Multifactorial Disease Characterised

Running head: REFLECTIVE JOURNAL
Reflective Journal
Name of the Student
Name of the University
Author Note

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Introduction
Cancer is not a single disease and is not caused by a single factor. It is the multifactorial
disease characterised by the uncontrolled cell division (Kahana et al., 2016). In advance stage, it
spreads trough entire body via metastases. When talking about the cancer, there is no single way
to do it, may it be the conversation is occurring in the hospital or in the patent’s home. The terms
battling or fighting cancer are the terms indicating how people choose to live with cancer and
respond when they have no control over it. There are discreet stages of the cancer each with its
own characteristics, needs, interventions and existential crisis. It includes before diagnosis,
diagnosis, treatment, recurrence, chronicity and end of life (Kahana et al., 2016). In each phase
the patient is exposed to varying vulnerabilities. Overall it is considered to be the vulnerable
experience as the disease affects people both physically and mentally. It also significantly affects
the loved ones mentally and socioeconomically (Kahana et al., 2016). During this journey, the
response of the patient and the families towards the illness is also influenced by the way the
cancer related information is relayed by the health care professionals. The communication
system between the patient and the radiation practioner or/and therapist determines the patients
outlook towards the illness, the psychological impact and the vulnerability experienced by the
patient.
The essay deals with the journey of the cancer patient named Michelle Sullivan. She was
diagnosed with the Triple Positive Breast Cancer. The essay is the reflection on the care of the
patient as well as communication between her and the medical practioner. The aim of the
reflective paper is to highlight the experiences of the medical professionals associated with the
Michelle’s cancer surviving journey; and the inconsistencies related with care and treatment

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process. It includes the communication strategies used by the medical practioners to ensure
effective communication with the patient. Further, the essay also demonstrates the impact of the
health care provider’s professional and unprofessional behaviours on the health outcomes of the
cancer patient. The reflective journal also outlines the learning and insights drawn from the
encounter with Michelle to conclude the factors that marks the best care.
Discussion on reflective practice and its importance to me as a medical radiations student
A reflective journal is the record of an individual’s thoughts, impressions and feelings. It
is used as a tool for self assessment and plan for future practice in similar situation, while
evaluating the effects of change (Horton-Deutsch & Sherwood, 2017). Reflective practice is
important for students in any setting as this process prompts thinking aloud. It allows one to
enter into a discussion with oneself regarding the experiences and the events that may affect the
professional practice. Students can construct their own learning goals by giving meaning to the
events and experiences. The quotations used by the students in their own reflective journals give
an insight of their emotional experiences and the practical skills development (Horton-Deutsch &
Sherwood, 2017). This is based on the philosophy that by reflecting a student actively engages in
learning instead of accepting the information passively as per Horton-Deutsch and Sherwood
(2017). There are various models of reflection that will enable one to reflect systematically to
reach a conclusion. It includes Atkins and Murphy frameworks, and Gibb’s reflective model that
are highly cited in the literature for its high significance (Lestander, Lehto & Engström, 2016).
According to radiation therapists, reflection is an integral part of the practice as well as
professional life. They engage in different modes of reflection as they perceive that it directly
affects their personal growth and the clinical practice (Cashell, 2010). In several studies

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conducted to obtain the perspective of the nurses and other health care professionals on reflective
practices, a positive outcome was evident. The common advantage reported by them is
improvement in the patent care (Coleman & Willis, 2015).
According to Tan, Cashell & Bolderston (2012) reflective journal for the radiation
students is essential to gain insights by indentifying their needs. Students are benefitted by
exploring and confronting the emotional side of the professional practice. Radiation students can
track how well they can communicate with the patients and the team of radiation therapists in
which they are working. Reflective practice will help develop critical thinking skills and learn to
cope up with each situation. This is also in alignment with the Schön’s definition of reflective
practice that emphasized on the retrospective critical thinking (Schön, 1987). I agree with this
view as I believe that refection should be practiced in present times to rectify any wrong step in
the care process that may affect the patient outcomes. Both Schon and Gibb’s view (Gibb’s
reflective model) on refection touches the concept of feelings in reflective practice and its link to
taking actions for future practice (Lestander, Lehto & Engström, 2016).
It can be interpreted from the literature review; refection will help one to perform their
professional duties in a manner that aligns with the accompanied values and ethics. I also believe
that refection is beneficial in improving self awareness. An individual can become the critical
reflector to understand personal actions and behaviors and how it impacts others and themselves.
In turn this will modulate the overall behavior of a person both as a radiation therapist and as a
human being. It will enable one to better perceive the right or wrong actions or behaviors that
may directly hamper the patient outcomes. In conclusion I believe that reflective practice is the
integral part of the student associated with any medical profession.

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Reflective practice is not without any barriers. Medical professionals have busy schedule
creating time shortage for engaging in reflective practice. Further, constraints include lack of
motivation to reflect on past experiences or commitment towards identifying the learning needs
for future growth and development. Such barriers if not overcome may lead to failure in
accepting the change required in personal and professional domains.
Discussion on the characteristics of the health professional, within relevant scope of practice,
governance and practice frameworks
A health care practice is regulated by the code of ethics, code of conduct and
professional standards in every country. When it comes to the medical practioner-patient
relationship there are various ethical considerations such beneficence, public rights, privacy and
confidentiality of the information. Other than dealing with patents these ethical considerations
are also important to determine the workplace professionalism. It includes attitude and behaviour
towards the seniors, colleagues, leaders and mangers. It facilitates working with integrity and
prevents unprofessional conduct. These standards and code of conduct are valuable for
professionals to understand the factors that may evoke ethical and legal implications. It will help
understand how these may impact the profession and the patient care (Doherty & Purtilo, 2015).
In Australia there are various organisations that have developed the practice standards as
well as code of conduct for the medical radiation practioners. One of the organisations is the
Australian Health Practioner Regulation Agency or AHPRA (Australian Health Practioner
Regulation Agency, 2017). It develops the standards and code of practice for the radiations
practioners as guided by the ARPSANA and implements them into practice. The primary
authority in Australia for radiation and nuclear safety is known as the Australian Radiation

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Protection and Nuclear Safety Agency (ARPANSA). This government agency is committed to
the public protection as well as saving environment from detrimental effects of the radiations. It
develops standards for radiation and nuclear safety in collaboration with the “Radiation Safety
Health and Safety advisory council” (Australian Health Practioner Regulation Agency, 2017). It
ensures regularity within all the practices. The standards developed by this agency pertain to the
clinical education, patient care, training and development of the practioners and the accreditation
of practice (Australian Health Practioner Regulation Agency, 2017). AHPRA is responsible for
the registration and accreditation of 10 health professions across Australia. It supports the
national boards of Australia for registration of the practioners into various fields, health schemes
and accreditation schemes with the primary goal of ensuring the patient safety. It implements the
national schemes under the National Law of different states and territories (Australian Health
Practioner Regulation Agency, 2017). The standards created by them are guided by the research
conducted by the international organisations such as “United Nations Scientific Committee on
the Effects of Atomic Radiation” (UNSCEAR) (Australian Health Practioner Regulation
Agency, 2017). These guidelines have been found to promote the safety of people as radiation
professionals are obliged to adhere to these guidelines. It assists them to save the patients and
colleagues from the ionizing and non-ionizing radiations.
In Australia the organization designated for the medical radiation profession is the, “The
Medical Radiation Practice Board of Australia” (MRPBA). This national board is responsible for
setting standards, values and code of conduct to support all the practioners of medical radiation
domain (MRPBA, 2015). It enables them to deliver suitable work within the ethical boundaries.
The code 1.2 highlights the elements of the good radiation practice emphasizing on values,
qualities trustworthiness, and compassion that facilitate patients trust and reliance on practioners.

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It also highlights the importance of the reflective practice for the practioners to stay updated with
changing demands of the profession. As per literature these standards and code of conduct have
been successful in enhancing the patient outcomes as well as work experience. The MRPA in its
code 3.3 states the importance of the communication in building therapeutic relationship with the
clients and giving effective treatment (Medical Radiation Practice Board of Australia, 2014).
There is a need of regular audit to ensure that three is compliance with these standards. Regular
audit and stringent policies to punish non-compliance to standards is necessary for the
practioners to work within scope of practice. Audit is necessary as setting standards alone does
not necessitate ethical practice (Ivers et al., 2012). There is need to ensure sufficient awareness
among the practioners about the import mace of these standards.
Reflections on Michelle’s cancer journey and how this will impact me as a medical
radiations professional
My first encounter with Michelle occurred in month of April during one of my lectures
within RMIT, Bundoora campus. She had visited to discuss her journey of cancer. She was
introduced as Michelle Sullivan, a 52 year old woman. She was diagnosed with Triple positive
breast cancer and was completely cured. She also had Ductal Carcinoma in Situ (DCIS) confined
to breast. Her story comprehensively described how communication is the detriments in addition
to others detriments that commonly accompanied cancer.
Description
As I listened to the story of Michelle, she would not have been diagnosed until quite late,
if only she had not received the letter for free breast screening in 2015. She was notified to be
entitled to free mammogram by Breast-Screen Australia on the 50th birthday.

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Due to lack of complete understanding of what a breast screening program entails the
woman had a disturbed communication with health practioner at first interaction. She was least
aware that her complain about feeling lump in her breast would not be resolved in the screening
clinic. After two weeks of mammogram she was called for follow up, and was conformed for
biopsy. She was then diagnosed with DCIS before Christmas. It was found to be small
aggressive tumour present in the inner lining of breast milk duct. Treatment was started
immediately after her diagnosis. It comprised of breast surgery, chemotherapy and radiotherapy.
While narrating her story, Michelle demonstrated her struggle more due to lack of
emotional support than the physical side effects such as hair loss, fatigue, and others. Her partner
being female she was not asked to accompany the treatment procedure. During her surgery, her
cancer was found to non-metastatic Triple Positive Breast Cancer. The name was because the
patient had tumours positive for Estrogen and progesterone, and high level of HER2.
Based on her narration it was evident that she had disturbed communication with the
staff and lacked empathy from the therapists. Sometimes she lacked detailed clarity over her
symptoms and disease progress. It increased her anxiety and made her difficult to cope with
illness on several occasions. It was also not constructive for her family to manage the feelings.
One such incidence includes professional not informing the purpose of the “blood pooling test 3-
4 times in 12 month time”. Further, Michelle also emphasised on the measuring day where she
became highly anxious as the 5 radiation therapists argued amongst each other about where to
begin. It was a situation of disgust and helplessness as she was lying naked. In Michelle’s words,
this was the condition where, “no animal puts themselves into”. Further, rounds of helplessness,
confusion and anxiety occurred as a new team was involved in her case in every session. She was
at terrible discomfort when discussion occurred among staff due to her large breasts. Such

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unprofessional behaviour and lack of compassion made her agitated and left dissatisfied. She was
also verbally abused by receptionist for requesting change of schedule. Further, the patient also
narrated that there was a lady from the radiation therapy team who was very polite and informed
patient about every details of the procedure. It gave hope and courage to Michelle. Also there
were other practioners she mentioned who at the time of bone scan showed compassion and
provided sufficient information to address her concerns. Michelle liked their professional
behaviour and her satisfaction was evident from phrase, “they were a great team...instilled
confidence in me”.
At the end of the narration, I started to ponder what could have I done as the practioner
that would have given a different experience to Michelle? I questioned myself about measures
that could be taken in such situation to enhance the patient satisfaction.
Feelings
After hearing the story of Michelle I felt a lump in my throat. Realisation dawned on me
as I was pondering over her helplessness, anxiety, discomfort and disgust due to inappropriate
communication with the therapists and staff, rude response of the receptionist, and negligence of
the radiation therapists leaving naked patient on table. She has encountered poor empathy right
from her day of mammogram tests. I felt angry as I am making career in the field of radiation
therapy. This not the kind of professional I wanted to be. I was imagining myself lying on the
radiation table naked with raised arms. I soon found myself in motion of tears as Michelle’s
words echoed in my ear “can someone please talk to me?” No human being can tolerate such
animal like treatment with themselves or with their loved ones. She was no wax model but a
human being with ability speaks and feels. How can practioners neglect her like any other object
in the room? I felt the patient’s dignity has been breached. Michelle and her partner were

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completely unaware of her disease. The behaviour of the practioners further added to their
distress. It altogether worsened the quality of her life.
Being a part of such profession it was disappointing to find the level of unprofessional
behaviour existing. I could understand how lack of communication and reassurance can make a
patient overanxious and apprehensive. It was evident from the patient’s words, “there was this
sense of vulnerability that really shocked me”. She was already unprepared for the consequences
of such health debilitating disease. Michelle was subjected to grater vulnerability by
professionals making her feel insignificant with growing intensity of her treatment. She was not
involved in the decision making or the intense medical discussion. It was thus obvious for any
patient to feel unimportant. I too went under shock after narration of heart wrenching story and
felt dismay. I could now better understand the struggle of the cancer patients as I have
personally neither encountered such story before nor had any person in my family with chronic
illness.
Once gain I realised the importance of reassurance, empathy and effective
communication to improve patient satisfaction. Emotional support for patient is as important as
the physical treatment. It gives hope and reinforces the patient’s courage to cope up with the
illness. This was also evident from the positive communication style of one of the practioners in
radiation therapy department, at Peter MacCallum Cancer Centre, who could instil sense of
comfort in patient. This has positive impact on me after I had felt frustrated on hearing the
negative experiences of Michelle. I felt inspired when Michelle mentioned about few practioners
who were compassionate and understanding. She felt satisfied, motivated and encouraged with
their behaviour as they informed of proceedings of the day, actions and treatment steps. I decided
to conduct myself in the same manner in future practice to set good example for others.

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Evaluations
On evaluating the professional behaviour of the practioners during radiation therapy, it
can be concluded as lack of compassion, and poor demonstration of empathy. The patient could
not be dependent on them. It could be considered as non compliance to the code 1.2 of MRPBA,
which states the practioners to demonstrate high integrity and show compassion and to be
dependable. All the three elements were missing in the radiographers. However, other workers
complied with this code who spent time with Michelle to explain her purpose of the medical
procedure and reassured that she was in safe hands. This behaviour demonstrated
professionalism and was in alignment with the standards and codes of effective communication
as per Medical Radiations Practice Board of Australia (2014).
Analysis
Michelle has been subjected to poor communication, vulnerability and negative response
by range of people including therapists, radiographers, and nurses. According to Song, Hamilton
& Moore (2012) poor communication during treatment and negative experiences increases the
patient psychological distress and negatively impacts the recovery process. Anxiety and
depression increases with lack of informed and inclusive decision in health care (Aning et al.,
2012). The confidence on the outcome of treatment and hope to survive diminishes with
physical and psychological impact of the treatment. In such situation vulnerability may be further
exacerbated if anxiety is unaddressed. Vulnerability can be reduced if the practioner builds
therapeutic relationship with the patient right from the day of diagnosis. Demonstrating the
patient centered care is a good way to reduce overwhelming feelings of the patient during
treatment (Tsianakas et al., 2012). The practioners must adhere to the section 2.3 and 3.9 of code
of conduct that emphasises on shared responsibility between patient and practioner as well as

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care inclusive of family members. In contrast to this the radiographers did not involve Michelle’s
partner. The patient was neglected on table while the professionals were busy in decision
making. As per section 3.3 the practioners must engage in active listening to carefully address
the patient’s worries as it may impacts the health perspective of the patient (Medical Radiation
Practice Board of Australia, 2014). In the screening department, the professionals neglected the
patient’s query for lump in breast.
Conclusion
It can be concluded that the unprofessional behaviour of the therapists and staff was
preventable by complying with the professional standards. The reflective framework suggested
by Gibbs helped identify the areas of improvement for promoting the patient satisfaction. It
involves active listening to patient’s concerns, and responding respectfully. It also includes
taking into consideration the patient’s rights, self respect and maintaining dignity. Provision of
compassionate care and being empathetic is an important determinant of positive patient
outcomes and recovery. Further, practioners must inform patent about every detail of treatment
and include in decisions to reduce anxiety. Family members should be involved for promoting
greater support. Based on evaluation and analysis, it can be concluded that patients remember the
negative experience more than the positive ones. It can be concluded from the reflection that self
awareness of skills, attitudes and knowledge is essential for professionals to drive high quality
and safe care.
Action plan
My future plan is to develop active listening skills to address the patient queries
diligently. I will spend adequate time with the patient to develop therapeutic, compassionate
relationship and ensure dependability. I will work on my verbal and nonverbal skills to ensure

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positive outcomes through communication. I will be transparent, honest and maintain integrity so
that the patient can develop faith and trust in health care service. To provide emotional support I
will reassure her safety, involve family members and partners in decision making. To address
their anxiety and confusion, I would detail the purpose of the procedures and state the numbers
and relevant facts/figures. These measures will improve the emotional and physical wellbeing of
the patient as evident from literature. The reflection helped to understand effective
communication could improve the recovery of cancer patient, give them confidence, satisfaction
and increase health outcomes. It plays a great role in coping mechanism during cancer
treatment. Therefore, I will cater to clients needs, rights, preserve dignity and deal respectfully. I
will take patient’s feedback and apologise for any fault from my end.
Conclusion
In conclusion reflection plays a significant role in evaluating and analysing a situation to
identify the areas of improvements. Refection increases self awareness and ability to perceive
others concerns. It is an effective tool to update personas skills, attitude and knowledge based on
the current demand of profession. At personal level it is effective method to deal with real life
situations by developing critical thinking and problem solving skills. Hence, all the students and
professional must adopt reflective practice. Such practice helps us tune our behaviour as per
patients needs even though we cannot control the disease and it impact. However, responding to
the disease is under our control. The practioners could have behaved professionally which would
not have exacerbated Michelle’s anxiety already caused by treatment. Lack of communication,
compassion and empathy affects a cancer patient’s recovery more than the side effects of illness.
One can eliminate these elements by adhering to professionals standards of code of conduct. My
future plan is to overcome such communication issues.

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