This journal discusses various scenarios and the actions taken by the nurse to address the issues. It also highlights the importance of communication, patient education, and ethical dilemmas in nursing practice.
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Running head: REFLECTIVE JOURNAL REFLECTIVE JOURNAL IN NURSING Name of the Student Name of the University Author note
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1REFLECTIVE JOURNAL Introduction Reflection in nursing practice works as a foundation stone for development of experience of nursing professionals (Lestander, Lehto & Engström, 2016). Through this practice, nursing professionals are able to connect their working experiences with the theoretical knowledge of the clinical context, and then depending on that they can modify the clinical practice and develop fresh insights for future practice. Nursing professionals deal with multiple patients with different ailments and hence, positive and negative effect of those experiences affect their ability to comply with the nursing process (Snyder, 2014). Scenario 1: Meeting educational needs of patients and their families Description of event While working with a patient affected with dementia, the primary thing I noticed was their lack of knowledge regarding their ailment. They were not aware about the factors upon which they need to focus and their family members as well, did not asked me about the preventive measures they need to take for the benefit of the patient (Smolowitz et al., 2015). Therefore, lack of knowledge and understanding of the need while suffering from dementia prevailed ion patient and his family. Therefore, my objective was to make them aware of the crucial phase of dementia and the preventive measure they should be following asMarcus (2014) has mentioned that these information are important for health improvement of the patient. Feeling/thought I was very hopeful about my objectives and was confident that within a week, through several sessions and presentations, I will be able to make the patient and his family aware of
2REFLECTIVE JOURNAL every minute detail of care process for dementia affected patients. Therefore, I was surrounded with positive thoughts regarding the educational session of the patient and his family. Analysis Whileconductingthe process, I came to know that dementia and other similar mental disorders are perceived by the society as a limiting factor and hence, there is very less amount of information is available within the society. Hence, this analysis made me moredeterminedto make this patient and his family aware of the dementia associated situation, so that they can overcome the stigmasuch as social isolation, not trusting the healthcare professionals, doubting their self as mentioned in the research by Turchi et al. (2014). Evaluation Whileevaluating the positives and negatives of the situation as suggested by the researchersTurchi et al. (2014)while working with patients of dementia, I understood that, eliminating social stigma is a long process, however I was able to make the patient understand his condition and he was able to take proper care of all preventive measures so that improvement in his condition could be seen. Conclusion Patient education and inclusion of family in the care process is a process through which knowledge related to the disorder could be spread to the society and negative thoughts, discrimination and stigma associated to dementia could be eliminated.
3REFLECTIVE JOURNAL Action plan After successfully completing the session for the patient with dementia, I would try to educate and spread awareness to each of mypatientsand their families so that through them, the awareness could be spread to their immediate community and involving the patients and families in the care process for patients with dementia becomes easier (Marcus, 2014). Scenario 2: communication issues with patients and colleagues Description While working with a 70 year old patient suffering from vascular dementia, I perceived the communication gap present in both, nurse and patient as well as among the administration as I observed that patient, in his severe health condition, was unable to communicate his needs to the nursing professionals. Further, I also observed that majority of theaged care professionals were unable to understand the need ofcommunication so that quality of the care process could be sustained, as majority of the healthcare services do not provide proper aged care nursing communication associated training to help them to improve their quality(Strang et al., 2014). Feelings While observing the situation within the care facility regarding the gap in communication, I felt the importance of communication for our patients and hence, I thought of providing a detail of this loophole to the supervisor. This was necessary for the patient as he was suffering from vascular dementia, in which speech and memory of the patient is primarily affected (Green et al., 2015). Hence, I felt determined that I will be sharing each of these concerns to the higher authority so that they can implement strategies to improve the communication situation among nursing professionals and provide necessary care to the patients.
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4REFLECTIVE JOURNAL Analysis While escalating this issue to my supervisor, I came to know that the communicating gap is present within the healthcare facility because the ratio between the patient and nursing professionals are not proper, due to which one nursing professionals have to take care of more than 5 patients at a time. Thereby affecting the care process and communication among the professionals (Green). Evaluation While evaluating the situation, the strategies taken for effective communication and the idea of informing the higher authority of the healthcare facility regarding the process should be mentioned. I was able to evaluate the lack of staffs, and associated mishaps occurring in the facility and hence, asmentioned in the research ofStrang et al.(2014) it was an effective step to manage the healthcare process. Conclusion In conclusion, it could be said that communication and interaction among nursing professionalsand between nurse and patient is an importantpillar for healthcare processes, however due to several reasons, this communication process becomes affected. Similar aspect was identified by me in my clinical setting and i took necessary steps to mitigate the disadvantage. Action plan Besides providing training to the healthcare staff regarding the strategies for complying with theinterpersonal communication among the staff or with patients, I will advocate for
5REFLECTIVE JOURNAL implementation of culturally competent care, by employing translator so that instructions and interventions could be easily transferred to the patients asDouglas et al. (2014) mentions it as an effective step. Scenario 3: Clinical issues and ethical dilemmas Description of the situation This clinical issue was faced by me while working with an elderly patient suffering from dementia and multiple episodes of fall. The clinical issue associated to this situation was related to his preferences and hence, it affected the clinical situation ethically (Ponte et al., 2014). The patient suffering from multiple fractures was continuously requesting for a walk in the garden and often used to refuse the support from the assistant while using washroom. This was a serious concern as the patient had higher risk of fall and as his care taker, it was my responsibility to fulfil the need of patient to comply with patients ethical rights. Feelings While dealing with the patient and his needs, I was very nervous about the fact that, I wanted to comply with the ethical care process, without affecting my duty of care. However, I was completely confident about my strategies as I had faced such situation in my early nursing career. Therefore, I was hopeful that I will be able to provide the patient with his autonomy with taking care of his fall related risk. Analysis While analyzing the situation, it was understood that due to severe health condition, patient was suffering from depression and stress due to which, he wanted to conduct his activities
6REFLECTIVE JOURNAL of daily life on his own (Dwarswaard & van de Bovenkamp, 2015). To understand the mental state of the patient I started communicating with the patient and it was found that patient was unaware of his severe condition, and upon making him aware of his risk of fall, he agreed to utilize the healthcare professional support for his activities of daily life. Further, I made him aware of our duty of care and its importance in his health improvement and hence, through this process, he agreed to utilize the wheelchair or assisted walkers for his movement within his ward and agreed to every intervention to lower his risk of fall and improvement of his dementia associated condition (Ponte et al., 2014). Evaluation The evaluation process was conducted to understand the effect of measures taken for the compliance of ethical principles in the care process of the patient with severe dementia and high risk of fall (Dehghani, Mosalanejad & Dehghan-Nayeri, 2015). It was seen that after educating the patient with the risk factor associated to his situation and the strategies I am implementing to minimize his risk of fall, he started complying with the strategy and utilizing the assistant provided to him for his safe movement within the healthcare facility. Therefore, the strategy of spreading awareness and complying with the duty of care for the nursing professional was an important strategy which was successful in case of this patient (Dehghani, Mosalanejad & Dehghan-Nayeri, 2015). Conclusion In the conclusion, it could be said that complying with the duty of care was an effective step for the care process of the dementia affected patient as it included the scope of maintaining
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7REFLECTIVE JOURNAL the ethical principles too. Therefore, it was a good decision to include this in the care process and provide the patient with effective care process. Action plan To further maintain the safety of the patient above every ethical and duty of care, I would talk to the supervisor and explain this situation to him so that he can take effective steps for the implementation of thisprocess. Weekly assessment of the compliance of the healthcare professionals for safety and security will be conducted to assure this.
8REFLECTIVE JOURNAL References Dehghani, A., Mosalanejad, L., & Dehghan-Nayeri, N. (2015). Factors affecting professional ethics in nursing practice in Iran: a qualitative study.BMC medical ethics,16(1), 61. DOI: https://doi.org/10.1186/s12910-015-0048-2 Douglas,M. K., Rosenkoetter,M., Pacquiao,D. F., Callister,L. C., Hattar-Pollara,M., Lauderdale, J., ... & Purnell, L. (2014). Guidelines for implementing culturally competent nursingcare.JournalofTransculturalNursing,25(2),109-121.DOI: https://doi.org/10.1177%2F1043659614520998 Dwarswaard, J., & van de Bovenkamp, H. (2015). Self-management support: a qualitative study of ethical dilemmas experienced by nurses.Patient education and counseling,98(9), 1131-1136. DOI: https://doi.org/10.1016/j.pec.2015.05.017 Green, B. L., Saunders, P. A., Power, E., Dass-Brailsford, P., Schelbert, K. B., Giller, E., ... & Mete, M. (2015). Trauma-informed medical care: A CME communication training for primary care providers.Family medicine,47(1), 7. Lestander, Ö., Lehto, N., & Engström, Å. (2016). Nursing students' perceptions of learning after high fidelity simulation: Effects of a Three-step Post-simulation Reflection Model.Nurse education today,40, 219-224. DOI: https://doi.org/10.1016/j.nedt.2016.03.011 Marcus, C. (2014). Strategies for improving the quality of verbal patient and family education: a review of the literature and creation of the EDUCATE model.Health Psychology and
9REFLECTIVE JOURNAL BehavioralMedicine:AnOpenAccessJournal,2(1),482-495.DOI: https://doi.org/10.1080/21642850.2014.900450 Ponte, K. M. D. A., Silva, L. D. F. D., Aragão, A. E. D. A., Guedes, M. V. C., & Zagonel, I. P. S. (2014). Clinical nursing care to comfort women with acute myocardial infarction.Texto & Contexto-Enfermagem,23(1), 56-64. Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C., & Wood, L. (2015). Role of the registered nurse in primary health care: meeting health care needs in the21stcentury.NursingOutlook,63(2),130-136.DOI: https://doi.org/10.1016/j.outlook.2014.08.004 Snyder, M. (2014). Emancipatory knowing: Empowering nursing students toward reflection and action.JournalofNursingEducation,53(2),65-69.DOI: https://doi.org/10.3928/01484834-20140107-01 Strang,S.,Henoch,I.,Danielson,E.,Browall,M.,&Melin‐Johansson,C.(2014). Communication about existential issues with patients close to death—nurses' reflections oncontent,processandmeaning.Psycho ‐Oncology,23(5),562-568.DOI: https://doi.org/10.1002/pon.3456 Turchi, R. M., Antonelli, R. C., Norwood, K. W., Adams, R. C., Brei, T. J., Burke, R. T., ... & Levy, S. E. (2014). Patient-and family-centered care coordination: A framework for integratingcare for childrenand youth acrossmultiplesystems.Pediatrics,133(5), e1451-e1460.
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