Reflective Essay on Group Patient Care

This essay reflects on a group patient care experience in a clinical setting, highlighting the effectiveness of teamwork and the role of each team member. It discusses the importance of coordination, communication, and professionalism in providing quality care. The essay also emphasizes the benefits of team-based care and the learning opportunities it provides for trainee nurses. The case study focuses on a patient with chest pain and the steps taken by the team to diagnose and treat the condition. Overall, the essay highlights the significance of teamwork in delivering efficient and effective patient care.

Reflective Essay on a Group Patient care in a Clinical Setting
1. Introduction
This essay is a reflection of my encounter with a patient in a clinical setting
(Casey and Wallis, 2011). It will show how much effective I was to demonstrate my
clinical and interpersonal skills as a nurse working with a team of health care
professionals in a busy critical care unit. I am going to focus primarily on one patient
and how my group working as a team could provide the effective care to the patient's
satisfaction. In accordance with the NMC professional code no name will be used to
protect patient (nhs.uk, 2017) as well as group members’ confidentiality
(England.nhs.uk, 2012).
Implementing effective teamwork skills is a necessity in nursing (Sullivan. and
Garland, 2010).. I would think about the dynamics of my own personal experience (
Huber, 2013) .about the clinical encounter and how a team can be more effective in
providing a better solution. A well-coordinated teamwork plays an important role in
faster and better realization of a common goal in a team assignment. I was posted to
the cardiac care unit where the patient turnout is more and the treatment is time-
critical. A team is therefore essential for such an emergency unit (Sinatra-Wilhelm,
2012). Each team member plays his or her specific role and takes on various
responsibilities that together can ensure that the team functions well and achieve a
common goal. A well planned team care improves the coordination, completeness,
effectiveness, efficiency and quality care for the wellbeing of both the caregiver and
patient. To accomplish this, the transformation to group based primary care is
required for most of the practices, conceptual changes in the orientation of care is
necessitated with group dynamics and in providing training and education to primary
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care staffs and patients to understand their roles and responsibilities (Dong and
Temple, 2011). The team I am referring includes clinical staff, such as doctors A and
B, both cardiac specialists, myself as a student nurse trainee, doctor assistant C, a
specialized nurse D who is also my mentor. However, my team also included other
professionals, which may be needed in case of urgency, such as care manager F,
dietician G, pharmacist H, as well as non-clinical staff such as receptionist I.
I am going to use Gibbs’ Reflective Cycle model (Gibbs, 1988) to present my
reflection as it is a very popular model for such types of reflective essays. Reflection
(Davies, 2012) is excellent tool to learn from experiences.
It is seen as a important methodology especially for experts who learns through
understanding all through their profession (Jasper, 2013). Generally reflective process
is the way to learn from an earlier exercise or encounter (Husebø, O'Regan and
Nestel, 2015) to gain new insight about oneself and/or practice (Jasper, 2013). This
technique is viewed as an approach to promote the professional and self-improvement
of independent and qualified professionals, and ultimately stimulates both individual
and professional growth (Jasper, 2013). The “reflective cycle of Gibbs” dates from
1988 and includes six reflection stages that empower the reflector to reflect all stages
of an activity or experience (Brookes.ac.uk, 2017).
2. Description
During my posting at the acute cardiac care unit, I encountered a patient named Mr J.
The real name has been kept confidential due to confidentiality, “Standards of
conduct, performance and ethics for nurses and midwives article 5, 6 and 7” (Myatt,
2015), is about respecting people’s right to maintain confidentiality (Borneuf. and
Haigh,2010). I am going to maintain this confidentiality throughout my career. Mr J
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aged 50 was admitted to the acute cardiac care unit with severe chest pain. I got an
information beforehand that Mr J has to be admitted immediately and I should make
necessary arrangement. I called my mentor D and we two arranged necessary
equipment ready for the patient. I got the patient history and found that he was
admitted to the same ward one year back with similar symptoms. His body weight is
90 kg , height 175 cm, BMI was 30.5 ; it shows that he was overweight. At the time of
admission patient was complaining about breathing problem for last two weeks and
the situation became worse on the day of admission (Dewar and Nolan., 2013). The
specialist doctor A and B were informed and A is expected to arrive within one hour
and B will be delayed as he was busy with a surgery. However assistant physician C
was available.
Before admission to the hospital, patient was taking prescribed medicines to control
blood pressure and hypertension. He was not having any allergy to any medicine and
he had not taken any traditional medicines. His family history showed that his father
died of heart disease 10 years ago and his brother was also suffering from
hypertension. Mr. J drinks occasionally. At the time of admission the patient was
having senses and was able to talk slowly but from facial expression we can make out
that he was suffering from acute pain.
Immediately after placing the patient on the bed physician C conducted some
diagnostic investigation known as PQRST pain assessment where P stands for
position of pain, Q stands for quality of pain whether it is a dull ache, pricking or
crushing pain. R stands for radiating pain, Common sites include the anterior chest,
shoulders and arms, S stands for severity of pain and T stands for duration of pain.
After analysing the symptoms the assistant doctor C talked to the specialist doctor A
over phone and dictated me to record the symptoms. He informed the specialist nurse
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D to immediately act on the following. I was assisting my senior to conduct the
following:
A 12-lead ECG is to be performed and the output should be checked by a medical
super at the earliest; to continue access to a defibrillator and to conduct diagnostic
tests such as a full blood examination (FBE), troponin and electrolytes. Other tests
included liver function test, urea and electrolyte test and cardiac enzyme.
I informed pathological department to come and collect the necessary samples for the
tests mentioned by the physician C. The assessment of the chest pain of the patient
was necessary as it would help in diagnosing the root cause of the pain so that prompt
and appropriate measures can be taken to reduce the pain and treat the root cause. The
patient’s SPO2 was found to be 92%. Oxygen therapy is only indicated in the hypoxic
patient with a SpO2 less than 93%,. The heart beat was 105. It is very much on the
higher side and blood pressure was 175/95. It is very much high. I took the body
temperature which was recorded as 370C.The temperature was normal. I assisted my
senior nurse to apply urinary catheter to the patient to monitor the fluid outflow. I was
told to observe the readings of different parameters like heart beat and blood pressure
on an ongoing basis. The entire diagnosis process was going on in a very calm
environment which is a necessity for a heart patient. The specialist physician arrived
within one hour and went through the data collected so far and based on the
symptoms and available data Mr J was diagnosed with congestive cardiac failure
(CCF) with fluid overload. The patient was also suffering from hypertension. The
doctor prescribed a number of medicines which are to be administered as per dose and
period for next seven days. The patient’s daily fluid intake was restricted to half litre
per day and oxygen therapy has to be given using a face mask as the patient was
having short of breath. After 12 hours the patient started showing improvement.
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My role was proactive as I was working as a helping hand for my senior nurse and the
doctors who had attended the patient. I was continuously monitoring the different
parameters as instructed by the physician to record every half an hour. I along with
my senior administer stress tests and electrocardiograms to patients as he was
suspected of heart attack. I was monitoring patients' vital signs and administering
medications. My senior was reporting the patients' status to doctors and I was
communicating with the families and friends of the patient.
My group acted like a cohesive unit and the entire diagnosis and intervention was
carried out smoothly. Without a team effort such a critical case cannot be handled by
one or two individuals. This experience has given a lot of learning points how to deal
with a critical situation without any problem. This team dynamics is a welcome
change in the medical care system and gives satisfaction to all the members of the
team. Moreover I can show more maturity and professionalism in my future
assignment when I come across such a situation. This kind of on the job exposure is a
welcome change to the trainee nurses in critical unit setup. There was absolute
coherence in thought and ideas among all the team members and the communication
was highly professional in nature. The ultimate beneficiary is the patient who was
getting dedicated care from all of us and also the family members who were informed
about the developments from time to time.
3. Feelings
This is my first experience to perform in a group. I have been working in this unit for
last three months but I was only interacting with the mentor and my role was limited
to helping my mentor in day to day activities. I was unsure about my position. But the
group activity has given me a lot of pleasure. I started feeling that I am equally
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important. Ultimately, I have got the confident or experienced enough to deal with
this type of situation in future and after a few encounters like this I will be in a
position to take a lead role in my group. Initially I was a bit suspicious about whether
I would succeed in such an experienced group but the group dynamics has helped me
to identify my role clearly and I performed this with dedication and perfection. I want
to add a few lines about the benefit of team. Team is necessary to work as a unit when
a particular task requires involvement and co-operation from a number of persons.
The team members should demonstrate co-ordination among themselves to make a
successful team.. It is significant to classify the roles of individual members for
improving the effectiveness of the team. It is observed that a team with a balance of
personality types perform better than those with similar personalities.
4. Evaluation
I was fortunate enough to say that my first experience to perform in a group is quite
pleasant. This is because all other members were highly professional (Tang, Chan,
Zhou. and Liaw, 2013) and they know their job very well. My senior mentor was very
helpful to me as she was knowing that this is my first encounter in a group and she
was assisting me whenever I had a doubt. However one small incidence has created a
little confusion but was settled very amicably. I observed that the specialist doctor A
was not following aseptic procedure before and after checking the patient. I was a bit
nervous to point out the same to such a senior doctor who is having a very busy
schedule. I discussed the matter with my mentor and she took me to the doctor at a
corner and informed him that he should wash his hands before and after touching the
patient. The doctor felt a little hesitant at first sight and controlled himself and said
that he would wash his hands now and in future he would follow this meticulously in-
spite of his busy schedule. I was very happy with this particular incidence. In a
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nutshell I can say that except that incidence the entire episode was a good experience
to me. My main role was to inform the diagnostic centre to conduct different tests ,
evaluate the patient’s health, administer \the prescribed medicines , collect data from
the monitors, to observe any side effects due to the medicines and provide support to
the patien. I can acknowledge that I was committed and performed the duties with due
diligence. In future I shall be able to perform much better because I had some
hesitation during interaction with other group members but in my next assignment I
shall be more mature and shall be able to perform my duty with greater ease and
comfort.
5. Analysis
A number of government literatures support that hand hygiene is an important aseptic
technique to reduce cross-infection (Mortell,, Balkhy, Tannous and Jong., 2013), and
it is also observed that many professionals who are directly involved with health care
support do not follow the aseptic procedure of hand wash as per guidelines (Paul, Das,
Dutta, Bandyopadhyay and Banerjee, 2011). There is a high risk of these health
workers spreading infections through uniforms, and there is a need to review policies
on staff dress (Shelton, Raistrick, Warburton and Siddiqui, 2010). The “Nursing and
Midwifery Council Code of Professional Conduct (2004, section 8)” states that a
nurse should always be proactive to identify and reduce the risk to patients and
clients. So it is my duty to point out this irregularity to my mentor who was
supervising Mr J.
Team-based care is beneficial to the patients in many ways like extensive access to
care (additional reporting hours, less waiting time), more efficient and effective
delivery of extra services that are required to give quality care, for example,
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behavioural health, training to the patient , education for self-management ,
coordination of care, better job satisfaction and a situation where all medical and non-
medical experts can perform work that matches their capabilities. Fundamental to this
methodology is the conviction that, when practice utilizes the expertise of various
distinctive colleagues, patients are bound to get better consideration they require. A
group can likewise make necessary environment for overall quality improvement
utilizing intra-group communication and critical thinking. Different strategies can be
adopted for information driven and continuous quality improvement (Stonehouse,
2011). My contribution to the group is quite significant because I was proactive in
whatever job I was assigned to. I contacted the pathology department to collect the
samples for different tests as recommended by the doctor and I actively inquired
about the reports that were essential to the treatment. In addition, I noted the readings
of various parameters of the monitors at dotted times and determined whether there
was any change in the patient's condition, or whether there was any side effect to the
drugs being administered. I helped my mentor to adjust various instruments to the
patient's body. When the patient tried to express something, I was patient to know his
problems. In short, I have justified my role in the group.
6. Conclusion
From this experience, I have learnt that I should be more assertive and try to add
professionalism (Williams, Woolliams and Spiro, 2012) by the by ( not feel just as
though I can't accomplish something on account of my position inside the group or
length of experience) if I have to encounter similar situation in future. The knowledge
I have picked up from this experience implies that I should not be worried about the
outcome of an encounter as a disciplined effort from all the group members can solve
even the most critical situations. A greater emphasis should be given within the group
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to build strong working relationships between healthcare professionals (LaMartina.
and Ward-Smith, 2014) so as to increase levels of group cohesiveness. In this case, I
was a little hesitant to act because other than my mentor I was not familiar with the
doctors. For a newcomer, according to me I have done whatever was necessary. Over
reaction may create problems in the group, so I preferred to keep patience, though
constantly monitoring the condition of the patient. In the present case most of the lead
roles of nursing was done by my mentor but in subsequent assignment, I intend to
take lead in some of the activities like talking to the patient’s family or relatives, and
the education part of the patient before discharge from the hospital.
My learning points from this exposure are listed below:
1. For critical units when contribution from a number of persons are required, a group
performs better.
2. The group should work as a professional unit and individually nobody should show
any ego during the group activity.
3. Each member should know and understand individual role to perform in the group.
4. There should be cohesiveness in the group and each member should respect the
others.
5. The senior experienced members should act as a mentor to the junior members so
that junior should come competent in the particular field.
6. Service and satisfaction of the patient should be guiding principle of the group.
7. In case some misunderstanding happens between some group members, it should
be sorted out amicably.
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8. I have learnt how to make practical use of Gibbs reflective cycles to write this
essay.
7. Action Plan
In future I want to be more proactive in dealing with a situation, regardless of my role
within the team or the level of experience; this includes dealing with a patient under
stress, ensuring that information is communicated to the relevant staff and intervening
when I believe that this poses a risk to the health or mental well-being of the patient.
In addition, I want to improve my communication skill relating to communication
with the patients which is a different technique. For that I shall conduct independent
research into their specific needs; the information that I can use in my nursing
practice.
From my experience gained from the group activity (Atay and Karabacak, 2012) , I
can assume that in the event of patient sends some triggers, the group will work
professionally to address the problems. I will continue to document my regular
professional practice using the reflective model of Gibbs. I shall apply consistently
and confidently the principles and values described by the National League for
Nursing with regard to the individual needs of service users that is “to respect the
dignity and moral wholeness of each person without conditions or restrictions and
confirm the uniqueness of and the differences between people, their ideas, values and
ethnicities” (Nln.org, 2017). These are promoted by the National Health Service
(NHS) (England.nhs.uk, 2012), which originated from the ideal that quality health
care should be available to everyone and meet everyone's individual needs.
References
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Atay, S. and Karabacak, Ü., 2012. Care plans using concept maps and their effects on the
critical thinking dispositions of nursing students. International Journal of Nursing
Practice, 18(3), pp.233-239.
Borneuf, A.M. and Haigh, C., (2010) The who and where of clinical skills teaching: A review
from the UK perspective. Nurse education today, 30(2), pp.197-201.
Brookes.ac.uk. (2017). Reflective writing: About Gibbs reflective cycle - Oxford Brookes
University. [online] Available at:
https://www.brookes.ac.uk/students/upgrade/study-skills/reflective-writing-gibbs/ [Accessed
20 Apr. 2019].
Casey, A. and Wallis, A. (2011). Effective communication: Principle of Nursing Practice
E. Nursing Standard, 25(32), pp.35-37.
Davies, S., (2012). Embracing reflective practice. Education for Primary Care, 23(1), pp.9-
12.
Dewar, B. and Nolan, M., (2013). Caring about caring: developing a model to implement
compassionate relationship centred care in an older people care setting. International journal
of nursing studies, 50(9), pp.1247-1258.
Dong, D. and Temple, B., 2011, July. Oppression: A concept analysis and implications for
nurses and nursing. In Nursing Forum (Vol. 46, No. 3, pp. 169-176). Malden, USA:
Blackwell Publishing Inc.
England.nhs.uk. (2012). Com Nursing Our Vis mpassi g, Midwif sion and on in fery and C
Strategy Practi Care Staf \ ice ff 1. [online] Available at: https://www.england.nhs.uk/wp-
content/uploads/2012/12/compassion-in-practice.pdf [Accessed 20 Apr. 2019].
Gibbs, G., (1988) Learning By Doing:. A Guide To Teaching And Learning
Methods Further Education Unit .
Huber, D., 2013. Leadership and nursing care management. Elsevier Health Sciences.
Husebø, S., O'Regan, S. and Nestel, D. (2015). Reflective Practice and Its Role in
Simulation. Clinical Simulation in Nursing, 11(8), pp.368-375.
Jasper, M., (2013). Beginning reflective practice (ed.). Hampshire: Cengage learning.
LaMartina, K. and Ward-Smith, P., (2014). Developing critical thinking skills in
undergraduate nursing students: The potential for strategic management simulations. Journal
of Nursing Education and Practice, 4(9), pp.155-162.
Mortell, M., Balkhy, H.H., Tannous, E.B. and Jong, M.T., 2013. Physician ‘defiance’towards
hand hygiene compliance: Is there a theory–practice–ethics gap?. Journal of the Saudi Heart
Association, 25(3), pp.203-208.
Myatt, R. (2015). Nursing and Midwifery Council revalidation. Nursing Standard, 30(7),
pp.52-60.
11

nhs.uk. (2011). Principles and values that guide the NHS. [online] Available at:
https://www.nhs.uk/using-the-nhs/about-the-nhs/principles-and-values/ [Accessed 20 Apr.
2019].
nhs.uk. (2015). Principles and values that guide the NHS. [online] Available at:
https://www.nhs.uk/using-the-nhs/about-the-nhs/principles-and-values/ [Accessed 20 Apr.
2019].
Nln.org. (2017). Core Values. [online] Available at: http://www.nln.org/about/core-values
[Accessed 20 Apr. 2019].
Paul, R., Das, N.K., Dutta, R., Bandyopadhyay, R. and Banerjee, A.K., 2011. Bacterial
contamination of the hands of doctors: a study in the medicine and dermatology
wards. Indian Journal of Dermatology, Venereology, and Leprology, 77(3), p.307.
Shelton, C.L., Raistrick, C., Warburton, K. and Siddiqui, K.H., 2010. Can changes in clinical
attire reduce likelihood of cross-infection without jeopardising the doctor–patient
relationship?. Journal of Hospital Infection, 74(1), pp.22-29.
Sinatra-Wilhelm, T., 2012. Nursing care plans versus concept maps in the enhancement of
critical thinking skills in nursing students enrolled in a baccalaureate nursing
program. Creative nursing, 18(2), pp.78-84.
Stonehouse, D., (2011). Using reflective practice to ensure high standards of care. British
Journal of Healthcare Assistants, 5(6), pp.299-302.
Sullivan, E.J. and Garland, G.,( 2010). Practical leadership and management in nursing.
Pearson Education.
Tang, C.J., Chan, S.W., Zhou, W.T. and Liaw, S.Y., 2013. Collaboration between hospital
physicians and nurses: an integrated literature review. International nursing review, 60(3),
pp.291-302.
Williams, K., Woolliams, M. and Spiro, J.,( 2012). Reflective writing. Macmillan
International Higher Education.
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