- Internal Code :
- Subject Code : GDN3988
- University : Institute of Health and Management
- Subject Name : Nursing
Clinical Practice Issues
Reflection is the process of continuous learning that enables making sense of the experience so that good learning can be made out of that experience (Lee & Jang, 2019). It enables an individual to describe the event and analyze the learning from events that can be best applied in future work. A reflective journal is the collection of journals that are reviewed in order to enrich the knowledge and learning (Padden- Denmead et al., 2016). The reflection model that will be used in this essay is Gibb’s reflective cycle that provides the structure to learning from the experiences and has six major stages that are description, feelings, evaluation, analysis, conclusion, and action plan (Li, Chen, Liu & Deng, 2020). This essay focuses on three reflections that are based on clinical practice issues in the nursing domain.
Incident 1: Patient Centered Care
Description: This is the case of a young patient, Mrs. Kate who is 33 years old and has been admitted to the hospital setting. While I was attending another patient, my colleague nurse was attending this patient Kate. I observed that she did not involve the patient in her own care plan and did not even consider her preferences for the type of care that she requires at home and her cultural preferences in the terms of eating and medicines. The patient was disappointed to see this and she was highly dissatisfied with the service. I informed this observation to my RN and she took the action to intervene in the process. The RN carefully talked to the patient and learned that she prefers herbal medicine over the drugs that were prescribed by the patient.
Feelings: I was shocked to see the patient disappointed and also with the behavior of the nurse because she violated the rules and regulations of the hospital settings. I wanted to talk to her right there but I better chose to talk to my RN so that she can take strict action against her. I then assisted the patient in getting comfortable and the RN considered her preferences and respected her cultural preferences also.
Evaluation: The health care professionals must always be competent in adhering to all the policies and standards that are related to their professional domain (Egener et al., 2017). The nurse’s actions hurt the patient’s sentiments and she failed to deliver the patient centered care. The delivery of patient centered care is very important and the value of patient centered care in the health care setting is high. From the situation, I evaluated that the nurses must always respect the patient’s preferences and values thus their identity too. They must be always empathetic towards the patient and should work in collaboration with the family members so that the holistic approach of care is used for patient care. The family members also play a very important role in making health care professionals learn about the specific culture and the patient's preferences (Goldfarb et al., 2017).
Analysis: The patient centered care is the core of health care settings and must be always promoted within the health care professionals so that all are trained to increase patient satisfaction. It also increases the chances of better patient outcomes and the patient’s satisfaction can be better achieved (Mohammed et al., 2016). This type of care also focuses on the emotional comfort along with physical comfort. In patient centered care, the family is always welcomed and it is involved in the decision making for the patient's treatment plan and care plan. Communication is always effective in this setting and this is the cultural shift to patient centered care. The implementation of this allows the nurses to use decision-making skills and a collaborative approach in which the patient's family members are involved in patient care. The registered nurse standard 1 states that the nurses must respect all the cultures and experiences including responding to the families and maximize their role in the care plan (Nursing and Midwifery Board of Australia, 2016).
Conclusion: The importance of cultural competence in nursing holds paramount importance and one of the most important skills in nursing is respecting the different cultures of the patient and this is very important. The nurses must always respect the cultural difference of Aboriginal patients because they have varied cultural preferences that lead to an increase in patient satisfaction. The nurses must always be skillful in involving the patient in their care plan and treatment plan thus helping the patient in getting care as per their preferences.
Action plan: I have learned the importance of patient centered care and its impact on patient satisfaction. I will implement this learning in my future work and will ensure that my colleague nurses also follow these.
Incident 2: Ethical Dilemma
Description: During my clinical placement, I was attending an Aboriginal young patient who was suffering from comorbidities. He was required to attend the dialysis treatment on an alternate day basis in order to maintain fluid and electrolyte balance in the body. He was getting this treatment in the hospital that was 200 km away from his rural area. After a certain period of time, he refused for the treatment and stated that he wants to spend the rest of his life's time with his family.
Feelings: I was in an ethical dilemma as I never expected a young patient refusing for the treatment. I was in a dilemma as I had to choose between two major ethical principles that are autonomy and beneficence.
Evaluation: The learning that day helped me in forming new basics for my work. My RN intervened and she found out the best possible solution using her decision-making skills. She respected the patient’s autonomy of spending time with the family and also respected the ethical principle of beneficence (Micek, 2016). She made provision for dialysis in the community services for this patient in his rural village area.
Analysis: The health care professionals face many ethical dilemmas especially when they are caring for terminally ill patients. The solution to an ethical dilemma must be the one that supports the ethical principles and also is safe for the patient. The RN practiced as per the standards as standard 6 states that the RN must provide comprehensive safe care to the patients and must use the appropriate process for the actual risk related system (Nursing and Midwifery Board of Australia, 2016).
Conclusion: This decision helped me in learning the importance of the patient's autonomy with respecting the ethical principles. This solution for the ethical dilemma was one of the best according to me.
Action plan: I have learned this learning that the solution to an ethical dilemma must always be solved respecting the ethical principles of the nursing profession. The nurses play a very important role in delivering safe and high-quality nursing care. Thus, this learning has shaped my practice and has made me deliver safe nursing care to my patients.
Incident 3: Drug Administration
Description: While I was working for an elderly patient, I was instructed by my RN to administer the specific drug that is morphine to the patient because of the higher value at the pain score scale. This was a postoperative pain management intervention that was to be delivered by me. I prepared to administer this drug and unaware of the route of administration, I agreed upon doing it. While I prepared to give this drug to the patient, I was alerted by my RN that I was incorrect as it is to be administered through the IV route.
Feelings: I was appalled as I was about to make a medication error. I stopped there but I felt guilty because the patient was already in pain and I was about to make a medication error that would have resulted in the unsafety of the patient. I would have troubled the patient more and this was my biggest regret.
Evaluation: The medication error is mostly made by the nurses and they are responsible for this type of error made within the health care setting. There are different types of a medication error that includes the improper administration route (Dyab et al., 2018). I was then told by my RN that in such cases one should use evidence-based practice so that patient safety is ensured.
Analysis: The medication errors are not only monetarily costly but also costly in other terms like it causes loss of trust by the patients and leads to reduced patient satisfaction. I should have used evidence-based practice as it ensures patient safety. The use of EBP results in the delivery of the highest quality of patient care and patient outcomes (Harkanen et al., 2020).
The proper route of administration of morphine is intra-venous and this learning will help me in using EBP for further practices.
The improper route of administration of drugs can have a fatal impact on the patient. The nurses must always make use of EBP for the delivery of high quality and safe nursing care to the patients and this also ensures greater patient satisfaction. The medication error is a preventable error thus the use of EBP can help in the prevention of these kinds of errors.
Action plan: In the future, I will always make use of EBP into my nursing practice and will use literature especially for the administration of drugs. The drug administration will be done in the presence of my RN and I will learn new techniques for the administration of drugs (Potter, Perry, Stockert & Hall, 2020). In my future work practice, I will always prevent medication error as it is the most preventable cause of the patient's harm and work towards patient safety.
Conclusion on Clinical Practice Issues
The conclusion drawn is that all the three reflections are on the basis of fundamentals of effective nursing practice that are drug administration, ethical dilemma and patient centered care. Better patient outcomes can be achieved with the use of patient centered care and health care professionals must use effective approaches to reflect on their past events. The reflection helps in leaning that can be applied in the future practice and this should be their regular practice. The reflective journal is thus very important and it should be maintained as it helps in the continuous learning process.
References for Clinical Practice Issues
Dyab, E. A., Elkalmi, R. M., Bux, S. H., & Jamshed, S. Q. (2018). Exploration of nurses’ knowledge, attitudes, and perceived barriers towards medication error reporting in a tertiary health care facility: A qualitative approach. Pharmacy, 6(4), 120.
Egener, B. E., Mason, D. J., McDonald, W. J., Okun, S., Gaines, M. E., Fleming, D. A., ... & Andresen, M. L. (2017). The charter on professionalism for health care organizations. Academic Medicine, 92(8), 1091.
Goldfarb, M. J., Bibas, L., Bartlett, V., Jones, H., & Khan, N. (2017). Outcomes of patient-and family-centered care interventions in the ICU: A systematic review and meta-analysis. Critical Care Medicine, 45(10), 1751-1761.
Härkänen, M., Turunen, H., &Vehviläinen-Julkunen, K. (2020). Differences between methods of detecting medication errors: A secondary analysis of medication administration errors using incident reports, the global trigger tool method, and observations. Journal of Patient Safety, 16(2), 168-176.
Lee, M., & Jang, K. S. (2019). Reflection-related Research in Korean Nursing: A Literature Review. Journal of Korean Academy of Nursing Administration, 25(2), 83-96.
Li, Y., Chen, W., Liu, C., & Deng, M. (2020). Nurses’ psychological feelings about the application of Gibbs reflective cycle of adverse events. American Journal of Nursing, 9(2), 74-78.
Micek, M. A. (2016). Ethical dilemmas when refusing medical treatment: modernized bioethical principle of autonomy. Retrieved from https://pdfs.semanticscholar.org/3f8b/18bdeae5e42c753e6b392ba950363b43723e.pdf
Mohammed, K., Nolan, M. B., Rajjo, T., Shah, N. D., Prokop, L. J., Varkey, P., & Murad, M. H. (2016). Creating a patient-centered health care delivery system: A systematic review of health care quality from the patient perspective. American Journal of Medical Quality, 31(1), 12-21.
Nursing and Midwifery Board of Australia.(2016). Registered nurse standards. Retrieved from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx
Padden-Denmead, M. L., Scaffidi, R. M., Kerley, R. M., &Farside, A. L. (2016). Simulation with debriefing and guided reflective journaling to stimulate critical thinking in prelicensure baccalaureate degree nursing students. Journal of Nursing Education, 55(11), 645-650.
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2020). Fundamentals of Nursing-E-Book. Elsevier Health Sciences.
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