Bmj, 350, h181. Doi: 10.1136/bmj.h181
Feo, R., & Kitson, A. (2016). Promoting patient-centred fundamental care in acute healthcare systems. International journal of nursing studies, 57, 1-11. Doi: 10.1111/hex.12020
Fox, A., & Reeves, S. (2015). Interprofessional collaborative patient-centred care: a critical exploration of two related discourses. Journal of Interprofessional Care, 29(2), 113-118. Doi: 10.3109/13561820.2014.954284
Howatson-Jones, L. (2016). Reflective practice in nursing. Learning Matters. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=0OaICwAAQBAJ&oi=fnd&pg=PP1&dq=reflective+practice+in+nursing&ots=1kQQxOqPgv&sig=dL1zlsWT9F1vCz22VJ4T9yBabEg#v=onepage&q=reflective%20practice%20in%20nursing&f=false
Johns, C. (Ed.). (2017). Becoming a reflective practitioner. John Wiley & Sons. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=9tnCDgAAQBAJ&oi=fnd&pg=PP2&dq=reflective+practice+in+nursing&ots=CQSimqxQje&sig=N39SJaPtiPJ2448qPtX50ri3DUk#v=onepage&q=reflective%20practice%20in%20nursing&f=false
Joseph, M. L., & Bogue, R. J. (2016). A theory-based approach to nursing shared governance. Nursing outlook, 64(4), 339-351.
Pulvirenti, M., McMillan, J., & Lawn, S. (2014). Empowerment, patient centred care and self?management. Health Expectations, 17(3), 303-310. Doi: 10.1111/j.1369-7625.2011.00757.x
Redmond, B. (2017). Reflection in action: Developing reflective practice in health and social services. Routledge. Retrieved from https://www.taylorfrancis.com/books/9781351905930
Safetyandquality.gov.au. (2018). Preventing Falls and Harm from Falls Standard 10. [Online] Available at: https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/NSQHS-Standards-Fact-Sheet-Standard-10.pdf [Accessed 22 Oct. 2018].
Vincent, J. L., Shehabi, Y., Walsh, T. S., Pandharipande, P. P., Ball, J. A., Spronk, P., … & Badenes, R. (2016). Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive care medicine, 42(6), 962-971. Doi: 10.1007/s00134-016-4297-4
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