Background
The reflective practice is a tool that provides the health care professionals with the opportunity to explore the positive and negative aspects about their own practice (Dubé & Ducharme, 2014 pg no 91). This enables nurses to explore their strengths and weaknesses and learn from the errors committed to inform practice. Hence, the importance of having a reflective practice in the health care profession is extreme (Johns, 2017 pg no 2-18). In this essay I will explore the aspects of patient care experience and partnering in care taking the assistance of the interview of Mr. William Taylor. The essay will take the assistance of the Gibbs reflection cycle to reflect on the standards of prevention of fall and My Health Records in accordance with his experience.
Description:
It is the first stage of the Gibbs reflective cycle, which allows the nurse to explore the experience of the patient in the care and its quality (Dubé & Ducharme, 2014 pg no 91). In this case, a 75 year old patient named William Taylor had been interviewed regarding his experience in the care. The patient had suffered from two consecutive falls and many other illnesses for which he had to visit the health care facility many a times. However, the care experience of the patient had been not up to the mark which affected his inclination to visit health care facilities. Exploring the positive aspects of the care experience, Mr Taylor had been informed about his present health adversities. Although, the negative experience includes not being informed or educated about the falls prevention/ harm from falls and My Health Record.
Feelings and thoughts:
There are many areas of unsafe practice according to my best understanding of the experience that the patient had such as fall risk management and My Health Records (Safetyandquality.gov.au, 2018). As per the interview, the patient visited a General Practice setting soon after the first fall, and the GP failed to provide and fall risk assessment and prevention strategy to him. Due to the negligence and inappropriate practice standards he had to undergo another which is deeply disheartening. Furthermore, the patient has had a terrible experience of having to sit 11 hours with excruciating pain in the chaotic environment of Emergency departments(ED) where he had to go up to the counter to fetch pain medication. I believe this is extremely inhumane and morally distressing for a patient to be left unattended in a chaotic environment.
Discussion
Values and beliefs:
My values and beliefs centre on responsibility and accountability for the patients and providing safe and optimal care to them. My care approach as a student nurse is dominated by the moral righteousness and accountability for ensuring the safety and wellbeing of my patients with respect to my background and upbringing. In this case, the casual approach and negligence had resulted in a patient having a bad experience in the facility (Eaton, Roberts & Turner, 2015 pg no 181). If I had been involved as a nurse in the experience I would have ensured effective communication and information sharing with Mr. Taylor, most preferably taking the assistance of My Health Records I would have also ensured taking fall risk assessment and fall prevention strategies with his collaboration to ensure his safety. These values and beliefs have developed me as a responsible and accountable nurse. These values will help me continue safe and lawful practice which will benefit me as a professional and the patient and their family as well ensuring safe and effective care.
Analysis:
The care experience that Mr. Taylor had through the many health adversities and incidents that he has went through had been inadequate. Justifying this statement, it has to be mentioned that two very important standards of National Safety and Quality Health Service Standards or NSQHS are clinical governance and partnering with consumers (Safetyandquality.gov.au, 2018). As per the first standard, the care professionals must take efforts to ensure reliability, safety and quality of health care and optimal health and wellbeing status for the patients. This had been violated for the patient facilitated by inappropriate risk assessment and care planning to address his care needs. As per partnering with consumers, a person-centred health system with collaborative decision making of the patient is needed to be established for safe and effective care. In this case, although the patient had been informed about his complications, there had not been effective strategic care planning with the patient. Drawing reference from the clinical governance standard again, there had not been any initiative to introduce the patient to My Health records. This could have helped him to better manage his multiple illnesses considering his age and remote location (Joseph & Bogue, 2016 pg no 339-351).
The second aspect of the inadequate care for Mr Taylor relates to the fifth NSQHS standard, Comprehensive Care. This standard directs the nurses to integrate screening, assessment and risk identification processes for an individualized care program for the patient (Safetyandquality.gov.au, 2018). Mr. Taylor had sustained two consecutive falls and even after his visit to the GP after his first fall no fall risk assessment or fall prevention planning had been carried out for him. According to the standard 5.24. Preventing falls and harm from falls, falls prevention, minimising harm from falls, and post-fall management are necessary care steps after a patient encounters a fall. Neither of these necessary care interventions had been taken for Taylor, which resulted in further adversities and deleterious incidents for him. Phelan, Mahoney, Voit and Stevens, (2015 pg no 281-293), have stated the lack of proper fall risk assessment for elderly patients is an unsafe and inadequate care practice which jeopardizes the health and wellbeing of the patient. Hence, I have considered these two aspects as examples of inadequate care for William.
Conclusion drawn
Conclusion drawn:
I would like to highlight the two main themes of the care experience that Mr. Taylor had, lack of education and information sharing with the patient regarding risk prevention and lack of adequate care to him. Concluding the analysis, the patient experienced negligence, casual care approach and unsafe practice at different times he had visited the facility for. As discussed by Nichols, Horner and Fyfe (2015 pg no 23-31), the aged patient population often experience complicated co-morbidities and an individualized and systematic care planning is imperative. Positive participation in the care planning and implementation is also a very important aspect of care for elderly patients. Active participation and chance to collaborate allows patients to have better control of their health and also provides a sense of empowerment and value. In case of Mr. Taylor, both these crucial requirements of compassionate care planning had been missing which deteriorated his experience and reduced his help seeking behaviour (O’Beirne et al., 2018 pg no S1-S115).
Furthermore, the lack of fall risk assessment for Mr. Taylor is undoubtedly a grave violation of the professional code and conduct (Safetyandquality.gov.au, 2018). The lack of any effort from the care professionals to introduce him to My Health Record is also a notable mishap in the clinical practice, which further deteriorated the quality of his experience. Hence, a conclusion can be drawn that there is need for enhanced accountability in the care providers and adherence to practice standards and protocol. The patient himself expressed the need for better communication and development of a therapeutic relationship to improve care experiences which I completely agree with. The impact of lack of effective communication and therapeutic relationship is predominant in the experience (Gelso, 2014 pg no 117-131). Hence, there is need for reform of the care services involving training and skill enhancement of the staff to provide better care experiences.
Action plan:
As a student nurse myself, I believe the lack of effective communication, therapeutic relationship and adherence to practice guidelines contributed to the most of the challenges. Hence, in order to ensure that I do not commit similar errors myself I will attempt to develop my professional skills with training and workshops. I will also be taking the assistance of my supervisors to enhance my knowledge of professional guideline and frameworks along with research to be informed and updated about the latest practice guidelines and provisions (Johns, 2017 pg 2-18).
Conclusion:
On a concluding note, this had been an excellent opportunity for me to explore the aspects of safe and unsafe practice. This also helped me recognize and distinguish inadequate care practices and its impact on the patient safety and care experiences. This essay successfully identified many aspects of inadequate and unsafe practice and related it with professional standards and legislations. It can be hoped that the knowledge gained about safe and adequate care practices and partnering in care with patients will help me provide optimal care in my future practice.
References:
Dubé, V., &Ducharme, F. (2015). Nursing reflective practice: An empirical literature review. Journal of Nursing Education and Practice, 5(7), 91. Doi: 10.5430/jnep.v5n7p91
Eaton, S., Roberts, S., & Turner, B. (2015). Delivering person centred care in long term conditions. Bmj, 350, h181. Doi: 10.1136/bmj.h181
Gelso, C. (2014). A tripartite model of the therapeutic relationship: Theory, research, and practice. Psychotherapy Research, 24(2), 117-131. Doi: 10.1080/10503307.2013.845920
Johns, C. (Ed.). (2017). Becoming a reflective practitioner. John Wiley & Sons. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=9tnCDgAAQBAJ&oi=fnd&pg=PP2&dq=reflective+practice+in+nursing&ots=CQSimqxQje&sig=N39SJaPtiPJ2448qPtX50ri3DUk#v=onepage&q=reflective%20practice%20in%20nursing&f=false
Joseph, M. L., &Bogue, R. J. (2016). A theory-based approach to nursing shared governance. Nursing outlook, 64(4), 339-351.
Nichols, P., Horner, B., & Fyfe, K. (2015). Understanding and improving communication processes in an increasingly multicultural aged care workforce. Journal of aging studies, 32, 23-31. Doi:10.1016/j.jaging.2014.12.003
O’Beirne, M., Freeman, T., Singer, A., Wiebe, E., Lacasse, M., Viner, G., …&Rourke, J. (2018). Family Medicine Forum Research Proceedings 2017Documentation of chaperone use Normative definition of comprehensive practice Adherence to Choosing Wisely recommendations within primary care Experiences with medical assistance in dying Effects of a criterion-based competency assessment tool on identification and management of residents in difficulty What’s in an ITER? Capturing resident progression toward competence using the Competency-Based Achievement System Realist Canada-wide audit of Triple C …. Canadian Family Physician, 64(2), S1-S115. Retrieved from https://www.cfp.ca/content/64/2/S1
Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2015). Assessment and management of fall risk in primary care settings. Medical Clinics, 99(2), 281-293. Doi: 10.1016/j.mcna.2014.11.004
Safetyandquality.gov.au (2018). NSQHS Standards (second edition) | Clinical Governance [Online]. Retrieved from https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/nsqhs-standards-second-edition/. [Accessed on 25th Oct. 2018]
Safetyandquality.gov.au. (2018). Preventing Falls and Harm from Falls Standard 5. [Online] Available at: https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/NSQHS-Standards-Fact-Sheet-Standard-10.pdf [Accessed 25th Oct. 2018].
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