NRSG370: Reflection on Care of a Dying Person Using 5Rs Framework

This report is a reflective analysis of a nursing student's experience in caring for a 45-year-old patient, Mr. James, diagnosed with advanced testicular cancer. The student utilizes the 5Rs framework (Reporting, Responding, Relating, Reasoning, and Restructuring) to dissect the emotional and practical aspects of providing end-of-life care. The report details the initial shock of the diagnosis, the doctor's communication strategies, and the student's personal responses to the situation. The student observed the doctor's use of verbal and non-verbal communication techniques and the importance of family support. The reflection emphasizes the importance of effective communication and the emotional challenges faced by nurses in palliative care settings. It concludes with the importance of reflective practice for professional growth and the value of the 5Rs framework in guiding the reflection process and highlights the crucial role of effective communication in palliative care, emphasizing the need for healthcare professionals to be well-prepared to interact efficiently with patients, their families, and other caregivers.

“NRSG370 ASSESSMENT TASK 2A” 1
Name of the Student:
Student ID Number:
Module: Topic: 2A Reflection on care of a dying person using five Rs
Specialty area:
Number of Words:

“NRSG370 ASSESSMENT TASK 2A” 2
1. Introduction: It is a great idea for nursing practice to concentrate upon the healing and
treatment process and improvise techniques for reflecting on the process as a whole, in
order to assess the accomplishment of the entire nursing process. The 5Rs Framework for
a Healing and curing method in the Health industry is one of the key process (Carrington
& Selva, 2010). Using the 5Rs Framework is critical to ensure that the entire nursing
process is properly reviewed and enhanced (Ryan & Ryan, 2013). Reporting, reacting,
relating, reasoning and reconstruction are the key steps of undertaking reflection using
the 5Rs framework (Project, 2015).
Any patient with an advanced, incurable illness is treated with palliative care (Doherty et
al., 2017). End-of-life care includes pain management and related symptoms of illness
and seeks to improve the quality of life by means of an integral strategy including
physical, social, psychological and spiritual care elements (Doherty et al., 2017).
Effective interaction between nurses and other health professionals, patients and family
members and caregivers is the primary feature of palliative care, particularly when
communicating uncomfortable news. Research has shown that healthcare practitioners
are citing certain problems in communicating effectively, especially because of the
complexity of providing patients and their caregivers with hope to improve their quality
of life through a holistic approach that involves physical, social, psychological and
spiritual care (Ghahramanian et al., 2014).
2. Reporting: Mr James was a 45-year-old manager of a construction firm who found a
testicular swelling. Initially, he overlooked this because he believed it was due to a sports
injury and felt ashamed to talk about it with a physician afterwards. After one year he
developed a respiratory problem and acute back pain and was admitted to the emergency

“NRSG370 ASSESSMENT TASK 2A” 3
ward. The pulmonary metastases and referred pains were due to para-aortic lymph nodes
triggering these symptoms. His prognosis was highly unsatisfactory and his family was
asked to be present there to assist him when he was diagnosed. The doctor communicated
the unfortunate information to Mr James and his family in a quiet place, where I and
another senior nurse were present. It is obvious that both Mr James and his family were
totally depressed.
3. Responding: This case produced enormous mental discomfort for me. I was naturally
apprehensive prior to the event as it was the first time that I had been to a situation where
such unpleasant news must be broken to the patient and his family members. I had not
been prepared for the intensity of my own feelings by seeing the responses of Mr James
and his wife to the news and found it difficult not to weep. But I was able to quickly
manage these feelings and I was determined to do my best to make end-of-life care of Mr
James as pleasant as possible and offer the patient and his family maximum support.
4. Relating: The doctor communicated the unpleasant information to Mr James and his
family highly efficiently and was able to use his past experience in a professional and
sensitive manner to manage such a scenario. The choice of a quiet place instead of an
open hospital ward was perfect for Mr James to receive the news. The doctor
concentrated mainly on the verbal techniques used for effective communication, but also
on non-verbal techniques like to sit down on their level instead of standing while they
were sitting. He maintained eye contact with both Mr and Mrs James throughout the
discussion. The doctor didn't hurry through his talk and patiently explained the diagnosis
and prognosis of Mr James to make sure that he understood his statements and explained
whenever necessary.

“NRSG370 ASSESSMENT TASK 2A” 4
5. Reasoning: Since I was involved with such a situation for the first time, my role was
mainly one of the observers. Nevertheless, it was still an outstanding learning experience,
and I was able to create both verbal and nonverbal communication abilities by observing
the entire sequence of events.
6. Restructuring: I could feel I would have kept my feelings under more control during
my reflection, but I was completely unprepared to see the reaction from Mr and Mrs
James to the unpleasant news. The doctor played an important role with assistance from
the other skilled caregiver, both having significant palliative care experience to deal with
such unpleasant circumstances. The doctor relied mainly on verbal communication while
communicating with men while relying on non-verbal communication methods while
communicating with women ("Communication skills 3: non-verbal communication",
2018). The observation of the other nurses easily by touching Mrs James to comfort her
helped the other family members to get a little relaxation and to slightly reduce
uneasiness in the room. I found that, throughout Mr James's end-of-life care, the family
appeared to regard the nursing caregiver as a comforter and closer than the doctor.
7. Conclusion: Reflective practice is having importance for the ongoing professional
growth of nurses as well as for their learning process. The use of the 5Rs framework
allows the nurses to proceed logically and structurally through the reflective phase
(Levett-Jones et al., 2010). In palliative care, effective communication is crucial (Kumar,
D′Souza and Sisoda 2014). Caregivers and other health practitioners must be prepared,
both with their clients and with their family/caregivers and with other caregivers to
interact efficiently.

“NRSG370 ASSESSMENT TASK 2A” 5
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