Self-Reflection on Community Health Nursing - Essay Example

?Running head:  Self-reflection on community health nursing This reflective essay details my clinical experience during a placement at a pediatric home care. The objective of this essay is to survey the use of interpersonal and communication skills in nursing. I have opted for community health as I spent substantial amount of time communicating with parents and guardians of patients. Basing on this, I will focus on ethical practice in two less complex clinical scenarios. To ensure the confidentiality of the clients as well as to protect their identities, according to the NMC code of professional conduct (2008), they shall remain anonymous, and in situations where I have to use their names, I will conceal their real identity. In addition, I have applied Gibbs (1998) reflective model to ensure that the structure if this essay is unambiguous and clear (Jasper, 2003). I will look at the incidences using multiple perspectives, which could in future be applied to change some aspects of the practice in future. Reflection is an important practice by nurses as through it, we get to understand as well as explore more of what we should do (Ghaye and Lillyman, 2001). I will use the model to facilitate critical thinking in relation to theories in nursing. Discussion will encompass the ethics on effective nursing practice and the elements that promote effective practice. Descriptions Introduction to Community Health Nursing  Clinical practice seeks to uphold the synthesis of community nursing theory by providing nursing care to clients who are based in the community settings. Implementation and assessment of nursing care are a necessity for clients within the community who suffer from common physiological problems and malfunctions (Jasper, 2003). The synthesis of health strategies using clinical practices in these settings concentrates on the promotion of health prevention of diseases and patient care, as well as to the surrounding communities. Technically, the goal is to protect, preserve, maintain and promote health. Based on the reflective cycle established by Gibbs (1988), I will offer a description of two nursing scenarios that my reflections are based on. In Scenario 1 I had a joint visit with RN to visit a 7-month baby who suffered from congestive heart failure and down syndrome. I did a follow up assessment. At the time, the baby was somewhat stable, but the foster mother was worried that she was going downhill. The baby girl was not responding to her feeds well- she was on 33mls/hr continuous. She weighed 12 pounds, HR- 140, SPO2 – 93 to 96, R-72, her chest sounded clear, but I could tell the baby was having some difficulty breathing because I could see the extra muscles being used, sunken chest and ribs. The foster mom was worried because she could not monitor the baby’s oxygen stats and upset because the hospital did not allow her to take a stats machine home. We reminded her of the things to monitor for such as chest congestion, fever, wheezing etc. She told us that if she needed anything she would call or worst case we would find out if she ends up going to the hospital. I agreed with the mom and felt that if her feeds didn’t get better, her respiration increased and her spo2 decreased she would need to go to the hospital. The foster mom said the last time they went into the hospital, which was a couple days ago her oxygen stat was below 80 percent and it was obvious her baby was going into respiratory distress. The foster mom had been an RN so she knew what she was doing and what to look for. We instilled confidence in her and told her to continue to do what she was doing and monitor the baby and to feel free to call us even if it was just to check oxygen stats over the weekend. We educated her on the tube feeds and told us when the respiration rates are too high it makes it difficult for the baby to eat so if she is worried at all and this persists to take her in. We ended off saying we could come by and check the oxygen stats of the baby throughout the weekend and that they baby was safe.  Competency # 37 Collects information on client status using assessment skills of observation, interview, history taking, interpretation of laboratory data and physical assessment, including inspection, palpation, auscultation and percussion.  Competency # 39 Analyzes and interprets data obtained in client assessments to draw conclusions about client health status.  That evening I looked up information on down syndrome and heart failure in regards to infants, children and kids to broaden my knowledge and make sure I understood what was going on with the baby and complications that I need to be aware of.  Scenario 2 I did a joint visit with my RN and was able to do the admission on a 2-year-old Punjabi girl. She had suffered an acute trauma. She had fallen from a wooden chair that crushed her right ring finger, no other ill effects from the fall were discernible. The grandmother at the time was the primary care giver while the mom was in India. The girl had no other issues and was currently on Tylenol 2.5mls at bedtime and at 1 or 2am if she wasn’t able to sleep during the night, which worked effectively to control her pain. After the assessment, I assisted the RN with the dressing change and I filled out a wound pathway form. We educated the grandmother on pain management and told her the next time we are scheduled for a dressing change to give her Tylenol an hour before to help with pain. I also completed a care plan with the help of the RN. We also educated her on signs and symptoms of infection, as well as on where to get resources for the dressing change -- such as gauze, Mepitel, stretchy cling, dressing tray. Competency # 46 Uses a critical inquiry process to support professional judgment and reasoned decision-making to develop plans of care. Competency # 92 Accepts and provides care for all clients, respectful of diverse health/illness status or diagnosis, or experiences, beliefs, and health practices. Competency # 43 Completes assessment in a timely manner. Finished assessment and asked all necessary questions to complete PAI assessment. Feelings I can now embark on the second stage of Gibbs (1988) reflective model, which requires discussion on my feelings and perceptions. In Scenario 1, having had a joint visit with RN to check on a 7-month old baby with a congestive failure and down syndrome, I was conscious of the delicate state of affairs as I was under her supervision as well as the scrutiny of the foster mother who had been an RN. As a result, I felt very nervous and panicky. The foster mother was present and seemed to be already looking worried, I couldn’t let her feel that I wasn’t aware of what I was doing. The foster mother was evidently worried as she couldn’t monitor the baby’s oxygen stats. I was however confident that since I had on many occasions carried out similar clinical procedures without failure, my practice must have been apt and curved to the task. To show I was in control, I joined the RN, of whom we had made the joint visit, to remind the foster mother of the things she should monitor such as chest congestion, fever and wheezing. Upon making these suggestions, I gained more and more confidence in our part as the nurses, and the mum, and even agreed with her that if her feeds didn’t get better, the baby’s respiration increased and her spo2 decreased, she would need to go to the hospital. Basing my actions on the NMC Code of Professional Conduct (2008), which requires nurses to treat their patients with respect and dignity, I let the foster mother to feel she was in control of the baby. In addition, the American Nursing Association (ANA) code of nursing ethics requires the client to support the client’s right to remain self-determined. By allowing her to seem like she was privy to some information and that she was in full charge of her baby, we embraced the principle of autonomy that is based on the right of self-determination and operationalized using the informed consent doctrine. The doctrine requires that clients are free to select of turn down healthcare interventions, and that they should be presented with all the information on their conditions to enable them to make informed decisions (Nursing and Midwifery Council, 2008). With regard to Scenario 2, the two-year old Punjabi girl show suffered an acute trauma after falling of a chair and crushing her right ring finger, I felt I was in control and that my RN looked up to me to carry out the assignment without interfering or interjecting. She made me feel I was a dependable part of the two-member team and this greatly motivated me. This further prompted me to involuntarily assist her with the dressing change and to filled out a wound pathway form. With much enthusiasm, we educated the girl’s grandmother who had accompanied her of pain management. Having embraced the feeling of team spirit, I was able I to quickly complete a care plan with the help of the RN. Evaluation The third stage of Gibbs (1988) reflective model demands that the scenarios be evaluated to establish the highs and lows of the process. It was creditable that the RN acted the way she did, as she appeared to let me seem like I was running the whole show during the joint visit to see the 7-month old baby. My RN’s enthusiasm and communication skills were evident, and so it inspired mine (Egan, 2002). We listened patiently to the foster mother in the first scenario, while paying attention to her frustrations and worries. This way, we were careful not to make any vile remarks or poor cold water on our client’s enthusiasm. The effective communication with the foster mother enabled us to understand the condition of the baby (Garnham, 2001). I could see something good coming out of the two scenarios, the two incidents have also allowed me the chance to link the community nursing theory with practical nursing. The way in which we communicated to the foster mother had a positive outcome. In addition, the team spirit we embraced with my RN was a plus. Almond and Yardly (2009) advises that effective communication is a vital factor that builds trusts and creates bond between the nurse and the patient. Beneficence recounts to the need for the nurse to help others to actively aim to do good. The highlights here are that we assessed the conditions of the two patients (in scenario 1 & 2) based on the information we received from the parent and guardian. This enabled my RN and me to make physical diagnosis of both situations. The point here is that we were able to accept both patients as unique individuals without pre-judgment, basing that one was adopted and the other was a Punjabi girl. Basing on these experiences, I have learnt that nurses shouldn’t make presumptions, and that patients’ values, backgrounds or beliefs stand to be respected, and that our personal prejudices shouldn’t affect how our nursing practice (Rogers, 1957). In fact, some theorists have come up with the contextualist’ frameworks that analyses the good and the bad through analyses of certain situations, these include cross-cultural or relational ethics model (Roper et al, 2000). However, I feel that I should be more assertive when it comes to questioning the way professional staff carries out the nursing practice. For instance, I couldn’t question my RN on why at some instances she seemed withdrawn and instead, assumed that her behavior was a sheer illustration of her patience with me (Rogers, 1957). Perhaps, if I had asked her questions, I could have learnt more from her, or made independent decision. Instead, I just seemed to tag along almost in fear that she was my supervisor. Nevertheless, from these two scenarios, I intend to be more proactive, ass according to NMC (2008), I remain personally responsible for my actions or omission in the practice, and that I must always justify my decisions. Some theorists have attempted to extend this perception of nurses as moral agents further developing the concept of emancipatory action that is based on the ideas of collaboration, partnership and empowerment (Nursing and Midwifery Council, 2008). Analysis Working in pediatric nursing environment implies working with the child, as well as the parent simultaneously. From the two scenarios, I have learnt that it is critical to begin with the least invasive procedure to create room from more assessments and interventions. Although there may be legal or ethical consensus that seeks to protect children’s interest, from my analysis and especially after assessing how the 7-month old baby in the first scenario seemed to suffer, I can confidently assert that decisions on health care should be best based on the interests of the children and not the parents or guardians. The best interests standards is therefore of much essence in pediatrics as it protects the children since the children lack the capacity to express themselves or their own interests compared to adults (Ghaye & Lillyman, 2001). I had felt affected with the two scenarios as they were both heartbreaking. In the first scenario for example, the seven-month old baby was not responding to her feeds. She was on 33mls/hr continuous. She weighed 12 pounds, HR- 140, SPO2 – 93 to 96, R-72, her chest sounded clear. In addition, I could tell the baby was having some difficulty breathing as I could see the extra muscles being used, sunken chest and ribs. This really made me to sympathize, and because negligence could have played a factor to her severity, I felt overwhelmed with emotions. Nurses may become emotionally affected given the complex nature of the cases, however, as they are professional, they do not have to become emotionally involved. Effective communication entails the entire process of passing information between two individuals (Briggs, 2006). It is a creating an element that build trust between the patient and the nurse. In both scenarios, no treatment or intervention could have been possible without communication. To show the important role communication plays in the nursing profession in the nursing profession, NMC (2007) illustrated it as being a critical for competence in nursing. To collect information on the 7-month old baby, we have to effectively communicate with her foster mother. This required the use of interpersonal skills such as verbal and non-verbal communication. Non-verbal communication involves information that is transmitted without speaking. In the first scenario, this was the primary form of communication as the baby couldn’t talk and so we had to engage fully with the foster mother. The mother’s body language showed that she was tensed and worried, and therefore, we had to approach her with empathy to make her feel that we understood her situation and to encourage her to participate in communication (Peate 2006). This required actively applying body language. For instance, sitting squarely towards her, maintain eye contact, leaning towards her, encouraging her to relax and giving her confidence in what she did. The same case happened in the second scenario, where we had to communicate with the two-year old Punjabi girl’s grandmother. Further, verbal communication with the foster mother and the grandmother of the Punjabi girl called for the application of para-verbal communication and facial expressions. The two may give clues that support, disguise or contradict the verbal message, therefore we had to exude enthusiasm, friendliness and warmth when approaching them. Both situations were further assisted by the use of para-communication, which involve the cues that come with verbal language. These may include assuming a friendly tone or pitch when communicating to the patients to add weight to the spoken words. In addition to the interviews, ways of ensuring effective collection of information on the statuses of both patients included by observation, interpreting histories and laboratories as well as through physical assessment – including percussion, palpation, inspection and auscultation. Action Plan Deployment of Gibb’s reflective cycle has been instrumental in interpreting the two scenarios, putting things into perspective as well as recognizing how can place this learning experiences into positive use for my future nursing practice. As a result, if similar situations had to rise again, I would suitably apply communication skills to discern different situations, question the nurse’s decisions, take full charge of both situations as well as ensure that my conducts and those of the other nurses in the team are acceptable (Jasper, 2003). Following this two experiences, I have learnt the value of being assertive whenever I feel that I shouldn’t be overshadowed by my superiors’ behaviors (Rogers, 1957). This is supported by some current developments in nursing that continue to recognize nurses as moral agents. Nurses should not be treated as “mindless” assistants who should simply follow orders from the superior orders, or doctors. This is because nursing practice is based on commitment and responsibility that targets actively promoting the welfare of the patients, as well as their families and communities. With my action plan, I also intend to engage in discussions with qualifies nurses on techniques in communicating with parents and discerning children’s conditions as nurse has a very significant role in communicating with patients. Conclusion In conclusion, the reflective essay has enabled me to discover my strengths and weaknesses, as well as frame my feelings and perceptions. In addition, the virtue of critical reflection has elevated my level of awareness with regard to evidence-based practice (Ghaye & Lillyman, 2001). Further, my competence in clinical practice has been put to task and I now feel that my professional and personal development has developed progressively (Rogers, 1957). I have also been able to conceive that nursing is a profession in which I have to be proactive. Lastly, critical reflection has enabled me to understand that teamwork -- between the nurses and patient -- is important for effective nursing practice just like any other aspect of clinical medicine (Coles & Marjoram, 2009). References Alexander. M, Fawcett. N, & Runciman. P, (1994), Nursing Practice - Hospital and Home - The Adult. Churchill Livingstone:London. Almond, P. & Yardley, J. (2009) An Introduction to Communication. Chapter 1 IN Childs, L., Coles, L., & Marjoram, B. (eds.). Essential Skills Clusters for Nurses. Basingstoke: Palgrave Macmillan. Dougherty, L & Lister, S (2008) The Royal Marsden Manual of Clinical Nursing Procedures. 7th ed. Oxford: Blackwell Publishing. Egan, G (2002) The Skilled Helper: A problem management approach to helping. 7th ed Brooks / Cole. California. Garnham, P (2001) Understanding and dealing with anger, aggression. Nursing Standard no6, vol 16. P37-42. Ghaye, T & Lillyman, S (2001) Reflection: Principles and Practice for Healthcare Professionals. Wiltshire, Mark Allen Publishing ltd Gibbs, G (1988) Learning by Doing. A Guide to Learning and Teaching Methods. Oxford: Further Education Unit, Oxford Polytechnic. Jasper, M (2003) Foundations in Nursing and Health Care: Beginning Reflective Practice. Nelson Thornes. Oxford. Nursing and Midwifery Council (2008) Code of Professional Conduct. NMC. London. Rogers, C. R (1957) The Necessary and Sufficient Conditions of Therapeutic Personality Change. Washington, DC: American Psychological Association Roper, N, Logan, W & Tierney, A J (2000) The Roper Logan and Tierney Model of Nursing. Churchill Livingstone. London Read More