Reflective Framework For Workplace Learning: Application Of Registered Nurse Standards For Practice In Australia Essay.

You are required to identify an evidence-based reflective framework and apply this to write a critical reflection relevant to the Workplace Learning experience(s) that you have completed throughout your degreeYou are required to evaluate your practice to demonstrate that you meet all seven of the Registered Nurse Standards for Practice (Nursing and Midwifery Board of Australia, 2016), through examples from your clinical practice and exploration of the standards. You will need to access health information and research to support your critical reflection.

You are then required to create a future professional development plan, based on your reflection, to guide your ongoing development as a Registered Nurse. A template will be provided in the subject’s Interact2 site. The future professional development plan will be attached as an appendix and will not form part of the word count for this assessment.

Gibbs Reflective Cycle and Registered Nurse Standards for Practice

This report has been written in accordance with the reflection of learning of the workplace and the experience that I’ve collected while completing my Bachelor of Nursing course at CSU. Three experiences of mine from the workplace will be stated in this report and will also be addressed with the help of Gibbs reflective Cycle to know the knowledge that I’ve gathered from the workplace experiences.

Gibbs reflective Cycle is used for the purpose of reflective leaning and to share the experiences gained while performing a task and the framework was provided by Graham Gibbs in the year 1988 (Davies, 2012). There are altogether seven Registered Nurse Standards for Practice in Australia and three of them, which include thinking critically and analyzing Nursing Practices, engaging in therapeutic and professional relationship as well as maintaining capability of practices will be described respectively with the help of case studies along with personal experience from Gibbs reflective Cycle.

Case study 1- Ms X

Description

Ms X was admitted to the elderly ward when she was diagnosed with advanced mixed bilateral leg ulcers. I along with my superior professionals started delivering care to her according to the guidelines. She was very quiet and unwilling to talk with me during my sessions with her. We gave her evidence-based safe and quality practice for wound management as per the first NMBA standard, but her ulcers did not heal.

In order to understand her case study and as per the fourth NMBA standards RNs must accurately conduct comprehensive and systematic assessments, I redid all the assessments with her (Nursing and Midwifery Board of Australia, 2016). I cultivated an interpersonal association with her and found out that her mental condition is disturbed as she was self-conscious and stressed due to her obesity. She underwent psychoanalysis and then psychotherapy. Her behaviour as well as her wounds improved.

Feelings

I was astonished to find out that Ms X’s mental issues were hindering her physical care so much that her wounds did not heal. I also felt disappointed with myself that we could not identify the state of her mental condition as I did not follow the second standard of NMBA, which suggests engaging in therapeutic and professional relationship through effective communication.

Evaluation

Ms X’s case was difficult for me as I could not identify the domain of practice which was lacking in my care delivery. My practice included pain settlement, wound management, educative sessions, etc. according to the standards of NMBA. In spite of giving appropriate service, no positive outcome was observed. Ms X’s mental state obstructing her physical symptoms improvement came as a surprise to me. I could not believe an elderly woman could be so self-conscious about her weight.

Case Study 1 - Ms X

Analysis

It can be analysed that Ms X’s mental condition should have been assessed at the start of her care planning as the fifth standard of NMBA suggests development of safe and comprehensive nursing plans based on the assessments. Various researches have proved the significance of motivation, social assistance, spouse relationship in care delivery, etc. as a contributor in wound healing. However, I only paid attention on medicinal therapy. I practiced a disease-centred care instead of a person-centred framework which is should have as per second NMBA standard. I should have understood that good therapeutic communication could have helped in fulfilling Ms X’s physical, emotional and spiritual needs (Mills, 2017)

Conclusion

When I look back at this case, I feel disappointed that because of my lack of understanding on handling this case Ms X had to experience the pain and ulcers for prolonged time. If I had paid attention to her mental issues at the initiation of her care, her stress would have been diagnosed earlier. I also regret discriminating her based on her age thinking that a person of her age could not be conscious of her weight.

Action Plan

In future, I will make an effort to form a personal relationship with all my patients from the beginning irrespective of their disease (Berman & Chutka, 2016). I will try to manage the person as a whole and not just their illness (Morrissey & Callaghan, 2011). I will learn the skills of therapeutic communication and assessments. I will abstain from discrimination.

Case study 2- Mr Y

Description 

I and my peer Jon (pseudonym) had to observe a senior professional. While doing ward rounds, the senio checked up on Mr Y’s current condition who was recently operated for cholecystectomy and shifter to the ward. His mother was present as the attendant. After the senior doctor went, Mr Y seemed restless and complained of severe pain. Seeing this, Mr. Y’s mother got anxious and started crying. While all this was happening Jon got panicked and froze at his place. I was unnerved initially but then established communication with Mr Y and assured him that the Doctor is on his way. Then I asked Jon to call the senior doctor. After my continuous motivation, Jon calmed down and was back with the doctor and he managed Mr Y. I took Mr Y’s mother outside the ward and comforted her.

Feelings

I felt helpless as I wanted Jon to take care of at least one of them (Mr Y or his mother) so that the senior doctor could be called but it seemed that Jon himself needed to be calmed. At that point, of time I really needed Robert to work alongside me but he couldn’t. My job became difficult as Jon didn’t support me, as collaborative practice is one of the aspects of second standard of NMBA. 

Case Study 2 - Mr Y

Evaluation

The incident required quick thinking, action and communication. The accountability of clinical decision-making was especially daunting for me as as per the second NMBA standard, I had to lead the collaborative practice in this case.

Analysis 

It should be understood that effective communication in health care is challenging to get as the nature of the work environment is demanding. I used different verbal and non-verbal communication techniques with Mr. Y (W.Y.Kee et al., 2017). I also focused on listening and showing empathy towards Mr Y’s mother to build the emotional dynamics in the communication.

Conclusion 

When I look back at this incident, I realise the senior doctor must have called sooner as the delay of even few seconds could have led to grave complications for Mr Y. I realise that I need to be empathetic with colleagues by understanding the pressures they may be under, but it needs to be made sure that their incompetence does not put patients at risk.

Action Plan

In future, in emergency situation, I will attempt to develop my communication skills with my colleagues to ensure effective collaborative practice as it is essential in delivering best possible care (Nijagal, Kupperman, Nakagawa, & Cheng, 2015) .

Case study 3- Mr Z

Description

This is the first stage of the Gibb’s reflective Cycle and this stage is concerned with the experience that an individual had while working (Bassot, 2016).  Mr Zwho is a patient of 57 years of age was diagnosed with terminal illness and the patient was not aware of his condition. After the diagnosis I let the family members know the condition of the patient and the family members told me to keep the illness of the patient a secret and not to disclose anything to Mr. Z which is against the healthcare ethics.

Feelings

This is the second stage of the Gibbs reflective Cycle and this stage is related to the feelings that were there during the happenings and what I’ve felt during these experiences (Howatson-Jones, 2016). I felt that Mr. Z should know about his disease before the treatment is conducted. As before the treatment of terminal illness, disclosing the patient’s disorder to the patient can improve the motivation power, so I felt that the patient should be disclosed with his illness and for that reason.

Evaluation

There are some positive as well as negatives about a situations that are created and these things are necessary to make it understand to the other person (Smith, 2016). It was essential to make the family of Mr. Z understand that terminal illness is a disease where disclosing the disease to the patient make the situation better and also make the outcomes better. As the family requested not to disclose anything to Mr. Z, this was a negative situation, while the positive situation is related to disclosing his illness to Mr. Z which can help in the outcome of the disease a better one.

Case Study 3 - Mr Z

Analysis

It can be analysed that as per the second standard of NMBA I should provide support and direct Mr Z and his family to resources to take the most appropriate health-related decisions.

Conclusion

The conclusion is the stage, when it is evaluated that which situation could have been handled in a better way and if those situations arise again how those situations can be handled (Brock, 2014). As Mr. Z was suffering from diabetes, there were a few precautions that were required to be taken but if he is not aware of his situation, he will not take any dietary control which can result to higher diabetes or sugar in his blood level. Thus, this situation could have been handled with communicating in a better way with the members of the family and this could have helped in the process of avoidance of more serious life threat for the patient.

Action Plan

In future, I will make myself more aware with the ethical code of conduct and principles as per the NMBA standards and ensure that my practice falls within the ethics.

Conclusion

Thus, from the above study, it can be concluded that Gibbs reflective Cycle plays an important role in providing assistance to the knowledge and increases the experience of an individual (Bulman et al., 2013). Similarly, in my case, Gibbs reflective Cycle has helped me in the process of gaining understanding of the situations while working in healthcare during my Bachelor of Nursing course at CSU and this will also assist me during the future course of action preparation as well as will overall help me to increase my working ability.

References

Bassot, B., 2016. The reflective journal. Macmillan International Higher Education.

Berman, A.C. & Chutka, D.S., 2016. Assessing effective physician-patient communication skills: “Are you listening to me, doc?”. Korean journal of Medical education, 28(2), pp.243-49.

Brock, A., 2014. What is reflection and reflective practice?. In The Early Years Reflective Practice Handbook (pp. 25-39). Routledge

Bulman, C. and Schutz, S. eds., 2013. Reflective practice in nursing. John Wiley & Sons.

Davies, S., 2012. Embracing reflective practice. Education for Primary Care, 23(1), pp.9-12.

Howatson-Jones, L., 2016. Reflective practice in nursing. Learning Matters.

Mills, J., 2017. Therapeutic Communication In Mental Health Nursing: Aesthetic And Metaphoric Processes In The Engagement With Challenging Patients. Issues in Mental Health Nursing, 38(8),pp- 684.

Morrissey, Jean, Callaghan, & Patrick. (2011). Communication Skills For Mental Health Nurses: An introduction. McGraw-Hill Education.

Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. Melbourne: www.nursingmidwiferyboard.gov.au .

Smith, J. and Roberts, R., 2015. Reflective practice. Vital Signs for Nurses: An Introduction to Clinical Observations, pp.222-230.

W.Y.Kee, J., gKhoo, H.S., Lim, I. & Y.H.Koh, M., 2017. Communication Skills in Patient-Doctor Interactions: Learning from Patient Complaints. Health Professions Education.