This essay will discuss a significant event in relation to the peoples priorities identified within the Healthcare Quality Strategy. The essay will demonstrate my understanding and views on reflection and the issues surrounding my practice. I have chosen Gibbs’ (1988) reflective framework as it has a structured format and six steps which follow in order starting with a description of the event and ending with an action plan for future practice. The steps are Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan (Gray, 2007). Reid, (1993) describes reflection as a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice.
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The Scottish Government introduced the Healthcare Quality Strategy for NHS Scotland in 2010, their aim is to deliver the people’s priorities which are: firstly caring and compassionate staff and services, good communication and a clear explanation about conditions and treatments, effective teamwork between clinicians, patients and others, a clean and safe care environment, continuity of care and clinical excellence. Secondly, to bring together the patient’s priorities as well as the values of everyone working within the NHS Scotland. Thirdly, by applying these three interventions and putting them into practice improvements within priority areas of the Healthcare Quality Strategy will be met (Scottish Government, 2010, p.6). This reflective account will focus on the importance of communication and will identify if the priority was met in relation to my significant event and it will further clarify its importance (Scottish Government, 2010, p.6).
Whilst on my Management Placement I met Janet, all names have been changed to protect her identity and maintain her confidentiality (NMC, 2008).
Janet is 65 years old and has been admitted to my ward for palliative care. She has end stage bowel cancer and is awaiting a bed at the local Hospice. Janet lives at home with her husband, she has a full package of care and her son also visits on a regular basis. However, Janet’s doctor has requested that she be admitted onto the ward as she is now confined to bed because of increased pain and a general deterioration of her condition (Dougan and Colquhoun, 2006).
Whilst carrying out my training as a student nurse, I have met a number of palliative patients and I feel that I lack confidence when communicating with these patients and their families at this difficult time. However, as I was on this ward for a longer period of time I was able to build up a good rapport with Janet and her family and this allowed me to provide good patient centred care (NMC, 2008). Therefore when dealing with Janet and her family at this difficult time I must treat Janet as an individual (NMC, 2008), provide her with the best care and be caring and compassionate always (Scottish Government, 2010, p.6). I was privileged to have the opportunity to be involved in Janet’s care as well as working within a ward of clinical excellence (Scottish Government, 2010, p.6).
Over the next few days whilst looking after Janet and taking part in the ward rounds, I was able to plan Janet’s care, the Doctor explained to me that Janet was not going to improve and we would have to keep her comfortable and pain free. Palliative care patients must have good symptom control of their pain and also nausea and vomiting. Janet was placed on a syringe driver to control her pain. A syringe driver is a small portable pump which is attached to the skin by a cannula and gives the patient a continuous dose of analgesics and/or anti-emetics (MacMillan Cancer Support, 2012).
In relation to the Scottish Government’s Programme “Living and Dying Well” when caring for palliative patients a holistic approach with continuity of care is extremely important (Scottish Government, 2008) and all nurses have a central role in providing information, care and support (Kennedy and Lockhart, 2007). Excellent communication and good interpersonal skills are paramount when caring for Janet, it is important not only to establish Janet’s wants and needs but also her families. It is imperative when relaying any information to Janet or her family make sure they understand it, if not explain the information to them again (NMC, 2008). Also when dealing with members of the multi-disciplinary team, effective teamwork is imperative again providing Janet and her family with continuity of care and the clinical excellence they require from all staff.
Palliative care helps to improve the quality of life for patients and their families who have to come to terms with the difficulties associated with life threatening illness. It is about identifying the patient’s needs through accurate assessment, good symptom control and sensitive nursing care (Scottish Partnership for Palliative Care, 2012).
In addition to caring for Janet on the ward I was given the opportunity to go to the Hospice and meet with Janet’s palliative care nurse and also be included in her multi-disciplinary team meeting. This again highlighted the importance of good communication and good record keeping as all team members were aware of Janet’s circumstances and could pick up her case notes and know exactly what was happening with Janet at any given time (NICE, 2004). This meant that when I was communicating with Janet and her family I was more confident and I was able to communicate in a language that they understood (Dunne, 2005). As well as building a trusting relationship between nurse and patient, good communication skills helps to reduce fear and anxiety at this stressful time (Dunne, 2005).
In relation to Janet’s transfer from hospital to Hospice the Liverpool Care Pathway (LCP) was put in place, this model allows all staff on the ward and any multi-disciplinary team members’ guidance on all elements of Janet’s care. It provides a holistic approach to Janet’s care and support for her family in the last few days of her life (Marie Curie Palliative Care Institute Liverpool, 2012).
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Good communication is paramount when dealing with the palliative patient as this forms the basis of a good nurse/patient relationship which greatly improves care and helps to reduce anxiety and stress for patients, relatives and carers (Kennedy and Lockhart, 2007). At the time of this experience I felt I communicated well with Janet and her family and the care I delivered was to a high standard and to the best of my ability. She appeared less anxious than when she was initially admitted onto the ward. I felt my mentor and myself displayed good communication skills, through verbal and non-verbal communication which in turn was upheld through good record keeping and accurate documentation throughout Janet’s hospital stay (NMC, 2009).
On reflection this event has brought further awareness of the level of involvement of staff members from auxiliaries, nurses and consultants. This was shown by the number of multi-disciplinary meetings, assessments, re-assessments, written correspondence and working hours placed into looking after this patient (NMC, 2009). All staff members were committed to providing the correct input and treatment for this patient and to make her last few days as comfortable as possible (Scottish Government, 2010), which also ensured clear communication and collaboration between the doctors, family and nursing staff (Scottish Government, 2010).
This reflection has demonstrated the difficultly in caring for palliative care patients. It requires a holistic approach to ensure that the patient and their family receive the best possible attention. Nurses have a duty to ensure that the care they deliver is of an acceptable standard (NMC, 2008). While participating in ward rounds I took on board the doctor’s instructions and carried out and prioritised the care of my patient, therefore making Janet’s stay in hospital as comfortable as possible. The code provides values, which can be adapted to any setting and as long as these are followed, nurses will be able to carry out their legal and professional duty of care (NMC, 2008).
Palliative care is a sensitive subject to deal with but I feel that as long as you treat the patient as an individual, listen to their wants and needs, then a positive outcome can be accomplished. Communication and good interpersonal skills are once again highlighted as an essential part of good nursing practice. I must be an effective communicator and be able to provide a high standard of care at all times and this is imperative when dealing with palliative care patients. I must also keep my knowledge and skills up to date (NMC, 2008).
In relation to my transition from student to staff nurse I am aware of how important everything I have learned throughout my training is, from personal care, comfort, empathy, a caring and compassionate manner, clear and effective communication, prioritising care and being part of a team and this is only a very small portion of what I have learned. I will take all of this knowledge with me and put into in practice when I am caring for patients and their families in the future as a staff nurse.
Through experience of this placement and in relation to my transition from student nurse to staff nurse; the steps to facilitate an improvement and development would be to ensure effective communication with all staff and all members of the multidisciplinary team. This includes accurate record keeping and the collection of all relevant information from the patient and their family in order to deliver safe effective patient care. It also promotes a positive nurse-patient relationship and offers reassurance at this difficult time (Dunne, 2005). In addition palliative care does not only deal with cancer patients but with patients who have long term chronic illnesses such as multiple sclerosis, heart disease and respiratory problems, therefore palliative care is relevant today and also in the future because, we will be caring for an ageing population (Scottish Partnership for Palliative Care, 2012)
In conclusion reflection is about making sense of the daily challenges which are put before you, as a student nurse transitioning into a staff nurse it’s about keeping my skills and knowledge up to date and reflecting on my daily practice in order to achieve the best outcome for my patient (Taylor, 2006). Bowie (2010) states that positive practice should be highlighted as it allows others to learn from it and provides opportunities to improve the safety of patient care. Reflecting on these events has helped me to identify areas where practice needs improvement and given me a greater insight into my own role as a registered nurse.
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