Perceptions and Expectations of Nursing Practice - Personal Statement Example

Write a reflective account discussing your initial perceptions and expectations of nursing practice related to your experience of the adult patient in the practice setting. Include reflection on how you feel illness and the need for nursing care impacts on the adult patient. Introduction: My initial perceptions and expectations of nursing practice led me to believe that the knowledge and skills that I acquired would be all that was required in coping with illness and the difficulties that patients placed under my care. However one incident during the initial period of nursing practice was to turn these perceptions and expectations head over heels and make me realize that the nursing profession was not just the acquiring of skills and knowledge, but involved a deeper understanding of the individual seeking care in the face of illness. Gibbs Reflective Cycle: I intend using the Gibbs Reflective Cycle to provide an understanding of this incident. The reason for this choice is that the Gibbs Reflective Cycle is a suitable model for reflecting on incidents that occur to an individual and the possible impact this experience has on future action of the individual (Reflective Practice). Description of the Event: I was posted in a ward that cared for both male and female adult patients in keeping with my choice of posting. After nearly a month of my posting a Moslem woman was admitted into my ward. She was forty-eight years old. She was suffering from diabetes mellitus and had not maintained her diet, exercise and insulin regime. As a result she had developed an ulcer at her right calf. Her treatment included injections of insulin, a strict diet and medicated dressings and positioning of the infected foot. Once she was settled in her bed I attempted to communicate with her. I found her totally unresponsive. I was irked, more so irritated with this uncooperative patient. I decided I would do the needful and if she cooperated well and good for her. I had to record her blood pressure immediately. I tried to tell her that I needed to take her blood pressure. She hardly paid heed to her. I decided that there was no point in talking to her and got down to the business end taking her blood pressure. The moment I touched her, she became violently remonstrative. Fed up with the situation I went to the nursing supervisor to complain about the uncooperative patient. The nursing supervisor decided to come and see for herself. I found my patient willing to meet the eyes of my supervisor, but not responding to anything she said. A little later the supervisor turned round and told me that the patient did not understand English. The supervisor took her blood pressure the patient did not remonstrate, but appeared unhappy about me hanging around. That gave me the impression that the patient did not like me. My supervisor advised me to talk to the family, as they were expected in the evening visiting hours and to get them to make the patient understand all that was needed to be done and try to get the cooperation of the patient. Before that could happen I ran into another problem. Her lunch arrived and she just refused to eat. I started getting worried that she could go in for hypoglyceamic shock. It did not end there. A little while later I found the patient get restless and attempt to move out of her bed, despite the advice of bed rest. I tried to stop her, but she went to the corner of the ward and spread a sheet on the floor and knelt down and started praying. I felt stupid in trying to stop the woman from saying her prayers. Evening came and her family arrived. It was a relief to me when I found that her two sons spoke English. I informed them about the problems I was facing. It was through them that I understood that their mother had come to the country a short while back and did not know a word of English. She was deeply religious and my being a male made her reluctant to for me to touch her. It was the Moslem month of fasting and hence she would not touch food between sunrise and sunset. In addition she would pray five times a day. It was then that I realized that it was not that the woman was uncooperative, but that her lack of English communication skills made it impossible for her to communicate with me. Her religious sentiments created problems in her accepting care from me and not her animosity. I made the family understand that she was ill and needed to nursing care and appropriate nutrition. After a lot of discussion in their native tongue, they came back to me and told me that there would be no problem in me providing the nursing care, but that she would not stop her prayers. Later in the evening I bade all my patients’ goodnight and left. This time her ignoring me did not irk me. In the night I went to meet a Muslim friend of mine to get a better understanding of the situation. He made me understand that she would be uncomfortable in the care of any male nursing professional and I needed to do something about that. From him I learnt a couple of Muslim greetings. The next morning when I reached my ward I greeted them in my usual manner, but to the Muslim lady I said “Haslam Mallikum”. Her initial reaction was shock and then her first words to me came in the form of the return greeting “Mallikum Haslam”. In the adjacent ward was a female nursing professional, who was a good friend of mine. I approached her and told her my problem. She offered to provide all the nursing care that required physical contact for the patient. I chose not to interfere with the prayer routine of my patient. The next day I greeted this patient of mine with a “Quda Hafeez”. This time there was no shock, but the first smile and the return greeting. In two weeks her ulcer healed and she was discharged. I was around to see her off. She could not thank me in English, but I read it in her eyes. The thank you was given not for any knowledge or skills, but for the understanding that I had shown to an ill woman in a strange land. Feelings: This event is something that I cannot forget for it changed the manner at which I look at my profession now. Each time I think about it I feel remorse at my superior attitude. At the start of the event I was irked and irritated at the patient. I had been landed with a pain in the form of the Muslim lady. My supervisor was the first to realize the difficult situation that the Muslim lady was in and advice me on the language problem. The sons were not surprised at the situation that had arisen between me and their mother. It was through them that a window to their religion and culture was opened for me. My Muslim friend was amused at the situation I found myself in, but it was his assistance that provided me with a deeper understanding of the Muslim religion and culture. My lady colleague in the adjacent ward showed understanding of the situation and it was her assistance that helped the Muslim lady and me get over an awkward situation. The successful outcome for the Muslim lady through the nursing care makes me happy. I am also happy that it made me a better nursing professional, endowed not only with knowledge and skills, but an attitude for understanding. This makes me look back on this event as a learning process that started as a difficult situation and culminated in a successful outcome. Evaluation: This is an incident that has resulted from the increasing migration of people and their religion and cultures from their place of origin to newer lands where the religion and cultures are vastly different. Such migration has been the result of globalization that is turning the world into a single global village. Migrants into a nation needing healthcare bring about conflicts between patients and nursing professionals as a result of cultural differences and institutional conditions (Teil, E., 1997). Such incidents between different religions and cultures in different environments are bound to increase and calls for cultural competence in health care environments (Cioffi, J., 2005). Such cultural competence needs to be a part of the education curriculum for nursing professionals to enable minority cultures in a nation to feel that there is equitable distribution of healthcare services to all the people. Through education to create cultural competence students realize the need for change in them to interact with other cultures and this would enhance their personal growth, resulting in enhanced care for all those who come under their nursing care. (Duffy, M.E., 2001). In the incident the lack of cross cultural competence led to confusion for the nursing professional and additional distress for a patient already in stress due to illness. The initial reaction of the incident would have had a negative impact on the patient’s route to recovery, but the subsequent cultural competence gained by the nursing professional would have contributed to the reduced stress on the patient and the successful outcome that resulted. Analysis: This incident is an example of the manner in which nursing care of a patient from a totally different culture is a dynamic, complex and tension-filled phenomenon (Spence, D., 2003). The initial interaction between the nursing professional and the patient was all wrong. The nursing professional was more concerned in the execution of the nursing functions rather than in analysing the individual nature of the patient and what was best for the patient from the patient’s perspective. On finding difficulty in executing the nursing functions, the nursing professional was more worried about the consequences for himself than the care of the patient. The complaining to the supervisor highlights this mental frame of the nursing professional. It was not seeking guidance, but complaining so that the responsibility of the patient was no longer entirely that of the nursing professional only. The experience of the nursing supervisor was the first reason for the creation of a better understanding of the situation, by the spotting of the language barrier and the advice to seek the assistance of the family in overcoming the language barrier (Zielke-Nadkarni, A., 2003). In normal circumstances the family members of adult patients are more recipients of information from nursing professionals on the condition of the patient and seldom play a meaningful role in contributing to nursing care of the patients (Astedt- Kurki, P., Paavilainen, E., Tammentie, T., Paunonen-llmonen, M., 2001). However in this incident it was the contribution of the family members that led to reduction in the tension between the patient and the nursing professional. The remaining irritant was the religious requirement, which the nursing professional tolerated. This tolerance would have come earlier had the nursing professional realized the devoutness that Muslim women have for their religion (Carter, D.J. & Rashidi, A., 2004). Proper understanding of the Muslim culture came from the friend and the required assistance to ease the tension from the colleague in the adjacent ward. It was the contribution of the nursing supervisor, the family members, the Muslim friend and the nursing colleague that helped the nursing professional get over the complexity and tension of the situation. From then on the understanding of the nursing professional led to the successful outcome of the incident. One of the codes of the Nursing and Midwife Council reads as “make the care of people your first concern, treating them as individuals and respecting their dignity” (The new draft Code of Conduct). If the nursing professional had followed the dictates of this code in respecting the dignity of the patient the tension between the patient and the nursing professional could have been avoided. Conclusion: There were errors on the part of the nursing professional in believing that all it takes for good nursing care and successful outcomes is the good knowledge and skills. There is a human element of understanding in the provision of care to those who are ill. The illness makes them stressed and cross cultural tensions enhance the discomfort. The dignity of the patient was at stake and hence the response. The moment dignity was reassured the tension dissipated leading to more cordial relations, despite the inability to communicate verbally. The outcome was successful as a result of the removal of the tension that existed. Action Plan: My action plan for the future involves making sure that I understand the individuality of patients under my care and respect their dignity. This will ensure that I avoid creating situations of tension between me and patients in my care, so that the result of the care that I provide them results in successful outcomes. (Word count 2128) Literary References Astedt- Kurki, P., Paavilainen, E., Tammentie, T., Paunonen-llmonen, M. (2001). Interaction between adult patients' family members and nursing staff on a hospital ward. Scandinavian journal of caring sciences, 15(2), 124-150. Carter, D.J. & Rashidi, A., (2004). East meets West: integrating psychotherapy approaches for Muslim women. Holistic nursing practice, 18(3), 152-159. Cioffi, J. (2005). Caring for Women From Culturally Diverse Backgrounds: Midwives' Experiences. Journal of Midwifery and Women’s Health, 49(5), 437-442. Duffy, M.E. (2001). A critique of cultural education in nursing. Journal of advanced nursing, 36(4), 487-495. Reflective Practice. Retrieved February 28, 2007, from Website: http://www.devon.gov.uk/reflectivepractice.pdf Spence, D. (2003). Nursing people from cultures other than one's own: a perspective from New Zealand. Contemporary nurse: a journal for the Australian nursing profession, 15(3), 222-231. Teil, E. (1997). Head outside--feet inside. How do patients from other cultures experience the German health care system? Pflege, 10(4), 193-198. The new draft Code of Conduct. Retrieved February 28, 2007, from NURSING & MIDWIFE COUNCIL. Website: http://www.nmc-uk.org/aArticle.aspx?ArticleID=2368 Zielke-Nadkarni, A. (2003). The meaning of the family: lived experiences of Turkish women immigrants in Germany. Nursing science quarterly, 16(2), 169-173. Read More