Reflecting on Nursing Practice: A Case Study Using Tanner's Models

This report presents a reflective analysis of a nursing experience, employing Tanner's reflective model of clinical judgment. The author, a nursing student, recounts an encounter with an elderly patient of Asian background who was admitted with diabetes, obesity, and arthritis, and who held strong beliefs in spiritual healing and Ayurveda. The reflection details the challenges of building a therapeutic relationship with a patient distrustful of Western medicine due to past experiences with racism. The report progresses through Tanner's four stages: description, interpretation, reflection-in-action, and reflection-on-action. It highlights the importance of cultural sensitivity, effective communication, and respecting patient autonomy. The author describes how they built trust, addressed the patient's concerns, and provided culturally appropriate care, ultimately leading to the patient's cooperation with treatment. The report references the Nursing and Midwifery Board of Australia's standards of practice, specifically standards 2 and 4, to demonstrate how the author's actions aligned with professional guidelines, including comprehensive assessment, therapeutic relationships, and patient advocacy. The author concludes by emphasizing the commitment to adhering to these standards in future practice to ensure safe and effective patient care.

Rnning head: REFLECTION WITH TANNER’S MODELS
REFLECTION WITH TANNER’S MODELS
Name of the student:
Name of the university:
Author note:

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The nursing and midwifery board of Australia called NMBA has provided guideline of
standard for effective nursing practices. This care ensures that the nurses provide interventions
which are preventive, curative, formative, restorative, supporting as well as have different
palliative element (Fisher 2017). Out of the different standards, the two which could be used in
this assignment are standard 2 and standard 4 which states that Nurses should comprehensively
conduct assessment. This assignment will be mainly based on a reflective Framework provided
by Tanner which would help in systematic proceedings with the different steps of reflection. This
would help me to reflect the experiences in details and thereby derive knowledge from them.
The first step of Tanner’s reflective model of clinical judgment states description of the
background of the experience of the nurse. During my internship phase, I experienced an
incident where an old patient of an Asian background was admitted and was not a believer of
Western mode of treatment. She mainly believed in spiritual healing and considered Ayurveda as
the most beneficial treatment. She was suffering from diabetes type 2 and was obese. She was
also a patient of Arthritis and had restricted mobility. She had faced racism during her younger
years in the nation for which she had become why restrictive and adamant in her approaches
towards Australian. She did not want to stay in the hospital but due to the request of her son and
daughter in law, she decided to get admitted.
I noticed that she was not cooperating with me as she was not being able to rely on me
and on Western education. The racism that she faced in her younger days were restricting her
(Birks e al. 2016). She was quite concerned that whether I would be able to follow her cultural
traditions. She was not being cooperative and for this reason I was not being able to either start

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my treatment or diagnose her symptoms closely. She was quite concerned about her autonomy
and dignity.
The next stage is called the interpreter stage. From the entire incident, I noticed that the
patient might have gone through several unexpected and tragic events with Australians in her
yester years. For this, she has suffered both mentally and physically. I also realized that this
negative feeling would affect the relationship that needs to be developed between me and the
patient for effective treatment. Therefore, it was very important for me to develop a therapeutic
relationship with her so that I can gain her trust (Scanlon et al. 2016). Developing trust is very
important as this would make the patient feel mentally stable and she would co-ordinate and help
me with the interventions. I also noticed that she is quite concerned about her cultural traditions
and preferences and therefore she is quite concerned about her treatment methods. Therefore in
my treatment methods I have to be very careful so that I do not hurt her emotions about her
cultural traditions (Sivaraman and Green 2015).
At first I tried to cool her down by telling her that the Australian in the early years were
insensitive. However with the passing of years the Australians have taken all as their own
brothers and sisters. Making her feel comfortable was my primary aim and counseling her about
her perceptions about the Australian was extremely necessary to develop trust in me as well as
the western Healthcare system. My procedure of listening her every experience with concern
and concentration made her feel respected and important and she gradually started relying on me
(Cashin et al. 2015). I was gradually being able to develop a relationship where she was able to
confide in me and was following my advices properly. I also educated her about the recent
advancements that the Western Healthcare system had made which made her quite amazed. At
the same time I also told of the benefits of Ayurveda which made her feel that I also respected

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her cultural preferences. She was quite happy with the discussion and she became ready to help
me and corporate with me in the treatment procedures. To this, all her family members were very
happy and they completely were amazed about how I was being able to successfully develop
relationship with their mother who was very adamant.
The next stage is called the reflection in action stage. I started my treatment with the
patient first asking for her consent which made her very happy. I first calculated her blood sugar
level which was very high at that time. I injected her insulin and provided her with the necessary
medication. She was also having wound on her foot due to the effect of diabetes and therefore
podologist was called for. I also made her understand about the importance of maintaining the
correct diet to properly maintain her weight. I also appointed for a Physiotherapy session with
her so that she can be relieved of the pain from her knees as she was also suffering from arthritis
(Kyle et al. 2017). It was the patient who told me that my educating her about the entire
procedure before applying the interventions made her feel respected and confident that he would
get well very soon.
The next stage is called the Reflection or action stage. With the help of standard 2, I was
effectively able to handle the patient. It says engagement in therapeutic and professional
relationships by the nurse. It states that there is an urgency to communicate effectively and be
respectful of the dignity of a person as well as her culture, values and beliefs. While handling the
patient I followed this criterion which helped me to communicate with her easily and thereby be
respectful to her dignity and culture. This made her comfortable with me and she was able to
open her up in front of me with all the experiences of a life. This Standard also states the
importance of recognition of patients as the experts in their experience of their life. Therefore
while communication I gave her enough scope so that she can open up the experiences of her life

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and thereby I can develop an understanding of the different hardship she had gone through her
life. Tthis helped me in developing my treatment approach. This standard also stated providing
support to the patient and directing them to resources so that they can optimize health related
decisions ("Standard of practice, Nursing and midwifery board of Australia", 2017). Here I
educated her about the importance of proper diet and how proper diet can help for maintain her
blood sugar level as well as her pain in the arthritis.
The next standard that was followed by me was standard 4 called comprehensively
conducting assessment. It states the importance of conducting assessments with a Holistic as well
as culturally appropriate ("Standard of practice, Nursing and midwifery board of Australia",
2017). Therefore I mainly focused on making the patient comfortable mentally as well as
physically so that the treatment I provide give the best outcome. Forcing a patient with
interventions which are without his or her wish does not yield successful result. Therefore I
followed culturally appropriate as well as holistic treatment methods which kept her internally
peaceful and happy. Moreover, it also stated the importance of the use of assessment techniques
to collect relevant and accurate information to inform practice. Besides the various important
diagnostics that have been performed to measure her blood sugar level, I also took verbal consent
from both the family members as well as the patient in documented form about the different
assessments which were conducted. Moreover I also engaged in to effective communication with
the patient to gain relevant data about her health and also followed medical history which was
provided to us by her family members. It also states the importance of working in partnership
with different experts to determine the factors that affect the health of the patient. Therefore I
also took suggestions of doctors, podologist and Physiotherapist so that the care which is
provided to her becomes comprehensive in nature.

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Therefore in my future practices also I will strictly follow each and every standards of the
code in order to ensure the safest care to patients.

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References:
Birks, M., Davis, J., Smithson, J. and Cant, R., 2016. Registered nurse scope of practice in
Australia: an integrative review of the literature. Contemporary nurse, 52(5), pp.522-543.
Cashin, A., Buckley, T., Donoghue, J., Heartfield, M., Bryce, J., Cox, D., Waters, D., Gosby, H.,
Kelly, J. and Dunn, S.V., 2015. Development of the nurse practitioner standards for practice
Australia. Policy, Politics, & Nursing Practice, 16(1-2), pp.27-37.
Fisher, M., 2017. Professional standards for nursing practice: How do they shape contemporary
rehabilitation nursing practice?. Journal of the Australasian Rehabilitation Nurses
Association, 20(1), p.4.
Kyle, R.G., Medford, W., Blundell, J., Webster, E., Munoz, S.A. and Macaden, L., 2017.
Learning and unlearning dignity in care: Experiential and experimental educational
approaches. Nurse Education in Practice, 25, pp.50-56.
Scanlon, A., Cashin, A., Bryce, J., Kelly, J.G. and Buckely, T., 2016. The complexities of
defining nurse practitioner scope of practice in the Australian context. Collegian, 23(1), pp.129-
142.
Sivaraman, G. and Green, N., 2015. Continuing professional development: Can-and should-what
you do on social media cost you your career?. Queensland Nurse, The, 34(4), p.32.
Standard of practice, Nursing and midwifery board of Australia. (2017). Retrieved 19 October
2017, from http://file:///C:/Users/user00/Downloads/1798150_1830561517_Nursing-and-
Midwifery-Board---.PDF