Reflections in Healthcare: Ethics and Professional Duty

Introduction

This reflective essay is based on my experiences during my two months placement in a gastroenterology ward. The essay is aimed at discussing ethical behaviour as an aspect of personal effectiveness and the professional duty of candour. My focus on ethics is based on the knowledge of the important role played by ethics for all healthcare providers (Kangasnjemi et al. 2015). The professional duty of candour is an ethical aspect and requires that healthcare professionals have to be open and honest with their patients when something goes wrong with the cause of their care and treatment, or there is a possibility of distress or harm.

I adopted the Gibbs (1988) reflection model to map my reflective process. My reflection is on a particular patient who we will refer to as Peter, not his real name. Hiding his real identity is in line with the NMC (2020) Code of Professional Conduct that requires that patient’s confidentiality has to be guaranteed.

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Reflection

The Gibbs reflective cycle is an effective way of working through experiences (Husebo et al. 2015). There are six stages covered in the model, describing the experience, expressing feelings and thoughts on the experience, evaluating the experience identifying the good and bad, analysing the situation and making sense of it, concluding on what has been learned and what could have been done differently, and finally, developing an action plan on how one would deal with a similar situation in the future, and the appropriate general changes (Li et al. 2020).

Description of the experience

Peter was a 32 year old gentleman with a young family who had suffered from the irritable bowel syndrome for a long time and displayed multiple constant symptoms including flatulence, dyspepsia, constipation and diarrhoea. On this specific day, his condition deteriorated and was experiencing severe gassiness, bloating, diarrhoea, and constipation. He had lost weight over a two week period and also had rectal bleeding. He also had difficulties swallowing. Generally, Peter looked weak and looked very worried.

The remit of the clinical area (gastroentorology ward) where I was placed revolves around all gastrointestinal (stomach and intestines) and hepatological (liver, gallbladder, pancreas and biliary tree) disorders, with focus on key diseases such as gastrointestinal cancers, liver cirrhosis, gastrointestinal bleeding, gallstones, inflammatory bowel disease, gastroenteritis and irritable bowel syndrome. Given that this is my area of specialty, and due to the intricate diagnostic and therapeutic procedures (such as liver biopsy, colonoscopy, endoscopic ultrasound, and so on) that it involves, it is vital that I obtain and develop the requisite level of education, training and practical experience. This is important as it will significantly contribute to my professional development, as well as enable me to offer the best quality care to patients. Therefore, I posit that my placement in the gastroenterology ward will expose me to a real practice environment and facilitate me to acquire the necessary knowledge, skills and experience that is core to my professional practice development.

Expressing feelings and thoughts on the experience

On my end, I was not worried as I knew that this was a situation that could be put under control. I however shared in his worries and pain and also sympathised with him for his pain. I gave him numerous assurances that he would be okay. Despite my own feelings and thoughts, I remained cognizant of the need to stay in control as well as getting the patient in the right physical and mental state of what would follow- an assessment. I attempted to make Peter as relaxed and comfortable as I possibly could. Train and Padmore (2018) assert that making the patient (service user) feel relaxed and comfortable, thereby reducing any anxiety they have, is a key aspect of an effective assessment. The creation of a relaxed and friendly atmosphere is also important for the establishment of rapport and therapeutic relationship with the service user.

Evaluation of the experience

The NMC code (2020), requires that the consent of patients has to be obtained before they are accorded any form of treatment or care. In line with this, we had to obtain consent from Peter to go on with treatment procedures. After the initial assessment, we explained to him that the immediate focus would be on relieving the severe symptoms so that he could live as normally as possible. Having a good understanding of what IBS is and how to treat it determines the extent of success of treatment. To deal with the pain and diarrhoea, low-dose antidepressants would be administered, while laxatives could be used for his constipation.

The assessment and provision of the necessary care to Peter, as described above, occurred in compliance with the stipulations of the NMC (2018) which outline the power and rights of a service user. By explaining (informally) to Peter the course of action to be taken enabled him to decide what he wanted or was comfortable with- this gave him as sense of power as he had the chance to decide what he thinks is important for him, and makes him feel valued as a part of this treatment process (Barker and Buchana-Barker, 2005).

Nurses are considered as patient advocates and have to find a balance during the delivery of patient care. Beneficence, justice, autonomy, and non-maleficence are the main principles of ethics. Autonomy refers to the rights of a patient to make their own decisions on the basis of their values and beliefs (Chadwick and Gallagher, 2016). Explaining the proposed treatment plan to Peter ensured that he was adequately competent to make an increasingly informed decision on whether he wanted the prescribed treatment and he was informed that it was within his legal rights to opt out of the treatment at any point he so wished. By doing this, my team and I sought to promote Peter’s autonomy as well as respect for him as the service user. I feel that this is vital as it significantly contributes to their increased participation and engagement in their assessment and treatment process, thereby the negotiation of the necessary actions and realization of the targeted treatment outcomes. It is always within the rights of a patient to refuse any forms of treatment, and medical interventions, regardless of the benefits they stand to accrue. Fortunately for us, Peter consented to the medication we recommended.

The principle of beneficence requires that healthcare workers always have to act in ways that are beneficial to others, and are morally and legally obligated to do good (Thomas and Mathew, 2020). Administering laxatives and low-dose antidepressants was to Peters best interests as this would help relieve the immediate symptoms, after which she would be put under a comprehensive treatment plan encompassing management of lifestyle, diet and stress.

The justice principle requires that all patients are treated in a fair manner and as equals. Justice is related to how people are treated when there are competing interests with others. We ensured that Peter was fairly and equally treated and at no instance was he neglected or discriminated in any way. All available healthcare services were available to him without any form of discrimination. There were also fairness in the amount of time that was accorded to him for care. This, I believe is a core requirement in healthcare and service, and by ensuring fairness and equality during my practice placement, I was able to develop my professional practice and effectiveness. Therefore, I will, at all times during my practice, ensure that I treat patients fairly by respecting their power and autonomy, and basing all my care decisions on the patients’ needs, as well as tailoring the care I provide them with to ensure that they suit and contribute to the realization of their health goals.

Patients also have a right to no harm as per the principle of non-maleficence, which requires that no harm is done to patients. Therefore, we put efforts to ensure that the care that we provided Peter did not harm in any way, but instead relieved his symptoms. The provision of safe patient care is a core function of healthcare professionals and which is clearly outlined by the NMC, which also highlights the necessary qualifications (education and training) that individuals should acquire before being allowed to practice. Therefore, I feel that through my education and training at the university and my actual practice environment placement, I will develop the required level of professional effectiveness with regard to the performance and execution of my roles as a gastroenterologist, including diagnosis, assessment of patients’ needs, planning interventions and delivering safe care and promoting service users’ health outcomes.

One of the areas we failed in was in that we did not involve any of Peter’s family members. The involvement of any of his family members, for instance, his wife would have gone a long way in improving different aspects of hospital performance, which include safety, quality, financial performance, patient’s experiences of care, and patient outcomes. There are multiple benefits of patient and family engagement, which when coupled together lead to better patient outcomes for patients.

Analysis of the situation

After the administration of the laxatives (milk of magnesia) and the low-dose antidepressants (Tofranil), his symptoms were observed to diminish and he gained some stability. The professional duty of candour requires that all healthcare professionals have to be honest with their patients whenever there are things that aren’t right. This duty required that we had to tell patients, and whenever appropriate, their advocates, carers and families, whenever there were things that were not right, apologise to patients, accord the patients appropriate remedy and support for purposes of putting matters right, and fully explaining to the patients the short term and long term effects of whatever happens. We were open and honest with Peter pertaining the nature of Irritable Bowel Syndrome, in that while his IBS would not get worse over time, but the symptoms would continuously persist if he did not take his medication seriously, which would bring immense pain and discomfort on himself.

Conclusion

My placement in an actual practice environment, during which I was actively engaged in the assessment and delivery of care to Peter, provided me with an important opportunity to utilize the knowledge and skills I had acquired through my education at the university. It also provided me with the chance to work with and learn from older professionals who are widely experienced in the specialty. Therefore, I can assert that this practice experience will significantly contribute to my professional development and effectiveness.

Action plan

To keep Peters symptoms of the Irritable Bowel Syndrome under control, I recommended to him that he eliminates high gas foods which lead to increased gas, gluten which causes diarrhoea, and FODMAPS. Additionally, I recommended different several medication including fiber supplements to help control constipation, and alosetron. Alosetron has been found to be effective in relaxing the colon and additionally slowing the movement of waste as it passes through the lower bowl. Peter would then report to the hospital two weeks after the meet up to report on his symptoms.

Following my involvement in planning the care for Peter, I got to learn how care plans should be developed. Given that care plans aim to address the patient’s needs they should be developed in collaboration with the patient. Due to their significance in delivering care to patients, care plans should/ must be developed with nurses’ help and the support of a multidisciplinary team, as well as incorporate SMART healthcare goals that revolve around the patient’s needs (Bianchi et al., 2018). Engaging patients in developing and implementing their care plans is important as it will result in personalization, which in turn contributes to adherence, and therefore improvement of health outcomes (Davies and Craig, 2009). This experience is vital given its contribution to my professional effectiveness with regard to development and implementation of care plans.

Development plan

Personal effectiveness development need

I know that to be effective, I have to be different and I will need to allow curiosity and originality into my mind. I plan to develop these traits through continuous learning to acquire more skills, become more competent and become increasingly objective so that I become increasingly effective in providing patient care and become more ethical (Kastikitis et al. 2013). My plan is to grow continuously by acquiring more knowledge through daily experiences during practice and also by going back to school and acquiring higher qualifications. I plan to pursue a Master’s Degree in nursing.

What is to be gained from the development

Nurses have been found to become more professional and grow in their roles after they attain higher academic qualifications. This is what I plan to achieve by enrolling for the Master’s Degree program. My plans are to take each class one at a time, and put efforts to ensure that I gain the necessary knowledge that would enable me to grow in the field. I believe the Master’s Degree program will open for me more opportunities to further my education to the doctorate level.

Required support and feedback

Nursing is an evidence based practice and therefore the care accorded to patients, their families and those who care for them has to be proven through research as the safest and most effective way of implementing care. I require the financial and material support of my family and any well-wishers to enable me to complete the course smoothly and on time.

I will require the support of my colleagues and patients to provide me with feedback on my progress of my professional growth.

How to evaluate how the development is to be reviewed

The Master’s Degree program spans a duration of three years. I will be reviewing my development after every six months after I begin the course. I will use patient reviews to evaluate my professional development. I will request different patients who pass through my hands to provide me with feedback, from which I will be able to determine whether I grow professionally. Another way I will evaluate my development is through asking for feedback from my colleagues. In addition, I will gauge my effectiveness through patient outcomes, and their speed of recovery.

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Conclusion

Without a doubt, I witnessed immense personal progress through this placement. Through clinical practice and observations, I was able to develop my nursing skills as an independent learner and also as a member of a healthcare team. In the different patient situations that I was presented, I stayed ethical. I commit to continuously engage in reflective practice for purposes of evaluating different clinical incidents, both positive and negative. That is because I have found reflection to be instrumental in the development of enhanced understanding and contemplation of events which happen, and my emotions, behaviours and actions, in addition to also better understanding patients and other members of the healthcare team. Reflection on practice increase the knowledge around a situation and is key for professional development. As a result of my placement and subsequent reflection on my experiences during the period which have equipped me with increased knowledge and clinical skills, I believe that I have sufficiently developed my professional practice and effectiveness as a young, aspiring healthcare professional.

References

Bianchi, M., Bagnasco, A., Bressan, V., Barisone, M., Timmins, F., Rossi, S., Pellegrini, R., Aleo, G. and Sasso, L., 2018. A review of the role of nurse leadership in promoting and sustaining evidence‐based practice. Journal of Nursing Management, 26(8), pp.918-932.

Chadwick, R. and Gallagher, A., 2016. Ethics and nursing practice. Macmillan International Higher Education.

Husebø, S.E., O'Regan, S. and Nestel, D., 2015. Reflective practice and its role in simulation. Clinical Simulation in Nursing, 11(8), pp.368-375.

Kangasniemi, M., Pakkanen, P. and Korhonen, A., 2015. Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), pp.1744-1757.

Katsikitis, M., McAllister, M., Sharman, R., Raith, L., Faithfull-Byrne, A. and Priaulx, R., 2013. Continuing professional development in nursing in Australia: Current awareness, practice and future directions. Contemporary Nurse, 45(1), pp.33-45.

Li, Y., Chen, W., Liu, C. and Deng, M., 2020. Nurses’ Psychological Feelings About the Application of Gibbs Reflective Cycle of Adverse Events. American Journal of Nursing Science, 9(2), p.74.

Nursing and Midwifery Council, 2018. The Code. (online). Available at https://www.nmc.org.uk/standards/code/read-the-code-online/ [Accessed 1 December 2021].

NMC, 2020. The Code. [online] Nursing & Midwifery Council. Available at: https://www.nmc.org.uk/standards/code/ [Accessed 1 December 2021].

Thomas, V.M. and Mathew, A., 2020. Truth-telling: Apply the principle of beneficence. Cancer Research, Statistics, and Treatment, 3(2), p.359.


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