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Utilizing Rolfes Reflective Model A Personal Account in the Urology Department as a Student Nurse

  • 08 Pages
  • Published On: 07-12-2023

Introduction

In nursing, reflective practice is important because it allows the nurses to determine their strength and weakness regarding actions and situation as well as knolwdege and skills to be improved (Reljić, Pajnkihar & Fekonja, 2019). In this reflection, the Rolfe’s reflective model is to be used in presenting the narrative regarding my work in placement. The specific model is been chosen to be used because it is simple and clarified due to which the person making reflection through the model experience less hindrance and make meaningful reflective interpretation regarding their actions and skills which are to be improved (Naicker & Van Rensburg, 2018). I am working as student nurse in the Urology Department and I would reflect on the personal account faced in providing the services.

What?

In the placement as a student in the Urology Department, one of my responsibility was to shadow the role of the registered nurses who were involved in providing palliative care to the patient suffering from urological cancer. In performing my responsibility, I was to regularly check that the health records of the patients to ensure they are appropriately maintained by the registered nurse and alert them if the actions are not been taken appropriately. I found that one of the registered nurses who was allocated to look after 3 patients in the palliative ward of the department did not followed effective protocol in recording the palliative patient’s data regularly. Moreover, she communicated with the patient in unempathetic and rude manner at times. I was aware of the situation and tried to discuss that the action performed are wrong, but she ignored my response and mentioned I am a student nurse and need no to ask her what to do as she is more qualified than me. Thus, I informed it to the clinicians and my mentor who intervened and mentioned the registered nurse to proper manage health record and behave with the patient in palliative care. The registered nurse after the intervention followed the proper protocols and the patient being happy with the condition tried to gift me some money which I immediately refused by mentioning what I have done is my towards him.

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In the placement, I was also responsible in helping her to get the monitoring tool such as Flexi cytosocopy to be sterilised after her use. I knew that after rinsing and disinfection in the sterilisation process, the Flexi cytosocopy is to be thoroughly dried before further use on the patient or for storage. This is because storage of Flexi cytosocopy without drying would lead to create bacterial transmission and infect the patient on further use (Seyam et al., 2020). However, the registered nurse I was shadowing for mentioned I need to bother regarding drying and interfered to take the tool from me to immediately store it. I politely asked her to let me dry the tool, but she resisted and did not allow to perform the task effectively. I informed regarding it to the mentor who intervened to let the registered nurse allow me to perform my duties properly with support.

In the placement, I was also responsible to provide and manage basic life support to the patient and manage use of resuscitation trolley under the supervision of the registered nurse and mentor. However, in many conditions, the registered nurses avoided to explain me the way to practically provide basic life support to many of the patient which led me to face hindrance in executing the action. I remained clam in the situation and instead of asking her I tried to access assistance from other registered nurses regarding the way basic life support are to be managed. It made the registered nurse I was allocated to assist to be angry with my behaviour and report against me to my mentor. The constant non-cooperation from the registered nurse at times made me develop irritability and lack of confidence to work with her. The lack of supportiveness in the placement made me develop avoidance in communicating with others.

So What?

The experience in the placement led me to understand that I have effective skill of maintaining professionalism in nursing. This is because I tried to follow all the professional standards and regulation mentioned to be followed in delivery of unhindered care irrespective of lack of support from registered nurse who I was assisting in delivering care. The NMC Code of Conduct for student nurses mention that no professional boundaries are to be violated under any condition and for this any gift from the patients are to be avoided (staff.city.ac.uk, 2018). I avoided to access the monetary gift from the patient which mention I am well-aware of way to maintain professional standards at work. The NMC Code of conduct fort student nurses mention that they have the responsibility to protect and promote the well-being of the patients (staff.city.ac.uk, 2018). I effectively followed this Code which is evident as I took immediate intervention to take assistance from mentor when the registered nurses avoided to listen to me even after acting inappropriately to manage care of the patient in palliative care to ensure the patient’s health and well-being. In palliative care, the empathy towrads the patient is to be maintained to help them feel valued and cared. This is because empathy makes patient feel the pain is understand by the nurse which makes them feel valued and ensure nurses are trying to delivery care with the knolwdege of the trauma faced by them to be lowered (McKinnon, 2018). In the placement, though the registered nurses at times failed to act empathetically, but I as a student nurse always acted with empathy and calmness to interact and deliver care to the patients in palliative care in the department to make them feel valued.

The NMC Code of Conduct mentions that the student nurses are required to have updated skill and knolwdege regarding the way to manage and deliver care as well as they require to keep clear records of the patients to be later used by the clinicians for review of evidence-based practise (staff.city.ac.uk, 2018). I had updated knolwdege regarding the way sterilisation of the monitoring equipment is to be made and therefore, avoided to follow the improper action asked to be followed by the registered nurse. Moreover, I was aware of the way to keep accurate records of the patients and since it was not performed by the registered nurse responsible I took immediate steps to resolve these issues regarding which I was successful. The learning regarding the basic life support is important in palliative care to deliver immediate support to the patient in emergency (Bussières et al., 2018). In the placement, I ensured developing effective practical knolwdege regarding the way to deliver basic life support with the assistance of registered nurses. I also expressed effectively ability in using the resuscitation trolley and monitoring the need of the patient. This is evident as I immediately identified the hindrance in care faced by the urology palliative care patients and took immediate initiative in resolving them along with supported enhanced monitoring to ensure the issues are not further raised.

The analysis of my nursing experience in the placement led me to identify that I have effective skill of communication ability, professionalism and initiative to work ethically (Lehmann, Sulmasy & Desai (2018). This is evident as each time I identified any issue with the patient care (patient record management and empathetic care) or managing my own task (sterilisation of monitoring tools) I interacted with the registered nurses and my mentor to create solution for the raised issue. Moreover, I never support any unethical activity towards the patient's care and always morally performed my duties by ensuring the beneficence of the patients. The nurses required to work ethically so that no deterioration in health of the patients are seen and they do not face legal actions (Sulmasy, López & Horwitch, 2017). I also expressed the strength of being calm in the tensed situation but express lack of self-confidence to work effectively. The calmness and confidence skill in nurse are required to be present because calmness helps them to avoid inappropriately reacting to complex situation and confidence leads the nurses to make enhanced decision to tackle complex conditions in care (Danielsson et al., 2018). Since I have the ability to remain clam I was always able to react politely in the unsupportive situation created by the registered nurse, but the lack of self-confidence led me to fail to take own decision and always access support from my mentor to make any decision to overcome complication.

The teamworking skill in nursing is important as the nurses are able to act collaboratively with their peers and colleagues to share patient care information to deliver enhanced quality support to the patients (Ellis, 2018). However, the analysis led me to understand that I have the weakness to perform effective teamwork. This is evident I was never able to form close interaction or bonding with the registered nurse I was working with to act as a team which was required in delivering quality care to the patients. Moreover, I lacked critical thinking as I was unable to critically analyse the reason behind the action of the registered toward me and way to resolve it on my own. Moreover, as a student nurse, I lack the skill of problem-solving because each time I have access support from my mentor in the Urology department to resolve raised conflict and problem in managing care for the patients and performing own duties. The problem-solving skill is important in nurses so that they are always able to resolve any issue or problem with confidence in the care environment without anyone’s help within limited time as assistance may not be always available (Abd El-Hay et al., 2018).

Now What?

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The reflection of the experience has shown me as student nurse the significance of maintaining professional, ethical aspects and effective communication at work. However, it failed to explain me regarding the way teamwork is to be established while being the team player in the care. For this purpose, I am going to involve in accessing teamworking training to learn regarding the way communication with the team members and leaders are to be developed to minimise misunderstanding and promote enhanced collaboration. Moreover, I would try to improve my problem-solving skills at work by evaluating work records of previous nurses and developing interaction with registered nurses to understand the factors responsible in creating rift between student and registered nurse. This is because understanding of the factors would help me to determine the related actions to be taken so that better relationship with the registered nurse can be made by overcoming the problem and conflict between me and her which is needed to deliver smooth and better-quality care. The confidence in delivering care is to be developed by evaluating different care records of the patients. This is because the care records act as practically evidence in supporting enhanced knolwdege of the nurses to develop gradual confidence in delivering and manging care.

Conclusion

The reflection informed I was acting as a student nurse working in the Urological department where I was responsible in providing care to a palliative care patient and performing duties like managing resuscitation trolley, basic life support, monitoring of patients, record keeping, sterilisation of equipment and others. The strength identified are effective communication, abiding by the Code of conduct by NMC, taking appropriate action in case of emergency, delivering ethical care and others. Moreover, I was able to maintain effective professionalism in care practice irrespective of the lack of support from the registered nurse whom I was assisting in shadowing her responsibilities of care. The weakness identified are lack of confidence in delivering care, critical thinking, conflict management, problem-solving skills and others.

References

Abd El-Hay, S.A., El Mezayen, S.E. & Ahmed, R.E., (2018). Effect of concept mapping on problem solving skills, competence in clinical setting and knowledge among undergraduate nursing students. J Nurs Educ Pract, 8(8), 34. https://www.researchgate.net/profile/Seham-Abd-El-Hay/publication/324016752_Effect_of_concept_mapping_on_problem_solving_skills_competence_in_clinical_setting_and_knowledge_among_undergraduate_nursing_students/links/5b6cc462299bf14c6d97d83b/Effect-of-concept-mapping-on-problem-solving-skills-competence-in-clinical-setting-and-knowledge-among-undergraduate-nursing-students.pdf

Bussières, S., Bégin, F., Leblanc, P.A., Tanguay, A., Paradis, J.M., Hébert, D. and Fleet, R., (2018). Clinical adverse events in prehospital patients with ST-elevation myocardial infarction transported to a percutaneous coronary intervention centre by basic life support paramedics in a rural region. Canadian Journal of Emergency Medicine, 20(6), 857-864. https://europepmc.org/article/med/29866213

Danielsson, L., Lundström, M.L., Holmström, I.K. & Kerstis, B., (2018). Anaesthetizing children—From a nurse anaesthetist's perspective—A qualitative study. Nursing open, 5(3), 393-399. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056443/

Ellis, P. (2018). Leadership, management and team working in nursing. Learning Matters. https://books.google.co.in/books?hl=en&lr=&id=cJRqDwAAQBAJ&oi=fnd&pg=PP1&dq=team+working+in+nursing+care&ots=uS3PPhRgkY&sig=EzHYuzO5HGe0XZm8C1UWIzDxKHk&redir_esc=y

Lehmann, L. S., Sulmasy, L. S., & Desai, S. (2018). Hidden curricula, ethics, and professionalism: optimizing clinical learning environments in becoming and being a physician: a position paper of the American College of Physicians. Annals of internal medicine, 168(7), 506-508. https://www.acpjournals.org/doi/full/10.7326/M17-2058?journalCode=aim

McKinnon, J. (2018). In their shoes: An ontological perspective on empathy in nursing practice. Journal of clinical nursing, 27(21-22), 3882-3893. http://eprints.lincoln.ac.uk/id/eprint/26382/1/__Client_D%24_Pub%20Materials_RCN%20Nottingham%202015_RCN%20Research%20Conference%20-%20programme.pdf

Naicker, K., & Van Rensburg, G. H. (2018). Facilitation of reflective learning in nursing: reflective teaching practices of educators. Africa Journal of Nursing and Midwifery, 20(2), 1-15. https://journals.co.za/doi/abs/10.25159/2520-5293/3386

Reljić, N. M., Pajnkihar, M., & Fekonja, Z. (2019). Self-reflection during first clinical practice: The experiences of nursing students. Nurse education today, 72, 61-66. https://www.researchgate.net/profile/Natasa-Mlinar-Reljic/publication/328854359_Self-reflection_during_first_clinical_practice_The_experiences_of_nursing_students/links/5e26df9f92851c89c9b5bba7/Self-reflection-during-first-clinical-practice-The-experiences-of-nursing-students.pdf

Seyam, R. M., Zeitouni, O. M., Alsibai, T. M., AlAyoub, A. J., Al-Qassab, O. M., AlDeiry, M. A., ... & Altaweel, W. M. (2020). The grasper-integrated disposable flexible cystoscope is comparable to the reusable, flexible cystoscope for the detection of bladder cancer. Scientific reports, 10(1), 1-9. https://www.nature.com/articles/s41598-020-70424-0

staff.city.ac.uk 2018, Guidance on professional conduct For nursing and midwifery students, Retrieved on 17 April 2021, from: http://www.staff.city.ac.uk/m.j.jones/PDFs/Guidance-on-professional-conduct-for-nursing-and-midwifery-students-September-2010.pdf

Sulmasy, L. S., López, A. M., & Horwitch, C. A. (2017). Ethical implications of the electronic health record: in the service of the patient. Journal of general internal medicine, 32(8), 935-939. https://link.springer.com/article/10.1007/s11606-017-4030-1

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