Reflection on Palliative Care: A Nursing Student's Experience

This reflection assignment focuses on a nursing student's placement experience in a palliative care unit and how it helped develop their competence and skills. The student describes their encounter with a terminally ill patient and the impact of cancer diagnosis and treatment on the patient's psychosocial health and well-being. The reflection also highlights the importance of effective communication skills and compassionate interaction to help terminally ill patients dealing with acute pain.

Running head: REFLECTION ON PALLIATIVE CARE
Reflection on palliative care
Name of the student:
Name of the university:
Author note:

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REFLECTION ON PALLIATIVE CARE
Introduction:
Reflection can be utilized as one of the most potent tools for improving quality and
competence when considering the palliative nursing practice. This assignment will utilize the
Gibbs reflection tool to describe the placement experience that I have attained as a student nurse
in the palliative ward and how it has helped me develop my competence and skills. My reflection
assignment will focus on the placement experience I have had this year. In November I had been
given the opportunity to have a placement experience in the palliative care unit and this has been
my first encounter with a terminally ill patient. Hence, it had been a great opportunity for me to
understand my skills and competence and discover my weaknesses or limitations so that I can
focus on improving it.
Description:
Reflection has been described by the Gibbs as the process of learning by doing, as it
provides the nursing professional with the opportunity to reflect on their own practice standards
and competence and skills (Jayatilleke & Mackie, 2013). As a nursing student, I had been given
the opportunity to assist in caring for a 65 year old woman suffering with the last stage of
lymphoblastic leukaemia. The confidential details of the patient will not be disclosed for the sake
of privacy, although for the reflection I call the patient by the name of Jane. Jane had been in the
health care facility for the past few months and the impact of leukaemia and the burdening
treatment has had a substantial impact on the psychosocial health and well-being of the patient.
It has to be mentioned in this account that cancer diagnosis and the subsequent treatment can
have a life altering impact on the patient’s perception of health and life in general (Ferrell, Coyle
& Paice, 2014). The impending death also affects the will to struggle anymore for the patient. In

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this case the patients had been suffering from acute pain and wanted to be relieved from the pain
by any means possible. Although her family was not agreeing with the intravenous morphine
therapy intended to use for the analgesia, especially her son. Her son Jake was not agreeing for
his mother to be put on such opioid based analgesics and wanted some other alternative pain
relieving techniques to be employed for his mother. I would like to mention in this context that
the family spent a prolonged amount of time arguing with the entire health care staff and denying
the pain management that Jane needed desperately. The doctors and the senior nurses were all
trying to explain to Jake that being in the advanced stage of the cancer the only available option
for Jane is the opioid based analgesics. Although, the rest of her distant family agree to the
analgesic treatment, her son was still adamant about the treatment required from the patient and
him being the next of kin of the patient, the care team for Jane was not able to opt for the
morphine injections. Unfortunately, the condition of the patient deteriorated quickly and her pain
become too much for the patient to endure. However, after close to 15 hours her son agreed after
he was consulted by the head oncologist and senior registered nurse with evidence based data
regarding the advanced stage of cancer of the patient and how only morphine could help numb
the sensation of pain for the patient. The evidence based data helped her so understand the
impact of pain and advanced cancer treatment and agreed to morphine being given to her.
Feelings:
It has to be mentioned in this context that this has been the first encounter I had with the
palliative care setting and the pain and suffering associated with the end of life care setting had a
significant impact on my communication skills and clinical reasoning competence (Dobrina,
Tenze & Palese, 2014). First of all, when I first interacted with Jane, she seemed very friendly to
me and we easily developed a therapeutic relationship. When she expressed her journey with

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cancer and her pain, I felt I could relate with her wishes to be relieved from the excruciating oain
as soon as possible. She expressed to me in the early hours of our interaction that during the
course of her illness she had not ever experienced pain of this magnitude and as a result the
patient was overwhelmed with the kind of pain that she had been feeling. Jane also expressed to
me and my buddy nurses that she agrees to take any injection or other therapeutic measure if
only her excruciating pain would subside for a few moments so that she could breathe. The
patient was teary eyed while expressing to us the kind of pain that she was feeling and her
desperateness was very conspicuous and clear. Hence, I was inspired to do as much as I could for
Jane and to address her wishes to let her pain subside completely. Although, I feel I have not
been able to effectively contribute to communicating with Jane and helping her cope with the
pain with nonpharmacological means of pain relief while the senior nurses and the doctors were
busy trying to communicate with her son to agree to the morphine treatment. I would like to
mention that I feel my personal coping strategies were not very useful either as I was moved by
the extreme that the patient was in and it clouded my better judgment and i failed to relieve the
patent of the anxiety, uncertainty and pain she was going through while her son was refusing
morphine to be injected to her. I feel that I still lacked proper communication skills and
competence that a nursing student should have while communicating and reassuring critically ill
patients.
Evaluation:
In the step of evaluation, I would like to mention, that my first encounter with the
practice scenario had undoubtedly been one of the greatest experiences for me. This experience
gave me the opportunity to understand the different factors associated with a practice scenario
with palliative nursing background and has helped develop a passion towards practicing in the

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palliative care scenario (Prem et al., 2012). First and foremost, I think the health care team had
easily developed a strong therapeutic alliance with Jane. The patient could easily express all her
doubts and wishes with the care team allotted to her. Along with that care programs designed for
her were patient centred and respectful to the wishes and demands expressed by her as well. It
has to be mentioned that the patient had been comfortable about expressing the expressing about
what she liked and did not like to the care professionals as well. However, the drawbacks of the
entire experience include the lack of involvement of her family and lack of proper information
sharing with the family members. It has to be mentioned in this context that the family members
of a terminally ill patient will need to given all the information with clarity and transparency
(Head, Washington & Myers, 2013). In this case, Jane’s son was her next of kin and yet the care
team and head nurses had not clearly mentioned to her about Jane’s needs for receiving
morphine previously and how important opioid based analgesics are to relieve the terminally ill
cancer patients in advanced stages to be relieved from the pain (Grant et al., 2015). The lack of
resources and evidence used from the beginning to explain to her son about the right of the
patient to choose any means of analgesic or any other kinds of treatments in perfect state of
consciousness resulted in a prolonged delay of required treatment to begin and as a result the
patient had to undergo a prolonged time of incapacitating pain which could have been relieved
much earlier if necessary evidence based effective communication was attempted from the
beginning. Along with that, it has to be highlighted here that my personal lack of skills of
resilience based practice and ability to handle terminally ill anxious patients with effective
communication and nonpharmacological mode of pain relief.

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Analysis:
According to the Zimmermann et al. (2014), the palliative care can be defined as the care
approach that attempts to improve the quality of life of the terminally ill patient with early
assessment and impeccable treatment intervention. Along with that, relieve the patient of the
suffering and pain that they are facing (Wiener et al., 2015). Along with that, considering the
concepts of patient centred care, the wishes and desires of the patient should be given the
ultimate importance in the care planning and implementation. With respect to Australian
legislations, an adult patient in full consciousness has all the rights to choose the kind of
treatment in proper conscious state. Hence, considering the ethics of patient autonomy, Jane
could not be denied of her right to morphine based analgesics to relieve her pain. In this case, the
family members of Jane, specifically her son was not aware of standard practices to utilize
morphine o other similar strong narcotics for analgesic purposes for cancer patients. Close to 15
hours were wasted while the senior RN, nursing supervisors and the head oncologist is
explaining to her son the importance of strong narcotic analgesic for the patient I was in charge
of controlling the patient along with my buddy nurse. Even though it was my responsibility to
communicate with Jane and help her be relieved from the acute pain, I was not able to invest my
100% to the job and I failed to reassure and calm her while she writhed in pain. As per my own
opinion I lacked confidence and compassionate communication and reassuring skills while
communicating with Jane. According to the Hui et al. (2014), in nursing practice it is essential
for the nursing professionals to have adequate communication skills not only for handling the
demands and requests of the patients, but also reassuring and calming the patient in any adverse
situation. Me and my buddy nurse failed to relax the patient or distract her with any
nonpharmacological mindfulness based intervention, rather we were too consumed with our own

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discomfort and grief at watching a patient suffer for lack of effective communication with the
family members.
Conclusion:
On a concluding note, reflective practice has slowly integrated in the health care scenario
as the integral part of the nursing practice providing startling insights regarding the quality of
care planning and clinical supervision or decision making. Reflection has been accounted for
being the practice that provides an excellent opportunity for the nursing professionals to undergo
continuous professional development by means of targeted continuous nursing education. This
has been an excellent opportunity for me to discover the different facts associated with caring for
a terminally ill patient. Along with that this reflection had been a potent tool for me to discover
my strengths and weaknesses that can play profound role in my future practice. In this case the
weaknesses that I discovered include lack of confidence, lack of persuasiveness, lack of
resilience and coping strategies, lack of effective communication skills, lack of quick clinical
judgments and overall skills to handle terminally ill patients.
Action plan: Plan for professional development:
In this case, I have discovered that lack of effective communication and compassionate
interaction skills to help terminally ill patients dealing from acute pain. Hence, I would require a
communication skill training program to enhance my skills (Goldsmith et al., 2013). I would opt
for therapeutic collaborative resilience building schemes under the provision for development
program for nursing students. Along with that I would also join personality development training
to enhance my abilities to overcome stress in emotionally exhausting situations while providing
care to the patients; so that in future when I encounter such situation i can overcome my own

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emotional turmoil quickly and invest myself completely in handling the patients and their issues.
I would also attempt to maintain a journal to keep track of my progress and will also approach
my supervisor to guide me through the entire process.
References:
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models and theories. International journal of palliative nursing, 20(2), 75-81.
Ferrell, B. R., Coyle, N., & Paice, J. (Eds.). (2014). Oxford textbook of palliative nursing. Oxford
University Press.
Goldsmith, J., Ferrell, B., Wittenberg-Lyles, E., & Ragan, S. L. (2013). Palliative care
communication in oncology nursing. Clinical journal of oncology nursing, 17(2).
Grant, M., Ugalde, A., Vafiadis, P., & Philip, J. (2015). Exploring the myths of morphine in
cancer: views of the general practice population. Supportive care in cancer, 23(2), 483-
489.
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