Significance of Reflective Practice in Nursing

Introduction

In nursing, reflective practice is important because it helps in developing a clear understanding of care situations along with assists in learning the knowledge and skills to be developed for their enhanced professional improvement. It is also important because it helps in sharing and learning from other professionals (Esterhuizen, 2019). The reflection of nursing care act as guidance for nurses to determine the actions in a similar situation that are avoided to be performed which support in creating better quality care to be delivered to patients (Galutira, 2018). In the current study, three reflections based on three different topics are to be presented that are emotional intelligence, conflict management and medication error. This is because often student nurses are seen to fail to control their emotions in delivering care and discussion of emotional intelligence is going to help them understand the importance of controlling emotions (Štiglic et al., 2018). Moreover, discussion of medication error and conflict management is necessary to understand the aspects of medication delivery that leads to error and nature of conflicts raised in caring for patients (Rutledge et al., 2018; Labrague et al., 2018). The reflections are to be presented by following Gibb’s reflective cycle. This is because the model helps in systematically evaluating the care experiences to determine the positive and negative actions along with future interventions to manage the negative actions (Li et al., 2020). According to the NMC Code conduct, the patient’s identity is to be safely secured to ensure confidentiality and privacy (NMC, 2018). Thus, during the reflection, pseudonyms of patients are to be used to indicate them so that their real identity and information are not made public. For nursing students seeking guidance, nursing dissertation help can be valuable in addressing these challenges effectively.

Reflection 1:

Emotional Intelligence

Description

In the elderly ward, I was allocated to take care of Mr. P who is 84-years-old was admitted for advanced stage leukaemia and had moderate dementia. In caring for P, initially he was often found to be confused and make poor judgement regarding my efficiency to deliver him care. He often showed non-compliance in taking medication by mentioning he does not trust me and thought I may intend to kill him.

During the care, once P reported that I did not provide him lunch and threw a bottle of water out of rage. I protected myself from getting hurt and politely mentioned him that his lunch was delivered in time by showing him the diet chart. He was confused with the situation and looked at me is a blank way without making any further comments. Later that day when I went to P to administer him medication, during which he cried and apologised for his behaviour. I felt to cry but controlled my emotions on watching him. Later I asked my manager if he could allocate other nurse to P’s care as I am finding it difficult to watch him suffer continuous negative emotion and pain. I also mentioned I feel extremely sorry and could not feel emotionally inspired to care for him any further after watching P suffer from pain in his chemotherapy days as he would remain cuddled in his bed with no intention to take medication from me. The manager asked me I cannot leave my duties of care based on my emotion and has to continue working to take care of P at all time till his last day at the hospital.

Feelings

In caring for P, at the initial stage when he expressed non-compliance, I would often feel frustrated and angry towards delivering him care. However, I would often control my emotions and feelings to politely provide care to him irrespective of his bad behaviour. As days of care for P extended, I controlled my negative emotions and gradually feel sorry for his condition as I know that his dementia situation is making him react in such an inappropriate way. The day when P threw the water bottle at me I was stunned and felt unsafe to provide him further care. His cuddling in the bed out of pain made me feel extremely sad and I cried later in my room thinking about his pain. The circumstances led me to feel I may not be competent enough to provide him care as I could not control his pain and suffering due to which I felt I need to leave the care responsibility for him.

Evaluation

The thing that went well was I expressed effective self-awareness of my emotions. It is evident as I always know how I felt in caring for P and way my expression of anger or frustration could ruin the care for which I controlled them to avoid them from getting expressed in front of the patient. This is important in effective care delivery because it assists the nurses to assume their feelings and its consequences which gives them develop greater ability to regulate their emotions and lower stress (Štiglic et al., 2018). The other thing which went well was that I expressed self-regulation of emotions. It is evident as I forever controlled all my negative emotion and remain calm in all situations to act empathetically and deliver proper care to P. This is important in care because self-regulation assist in remaining clam, coping with negative emotions, adapt to complex feelings and respond effectively (Cox, 2018). As argued by White and Grason (2019), ineffective self-awareness and self-regulation of emotions in nurses makes them fail to build positive therapeutic relationships with the patients. This is because it makes the nurses act in a negative way with the patients which causes dissatisfaction of care for the patients intending them to act without compliance and form hindered relationship with the nurses. It creates obstacles in reaching quality care delivery to the patients (Henry, 2017). The other thing that went well was that I was to act with empathy and compassion towards P. It is evident as I never acted in a rude or angry way with the patient irrespective of his vulnerable and non-cooperative behaviour. This is important as nurses by being empathetic express they understand the situation and pain of the patient. It makes the patient feel valued and develop gradual trust over the nurses out of being understood by others (Mohammadi and Yekta, 2018).

Similar thing was seen in case of P, where he gradually developed trust out of my empathetic care. The thing which did not went well was that I have lack of self-motivation to consistently work towards achieving my goals. It is evident as I felt less inspired to care for P every day and instead of developing actions to resolve his pain with increased arrangement of intervention, I tried to quit out of fear. As argued by Alconero-Camarero et al. (2018), lack of self-motivation leads nurses to experience more challenges in care. This is because without self-motivation the nurses succumb to their failures and negative emotions leading them to feel quitting responsibility. The other thing which did not went well was that I expressed hindered social skills. The individual who has good social skills in nursing are mentioned to be good at managing conflicting emotions and managing change along with handling good as well as bad news effectively (Pérez-Fuentes et al., 2019). In my experience, it was seen that I was unable to manage good and bad news regarding P with same ability and expressed failure to overcome my personal conflicts in delivering care to him.

Analysis

In nursing, Emotional Intelligence (EI) is referred to the ability of understanding, using and managing personal emotion to relieve stress, ability to empathise with other, overcome own negative emotions and challenges (Kotsou et al., 2019). In P’s case, it was seen that in some cases I lost my ability to maintain emotional intelligence as I was seen to express sadness and challenged emotions that was making me intend to avoid my responsibilities out of emotions. The student nurses are to maintain emotional intelligence by recognising their emotional triggers and shifting the focus away from the negative emotion through personal limitations (Sharon and Grinberg, 2018). In P’s care, I was able to control my emotional triggers and regulate my negative emotion in front of him. This is because I always kept a journal for my emotions where I would write down my thoughts to analyse them and determine way they can be controlled. It helped me show partial self-awareness and self-regulation required in emotional intelligence (Sharon and Grinberg, 2018).

The student nurses are to practice the way they are to react with self-awareness in controlling own emotions during care delivery (Pérez-Fuentes et al., 2018). I did the same which led me to be self-aware of my negative emotion and control them to effectively care for P. The self-regulation of emotion is also reached because I held onto the learned values of nursing and held myself accountable for any negative condition while remaining clam to develop solutions to cope with the emotion.

The student nurses to maintain emotional intelligence require to have support and motivation from supervisor (Štiglic et al., 2018). However, in P’s care, there was lack of motivation from my supervisor to overcome the negative emotions which is evident as he asked me to sort my emotions when I expressed feeling low to provide care to P. This made me lack hope to improve patient’s health condition and negative emotion. The lack of hope to overcome negative situation makes nurses demotivated and fail to overcome their negative intention of quitting to care (Di Fabio and Saklofske, 2021). Moreover, the failure to identify the changes required in care and develop hope for positive actions also leads nurses to develop poor motivation (Hajibabaee et al., 2018). Similar condition was faced by me due to which I expressed partial emotional intelligence ability. In nurses, poor social skills are faced because they fail to resolve the conflict raised from negative emotions leading them to avoid to involve socially with others (Cleary et al., 2018).

Conclusion:

The reflection led me to learn that there are five key elements of emotional intelligence which are self-awareness, self-management, empathy, motivation and social skills. The elements I expressed effectiveness are self-awareness and self-regulation of emotions and enhanced ability to show empathy. However, the skills to be improved are motivation and social skills. The experience could have been a more positive situation if I would have been able to inspire myself to overcome negative thoughts caused by the suffering of the patient. This is because the action led me to doubt my capability and think of overcoming my responsibility by avoiding it rather than facing it.

Action Plan

The action to be taken further is improving my self-motivation and social skills. For his purpose, I intend to set personal goals and benchmarks to be achieved in providing care to patients with complex health issues. This is because it would help me remain focused to think of achieving better actions (Cleary et al., 2018). Moreover, to improve self-motivation a positive mindset is to be developed so that negative thoughts are avoided that makes one feel fear of achievement (Henry, 2017). The social skills and additional skills required for better emotional intelligence are to be improved by me by working with a counsellor and asking views from experienced nurses regarding the way they practically control their negative emotion at work. This is because counsellor helps nurses to develop therapeutic ways in controlling negative emotion and the experienced nurses are able to share practical data regarding the way emotional intelligence at care are to be managed (Henry, 2017).

Reflection 2:

Conflict Management

Description

In the placement, while working as a student nurse I was allocated the responsibility to take care of Mr U who was 30-years-old. He was admitted to the hospital due to suffering from severe dehydration and had chronic kidney disease. The physician on assessing U mentioned he immediately require fluid transmission through the intravenous way as he is refusing to take any oral fluid out of continuous vomiting tendency. As a student nurse responsible for his care, my supervisor asked me to arrange IV (intravenous) fluids and make the cannula under her supervision. I initiated to make IV cannula on U’s forearm for which I applied a standard rubber tourniquet and to detect the best vein I went on to inspect his arm by touching. However, it was my first time and being nervous, I was taking time to detect the vein during which I was touching his arm. The patient mentioned that I am intentionally taking time and acted in a furious way by taking away his hand from me. He started to use abusive words and I was extremely confused regarding the way to calm him but still maintained positive conduct. I tried to act with compassion and empathy to calm him and explain my action, but he was not trying to listen to any of my words. In this condition, my supervisor interfered and explained to him the reason behind I was touching his arm that made him to calm down. My supervisor politely asked U to allow me to insert the IV to which he mentioned I need to be quick this time. This time my supervisor mentioned me the vein to which the IV is to be connected and I performed the action without involving in any further conflict with U.

Feelings

During U’s care, when he suddenly expressed non-compliance and entered into conflict with me by using abusive words I felt low self-esteem and anger. However, at the same time, I also felt that U may be making unnecessary judgement due to his stress with his current deteriorated health situation which made me further feel to still act with compassion towards him by hiding my anger. Moreover, I maintained positive behaviour because I felt expressing my negative thoughts would further worsen the situation. When the supervisor interfered on my behalf to calm the situation, I felt supported as well as incompetent out of being able to manage the situation on my own. At the end of the process, I felt extremely sad for being unnecessarily judged but was feeling confident as my supervisor mentioned to me that I tackled the situation effectively by acting with compassion and empathy

Evaluation

The thing which went well was that I was able to maintain patience during the entire situation which led the conflict not to be extended to higher levels that it cannot be managed at all. This is because maintaining patience by not reacting to the adverse comments during conflicts helps in processing the cause of the problem and create lack of instigation which may further infuriate the conflict (Grubaugh and Flynn, 2018). The other thing went well was that I was able to maintain positive attitude in front of the patient and the supervisor during the conflicting situation when U was unnecessarily blaming me for touching. The importance of positive attitude during patient-nurse conflict is that it helps the individual being blamed to avoid lose their emotional control and overreact which may hurt the sentiment of the patients (Abd-Elrhaman and Ghoneimy, 2018). The importance of level-headedness in conflict management assists in creating a calm demeanour (Özkan Tuncay et al., 2018). I was able to maintain level-headedness in the situation which helped me to avoid escalating the conflict.

The thing which did not went well was that I was unable to understand the body language and facial expressions of the patient to determine their emotions. It is evident as during the situation I later remembered that while I was touching U, he was making a frustrating noise from the beginning which I ignored. Moreover, I was so keen on attaching IV to his arm that I forgot to look at his face during the procedure to ensure if he is feeling calm or not. The other thing that did not went well was that effective communication was not established with U by me during the care. The communication is key to conflict resolution and management as it helps in resolving the doubts that raised the conflict through explanation and sharing of evidence against the doubts (Mishra et al., 2020). In the current situation, U was acting very rudely which made me unable to create a situation to make effective communication.

The other thing which did not went well was that I expressed hindered problem-solving ability and lack of immediate presence of ideas in resolving conflict. It is evident as with the intervention of the supervisor who mentioned U the reason of the need of extending the touching of his arm that is to avoid mistaking any vein to insert IV cannula which is needed to avoid him pain by avoiding the requirement of multiple sticking in his arm. I was feeling sad in the end because though my supervisor managed the situation, but it also indicated I was not able to manage the simple conflicting situation on my own and required my supervisor’s assistance.

Analysis

In nursing, conflict management is undertaking actions to resolve disagreement between individuals which in case not controlled leads the nurses to deliver low-quality care and escalate abusive situation (Arveklev et al., 2018). In caring for U, I maintained calm and controlled emotion so that the conflicting situation raised out of misunderstanding between me and him do not get escalated. The student nurses to achieve conflict management are to carefully make communication, perform active listening and have confidence in managing the situation (Hastings et al., 2019). In caring for U, I always felt lack of confidence which may have led me incapable to manage the raised conflict on my own. This is because lack of confidence in conflict management leads the nurses unable to feel strong security and determination in taking decision and applying them to resolve the matter (Mahvar et al., 2018). The student nurses to make conflict management are required to be proactive in determining the concern of the patient. This is because it helps the nurses to implement actions for conflict management at the early stage which helps in effectively solving the problem which leads to the conflict (Sbordoni et al., 2020). However, I was unable to determine U’s negative emotion at the early stage regarding touching his arm which made me face the conflict.

The student nurses are to perform active listening for conflict management as it helps in letting them know the reason and understand the thoughts of the person or patients who is presenting conflicting actions against them (Tadayon et al., 2019). At the care, I did not perform active listening which was evident as I was trying to explain to U that he is making wrong judgement without listening to why he is making such comment which led me to have failed problem-solving ability. However, my supervisor actively listened to U’s views which made her mention the reason I was touching and taking time instead of explaining that his judgement was wrong.

Conclusion:

The reflection of the experience led me to conclude that I have failed to make effective conflict management in care as it was my supervisor who intervened to manage the conflict and not me on my own. In conflict management, I did perform effective level-headedness, positive body language, maintain empathy towards patients and positive attitude which helped in avoid escalation of the conflict but did not assisted on resolving it. I expressed ineffective communication and active listening skills along with problem-solving ability due to which I failed to effectively manage the conflict on my own.

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Action Plan

In future, if similar situation is raised, the initial action to be taken for conflict management is actively listening to the conflicting ideas of the individual to understand the reason for the individual’s different thinking. This is to understand the evidence and information to be shared to resolving the problem which is creating the conflict. In addition, to make effective conflict management in future, I intend to think more creatively and ask right questions while considering multiple options to resolve the problem raising the conflict rather than concentrating on one solution. This is because there is no single way in managing conflict since different individual has different perspectives of same situation for raising conflicting views (Daniel and Daniel, 2020). Moreover, in similar situation, I would try to reach out to other for help without waiting for others to interfere as in time the conflict may escalate. It was my supervisor’s efficient problem-solving ability that he understood I needed help without me waiting to ask for it which may not always be available while acting as a registered nurse in future.

Reflection 3:

Medication/Drug Errors

Description

In the placement, while acting as a student nurse I was allocated to take care of patient named Mrs D who was admitted to the hospital due to severe chest pain and hypertension. She was also reported to have mild schizophrenia. The physician assessed her condition and diagnosed she is suffering from acute angina and hypertension. The physician prescribed propranolol (Inderal) to be provided to the patient in lowering her chest pain and raised blood pressure for the day. However, irrespective of the correct dose of the medication, D’s blood pressure and chest pain continued. At the time, the physician prescribed some other medication to be provided in combination with propranolol (Inderal). When the physician was writing the medication, he was in a hurry and made the writing in a manner I could not clearly understand. Moreover, he was on the phone and immediately left the place to attend some other meeting which led me no time to consultant the prescription with him.

The physician wrote amlodipine (Norvasc) to be provided to D with Inderal but the unclear handwriting made my supervisor read it as thiothixene (Navane) which is prescribed for schizophrenia patients. However, I knew D is already prescribed to take Chlorpromazine (Thorazine) as an anti-psychotic medication for her schizophrenia management and I thought same nature of medication may not be provided. Thus, I asked my supervisor to recheck the name with other experience nurse as the physician was not available over the phone. She took my idea and identified that medication error was going to happen as the medication is propranolol (Inderal). The next day when the physician came for D’s daily assessment I confronted the mistake to be made and way we averted it. I mentioned him my opinion to which he reacted in polite but firm manner that in case of any doubt I need to confirm with him.

Feelings

In the placement, when the drug error was identified by me, I felt scared that my supervisor is going to scold and humiliate me for making such assumption and trying to suggest her further actions to be done. However, she was calm and composed in the situation which led me to feel confident in speaking about the reason behind the doubt by me. When the physician asked me the reason for no calling him to resolve my confusion, I mentioned that I tried to call him. He mentioned he received only one call and since it was of such importance I should have repeated my calls which would made him call back or receive the call. I felt that I need to immediately apologise to him due to failure to repeat the call but mentioned him that I felt he would be disturbed so I avoided to call further. I felt scared of getting abused while informing the drug error to be made by my supervisor. However, my supervisor being in self-doubt avoided to react and accept my discussion which made me feel calm.

Evaluation

The thing which went well was that no adversities were faced by the patient as the drug error to be executed was averted in timely manner by implementation of effective decision. It is evident as the physicians checked the medication provided to D and mentioned that the right medication is being provided irrespective of the confusion we mentioned him regarding the error that could have happened. The other thing which went well was that effective actions were taken in managing and reporting the medication error without intending to hide it irrespective of avoiding its occurrence for the patient. It helped in following the NMC Code of Conduct by me where it is mentioned nurses are to report any error in care to the patients and their family members along with take immediate action to resolve the error on being detected (NMC, 2018). I informed the medication error and took ownership of the action in front of D’s physician and mentioned the way immediate actions was taken to resolve it so that its accrual occurrence can be prevented (Sherman and Cohn, 2019). This indicates I have acted morally in the care which is a good thing as it supported delivering ethical care to D.

The thing which did not went well was that right medication administration to D was not suggested carefully by my supervisor to me. It is evident as she did not bother to resolve her doubt raised due to lack of understanding of the handwriting in the prescription by the physician. I believed in my own instinct based on D’s health which I was not allowed to perform as a student nurse and asked her to recheck the medication before suggesting administration. The other thing which did went well was that I did expressed effective critical thinking skill. It is evident as I did bother to think the reason behind the physician to be prescribing D an anti-psychotic medication since his uncontrolled symptoms were all indicating issues regarding hypertension and cardiac health.

Analysis

The medication error or drug error are any nature of preventable event which may cause inappropriate medication to be administered to the patient while the control of the health management as well as medication is under healthcare professional (Di Simone et al., 2018). The student nurses to avoid medication error are to follow 5 R’s of medication administration which are right drug, right dose, right time, right route and right patient (nursingnotes.co.uk, 2015). In D’s case, the medication error was avoided to be occurred because I was able to follow the protocol of “right drug” as indicated under the 5 R’s of medication administration. The right drug was administered to D because of my ability to understand the medication requirement of the patients even though I failed to effectively understand the writing of the physicians on the prescription. Thus, carelessness was avoiding and the doubts was resolved by sharing the prescription to be read with another experience nurse for the time. I expressed poor ability in acting with competence because I worked beyond my ability by judging the use of a medication regarding which I had a doubt. In care, any doubt raised are to be resolved immediately by connecting with responsible professionals so that no care is delivered to the patient out of uncertainty and negligence which create risk of health adversity for the patients (Jember et al., 2018). Since I did not connect the physician, thus the competence issues remains with me.

The NMC Code of Conduct mentions that nurses are to act in best interest of the patient and provide them holistic care (NMC, 2015). In the current scenario, the Code was followed because as a nurse I averted the medication error which is in the best interest of the patient. The careless delivery of medication was intended to be made due to my supervisor’s action of assuming things rather than practically analysing them to determine the consequences to be faced in care. A hindered critical thinking was expressed by my supervisor mat be due to her lack of practical skill and enhanced knowledge in care. This is because lack of practical knowledge leads nurses to wrongly evaluate situations and made irresponsible decisions that create adversities for the patient (Jember et al., 2018).

Conclusion:

The learning achieved from the reflection is that carelessness in the care environment by the nurses leads to medication error and low-quality support to the patients. Moreover, poor handwriting of physicians while prescribing medication is one of the reasons for raising medication error in care. However, timely actions and informing the error to physicians while monitoring the patient’s health to take action if any adversities are raised due to the error helps in effective management of medication error in care.

Action Plan

In future, in similar condition, the initial step to be taken is that any doubts regarding the hand-written prescription is to be resolved by immediately contacting the physician in person or through mobile in case the physician is not present in the care environment. As a nurse, I would never make any judgement on my own beyond my competence to deliver care when in doubt and would try to connect with the physician first. This is because it would help me to reduce chances of error due to own mistake. Moreover, the prescription of medications is to be mentioned in computerised format compared to acceptance of hand-written prescription from physicians so that medication error can be avoided in care due to wrong determination of name of the drug. However, this action requires intervention from the leaders of the care environment as it is a change required at the organisation level. Moreover, as a student nurse I am going to undertake training regarding medication administration to patient. This is because medication administration training helps nurses to develop knowledge and skills in minimising medication error as they understand the way error are caused and way they are to be averted to provide quality care to the patients (Di Simone et al., 2018). Moreover, as a student nurse to avoid further medication error, I am going to act in collaboration with the pharmacists to determine the right nature, dose and way of medication to be administered to patients (Dirik et al., 2019).

Conclusion

The learning developed from the above reflection is that emotional intelligence is important in nursing because it helps the nurses to act professionally and potentially improve the care for the patients along with establish quality patient-professional relationships. The student nurses to show effective emotional intelligence are required to be self-aware of own emotions to avoid them to influence their thoughts and actions in care. Moreover, they are to self-regulate their feelings and act with empathy towards the patients irrespective of non-cooperative behaviour from the patients. Moreover, they are to improve their social skills and motivation to manage own emotions. The student nurses are also required to show effective conflict management as it helps in an unnecessary interruption in care. As a student nurse, I learned that conflict management can be achieved if compromises can be made and collaboration is achieved with other professionals. Moreover, conflict in care is to be managed by initially identifying the issue, understanding the interest of the individuals that raised the conflicting thoughts, evaluate option to resolve the conflict and implement action with enhanced thinking to manage the conflict. In addition, medication error is a major issue faced by nurses during care. It is often caused due to careless of resolving doubts regarding medication administration and improper handwriting of the physicians. Thus, nurses are to be careful and act in collaboration with the pharmacist as well as physicians and experienced nurses to avoid such error. The nurses are also required to undertake medication administration training and follow 5 R’s of medication administration to minimise chances of medication error.

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