The Adult Nurse has crucial roles to play in clinical practice according to the Nursing and Midwifery Council stipulations. Apart from ensuring that they embrace all the legal nursing requirements including using the evidence-based approach in practice, Adult Nurses must reflect on their performance in regard to their grasp of the values, beliefs, attitudes, and positive and negative behaviors. Reflection enhances learning from mistakes and thus improving the professional prowess of a given nurse (Bulman & Schutz, 2013). My reflection is based on my experience in different nursing units including adult surgical units, maternity, mental health units, geriatrics, general specialist medical care units, community and/or primary care. According to Driscoll (2007), my experience in clinical practice in the nursing units above is the first step in reflection.
The “what” in Driscoll’s reflection model particularly, includes my experience while providing care for an elderly man who was diagnosed with several stage 3 pressure ulcers after a long hospital stay. There are different values, beliefs, attitudes, and positive and negative behaviors that I can reflect on based on this particular event. In regard to values, I first embraced altruism which is basically selflessness in caring for the patient (DeNisco, 2019). I was fully dedicated to ensuring that the patient’s welfare is taken care of by the skin-care nurses and every healthcare provider in the skin-care unit. Altruism is emphasized in the NMC (2008) standards where a nurse is required to be kind and loving to patients under their care and above all remain calm to avoid both stress and burnout. Altruism enabled me to compassionately, offer the patient a healing environment that was positive for the patient until his wounds healed later in 3 months’ time. In line Driscoll’s model, I have learned to remain altruistic in the provision of healthcare to my patients.
Secondly, I learned to embrace autonomy, particularly while establishing a good nurse-patient relationship. In this regard, I always informed the patient of any medical care procedures he was undergoing including responding to his concerns fully. This included providing information on wound-dressing procedures, medicines to take, self-care, the importance of mobility in the prevention of further deterioration and development of pressure ulcers among others (Taradaj, 2017). This ensured that the patient only gave consent to the procedures he felt were helpful. This included the deliberations on medical insurance decisions that the patient sought to involve his family in. Allowing patient participation in their own care is emphasized in the NMC standards. Moving forward, I have always committed to ensuring that I embrace autonomy in handling my patients.
Human dignity as a value is paramount in nursing care as it emphasizes ethical behavior towards the patients. As stipulated in the NMC (2008) code of conduct for nurses and midwives, I offered the patient in the skin-care unit the management that encompassed the consideration of his dignity. I handled the patient as I would handle any of my beloved relative, considerate of the fact that he deserved proper care and was worth of unconditional respect despite his poor health. As an action going forward in line with Driscoll(2007), I will not in any way discriminate my patients in any way based on social, ethnic, political, religious and health status. I will ensure that their dignity.
Integrity is among the code of conduct for a nurse according to NMC (2008). In line with this value, I acted ethically, in an honest way, and maintained a fair approach to handling the patient. This include in cases when I offered him medications, helped him move and turn, as well as while providing cushioning materials to prevent pressure ulcer deterioration(Walker et al, 2017). As a learning point, I decided to always be guided by integrity to offer my patients safe, high quality and evidence-based care as required by the NMC standards. I also accord my fellow nursing care team respect and integrity as we collaborate to offer patients quality care.
Further, social justice is important in adult nursing (Warriner, 2016). In caring for the elderly patient with pressure ulcers, I upheld my patient’s freedom of choosing the type of care he needed at different times. This was of course without compromising my dignity as a nurse. I ensured that the patient was safe from any danger including injuries from probable falls that could further the deterioration of his wounds (Thomas & Compton, 2014). Driscoll (2007) emphasizes that the last step is to decide on the actions to take in the future after learning from an experience in the clinical setting. I will thus consider the above believes and ethical values that are engraved in the NMC code of conduct, in providing my patients with safe, high-quality, and evidence-based care.
Considering attitudes and behavior, I have learned to always remain positive in my professional practice. This is particularly in line with the Nursing and Midwifery Council code of conduct requirements. While taking care of the patient under care for pressure ulcers, I was able to maintain a positive attitude and behaved professionally in coordinating the work of the interdisciplinary team (Warriner, 2016).The positive attitude and ethical behavior enabled the patient to be confident in the care that was provided by the nursing team. My positive attitude while responding to the concerns raised by both the patient and any member of the interdisciplinary team facilitated the provision of not only safe but high-quality care for the patient until he healed of the stage 3 pressure ulcers. Professional behavior involves respecting patients, the nursing team, and self as nurse while making crucial decisions in nursing practice(Thomas & Compton, 2014). Ethics is thus paramount and this can be further defined in line with a nurse’ local country nursing regulations. As a resolution from my experience, I intend to always remain positive despite the difficulty that I may face while administering care to clients within and outside the hospital.
Concerning leadership, I was tasked with ensuring that the patient being managed for pressure ulcers was well handled by the interdisciplinary team. I was in charge of the patient’s pain management, wound assessment, documentation of the nursing process, facilitation of the patient’s mobility and ensuring the nurse in charge of patient nutrition was effective in their work. My leadership role was thus majorly the coordination and the facilitation of collaboration within the interdisciplinary team. Self-awareness is critical for a leader in understanding their weaknesses and strengths. I have been aware of my own principles, strengths and weaknesses in my nursing experience in line with competency 4 of nursing leadership in the NMC 2008 standards.
In my self-awareness reflection, I believe that through my nursing experience, I have not let my personal prejudices, beliefs, judgments, and even values affect the quality of care that I offered my patients (Masters, 2017). As a leader in the nursing unit, I ensured that the likely personal biases among the interdisciplinary team members were not a factor in influencing the healthcare needed for the patient with pressure ulcers. Where all of us as a team were short of information, I was able to consult the clinical nurse specialists. The decisions I encouraged the team to take were purely based on evidence from pressure ulcer care. More particularly, I could let the team address the knowledge deficits especially on accurate wound assessment and wound dressing methods(Nursing & Midwifery Council, n.d). Despite my strengths, I believe that my weakness was the fact that I was overwhelmed with some members of the team who could report late on call in the unit. While I have learned to be patient and controlled my disappointment in non-cooperative team members, I found myself overwhelmed. In line with Driscoll (2007) directive on the need for one to choose what to do after reflecting, I believe I need to cultivate more on my emotional intelligence so as to handle such cases in the calmest way possible.
In regard to leadership behaviors, I acted as a change agent by responding effectively to the complains and concerns raised by my colleagues in the nursing unit (Warriner, 2016). My response included availing of the needed support and communicating the concerns to the Nurse In-charge. I encouraged feedback from the team members as the coordinator, on patient care. This included consultations with skin-care nurses and the clinical nurse practitioners. More often, I could share my ideas and those brought out by some team members in the provision of safe and quality care to the patient (Bulman & Schutz, 2013). Going forward I will always be updating myself with the latest knowledge in nursing care so that I will be very resourceful to any given interdisciplinary team that I will lead.
Through the documentation of the nursing process, I could systematically monitor and evaluate the patient’s healing process in collaboration with the interdisciplinary team (Zuzelo, 2010). As a leader, I encouraged good-time management among the healthcare team. I also ensured that the available resources that needed to be used for patient-care were put to good use in line with NMC requirements. Having learned good time management emotional intelligence practice among other leadership skills described, I want to focus on further developing these skills.
Currently, I do not have any limitations that are likely to hinder my strive to develop the leadership skills that I have so far acquired through experience. The support system in place to assist me grow, include the educational knowledge in leadership that I am acquiring. Also, the on-field experience that I acquire while interacting with my patients in the different adult nursing units as well as with other professionals is helping me to enhance my leadership capacity (Warriner, 2016). This includes especially managing different people with varied personalities, from diverse cultures, and even with completely different preferences in nursing care priorities.
References
Berlin, J. (2015). Doctors’ functional leadership in psychiatric healthcare teams – a reversible leadership logic. Team Performance Management: An International Journal, 21(3/4), 159-180. https://dx.doi.org/10.1108/tpm-12-2014-0061
Bulman, C., & Schutz, S. (2013). Reflective practice in nursing. Hoboken: Wiley-Blackwell.
DeNisco, S. M. (2019). Role development for the nurse practitioner.
Driscoll, J. (2007). Practicing clinical supervision: A reflective approach for healthcare professionals. Edinburgh: Bailliere Tindall.
Masters, K. (2017). Role development in professional nursing practice.
Nursing & Midwives Council (n.d). Domain 4: Leadership, management, and team working
Nursing & Midwives Council. (2008). The Code: Standards of conduct, performance, and ethics for nurses and midwives
Taradaj, J. (2017). Prevention and Treatment of Pressure Ulcers by Newest Recommendations from European Pressure Ulcer Advisory Panel (EPUAP): Practical Reference Guide for GPs. Family Medicine & Primary Care Review, 1, 81-83. https://dx.doi.org/10.5114/fmpcr.2017.65097
Thomas, M. D. D. R., & Compton, M. D. G. A. (2014). Pressure Ulcers in the Aging Population [recurso electrónico]: A Guide for Clinicians.
Walker, R. M., Gillespie, B. M., Thalib, L., Higgins, N. S., & Whitty, J. A. (2017). Foam dressings for treating pressure ulcers. Cochrane Database of Systematic Reviews, Issue 10. Art. No.: CD011332. DOI: 10.1002/14651858.CD011332.pub2
Warriner, J. (2016). Leadership, Management & Team Working in Nursing (2 nd Edition) Ellis Peter and Bach Shirley Leadership, Management & Team Working in Nursing (2 nd Edition) 192pp £19.99 Learning Matters/SAGE 9781473918849 1473918847. Nursing Standard, 30(32), 30-30. https://dx.doi.org/10.7748/ns.30.32.30.s30
Zuzelo, P. R. (2010). The clinical nurse specialist handbook. Sudbury, MA: Jones and Bartlett Publishers.
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