Development in Nursing Through Crossfield Experiences

In nursing, professional development is essential as it helps to improve knowledge of working (Parandeh et al. 2015). The professional development can be achieved by the nurses through self-reflection. This is because in self-reflection the nurses can analyse their current way of delivering services to determine their strength and weakness to be resolved to act more effectively in providing greater satisfactory care to service users (Reljić et al. 2019). In this analytical reflection, my professional development as a student nurse is to be explained by using Crossfield experiences in child, adult, mental health and midwifery nursing. The compassionate person-centred care is the theme to be followed in explaining and reflecting different crossfield areas. In order to ensure confidentiality, pseudonyms of the patients are to be used so that the real identity of the individuals are no disclosed and reflections can be made by following the guidance mentioned by the Nursing and Midwifery Council (NMC, 2018).

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In my first crossfield area, I was entrusted to care for a child named Henry who had a fractured leg. On admission, it was seen he was suffering from intense pain and was also anxious which lead him to avoid accepting care from others and behave aggressively. As suggested by Keil et al. (2017), children suffer from social anxiety where they experience strong sensation of tension while being in the public. This is out of their feeling of nervousness among strange and unknown people. Thus, to calm Henry I told him that I know his mother as well as mentioned few details about his parents to make him feel that I am familiar to him. During communication, I maintained direct eye contact and show polite gestures as well as asked Henry that if he allows me to care for him I would offer him toys to play. This is done as in child nursing it is mentioned that sensitive, empathetic and respect in care is to be maintained (Baird et al. 2016). Therefore, my activity in the case of Henry helped me to initially show compassion by being sensitive to his needs to be fulfilled to make him calm and accept care.

After being clam, Henry mentioned how intense the pain he is feeling due to the leg. In regard to this, I asked him if I could check his leg to which he gave me permission. Thus, my strength in caring for the child was that I was able to show proper respect and sensitivity in a compassionate way towards him. During the examination of his leg, I tried to analyse it without inflicting further pain as well as used polite and smiling gestures while talking continuously to get assured he is not feeling extra pain to ease the child in the process. I assured him that I am going to give him an injection which is going to lower his pain. In this condition, he accepted to avail the medication to which I mentioned that he is a brave child. As mentioned by Blomberg et al. (2016), to show compassion the nurses required to act kindly along with use encouraging words towards the service users. This is because such act would make the service users feel being understood and motivated to accept care. Therefore, in my practice as child nurse, I was able to offer compassionate person-centred care to Henry as during the caring phase I analysed his specific needs and accordingly used encouraging words to motivate him to accept care.

The compassionate care by the nurses is essential as it helps the patients to be comfortable in accepting care without feeling any mental or emotional stress, in turn, allowing the patient develops greater will to survive (McSherry et al. 2017). In adult nursing experience, I was entrusted to care for stage II breast cancer patient named Sara who was 67 years of age and was undergoing the first cycle of chemotherapy. She was found to be anxious regarding her health and often expressed emotional breakdown. In order to lower anxiety of Sara regarding her health, I tried to communicate to her to understand the emotional support she required. During communication, I as did in case of Henry I maintained direct eye contact with Sara and used polite gestures along with became an active listener to understand her concerns in the similar I did for Henry. However, when Sara expressed her concern regarding body image after chemotherapy I was unable to control my facial expression of being thoughtful how she is going to manage her daily life whereas I was able to control my emotion in case of Henry. Moreover, I was unable to understand the way she is to be motivated and encouraged to resolve her worry regarding body image.

The study by Chambers and Ryder (2017) informs that offering emotional support to service users and maintaining positive body language is required to offer compassionate care. However, I was unable to show positive body language as instead of resolving the concern of Sara regarding her body image I personally became thoughtful and concerned regarding what could be done to help Sara. This lead Sara to become further depressed as she was not relieved of her concern. As mentioned by McSherry et al. (2017), unable to make patients relive of their concerns being critically-ill leads them to avoid showing support in accepting care. This is because they lose the zeal to live properly. Thus, my weakness in case of Sara was that as a student nurse I am incapable to determine the way depression and concern of adults with cancer are to be resolved to make them comply with care and be encouraged to live a better life by accepting care. This indicates, unlike Henry I failed to provide effective compassionate person-centred care to Sara as her emotional concerns were failed to be resolved by me with proper care services.

In another crossfield experience, I was provided the role to care for a patient named Hank who was suffering from schizophrenia. He was found to be facing delusions and hallucinations as a result of which he was admitted to the hospital. As asserted by Kilicaslan et al. (2016), people with schizophrenia develop delusional and hallucinating thoughts as a result of hyperactivity in the right and frontal-temporal lobes of the brain. The schizophrenic people due to delusion and hallucinations develop imaginations which are not real and initiate to hear and see things (Reeve et al. 2015). In the case of Hank, it was seen that he believe that I did not bath him. However, in reality, I did bathe him at the proper time under my supervision. The study by John et al. (2017) informs that making schizophrenia patients realise that they are hallucinating and having delusions by mentioning them to differentiate between thoughts and reality helps to resolve the symptoms. I had previously worked with 2 schizophrenic patients due to which I have the practical knowledge regarding the way to manage Hank's delusion. Therefore, through polite gestures and maintaining eye contact along with a positive body language as done in case of Sara and Henry I showed him that his clothes are cleaned as well as his hair is wet which indicates that he is already been given bath.

The study by Gould et al. (2018) informs that solidifying bonds with the patients by following their healthcare concern and complaints leads the nurses to deliver effective compassionate care. Thus, responding to the complaints regarding not given bath to Hank was an effective gesture of compassionate care showed by me as it helped me to show that I care whatever he says and wish to meet his needs. This is similar to the reaction I gave for Henry when he expressed concern regarding his pain. During the care, Hank was seen to be depressed at times because he realised that he is becoming burden of care for his family. The study by Lee et al. (2015) says that schizophrenic people develop attempt to self-harm out of uncontrolled hallucination and depression. I was concerned that Hank may involve in self-harm out of schizophrenia. Therefore, to improve his mood I develop active communication with him where I used encouraging words and informed him about various aspects which shows that he is capable to take his own care. The study by Ventriglio et al. (2016) informs that people with schizophrenia develop suicidal thoughts out of social impairment and lack of social support. Thus, I ensured that Hank's family members and friends pay him weekly visits to the hospital to ensure he has social support regarding his health. Moreover, I ensured I regularly interact with him for at least 30 minutes to help him share his emotions so that he remains motivated and do not develop suicidal thoughts. However, the study by Jakhar et al. (2017) informs out of the 270 participants suffering from schizophrenia evaluated for risk of self-harm and suicide attempts only 61 participants were identified to be at risk. This indicates that self-harm and suicidal attempt is not common among schizophrenia patients. Thus, I may lack effective ability to analyse person-centred needs of mentally-ill patients as in case of Hank it may be wrong that he has suicidal thoughts or would inflict self-harm just because he has schizophrenia. Therefore, it indicates that though I was able to offer compassionate care as the case of Henry but person-centred care was not able to be provided by me in this case like Sara’s case as I generalised the needs of Hank.

In midwifery nursing, I was entrusted to care for Annie who was pregnant and was in the labour room. She expressed anxiety that her baby may not be delivered properly and may die due to complications even though the vital of the baby was mentioned to be normal. One the key aspect of compassionate person-centred care is that the patient is to develop confidence in overcoming the health issue (Curtis, 2015). Thus, based on the fact I asked Annie if she wishes her husband to be present in the labour room to support her and resolve her anxiety. It leads her to disclose that her husband has recently left her and the baby for another woman. The NMC Code of Practice informs that to provide compassionate care with the nurses and midwives are to act in best interest of the patients (NMC, 2019). Therefore, in the process to offer compassionate person-centred care I failed to maintain professionalism by not considering the care to be provided in the best interest of Annie. This is evident as I did not bother to know whether or not her husband is there for her or not to assist. However, I tried to manage the situation as I did for Henry and Hank by developing polite communication with Annie and assured through positive body language and encouraging words that her baby will be properly delivered. I asked if she wishes to hold my hand during labour to which she smiled and accepted the offer. This indicates that though I initially failed to offer proper compassionate person-centred care but unlike Sara, I did not fail in case of Annie and ensured effective care is provided at the end.

The analytical reflection highlighted that I used effective evidence-based approach in practice. My strengths in the reflection identified is that I am able to provide compassionate person-centred care by offering encouragement and using positive gestures in case of child and midwifery nursing. However, I think I have weakness of generalising patient's needs which would create barriers to offer person-centred care along with compassion as seen from the case of Sara. Moreover, I have weakness of controlling emotions and have lack of knowledge regarding the way to offer compassionate care to mentally ill service users. Thus, in future, I need to keep in mind that I have to follow proper clinical procedure, understand patient’s history, consider individual needs of patients and control personal emotions to offer person-centred compassionate care to service users.

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References

  • Baird, J., Rehm, R.S., Hinds, P.S., Baggott, C. and Davies, B., 2016. Do you know my child? Continuity of nursing care in the pediatric intensive care unit. Nursing research, 65(2), p.142.
  • Blomberg, K., Griffiths, P., Wengström, Y., May, C. and Bridges, J., 2016. Interventions for compassionate nursing care: A systematic review. International journal of nursing studies, 62, pp.137-155.
  • Chambers, C. and Ryder, E., 2017. Excellence in compassionate nursing care: Leading the change. London: Routledge.
  • Curtis, K., 2015. Compassion is an essential component of good nursing care and can be conveyed through the smallest actions. Evidence-based nursing, 18(3), pp.95-95.
  • Gould, L.J., Griffiths, P., Barker, H.R., Libberton, P., Mesa-Eguiagaray, I., Pickering, R.M., Shipway, L.J. and Bridges, J., 2018. Compassionate care intervention for hospital nursing teams caring for older people: a pilot cluster randomised controlled trial. BMJ open, 8(2), p.e018563.
  • Jakhar, K., Beniwal, R.P., Bhatia, T. and Deshpande, S.N., 2017. Self-harm and suicide attempts in Schizophrenia. Asian journal of psychiatry, 30, pp.102-106.
  • John, J.P., Parekh, P., Halahalli, H.N., Menon, S. and Kutty, B.M., 2017. Auditory Verbal Hallucinations in Schizophrenia: A Model for Aberrant Self-consciousness. In Self, Culture and Consciousness (pp. 123-149). Springer, Singapore.
  • Keil, V., Asbrand, J., Tuschen-Caffier, B. and Schmitz, J., 2017. Children with social anxiety and other anxiety disorders show similar deficits in habitual emotional regulation: evidence for a transdiagnostic phenomenon. European child & adolescent psychiatry, 26(7), pp.749-757.
  • Kilicaslan, E.E., Acar, G., Eksioglu, S., Kesebir, S. and Tezcan, E., 2016. The effect of delusion and hallucination types on treatment response in schizophrenia and schizoaffective disorder. Journal of Psychiatry & Neurological Sciences, 29(1), pp.29-35.
  • Lee, K.H., Pluck, G., Lekka, N., Horton, A., Wilkinson, I.D. and Woodruff, P.W., 2015. Self-harm in schizophrenia is associated with dorsolateral prefrontal and posterior cingulate activity. Progress in neuro-psychopharmacology and biological psychiatry, 61, pp.18-23.

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