Assignment on Nursing Reflection 2022

Running head: NURSING REFLECTION ASSIGNMENT
NURSING REFLECTION ASSIGNMENT
Name of the student
Name of the university
Author note

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Introduction
The 21st century has observed multiple changes in every aspect of human life,
specifically in the healthcare sector that has not only improved the care process but also
developed care professionals by increasing their skills (Zamanzadeh et al., 2015). Nursing
professionals, in the modern age are aware of the challenges they would be facing in the
process and hence, they are equipping themselves with skills and strategies so that they could
develop and maintain quality holistic care (Chen et al., 2018). One such strategy is to
maintain nursing journal which is a documentation process that includes the ideas, healthcare
experience and personal thought of nursing professionals maintaining such records (Chinn &
Kramer, 2017).
As per Melin‐Johansson, Palmqvist and Rönnberg (2017) reflection in nursing
profession helps the nursing professionals by increasing their abilities and enhancing their
ability to learn from retrospection of incidences in their education, as well as professional
experience. Ramos et al. (2015) also mentioned in their research paper that nursing journals
are the most comfortable and effective way using which nursing professionals can develop
abilities to understand, implement and avoid practices that are not beneficial for patients and
the care process. Further, it was also observed in the discussion of Lestander, Lehto and
Engström (2016) that developing nursing journals make the professional more focused about
their job and they tend to implement changes in their practice.
In this discussion, I would also be discussing my course of reflective journal writing
and though this process, I would be discussing about one such incident in my nursing
profession till date that helped me to transition from student to a professional nurse. I would
provide a detailed information regarding the incidence associated with lack of cultural
competency that I witnessed while working in the care facility. I would be using Gibb’s

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Reflective Cycle to discuss about the breaching process and the change that I perceived in my
personality due to this incident.
Gibbs Reflective Cycle
Gibb’s reflective cycle is the reflective model that helps people to collect their
thoughts systematically and analyse their past experience within specific framework so that
they can structure their thoughts in phases (Waltz, 2019). This process helps them to open up
for adjustment and making changes to their processes so that they could evolve as a
personally and professionally (Husebø, O'Regan & Nestel, 2015). There are six steps of
Gibb’s reflective cycle, such as description of incidence, feelings related to the incidence,
evaluation, analysis related to it, conclusion and action plan that describes the strategies to
overcome the complication (Ramos et al., 2015). In the following section, I will be discussing
my complications associated with cultural competency that I observed in the care facility.
Description
In this section, I would discuss about my first clinical placement in the healthcare
facility, when I was assigned to take care of patients in the emergency ward. I was working
under the supervision of the registered nursing professional who was caring for primarily two
patients in that ward. One of the patients that we were working with was an Australian
aboriginal women, Mrs. X (38), who was unable to speak or read English and was admitted I
the healthcare facility after a critical accident. This accident was so traumatic that the patient
was unable to move her one hand and I was assigned to take care of her wounds, maintain her
dressing and taking care of medication dosage by maintaining medication documentation. As
I was assigned for the care of the patient from the Day 1, I was very much concerned about
their health and determined to provide both of the patients, under my mentor with effective
and quality care. This is because, I read in the theoretical classes that it is the duty of nursing

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professionals to provide equal and effective care to patients so that they could improve their
wellbeing due to the effectiveness of the care process.
However, I witnessed a complete different situation from the day 1 of the clinical
placement. Mrs. X was unable to read and write English language and hence, an interpreter
was assigned for this patient. Despite this, the patient seemed confused and was curious about
her health improvement and multiple times I saw that the interpreter is arguing with the
patient to calm her down and making her take the medications. I saw this situation for four
consecutive days then I realised that the patient is not being provided with culturally
competent care and the interpreter is unable to fulfil his duty to provide each information
associated with her care intervention to the patient effectively. On day 5, when I was
checking her medication dose, the patient whispered something in her own language and
upon asking the interpreter, he asked me to ignore the patient’s thoughts and focus upon the
care process. Therefore, this incident verified my thoughts associated with breaching of
cultural competency due to which the patient lost her faith and trust upon care system.
Feelings
As per Taylor et al. (2017) clinical placement is an important and crucial step for
nursing students that would become professional nurses in future as through the help of this
phase, they become aware of the system and the way they should perform to contribute in its
development. Therefore, I also felt very responsible and excited upon receiving this
opportunity to undergo my clinical placement situation. The first day of the clinical
placement went very fast as I was meeting new people and was understanding my duties. The
registered nurse, who mentored me during this phase, made me understand everything that I
would be performing in the emergency department and then introduced me to her patients.
This is the time, I observed a lack of trust and fear in the patient Mrs. X, as while greeting her
for the day, she did not reply. I came to know that she is an aboriginal patient who has been

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admitted due to a severe accident that hurt him in her right arms. I observed an interpreter
next to the patient and hence, I was assured that he would be able to take care of the patient
by making her aware of her healthcare process. However from the second day onwards, I
started developing a string feeling that the patient is unaware of any aspect of her care and is
not willing to stay and care interventions in this care facility. I was confused related to the
care process, because I observed the registered nurse to be considerate and compassionate
with other patients as well as with Mrs. X, however whenever I visited the patient, I felt she
is fearful or sad about her healthcare process. I often found her teary and scared of
medications. This made me feel that the despite having understood and read about the
cultural competency and its importance while dealing with multicultural patients, the
professionals in this hospital are unable to implement that in the care process. I felt sad as
well as helpless as I was a student nurse undertaking her clinical placement in the care
facility, despite that I was aware of the role and responsibilities of nursing professionals and
it made me felt strong and determined that i decided to advocate the patient’s complication to
my higher authorities.
Evaluation of the situation
While evaluating this clinical placement situation, I would mention that this incident
challenged me, my learnings my thoughts and my ethics in every possible way. I was new to
the system and in the care process, and hence, I was observing every single and minute
activities that was occurring in front of me. However, this incident related to the breaching of
cultural competency affected me by challenging my thoughts and my idea of an ideal
healthcare system, where everyone will be provided with effective and equal care process.
Evaluating my clinical placement from its commencement, all the care professionals that
worked with me in that emergency ward very supportive and helped me to understand the
care process. However, the incident that happened with the aboriginal patient affected my

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nursing principles. I have studied all the years that cultural competency is the most crucial
aspect of care process and every care professionals should be aware of the strategies using
which they could include such patients in the care system (Hunter & Arther, 2016). However,
the behaviour of the interpreter in this case situation challenged that thought and made me
aware of the truth that lies in all the healthcare facilities throughout the world. As per
Benbenishty et al. (2017), there are multiple examples of breaching related to cultural
competence that highlights the situation of multicultural care system throughout the world.
Townsend (2018) also identifies that majority of the care facilities are unable to implement
the four pillars of culturally competent care such as awareness, attitude, knowledge, and skills
among their nursing professionals. Therefore, breaching and resistance towards such
multicultural care is hampering the quality and improvement of the care process. While
caring for the aboriginal patient in emergency ward, I also developed these thoughts and
evaluated from the situation that the interpreter assigned for this patient is unaware of these
facts due to which he is neglecting and ignoring the rights related to autonomy and
beneficence of the patient. In this situation, the contributing of the registered nurse also
played in important role as she did not observe and advocate for the patient’s right to higher
authority so that they can change or replace the interpreter for Mrs. X’s care process.
Therefore, from the detailed evaluation of the care process, it could be mentioned that the
breaching of cultural competency was associated with the ignorance and negligence of the
nursing and other care professionals and the inability of the care facility to control such
situation, so that the trust and belief of the patient could be restored in the care process.
Analysis of the situation
This situation and incidence has helped me to understand that shifting from student
nursing professionals to professional nurses is important for every nursing professional as it
changes their thought process, make them adjust as per the situation of the care process. This

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changes could be both positive and negative that changes their ability, theory thought process
and their analysis. As per Norris (2018), this is the phase that challenges nursing
professionals and introduces changes that should be supported and managed through proper
analysis so that these processes could be used for positive development of the nursing
professional. In this clinical placement of my nursing career, I also witnessed such changes in
few of the nursing professionals that made them insensitive to the complications of the
patient was suffering from. Further, I analysed that the nursing interpreter ignored the patient
and her complications and due to this the patient was fearful and teary as she did not feel
connected to the care process. I also analysed that the nursing professional that was included
in the care process also neglected this situation and did not highlight this situation to higher
authority and hence, one healthcare professional remained unaware of his duties and role in
making the care process inclusive and culturally competent. As per Lea and Cruickshank
(2015), this is an important aspect that the care facilities should undertake and they should
also be able to observe such complicated changes in the care process so that they can
maintain the quality and efficiency of the care process. Therefore, from this clinical
experience, I analysed that despite being experienced for years in healthcare system, majority
of the care professionals are unaware of the cultural competency and its importance for the
growth and development of care process and obtain improved outcome for patients.
Conclusion from the situation
There are multiple conclusions that I draw from this above- mentioned incidence as
this situation challenged my thought process, my nursing knowledge and pushed me to
expand my thinking’s and observe every bit of action happening around me. I was able to
review all my educational and ethical knowledge related to nursing, its codes of conduct and
my duties as nursing profession within a span of few minutes. From the starting of my
clinical placement I was curious to understand the issues due to which the patient remains

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teary and frightened every time we visit her and after the analysis and evaluation of the
situation, I concluded that the patient is unable to understand our conversation and the
interpreter that has been assigned to bridge the gap of lingual and multicultural barrier is
unable to fulfil her duties. I should mention that the nursing professionals in the emergency
department were neglecting the patient demands and their ethical rights associated with
autonomy, beneficence, non- maleficence, and justice. In such situation, I concluded that the
interpreter was unable to understand the need of the aboriginal patient and did not perform
his duties by including the patient in the care process.
Application of management theories
This situation violated the human right of the patient and created culturally
incompetent care, continuation of which could affect the efficiency and quality of the care
process. In such condition, I decided for the implementation of Conflict management theory
and Leininger’s cultural care theory in the organisation as Johansen and Cadmus (2016)
identified these theories as crucial for development of cultural competency associated attitude
in employees. As per Başoğul and Özgür (2016), conflict management is dependent upon five
strategies in which, avoiding, collaborating, compromising, defeating and accommodating
plays pivotal roles, through the application of effective communication, problem resolving
and developing effective negotiation skills among the professionals. In conditions of cultural
incompetency and improper communication maong nursing professionals or nurse to patient,
application of conflict management strategies would help the nursing or healthcare
professionals to understand the way, they can deal with the situations, and they would be able
to overcome these critical conditions (Johansen & Cadmus, 2016). Similarly, the Leininger’s
cultural care theory is the nursing theory for cultural incompetency management developed
by Madeleine Leininger, through the discovery of elements of care. As per Wehbe-Alamah
(2018), application of this nursing management theory helps nursing professionals to develop

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culturally congruent care with application of assistive, facilitative, supportive and effective
decision making, that fit the patients, their culture, their communal guidelines and provides
them with equal care (Leininger, 2015).
While discussing the relation of this management theory in the care process, I would
again discuss the critical healthcare condition that I faced in the care facility, while
undergoing my clinical placement. The Aboriginal women was not informed about her care
process, the applied interventions and the pros and cons associated with by the interpreter and
when I approach for her assistances, I was also asked to stay away from her and focus upon
my internship. Therefore, it completely violated the cultural competency and equal rights of
care and hence, it becomes important that the nursing interpreter as well as the professionals
and higher authorities that remained silent during this process could become aware of the
violation of ethical and professional conduct they were involve in. hence, it was important to
implement management strategies so that this critical situation could be avoided and effective
care could be restored. Therefore, the Leininger’s cultural care theory and conflict
management theory were finalised for implementation as these two theories are capable of
addressing these health complications and provide the aboriginal patient with her rights of
equal and effective care (Leininger, 2015).
Action plan to address this complication
After being affected with this situation, I felt that I should use my thoughts my
knowledge and my observations to influence others and make this situation visible to
everyone important in the healthcare facility. I decided to advocate for the patients that
belong to other communities and are unable to speak or understand English. Therefore, as
actin plan, I would propose four actions, for both short and long term changes in the care
process so that such breaching incidences could be controlled. The first action plan that I
decided was the implementation of nursing training and education regarding the cultural

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competency so that they could understand its importance and the way they can implement in
the care process (Gallagher & Polanin, 2015). The education and training would completely
depend upon the importance and implementation of multicultural care for each and every
patient included in the care facility and would train the nursing professionals to be able to
conduct this in the care process (Repo et al., 2017). As per Cruz et al. (2016), this will work
both as a long term and short term action plan to effectively reduce the rate of complicating
in the care process.
The second action plan would be to include ALO or the Aboriginal Liaison Officer
in the care process so that these professionals can communicate with the patients, their
families and visitors of the care facility to understand their complications and make changes
in the system to include everyone in the care process (Kendall & Barnett, 2015). As per
Gadsden et al. (2019), it is an important strategy in which application of aboriginal
professionals in the care process would guide the nursing professionals for inclusive and
holistic care process. In the process, the third action plan would be implemented by recruiting
more nursing professionals of aboriginal background so that they could understand the health
complication, mental stress and other faced by these patients and develop an inclusive and
holistic care process using patient centered care approach (McGough, Wynaden & Wright,
2018). As per Liaw et al. (2016), nursing professionals with multicultural background would
help the care process to become inclusive and would increase the trust and belief of the
patients in the care process. Hence, these two would be the second and third action plan to
address the cultural competence breaching related complication in the care process (Auhl et
al., 2018). The fourth action plan would be restoring the four aspects of culturally competent
care professionals by influencing their awareness, attitude, knowledge, and skills positively.
As per Almatrooshi, Singh & Farouk (2016) implementing organisational policies are
effective in making care process holistic and make them understand that these policies would

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help them to improve their nursing skills and would improve their nursing efficiency.
Therefore, I would suggest multiple organisational policies so that cultural competency could
be maintained and through the application of multicultural aspects they could provide the,
with holistic and inclusive care process (Bailey, 2015).
Conclusion
While concluding this reflective journal, I would mention that there are multiple
aspects associated with cultural competency that was breached in the care process. I was able
to understand that the nursing education and professional nursing are different as their roles
and responsibilities, stress and burnout levels are different. While undergoing my clinical
placement, I was able to understand that the nursing interpreter was unable to lead his roles
and responsibilities while working with an aboriginal patient Mrs. X. To demonstrate
multiple aspects associate with this process, I used the Gibb’s reflective cycle and identified
the complex situations that challenged my thoughts, learnings and my nursing identity. In the
process, I was able to analyse and evaluate the situation based upon my on process and then
implemented four action plans in the process. These action plans are important for the
development and implementation of effective and quality care process. Therefore, this
nursing journal includes one of the critical situation of n=my nursing professional and
identifies the situation that changed me as a nursing professional as well as a person my
evolving my thoughts and my inner ethics.

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