episode of care nursing essay example

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Reflective practice Gibbs Model essay

Fundamentals of practice nursing (mod005146), anglia ruskin university.

dL dele 1 year ago gibbs reflection

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Preview text, effective communication and inter-professional, collaboration improve patient-centred care..

Contents CONTENTS

Introduction

Description

Action Plan

Assignment Conclusion

This essay will reflect on an episode of care I was involved in as a student in a Neurological Centre, which involved using effective communication to work collaboratively with Healthcare Assistants (HCAs) and other Healthcare Professionals, in order to plan and deliver patient- centred care for a patient, I will call Shelly. I will anonymise all names to maintain confidentiality (Nursing and Midwifery Council [NMC], 2018a).

Nursing Associates must be reflective practitioners (NMC, 2018b). I will use Gibb’s reflective cycle (Gibbs, 1988), which has 6 stages – Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan – to structure this essay. This is an appropriate model to use as a student as it will encourage me to link theory and practice, and develop an action plan identifying specific learning needs and goals for the future, which I will then be able to use as the starting point for further reflection (Tashiro, et al., 2013).

I will discuss and critically analyse key professional issues I have identified from this experience – good effective communication, inter-professional collaboration and patient- centred care – which will all be essential in my role as a Nursing Associate as outlined in the NMC Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018a), NMC Standards of Proficiency for Nursing Associates (NMC, 2018b), National Health Service (NHS) Constitution including the NHS values (Department of Health and Social Care, 2021) and the 6C’s (Department of Health, 2012).

According to Thistlethwaite and McKimm (2016), professionalism within nursing is difficult to define. All professionals have formal training and qualifications, accountability through their registration with a professional body - for example, the NMC - and a professional code of practice to follow – for example, The NMC Code. The NMC Code (NMC, 2018a), explains the standards required within nursing to ensure professionalism, patient safety, patient-centred care and quality of care are maintained (Lister, Hofland and Grafton, 2020).

patient advocate, but to instead check I had all the facts before making any decisions (Iezzoni, 2006). My thoughts and feelings changed as I considered Shelly’s nursing and therapy needs and as I spoke, listened and worked collaboratively with other professionals. Shelly thoroughly enjoyed attending Breakfast Club and said she would go again.

Due to effective communication (McCabe and Timmins, 2013), good inter-professional collaboration (Bridges, et al., 2011) and patient-centred care (Harris, 2021), Shelly had a positive care experience and outcomes. Her morning care needs were met, she attended Breakfast Club at 9, her blood sugars remained within acceptable levels, and she was also able to have a physiotherapy session before lunch.

I remained professional and learned the importance of not making assumptions (Iezzoni, 2006). Shelly was empowered and assisted to be involved in decisions concerning her daily care routine and morning therapy activities, she received patient-centred care and her individual needs and preferences were respected (Harris, 2021). I gained a better understanding of the specific roles of other professionals and the importance of developing effective professional relationships with them (NMC, 2018b). Shelly had aphasia, so good communication skills were essential to ensure she was able to effectively express her views (McCabe and Timmins, 2013). Shelly’s facial expressions and verbal comments, confirmed she had enjoyed and benefited from her morning therapy sessions (Bramhall, 2014).

HCA’s work effectively together, but have little contact with or knowledge of the role of other professionals at the Centre, which can lead to misunderstandings. I made sure I informed HCA’s of Shelly’s decision and I assisted them to provide her personal care in time for Breakfast Club. I was a positive role model and led by example (NMC, 2018b).

Professionalism is central to nursing, and it is essential Nursing Associates have a thorough knowledge and understanding of the NMC Professional Code (NMC, 2018a) and proficiencies for Nursing Associates (NMC, 2018b). These documents (NMC, 2018a; 2018b) stress the importance of Nursing Associates being positive professional role models, developing effective communication skills and inter-professional collaboration, and ensuring patients always receive quality, patient-centred care. According to Johnson (2015), positive role models are committed to developing effective therapeutic and professional relationships, and to providing high standards of care which respect diversity and individual choice.

Patient-centred care is a key principle of the NHS constitution (Department of Health and Social Care, 2021) and NMC Code (NMC, 2018a). It involves planning and delivering compassionate and effective care, which fully includes patients and ensures they remain at the centre of all decisions made (Harris, 2021). Patient-centred care must be holistic and involve therapeutic relationships and collaboration between everyone involved (Baillie and Black, 2014). According to Gluyas (2015), patients are at risk of losing their independence and dignity, and so effective communication, therapeutic relationships and patient-centred care are essential, which empower them and respect their individual values and preferences.

Various factors will affect the standard of patient-centred care provided for Shelly, including the work environment, type of leadership and structure of the Multi Disciplinary Team (MDT), shift patterns and available resources (Baillie and Black, 2014). According to Gluyas (2015), time constraints, different roles and attitudes of professionals involved, power imbalance between professionals and patients, language and cultural barriers, poor communication and lack of relevant skills, are also potential barriers to patient-centred care. Lawrence and Kinn (2011) found professionals often have different priorities and do not always ask or understand patients’ specific needs or concerns, which along with communication difficulties, including aphasia, can affect the planning and delivery of effective patient-centred care and stroke rehabilitation.

According to Baillie and Black (2014), it is essential management supports and prioritises patient-centred care, and provides the necessary resources and training to ensure all professionals have relevant knowledge and skills. Moore, et al. (2017), stressed the importance of professionals being committed to providing patient-centre care and changing their working practices to facilitate this. Gluyas (2015) suggested barriers to patient-centred care can be

in England have had a stroke. Like Shelly, stroke patients often experience aphasia - receptive aphasia involves difficulty in understanding words and expressive aphasia, difficulty in finding words (Waterhouse and Woodward, 2021). Aphasia affects language and not intelligence (Stroke Association, 2020). A good rehabilitation programme is essential, which meets Shelly’s specific needs and ensures she regains as much independence as possible (NICE, 2013 ).

Shelly has capacity to make simple decisions (Mental Capacity Act, 2005). Autonomy is an important ethical principle, which means Shelly must be assisted and empowered to be involved in care decisions she is able and wants to be (Beauchamp and Childress, 2001). Capacity must always be assumed unless a mental capacity assessment shows otherwise and consent must therefore be obtained for Shelly’s daily care (NMC, 2018a; Lister, Hofland and Grafton, 2020).

According to Baillie (2017) the 6 C’s – care, compassion, competence, communication, courage, commitment – introduced by the Department of Health (2012), as part of the Government’s response to a series of reports identifying incidents of poor care, are now recognised as fundamental values within healthcare. Shelly has a right to be cared for by Nursing Associates, committed to engaging in effective communication and therapeutic relationships, and to working collaboratively with others to provide her with the best possible patient-centred care, which respects her dignity and individual values, preferences and needs (Department of Health, 2012).

Good, effective, communication is essential within healthcare (McCabe and Timmins, 2013; Kourkouta and Papathanasiou, 2014) and is an important skill for Nursing Associates to develop (NMC, 2018a; 2018b). Communication is a complex process, involving information being transferred between at least two people (Bach and Grant, 2015), but unfortunately information is not always communicated effectively or accurately (Kourkouta and Papathanasiou, 2014). According to Lister, Hofland and Grafton (2020), effective communication is linked with improved patient care experience and outcomes.

Information can be communicated non-verbally as well as verbally (Bach and Grant, 2015), including through body language, facial expressions, touch, gestures, writing and reading (Stroke Association, 2020). According to Argyle (1988), only a small amount of information communicated is spoken. Non-verbal communication is therefore important and especially

when communicating with a stroke patient, including Shelly, with aphasia (Rousseaux, Daveluy and Kozlowski, 2010; Lister, Hofland and Grafton, 2020).

Nursing Associates need to be aware of potential barriers to effective communication and how to minimise these (NMC, 2018a; 2018b). Barriers can include lack of privacy and time, pain, fatigue, body language, language and jargon used (Ali, 2018), environment including noise and other distractions, work demands and personal characteristics of both the professional and the patient (Amoah. et al., 2019). Norouzinia, et al. (2016), found nurses focused more on work related barriers to communication, whilst patients were more concerned if the nurse had time to listen and was interested in their particular concerns. McCabe (2004) stressed the importance of identifying a patient’s own priorities, and ensuring communication is patient-centred and not task-oriented.

Specific barriers to effective communication with stoke patients have been identified. These include sensory - sight, hearing or speech – difficulties, cognitive difficulties and side effects of prescribed medication (Lister, Hofland and Grafton, 2020), Nursing Associates own attitudes and priorities, and lack of an empathetic understanding of the needs of stroke patients (Bright and Reeves, 2020), available communication aids, access to Speech and Language Therapists (SLT’s), and lack of knowledge of aphasia and specific communication skills to use with stroke patients (O’Halloran, Worrall and Hickson, 2011). According to Lister, Hofland and Grafton (2020), Nursing Associates are normally encouraged to ask patients open questions to encourage them to describe their experiences and needs in their own words, but Shelly, like other stroke patients with aphasia, had difficulty expressing what she wanted to say and preferred to be asked closed questions, slowly and clearly, which she could answer with a yes or no.

During the COVID-19 pandemic, face masks and other personal protective equipment (PPE) also became a barrier to effective communication with stroke patients (Ogunbiyi and Obiri- Darko, 2020). The National Healthcare Communication Programme (2021) suggested these barriers could be reduced by wearing clear name badges, looking directly at the patient, effectively using non-verbal communication, speaking clearly and clarifying information given had been properly understood.

According to Baille and Black (2014), listening is as important as what Nursing Associates do and say, and by using effective listening skills I was able to reassure Shelly that I wanted to accurately hear and understand what was important to her (McCabe and Timmins, 2013).

Tummers and Noordegraaf, 2020). The purpose of inter-professional collaboration is to achieve the best possible patient-centred outcomes, by ensuring care provided effectively uses the combined knowledge, skills and experience of all the professionals involved (Fewster-Thuente and Velsor-Friedrich, 2008; Baille and Black 2014). According to Bosch and Mansell (2015) it has the potential of reducing the workload of individual professionals and increasing job satisfaction.

A number of potential barriers exist to effective inter-professional collaboration which Nursing Associates need to be aware of, including poor communication and opportunities for group meetings particularly during the COVID-19 pandemic, different leadership styles and management structures (Seaton, et al., 2021), professional language and jargon, misunderstandings concerning the roles and responsibilities of different professions (Franz, et al., 2020), workloads, time restraints, power and gender differences (Fewster-Thuente and Velsor-Friedrich, 2008), lack of confidence, experience and appropriate support (Pfaff, et al., 2014), different training programmes, communication styles, ways of working (Foronda, MacWilliams and McArthur, 2016), and the attitudes, values, priorities and stereotypes of different professions (Green and Johnson, 2015).

According to Bridges, et al. (2011), opportunities to engage in inter-professional education with students from other professions, can help prepare Nursing Associate students to work collaboratively, by improving their understanding of their own and other healthcare professional’s specific roles. Franz, et al. (2020) also stressed the importance of appropriate training and supervision being available for inter-professional collaborative working. At the Neurological Centre members of the MDT work closely together within a small physical area and this can help facilitate collaborative working practices, by providing opportunities for informal conversations (Seaton, et al., 2021).

According to Bosch and Mansell (2015), lessons regarding collaborative working can be learned from sports, including the importance of all the team being committed, responsible and accountable for achieving agreed plans and goals, and overcoming any personal differences, barriers and problems. Green and Johnson (2015), similarly stressed the importance of professionals from different healthcare professions respecting and valuing the unique roles of each other, and making a commitment to share their resources, knowledge, experience, and skills, in order to work collaboratively together to improve the care provided for individual patients.

This episode of care had a positive outcome for Shelly and provided an excellent reflective learning opportunity to help inform my own practice. I learned professionalism is central to the role of a Nursing Associate and how important it is to be a positive role model. I developed my knowledge of patient-centred care, holistic needs associated with stroke and diabetes and inter- professional collaboration. This experience also provided an opportunity to develop my communication and team working skills. The outcome would have been very different, if I had acted on my initial assumptions and had not collaborated with other healthcare professionals.

The action plan is the last stage of Gibb’s reflective cyclical model (Gibbs, 1988). I will use what I have learned from this experience to set myself SMART - specific, measurable, attainable, relevant and timely - goals to achieve and further reflect on (NurseChoice, 2018).

As a Nursing Associate student, I will continue to develop my understanding of the NMC’s Professional Code (NMC, 2018a) and I will achieve the necessary proficiencies by the end of my course (NMC, 2018b). I will link theory and practice during each of my placements and I will aim to be a positive professional role model for others. I will develop my understanding of patient-centred care and appropriate nursing skills to effectively empower patients to be involved in decisions concerning their care.

Throughout my nursing career, I will take responsibility for my own continuing professional development (NMC, 2018a; Royal College of Nursing, 2019). I will develop my interpersonal skills and understanding of potential barriers to effective communication, including the risk of any assumptions or stereotypes affecting my decisions. I will also develop my knowledge, skills and experience of effective inter-professional collaboration, including my understanding of the unique roles and responsibilities of other healthcare professionals.

In my home placement, I will use the knowledge I have gained concerning diabetes and strokes to help improve the care I provide Shelly. An ongoing goal will be to research other medical conditions to help inform the care I provide other patients. I will also encourage better communication, understanding and collaboration between the nursing and therapy teams at the

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