Reflecting on the Journey: A Three-Year Nursing Degree Experience

Reflection is important for people to evaluate their past experiences and actions. Reflection in nursing is highly important for practitioners to determine their professional efficiencies, performance standard and areas of improvement that help shape their skills and abilities to improve their performance standard. This reflective essay is going to explore the experiences that I had gathered during the three years of my nursing degree course. in the main body of this essay, I will select and discuss one of the four key NMC codes such as prioritizing people, preserving safety, practising effectively and promoting professionalism. This essay will maintain all the ethical aspects thereby assuring the validity as well as the authenticity of its entire content. This essay will not be going to disclose any particular name as well as private information throughout the content thereby using pseudonyms to maintain patients' confidentiality (Caldicott, 2013).

While it comes to analyse the professional abilities and performance standard of student nurse reflection is an important process that assists nurses to evaluate their previous activities experiences, decision and approaches. as mentioned by Li et al. (2020), reflection needs to be done regularly that assists nurses to analyse the usefulness of what they perform and do throughout the day. Additionally, reflection assists nurses to not only improve their professional standard, accountability and decision-making skill but also assists them to determine the areas of improvement and weakness that are also crucial to be found out to make flawless performance in their professional field (Harerimana, 2018). several theories have been developed at different times to assist people in evaluating their previous actions. some important reflection theories are Gibbs reflective Cycle, Driscoll’s framework (2007), John’s Reflective thinking and Kolb’s reflective cycle. In this reflection essay, I am going to use Gibbs reflective model to reflect on my previous experiences and actions. I have chosen this model over the other reflective theories because Gibbs reflective cycle is a well-structured reflective model that is highly applicable for student nurses to evaluate their professional strength and weakness. additionally, it is expected that successful completion of this reflection by using Gibbs reflection model will assist me to learn new skills that will improve my performance standard. Gibbs reflective cycle consists of six reflective phases such as description, feeling, evaluation, analysis, the conclusion and proper action plan (Li et al. 2020).

Nurses play manifold roles including providing compassionate care to patients, meet their complex health needs, conduct relevant care setting for patients, act as health consultants, provide health education to patients and their family members and work in partnership with MDT (multidisciplinary team). as mentioned by Fraze (2020), nurses are the crucial part of the healthcare framework who are involved in developing a holistic care setting for patients in which patients’ physical, psychological, emotional and spiritual needs are determined and met. Throughout the course, I have learned that nurses should ensure that their duties toward their patients must be adhered to the professional standard of NMC codes (2018) in terms of providing compassionate and effective care to patients to meet their complex needs [NMC, 2018]. NMC code consists of four important professional standards such as prioritising people, preserving safety, practising effectively and promoting professionalism. Registered nurses, midwives and student nurses must follow and implement these standards while they are in their practice to ensure that effective, safe and high-quality care is provided to patients’.

This essay is going to discuss “Preserve safety”, in which I will reflect on how I have implemented this standard into my practice throughout my degree course. the NMC standard, “preserve safety” emphasizes the responsibilities of nurses to ensure that patients and public will not be affected or harmed during the practice. Additionally, nurses need to adhere to this standard during their practices to ensure safety at their workplace. this standard enables nurses to understand what are their professional limits and obligations that they need to follow in their practices (Yao et al. 2017.). The report from Care Quality Commission (CQC, 2015) and Francis Report (2013) have highlighted many cases of failure of a professional standard that interfere with the quality of care delivery process and patients’ wellbeing (Francis, 2018). a report from Mid Staffordshire NHS Foundation Trust Public Enquiry (2013) also highlights the failing of professional standard due to lack of skills and poor professional knowledge of nurses. for example, due to the fact that untrained and poorly skilled nursing staffs were conducting triage assessment of patients’ in A&E triage department, section 19.4 with NMC code was not met. This incident has pointed out big questions on the authenticity and accountability of professional nurses. in this incident, the poor professional standard and lack of skill of nursing staffs not only enhances the health risk for patients and the public but also mislead overall diagnosis of patients who were undertaking the triage diagnosis. Another example that has been reported by Francis report (2013) has highlighted nurses’ irresponsibility and lack of skill in ensuring safety for patients during the care delivery process (Francis, 2018). the report has stated that nurses in most of the times neglect the risk factors that are associated with treatment and care delivery process that they are going to implement on patients which enhance the overall health risk and chances of mortality in patients. as mentioned by Harrison (2018), nurses’ inability to adhere to the NMC standard “preserving safety” is not only due to their poor professional ability and knowledge but also due to the ever-increasing workload on them. recent pieces of evidence suggest that in the current era although the number of patients has been increased in NHS hospitals, the number of nursing staffs and professionals remain the same which pose additional workload on each staff. on the other hand, as nurses are involved in manifold duties throughout the day, the huge workload sometimes makes them unable to determine all the risk factors and safety issues for an individual patient that enhance the health risk of patients. throughout my practice, I had strictly followed the above-mentioned NMC code thereby providing safe as well as highly effective care that is relevant to the current health needs of patients. while implementing the NMC code into practice I always used my professional knowledge, analysing skill and self-confidence to ensure non-maleficence to patients and public during my nursing practice.

During my practices as a novice learner, I had faced a hard situation in which I was pressurised to work beyond my limits and competence. During my first placement in the emergency ward a 45 years old man John, who was suffering from severe breathing issues had been admitted. immediate after his admission I was told to carry out spirometry which put me into trouble as I never done this test before. Spirometry is a kind of PFT (pulmonary Function Test), which is widely used by modern nursing professionals and doctors to determine the functioning of lung of patients suffering from breathing issues. although I had good theoretical knowledge regarding carrying out this test, I had no practice experience on spirometry. the situation made me nervous and highly disappointed due to lack of self-confidence. In this context I had followed the section 15.1 of NMC code, that mentions that nurses must always work under their limit of competence (Griffith, 2016). In order to assure the safety during the treatment process I handed over the task of carrying out spirometry to my mentor. Being a practice nurse, I knew my limitations and weaknesses, which made me ensure that I would only deal with such task in which I was highly confident and efficient otherwise lack of competencies will interfere with patient’s safety and success of the diagnosis. After carrying out spirometry it had been diagnosed that John had COPD (chronic obstructive pulmonary disease) with oxygen saturation level 87% on the 15L oxygen flow which is lower than the normal range. Based on the British Thoracic Society (2017) the normal oxygen saturation range in adult is 95%-100%.

While taking care of John, I had learned how to assure safe care and treatment to patients by working under the limits of competencies and knowledge. This placement assisted me to understand the importance of working in MDT to assure patients’ safety by providing collaborative and high-quality care to patients. I always work in a multidisciplinary team in which I can discuss my decision, knowledge, and work process with other professionals and mentor that shape my skill and competency level. While taking care of John, I also discuss the ways and methods of providing safe and highly effective treatment to him that assisted me to provide the level of assurance and care to John that he needed to importance his emotional and psychological wellbeing.

Throughout the first placement, I realised that in many times I lacked my self-confidences while I was asked to be involved individually in any critical task. From this experience, I learned that nurses must have strong professional expertise and practical knowledge in caring out any task which enhances the overall confidences of the nurse in getting desired result for accomplishing the task. This experiences also enabled me to understand the importance of early recrement and recognition in case of patients suffering from the risk the cardiac arrest (Bruckel et al. 2017).

Benner's (2001) stages of clinical competencies have mentioned the second stage as the advance beginners (Beauvais and Phillips, 2020). Based on this concept, advance beginners are the student nurses who have strong level of involvement in their practical placement. Being an advance beginner, my second placement was in the ICU (Intense Care Unit) which bring several opportunities for me to improves my professional skills and knowledge as a student nurse.

During my practices in the ICU (Intense Care Unit), Ms. Florida, a 35-year-old lady had been admitted with severe lower abdominal pain and breathing issues. Immediate after the admission of this patient she was provided proper oxygen support. Determining the current heath condition of Florida and arranging immediate medical support for her enabled me to meet the standard of Section 13.1, that emphasizes on providing immediate treatment and medical support to patients with deteriorating health condition. I carried out Computerised tomography (CT) scanning of abdomen, abdominal ultrasound, blood test, ECG and stool test. During carrying out these tests I had used my expertise and best practical knowledge to get accurate result. through carrying out test the carefully and efficiency I handed over all the test report to doctors for the diagnosis. Based on the reports Ms Florida was diagnosed with acute pancreatitis and a lung infection. I had implemented the NMC code “preserving safety” in every step of providing care and support to Florida in which I ensured that proper medicines, foods and nutrition were provided to her. I also assured that the way all the tests are performed were highly safe and effective that did not have any chances of causing harm to Florida. Throughout the second placement I had learned how to provide immediate clinical support to a patient admitted to the emergency ward with severe health issues. additionally, throughout the practice I also shaped up my communication and interactive skill that enabled me to make highly effective as well as well-organised information delivery system in MDT in terms of transferring each health-related information of patients to all the members of the team. additionally, the placement also assisted me to learn how to carry out safe management of patient by providing them with safe environment, strong mental and physical support, right foods and timely medicines.

By reflecting on the experiences that I gained while providing care to Ms Florida I realised that I was panicked and confused while I witnessed the COPD patient first time. However, through ongoing training and practical education, I gained the knowledge on carrying out Computerised tomography (CT) scan of abdomen in terms of dealing with patients suffering from abdominal pain (Ishida et al. 2020.). The entire process of Computerised tomography (CT) scan not only assisted me to analyse the survival rate of Ms Florida but also enabled me to make a strong prognosis which is highly important in the care of determining the possible health risk and choosing relevant care setting for patients with pancreatitis.

Benner’s framework has mentioned the thirds stage as competent. Nursing student who has two years’ experience in the same roles can be considered as competent in their professional filled. Based on this perspective, I can say that I am deemed competent. While reflecting on my third placement I will discuss my nursing experience in COVID ward with taken care of a COVID 19 positive patient. COVID 19 is an infectious disease that has adversely attack the respiratory system of patients (Stebbing et al. 2020). Patients suffering from this disease have symptoms like fever, cough, respiratory issues and hypoxia. However, as times passes the symptoms of this disease changes at a faster rate. COVID 19 is highly contagious which spread through the droplets of the affected person while they sneezing or coughing. Still, now no vaccine has been invented against this disease which put global nursing as well as health care professional into a challenging situation to provide compassionate care to affected patients.

During my third placement in COVID ward, I was assigned to take care of a COVID 19 patient, who had been admitted at my ward with deteriorating health condition. after observing his situation I immediately check his oxygen level and pulse rate. His oxygen saturation level was 82% on the 15L oxygen flow, which presented that he suffered from severe hypoxia. Based on the British Thoracic Society (2017) the normal oxygen saturation range in adult is 95%-100%. After observing the current health condition of the patient, I immediately called professionals of MDT to provide immediate medical support to the person. I have carried out PFT for the patient which had shown that the patient had acute lung blockage which resist the entry of sufficient oxygen to alveoli. In this context the patient was shifted to CPAP machine. CPAP machine is highly useful medical equipment while treating a hypoxia patient in which an open airway movement has been created by sending pressured air to the lungs of infected patients to improves the oxygen saturation level (Radovanovic et al. 2020). CPAP machine creates the aerosol atmosphere in which droplets from COVID 19 patients are spread to the air which can infect the other people in that ward. in this context Under section 13.4 of NMC code “preserving safety” I assure that the process of using CPAP will be managed in such way that will not cause any harm of health risk to other patients and nursing as well as healthcare staffs in my ward. For implementing this standard, I emphasised on that all the members of MDT wore Personal Protective Equipment (PPE) while entering into my ward. I had also gained a strong practical and professional knowledge on how to use the CPAP machine in a useful and safe manner to ensure the betterment of patients’ respiratory system (Nakano et al. 2020). here I followed and implement the section 13.5 of the NMC Code “preserving safety”, in which I assured that I have used and handed the CPAP machined with best of my expertise and knowledge thereby assisting harmless and risk-free care process to the patient. Through using the CPAP machine and protective as well as safe care setting, the patient had recovered his oxygen saturation rate at 90-94% which was one of my big achievement as a student nurse.

The experience of my third placement assisted me to improve my competence level, self-confidence and my professional knowledge. being a competent nurse, I had successfully managed the of COVUD 19 patients by discarding any chances of contamination of the infection to others during the treatment. This placement enabled me to learn how to use my competency and professional skill while using the CPAP machine for providing airway support to COVID patients following all safety needs. as mentioned by Radovanovic et al. (2020), while using CPAP machined, nurses should be highly skilled to ensure that there is no single leak in patient’s mask or if the machine is not connected properly. being a competent nurse, I strictly adhered to the principles of “preserving safety” in order to ensure non-munificence throughout the care delivery process to the patient. In terms of managing patients’ safety, I had used SBAR process (Situation, Background, Assessment and recommendation) in terms of conducting effective communication with members of MDT to transfer them the current health status of the patient which in order to provide the patients immediate medical support for increasing his survival rate.

By reflecting on my previous experiences of my placement I can conclude that Gibbs reflective cycle enables me to determine my professional strength and areas of improvements which will assist me to shape my professional skill and knowledge that are important to grab good carer opportunities near future. moreover, the reflection improves my professional knowledge, self-confidence and competency level that are going to help me in providing safe and high-quality care to patients my future workplace. through reflecting on my placement, I have gathered knowledge on important standards of NMC (2018) that must be adhered into nursing practice to provide compassionate and safe care to patients. this reflection assisted me to determine my professional limits of competencies under which I need to work to assure patient safety. The clinical knowledge and professional skills that I developed throughout these three-year degree course will assist me to be a highly competent and skilled nursing professional in near future.

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