Reflective Journal: Experiences in a Palliative Care Ward (Nursing)

This reflective journal details a nursing student's experience in a palliative care ward, focusing on the care of an 88-year-old man, Mr. Keith, who suffered from a cerebral bleed and a perforated bowel. The student reflects on their feelings, the challenges of communicating with patients and families, and the importance of teamwork within the multi-disciplinary team. The journal highlights the application of the Gibbs reflective cycle, emphasizing the importance of communication skills, accurate record-keeping, and a holistic approach to patient care, including psychological, social, physical, emotional, and environmental needs. The student identifies areas for future development, particularly in understanding complications arising from conditions like CVA and developing assertive communication skills to improve patient well-being. The journal references several sources to support the reflections on best practices in nursing care.

Description
In a placement during my second year when I was working in a palliative care ward, I was
working under the supervision of my mentor, caring for a 88 years old man, Mr Keith who
was an inpatient on the ward for 12 days after being diagnosed as having a cerebral bleed.
This had left Mr Keith with a right sided aphasia. It was during this time it was diagnosed
that Mr Keith was also suffering from perforated bowel and after discussion with his family
from the medical stuff it was decided that Mr Keith was for no further active care and was
to remain in the side room for palliative care (Li, and et. Al., 2020).
Feelings
During my second year as a student nurse I had been involved with the care or palliative
patients. However, I felt I still lacked confidence in this situation in communicating with
patients and families. I had been involved in Mr Keith care from admission as I had been her
admitting nurse and I felt I had established a good patient and nurse relationship which in
accordance with the Nursing and Midwifery Council allows for patient centred care. This is a
difficult time for the Keith family and as stated within The Healthcare Quality Strategy for
NHS Scotland. I would strive to provide care that was both caring and compassionate.
Evaluation
The negative aspect of this situation was that I was dealing with a palliative care patient and
that it was inevitable that my patient would die.
Jones (2012) advocates that it is essential in nursing to have good communication skills. This
is also advocated by Dougherty and Lister who states that communication is an integral part
of maintaining a high quality of record keeping which is regarded as a vital standard of
practice by the NMC. Communication and written care records aid to establish a continuity
of care. As nurses have a crucial role in care provision. It is important to note that any
information that is given to Mr Keith’s family is given in an open and honest manner and to
ensure that they understand and give opportunity to ask questions (Markkanen and et. Al.,
2020.). As Mr Keith was a palliative care patient it gave rise to effective teamwork within the
multi-disciplinary team to ensure all Mr Keith’s needs were met as well as his families to
ensure continuity of care whilst showing clinical excellence.
Analysis
The World Health Organisation (ND) describes palliative care as “an approach that improves
the quality of life of patients and their families facing the problem associated with life-
threatening illness, through the prevention and relief of suffering by means of early
identification and impeccable assessment and treatment of pain and other problems,
spiritual, physical, and psychosocial.”
A holistic approach was taken in planning Mr Keith’s care incorporating psychological, social,
physical, emotional and environmental needs (Thiagraj and Karim, 2020). These needs are
not only imperative to the patient but also had to include all Mr Keith’s family in who he had
requested to be involved. Within the ward I worked active care plans and patient care plans

are reviewed daily and updated accordingly to ensure the patient receives the best possible
care.
Jones (2012) states that it is essential in nursing to have good communication skills. This is
also reiterated by Dougherty and Lister who states that communication is an integral part of
maintaining a high quality of record keeping which is regarded as a vital standard of practice
by the NMC (Taylor, 2020). Communication and written care records aid to establish a
continuity of care. Communication also incorporates the ability to listen and support and
ensure understanding.
In addition to caring for Mrs Wade I was also given the opportunity to be involved in
meeting with the multi-disciplinary team which in Mrs Wade’s case involved the palliative
care team for the hospital. This again reiterated the importance of good communication
skills and accurate record keeping to ensure that all participants in Mrs Wades care knew
exactly what was happening (SIGN 20??). In terms of communication I felt I was gaining
confidence especially with the family members as I had built up a rapport which was both
professional whilst being friendly and trusting (Fandizal and Handiyani, 2020).
Mr Keith as well as any patient within our care should receive care outlined by the people’s
priority. Patients receiving palliative care should be made comfortable and pain free and to
be cared for in a safe and clean environment.
Action Plan
I feel for future development I will take responsibility for my own learning in areas where I
felt I lacked knowledge. In this situation I had assumed that Mrs Wade was recovering from
her CVA, however I was unaware that the effect a CVA has on the brain can result in
continence issues and result in bowel perforation (Ahmed, 2020). I believe that in the future
and with more experience I will be aware of complication resulting from a CVA and although
I would not expect to be an expert I would be better equipped to deal with similar situations
in the future (RCN 2013).In future, I will aim to develop my assertive skills when working
with colleagues, in order to ensure that the well-being of clients is maintained. In my next
placement, I will make this a goal for my learning, and will discuss this with my mentor to
work out strategies for how I can achieve this.
Reference
Li, Y., and et. Al., 2020. Nurses’ Psychological Feelings About the Application of Gibbs
Reflective Cycle of Adverse Events. American Journal of Nursing, 9(2), pp.74-78.
Markkanen, P., and et. Al., 2020. A reflective cycle: Understanding challenging situations in a
school setting. Educational Research, 62(1), pp.46-62.
Thiagraj, M. and Karim, A.M.A., 2020. Reflective Practices To Explore Postgraduate Students
Learning Experience In Mobile Learning Platform. Sains Humanika, 12(3).

Taylor, D., 2020. Reflective practice in the art and science of counselling: a scoping review.
Psychotherapy and Counselling Journal of Australia, 8.
Fandizal, M. and Handiyani, H., 2020. Pengembangan Supervisi Refleksi “Gibbs” untuk
Peningkatan Kepatuhan Kebersihan Tangan Petugas Kesehatan. Jurnal Kepemimpinan dan
Manajemen Keperawatan, 3(1), pp.22-28.
Ahmed, A.M., 2020. From reluctance to addiction: the impact of reflective journals on Qatari
undergraduate students’ learning. Reflective Practice, 21(2), pp.251-270.