Reflective Writing On Nursing Practice: Adherence To NMBA Standards

Reflecting on the Incident using Gibbs Cycle

Reflective writings are essential in self-development because they involve life-long learning from personal experiences and encounters. My previous clinical placements have brought me into contact with people that have shaped my knowledge, attitudes, and perceptions about the nursing profession. As a student nurse, I have had anticipations of learning from Registered Nurses because I believed that they are experienced in the field and could help in my career development. There is however, one incident that occurred that made me to remain self-reliant and focus on my goal of adhering to the required standards of practice for registered nurses. This reflective piece of writing uses Gibbs Cycle to reflect on the incident that occurred in the third day of my clinical placement in one of the hospitals. The names of the RN who was involved in the incident will be concealed, as well as the name of the fellow student nurse that breached the confidentiality of the patient.

It was on the third day of my clinical placement and I was glad in my new environment, especially because I was prepared to apply the theoretical knowledge learned from the classroom environment. The Registered Nurse who was supervising me arrived late and asked me to accompany her in one of the ICU’s where we were to help in cleaning and dressing the wound of an elderly woman. The room was congested and there was no enough space to move around. Some patients were groaning in pain, but the elderly woman was sitting in an isolated corner with a large wound on her right leg. What surprised me more is that when the registered nurse looked at the woman, she became irritated and moved swiftly towards her. I thought that she was in a process of helping her, but when she looked at the woman’s wound; she spat on the floor and shouted to the elderly woman to stop acting silly. She told me that she had just dressed the wound the other day and the “stupid” woman had acted brave by undressing the wound. She took her phone from her pocket and took a photo of the sobbing woman who had now been embarrassed of what had happened. She posted on the Facebook group and wrote “This is Lisa, the stupid woman that makes me to hate nursing!! What would you do if your patient behaved like this crazy woman?” The ailing woman made some noise in the language I did not comprehend and we had to call a translator. I later learned that the woman knew her rights and was trying to stop the RN from sharing the photo on social media.

Relevance to Two of the NMBA Registered Nurses Standards for Practice

This was a shocking experience from my own point of view, especially because I had anticipated that the registered nurse could act in the best interest of the patient. I had anticipated that the RN could calm down and use that incident to teach me how to deal with such patients in future, but she instead acted contrary to the required standards of practice. I read in Australian Nursing and Midwifery Federation (2017) that nurses should protect the privacy of patients and avoid breaching confidentiality. They are also supposed to provide holistic care as discussed in Cashin, Heartfield, Bryce and Fisher (2017). Breach of confidentiality is regarded as a malpractice and is punishable by six months suspension and compulsory supervised retraining to enhance the nursing competencies of the RN (Andersson, Lindholm, Pettersson, & Jonasson, 2017). After the translator had come on board, I realized that we were dealing with an informed patient. She knew of her own rights and was threatening to sue the nurse for breaching her confidentiality.

Generally, the clinical placement was a motivating factor for my future career practice. It helped me to learn a lot about my career practice and the role I can play in delivering patient-centered care. When I relate the incident to the two NMBA standards of practice, I find that the RN had failed in her obligation of safeguarding the emotional and physical safety of the patient. The RN failed in her duty and instead of helping the patient in relieving the physical and emotional pain that accompanies diseases, she went ahead and attracted emotional trauma by exposing the patient on social media (Heydari, Kareshki, & Armat, 2016).

The Nursing and Midwifery Board of Australia (NMBA) (2016) has set standards for all nurses to adhere to. When I relate the incident to the second standard of NMBA, I find that the RN failed to engage in therapeutic and professional relationship when serving the patient. Therapeutic relationships help in understanding the patient while at the same time helping the registered nurse in delivering patient-centered care. Section 2.2 of the NMBA standards states that the RN engages in therapeutic relationships by respecting the patient’s dignity, values, beliefs, and culture (NMBA, 2016). The RN eroded the dignity of the patient by spitting on the floor, calling her names, and taking the photo of the patient and sharing it on social media platforms. This was demoralizing and reduced the values and beliefs of the patient who had expected that all RN act in the best interest of their patients as discussed in Shields and Delaney (2018). Her behavior and actions could have made the patient and others that were in the vicinity to lose trust and confidence in the qualities and abilities of RNs.

Lesson Learned and Future Career Practice

The sixth NMBA standard (2016) that nurses provides safe, appropriate, and responsive quality practice. Quality in this case means that the service and care delivered resonates with physical and psychosocial needs of the patient (Karami, Farokhzadian, & Foroughameri, 2017). Section 6.5 states that the RN practices in accordance with the established standards of practice. The standards of practice act as a guide and they are available at the national and state level. Each hospital also has standard guidelines that direct nurses in their therapeutic relationships with patients and their co-workers as discussed in Fukada (2018). In this case scenario, the RN exhibited incompetency and her actions demoralized the values and standards of practice that have been established to guide nurses in their professional practice.  Even though the RN was committed to serve the patient, it us evident that she was not committed to delivering quality and best practice that could maximize the welfare of the patient and yield positive outcomes as discussed in Kiernan (2018). She was expected to be competent in delivery of care, but instead acted contrary to the required standards of practice.

The nursing profession requires competency in language as well as professional requirement when dealing with patients (Abdolrahimi, Ghiyasvandian, Zakerimoghadam, & Ebadi, 2017). If the RN could have captured the language of the patient, she could have understood why the wound had been undressed. Even though I was only on the clinical placement, I could notice what was going wrong and attempted to persuade the nurse by asking her to stop sharing the photo but she went ahead and acted contrary. After my clinical placement, I later learned from a colleague that the RN had been suspended and her registration revoked. The patient had also sued the hospital for breaching her privacy. The consequences of incompetency in career practice affect not only the quality of service extended to the patient, but also the hospital organization where one is working. According to Halcomb, Stephens, and Foley, (2017), the development of professional competency requires commitment to the profession while at the same time drawing from personal values and beliefs. The RN acted contrary to the professional requirement by undermining the values of the career. I lost my trust and confidence in her and I was careful in the next days when I was working under her supervision. I had learned that she did not value the nursing profession and was always talking about how she was planning to quit and venture into another rewarding career. She asked me at one point why I had decided to become a nurse and I told her that it was more than a calling for me and I could not resist it.

Conclusion

This incident was both a learning experience and a motivation for my future career practice. It was a learning experience because it brought me to the real environment of what nurses encounter and how they should respond to such cases. It also confirmed my commitment to the nursing practice, especially because I intervened and tried to stop the RN from posting the photo and identity of the patient on social media. The incident challenged my perception of registered nurses, especially because I had not anticipated the RN to act unprofessional. However, I later learned that she was not committed to the profession and this could be one of the reasons that compelled her to behave in that manner.  

I am committed to the nursing profession and would not wish to see such incident happening in my future career practice. Even though the incident was demotivating and challenged my beliefs about the RNs and their competencies, I am determined to equip myself with values and knowledge that maximize patient safety. In this case, I am determined to enhance psychosocial safety as well as physical safety of patients. I will keep studying the NMBA standards and other professional requirements available to become competent in my career practice. I want to enhance therapeutic relationships with colleagues and patients to avoid demotivating student nurses that I will be supervising in future.

References

Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic physician, 9(8), 4968–4977. doi:10.19082/4968

Australian Nursing and Midwifery Federation (2017). Professional practice framework for nurses and midwives. Retrieved from https://anf.org.au/documents/policies/PS_Professional_practice_framework_for_nurses_and_midwives.pdf

Andersson, H., Lindholm, M., Pettersson, M., & Jonasson, L. L. (2017). Nurses’ competencies in home healthcare: an interview study. BMC nursing, 16, 65. doi:10.1186/s12912-017-0264-9

Cashin, A., Heartfield, M., Bryce, J., & Fisher, M. (2017). Standards for practice for registered nurses in Australia. The Australian Journal of Nursing Practice, 24(3). Retrieved from https://www.collegianjournal.com/article/S1322-7696(16)30003-8/fulltext

Fukada M. (2018). Nursing competency: definition, structure and development. Journal of Medical Sciences, 61(1), 1–7. doi:10.33160/yam.2018.03.001

Heydari, A., Kareshki, H., & Armat, M. R. (2016). Is nurses’ professional competence related to their personality and emotional intelligence? a cross-sectional study. Journal of Caring Sciences, 5(2), 121–132. doi:10.15171/jcs.2016.013

Halcomb, E., Stephens, M., & Foley, J., B. (2017). The development of professional practice standards for Australian general practice nurses. Journal of Advanced Nursing, 73(8). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28181277

Karami, A., Farokhzadian, J., & Foroughameri, G. (2017). Nurses’ professional competency and organizational commitment: Is it important for human resource management?. PloS one, 12(11), e0187863. doi:10.1371/journal.pone.0187863

Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review. Journal of Multidisciplinary Healthcare, 9, 537–546. doi:10.2147/JMDH.S116957

Kiernan L. C. (2018). Evaluating competence and confidence using simulation technology. Nursing, 48(10), 45–52. doi:10.1097/01.NURSE.0000545022.36908.f3

Nursing and Midwifery Board of Australia (2016). Registered Nurses standard for practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD16%2F19520&dbid=AP&chksum=ga2EcHDo5OKLhC%2BTVHZh2Q%3D%3D

Shields, C., M. & Delaney, R., K. (2018). Patient safety in inpatient psychiatry: a remaining frontier for health policy, 37(11). Retrieved from https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.0718