Category: Nurse

Description –

What happened in the immersive simulation resilience scenario?

The immersive simulation resilience scenario was a perfect opportunity for me to learn the importance of resilience in nursing. The scenario was set up in a way that every student contributed to a better learning experience. Various aspects of nursing were discussed in the simulation such as hand hygiene, effective communication, patient-centered care (PCC), and most importantly, resilience. A role-play was conducted with six student nurses and an older adult. The role-play setting revolved around an older patient with a past medical history of COPD admitted to the hospital with an infection. She was quite anxious about getting yet another hospital-acquired infection and frequently told the nurse that she wanted to go home. Likewise, she often prompted the nurses around her if everything was disinfected which showed that she was worried.

Feelings-

What were you thinking or feeling during the scenario?

During the scenario, I could recall my past experiences in clinical placements. I always felt that it was only me who was finding it hard to cope with the tough situations. I found the simulation class resourceful as it made me aware of the key attributes of successful nursing; effective communication and PCC. I realized that even though I was aware of these things before the simulation class, they were not always on top of my head. Additionally, seeing the nurses apply effective communication with the patient, for example, building a therapeutic relationship and rapport with the patient even when she was distressed was eye-opening. I would usually keep the conversation minimal if my patient was distressed but I have now learned that empathetic conversation can help make the situation less stressful for both the nurse and the patient. The session was very helpful and educational. It has made me reflect on my nursing practices.

Evaluation –

What was good/bad about the simulation? What impact did the simulation have upon you? Include references in this section.

I am very grateful for the opportunity provided to be a part of this simulation. Since nursing is a practice-oriented course, it is essential for the students to be involved in skill-based practice incorporated with the theory (Shin, Park & Kim, 2015). Simulation enables the students to work in a situation like a real-time setting, with extra time to learn and freedom to make mistakes which hone their practical skills making the student more proficient (Eyikara & Baykara, 2017). I feel like the close observation in the simulation has prompted me to question myself, “Am I competent enough as a nurse? Am I forgetting something important?”

Analysis-

Access current literature and relate the information that you have learned. What is in the literature that suggests how to manage the situation? Include references in this section.

Firstly, being a part of the hand hygiene team, I observed how common it is to forget the five moments of hand hygiene. According to studies, non-compliance with hand hygiene remains a great challenge in the healthcare system, and education and performance feedback have been known to improve hand hygiene (Gould, Moralejo, Drey, Chudleigh & Taljaard, 2017). This simulation has been insightful about hand hygiene compliance.

Likewise, seeing how the patient interacted positively when the nurses engaged her in the decision-making and reassurance has taught me that PCC is necessary for quality care. Generally, effective communication, health promotion, and partnership are important strategies to achieve PCC and thereby, holistic care of the patient (Constand, MacDermid, Dal Bello-Haas & Law, 2014).

Finally, resilience is the key to successful nursing as it helps us build strategies to overcome difficulties and make our practice better (Thomas & Revell, 2016). It can be simply defined as an individual capacity to restore one’s integrity while encountering adverse situations such as distress, death and dying, diversities, and confusion (Rushton, Schoonover-Shoffner & Kennedy, 2017). It is crucial for nurses to be resilient since nursing is equally challenging as other health majors but with additional challenges in the clinical arena (Reyes, Andrusyszyn, Iwasiw, Forchuk & Babenko-Mould, 2015). Having experienced some difficult situations myself, I have acknowledged that resilience is something I have developed over time in my clinical practices.

Conclusion –

Appraise how the experience of attending the simulation has informed your understanding or changed your perception. Consider what could you have done differently to improve the learning experience.

The experience of attending the simulation has brought to my attention that resilience is a major aspect of nursing. Coming across stressful situations such as communication difficulties, medical emergencies and many first experiences of death and aggression can cause burnout and distress in nurses (Reyes, Andrusyszyn, Iwasiw, Forchuk & Babenko-Mould, 2015). This applies equally in my past experiences and expect it in the days to come as well. However, being resilient has now filled me with a positive attitude toward these situations. Moreover, I have now developed a focus on contributors to resilience such as effective communication, PCC, and empathy. It could have been a different learning experience for me, had I volunteered to role-play a nurse. I suppose I would have had more exposure to resilience building if I had acted as a nurse and dealt with the tough situation. Nevertheless, this situation has been very fruitful.

Action plan-

How will you implement your learning from the simulation into your practice?

With a better understanding of possible challenges and interventions to deal with them, I believe I will be able to handle the situations more professionally and with a much more positive attitude rather than being stressed myself. It is interesting how a simulation session can boost students’ confidence to a great extent. I look forward to applying my concept of PCC in my clinical practices for better results. Likewise, in the days to come, I would be eager to attend more simulation classes to enhance my skills and my knowledge.

References

1. Constand, M. K., MacDermid, J. C., Dal Bello-Haas, V., & Law, M. (2014). A scoping review of patient-centered care approaches in healthcare. BMC health services research, 14(1), 271. doi: 10.1186/1472-6963-14-271
2. Eyikara, E., & Baykara, Z. G. (2017). The Importance of Simulation in Nursing Education. World Journal on Educational Technology: Current Issues, 9(1), 2-7. Retrieved from https://eric.ed.gov/?id=EJ1141174
3. Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. Cochrane database of systematic reviews, (9). doi 10.1002/14651858.CD005186.pub4
4. Reyes, A. T., Andrusyszyn, M. A., Iwasiw, C., Forchuk, C., & Babenko‐Mould, Y. (2015). Nursing students’ understanding and enactment of resilience: a grounded theory study. Journal of advanced nursing, 71(11), 2622-2633. doi: 10.1111/Jan.12730
5. Reyes, A. T., Andrusyszyn, M. A., Iwasiw, C., Forchuk, C., & Babenko-Mould, Y. (2015). Resilience in nursing education: An integrative review. Journal of Nursing Education, 54(8), 438-444. doi: 10.3928/01484834-20150717-03
6. Rushton, C. H., Schoonover-Shoffner, K., & Kennedy, M. S. (2017). Executive summary: transforming moral distress into moral resilience in nursing. Journal of Christian Nursing, 34(2), 82-86. doi: 10.1097/CNJ.0000000000000386
7. Shin, S., Park, J. H., & Kim, J. H. (2015). Effectiveness of patient simulation in nursing education: meta-analysis. Nurse education today, 35(1), 176-182. doi 10.1016/j.nedt.2014.09.009
8. Thomas, L. J., & Revell, S. H. (2016). Resilience in nursing students: An integrative review. Nurse education today, 36, 457-462. doi 10.1016/j.nedt.2015.10.016

Health can be viewed as the freedom from mental and physical illness which identifies the importance of good health in complementing a good life (Evans, 2017). My personal lifestyle is physically healthy as I do not smoke or drink alcohol however, I do struggle to eat healthily in terms of not maintaining a nutritious diet. Due to Covid, I have spent the majority of my time at home which has hindered my physical wellbeing although I do enjoy hikes and walks as they can be both mentally and physically advantageous to the body and mind. To maintain good health, it is vital to have a balance between physical activities and those that encourage mental well-being such as exercise which helps to clear the mind as well as connecting to a community and spending time with loved ones. In terms of mental well-being, my personal goal is to grow in confidence as I prepare for my first placement as currently, I can be quite reluctant to new settings and environments. At the moment, I can be overwhelmed by certain circumstances like having to step out of my comfort zone, and therefore hope that my placement can increase my self-esteem and alleviate any anxiety so that my mental well-being can be catered for. Despite these minute obstacles, I consider myself to be mentally and physically healthy as I am grateful to explore new opportunities such as my first placement. Good health and fitness are necessary for nurses to acknowledge so that they can be equipped to care for patients as well as ‘be role models for patients and be in the best of health in order to carry out nursing roles efficiently’. (RCN, 2021). This coincides with the NMC code of ‘practicing effectively’ (NMC,2018) as nurses can only provide effective care if they are also fit enough to care for others, highlighting the importance of good health for student nurses so that safety is preserved for both patients and nurses. It is important as a student nurse to attend to my own health and well-being for my placement so that I don’t fail in demonstrating efficient care and caring for myself mentally so that I am able to maintain a positive attitude in my work.

Initially, I wish to develop my mental well-being as my psychological state has evident ramifications on my physical well-being (Brennan, 2022). I am certain that aiming to develop ways to enhance my mental well-being, will incredibly boost my attitude in my work on placement as it will assist my confidence as well as my overall feelings. Personally, I think that working on techniques to reduce anxiety, for example, talking to someone about your feelings and exercising will impact your lifestyle as it will improve patience; a value which is significant for nurses, and aid you in remaining calm as well as assisting you in coping when under pressure, which is an inevitable situation when working in healthcare. Finding ways to alleviate anxiety will enable me to observe values such as altruism and compassion as they can support you in effectively caring for others because you yourself have developed various coping strategies to deal with certain situations. It is extremely important for me to address this as feelings of anxiety can be overwhelming for placement as you can begin to overthink and worry about miniature details in your work and question your performance negatively therefore it is vital to manage such emotions to ensure your work as a student nurse runs smoothly. It also ensures that your interactions with fellow members of the healthcare system are well-mannered and welcoming to improve your experience as a student nurse. To maintain my mental well-being, there are various channels in which I can ease any anxiety and stress that the University of Manchester can support such as the Wellbeing initiative and their support services which offer mental health advice and assist you in locating stability in your everyday life.

Psychology has always struck interest in me and throughout the nursing in society unit developing my knowledge further on this topic has opened my eyes to psychology in nurses and healthcare. Nursing is a difficult job physically and emotionally and it is important to be resilient and have emotional intelligence, especially through the current pandemic of COVID 19.

At the beginning of my university journey, I had an idea of what resilience was but over the last few months, I have developed a deeper understanding through various methods such as reading the class materials provided, live tutorials, and research. What is resilience? This is the capability of a person to overcome difficult situations quickly, resilience is also being able to adapt and grow from situations you have experienced and can be mainly identified as being able to express and evaluate, and self-regulate emotions.

Throughout the nursing in society unit and the materials provided, I learned that there are three different types of resilience 1. Natural resilience, is the resilience you are born with and that comes naturally this is your human nature 2. Adaptive resilience is when you are faced with a challenging situation for the first time and you are made to adapt to the scenario lastly 3. Restored resilience, is known as the type of resilience that you learn. When these are low it may have an effect on your mental health and cause you to become depressed, disconnected, and withdrawn.

Being able to be resilient and continuously build on this skill falls in line with the NMC code of conduct, for example, a nurse must demonstrate resilience and emotional intelligence and be capable of explaining the rationale that affects their judgments and decisions in routine, complex, and challenging situations.

After developing my knowledge and gaining a better understanding moving forward as a student nurse, I will focus on building my resilience and emotional intelligence so that when I am out on placement, I am capable to bounce back to the best of my ability and remain professional and carry on with my shift. I will practice this by ensuring that I have plenty of emotional support outside of placement and university, I will build on having trusting relationships with my mentors and other NHS employees so I can speak to them for advice and work past things as a team, I will also look into online resources such as http:www.nhsprofessionals.nhs.ukHealth-and-Wellbeing for further advice on how to manage stress and build on my resilience skills.

I feel like learning about the emotional intelligence and resilience required from nurses has really influenced my personal growth. Before starting university I had an enormous amount of respect and appreciation for nurses and the work they do, but being a student nurse now and learning about the various scenarios nurses can be put in every day and how nurses snap back and carry on with their day has really given me a deeper appreciation for the work that is being done within the NHS.

I also have realized the importance of speaking out to others such as work colleagues or family about how I may feel after facing a difficult situation during placement. Before starting the adult nursing course, I was nervous to be faced with a death as I was unsure how to handle my emotions afterward but through research and learning about emotional intelligence and resilience, I feel much more confident about being faced with difficult scenarios such as this.

Due to nursing being a difficult career both physically and emotionally attending placement will help build on my resilience skills and help me to further develop my professionalism. For example, as a student nurse, I will come across and witness upsetting situations that may affect me emotionally such as death as previously mentioned, terminally ill patients, potentially delivering upsetting news to families.

The primary search strategy for this literature review involved a search of the Scopus electronic journal database. Key words in the search included “roles of nurse’s in communication.” Additionally the phrase “ensure effective” was included. Articles were sorted using the relevance function. Despite a large number of initial results after removing articles not relevant to the topic and those considered too old to be included in contemporary literature review the number reduced to “100” articles. After reviewing abstracts for these articles a total of 10 studies were deemed to be appropriate in terms of study question, methodology and setting and were included in my review.

Introduction

Communication is a key aspect of daily living, with that it is required to be of paramount importance to nurses in the healthcare setting to have a clear understanding of ways to ensure effective communication with patients, families and other healthcare providers without barriers.

Throughout my research I have noted that everyone has a different perception, attitude, experience and perspective of communication. The aims of this paper is to discover how nursing professionals perceive the communication during clinical handover, explore differences between care staff in mental health facilities, nursing homes, and care homes with regard to knowledge about palliative care, time pressure, and self-efficacy in end-of-life communication, as well as aiming to identify determinants of high self-efficacy in end-of-life communication.

Furthermore, talk about how nurses fell underprepared when caring and communicating with people with a disability, review the literature examining the experiences and perspectives of General Practice nurses (GPN) regarding communication with patients about lifestyle risk factors and also explore how patient participation in nursing shift-to-shift bedside handover can be enacted.

Definition

Communication is a process, act, means and transfer of verbal or written message from a sender to a receiver. Nurses can be found almost everywhere in healthcare facilities because they are in the front-lines of patient care. Hence nurses act as a hub of communication, relaying and interpreting information between physicians, families and patients.

I have chosen communication as my issue because I work as a disability nurse in the community. When I used to work as disability carer and accompany my clients to clinics or hospitals, the nurses did not seem to be able to communicate effectively as they would shout or just look at me to communicate for them. At first I was understanding towards them as they were complex patients but as we became more frequent visitors of the same facilities, I expected them to have an inquiline of how to communicate with their patient.

During my placements I have noted that most nurses need to explore the concept of cultural sensitive communication as Melbourne is a multi-cultural state. Judging someone by the way they look, is not an identifier of their cultural background and may make someone uncomfortable with the nurse. Supportive communication strategies need to be implemented to create a sense of familiarity, respect, acceptance, understanding and safety for our patients.

Overview

Lewis, Gaffney & Wilson, (2017) employed a narrative literature review using electronic database searches was conducted using variants of the terms disability, nursing and acute care in the UK, Canada, Australia and Netherlands. Registered nurses (N=267) each acute care setting were asked to describe their experiences and answer research questions related to caring for patients with disabilities. The sample was drawn from main stream acute care settings in the named countries. The results demonstrated nurses were underprepared when caring for patients with disabilities, experienced challenges with communication and have ambiguous expectations of paid and unpaid caregivers. This study adds weight to the argument of this paper that nurses require strategies to communicate with patients with disabilities.

Jones, M Johnstone, (2019) used a qualitative exploratory descriptive approach with 71 registered nurses from emergency department, critical care, perioperative, rehabilitation, transitional care and neurosciences settings in Australia. Research method informed the works of (Patton, 2002), and (Sandelowski, 2002), which analyse using content and thematic analysis strategies. The techniques used were face-to-face (n=15), telephone (n=46) and email (n=10) interviewing. The questions asked specifically focused on definition, understanding, best and worst experiences, managing and personal life experiences that have influenced the discontinued communication (gap). Findings from the participants were, failure to communicate information required during handover and proper documentation made planning and delivery of care safely limited. This study provided a narrow spectrum of experiences and views of nurses while communicating with disabled patients, the sampling methodology and finite geographical sample made generalising the findings to the larger global nursing cohort difficult.

Cooper et el (2014). Conducted a descriptive survey with 111 nurses employed at two general hospitals in UK to investigate the nurses training and experience while communicating with patients and families during palliative and end of life care. The questionnaire mainly focused on nurse’s level of confidence, assessments tools relevant and level of trained provided. The findings were that nurses were generally confident managing symptoms, had less training and lacked formal assessment tools. Even though this study has given limited evidence of how to communicate during end of life care, the methodology was also limited to the UK which makes generalising it to the rest of the world nursing community hard.

Discussion

From the literature of Puckeridge, Terblanche & Massey, (2017) improving outcomes and achieving key performance indicators for all elderly patients who undergo surgery through effective collaboration and regular communication between a broad group of key clinical stakeholders. Results of the quality improvement project has seen a percentage of patients receiving surgery within 2 days rise from 85% to 96% and discharge to their place of residence improve from 20% to 54%. Detection of delirium rose from 22% to 34% over the reporting period enabling rapid management. This data reflects improvement to clinical documentation and appropriate communication from nurses to patients.

Student nurses require training on how to communicate safely and assertively in a clinical practice as this ensures that the student can conduct their learning in a professional manner. As a student myself I have learnt the types of tones to use in different circumstances during clinical practice e.g. during one of my placements I attended a session on how to communicate to people with Parkinson’s disease. It was very confronting for me as the tone they used seemed harsh to me. Half way through it I understood the ideology behind the tone, it was a firm way get the message across to the patient as their receptors needed one to take charge and tell them exactly what to do, they informed us on how to use clear, firm and short sentences. This new model had a 90% success rate which showed that once a nurse is clear and precise the patient is able to compile. Words like “Two steps forward” and “stop (pause) and stand straight” giving on command a time.

From the literature of Omura, Levette-Jones & stone, (2019) has done an evidence-based assertive communication workshop for student nurses. The research attests to the relationship between assertive communication and patient safety. The paper

Conclusion

Given the compelling research of the importance of clear, assertive, detailed and accurate communication in healthcare. The literature provided and my opinion on communication and how to it relayed from one person to another. Nurses need supportive strategies for developing therapeutic relationships, support continuing investment in assertiveness communication training programmes for nursing students, strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the process,

References

1. Lewis, Peter, Gaffney, Ryan J, & Wilson, Nathan J. (2017). A narrative review of acute care nurses’ experiences nursing patients with intellectual disability: Underprepared, communication barriers and ambiguity about the role of caregivers. Journal of Clinical Nursing., 26(11-12), 1473-1484.
2. Omura, Mieko, Levett‐Jones, Tracy, & Stone, Teresa E. (2019). Design and evaluation of an assertiveness communication training programme for nursing students. Journal of Clinical Nursing., 28(9-10), 1990-1998.
3. James, Sharon, Halcomb, Elizabeth, Desborough, Jane, & McInnes, Susan. (2019). Lifestyle risk communication by general practice nurses: An integrative literature review. Collegian: Journal of the Royal College of Nursing, Australia. 26(1), 183-193.
4. Tobiano, Georgia, Bucknall, Tracey, Sladdin, Ishtar, Whitty, Jennifer A, & Chaboyer, Wendy. (2018). Patient participation in nursing bedside handover: A systematic mixed-methods review. International Journal of Nursing Studies., 77, 243-258.
5. Jones, Angela, & Johnstone, Megan-Jane. (2019). Managing gaps in the continuity of nursing care to enhance patient safety. Collegian : Journal of the Royal College of Nursing, Australia., 26(1), 151-157.
6. Fossum, Mariann, Hewitt, Nicky, Weir-Phyland, Janet, Keogh, Martin, Stuart, Joshua, Fallon, Kethly, & Bucknall, Tracey. (2019). Providing timely quality care after-hours: Perceptions of a hospital model of care. Collegian : Journal of the Royal College of Nursing, Australia., 26(1), 16-21.
7. Tobiano, Georgia, Bucknall, Tracey, Sladdin, Ishtar, Whitty, Jennifer A, & Chaboyer, Wendy. (2019). Reprint of: Patient participation in nursing bedside handover: A systematic mixed-methods review. International Journal of Nursing Studies. 97, 63-77.
8. Manias, Elizabeth, Geddes, Fiona, Watson, Bernadette, Jones, Dorothy, & Della, Phillip. (2016). Perspectives of clinical handover processes: A multi-site survey across different health professionals. Journal of Clinical Nursing., 25(1-2), 80-91.
9. Puckeridge, Gillian, Terblanche, Morné, & Massey, Debbie. (2017). The SCHHS hip fracture clinical network experience–Improving care and outcomes through an interprofessional approach. International Journal of Orthopaedic and Trauma Nursing., 26, 24-29.
10. Spooner, Amy J, Booth, Natasha, Downer, Tai-Rae, Gordon, Louisa, Hudson, Adrienne P, Bradford, Natalie K, . . . Chan, Raymond J. (2019). Advanced practice profiles and work activities of nurse navigators: An early-stage evaluation. Collegian: Journal of the Royal College of Nursing, Australia.

Introduction

‘While death cannot be avoided, patients can still strive to die a good death’ – Stenhauser, (2000)

The above statement was made by Steinhause et all in the year 2000 to emphasize the fact that patients of terminal illnesses who are well informed of their closeness to death due to the incurable nature of their illness derive solace in their involvement in the planning of their end of life care, which includes finding and determining a befitting place of death for a patient of the administration of quality healthcare to a patient whose time of death is closer.

An illness is considered to be terminal when it cannot be cured and it is possibly leading to the death of the patient, Examples of terminal illnesses are cancer (at an advanced stage), dementia, lung disease, heart disease, etc. Terminal illness also known as the end-stage disease is a disease that will lead to death irrespective of treatment and care given to the patient. Therefore, end-of-life care is mostly considered as the appropriate treatment for patients with terminal illnesses (www.Mariecure.org). An end of life care is the assistance given to people who are in the last months or years of their life. This care is majorly put in place so that patients with terminal illnesses could access quality health care, live a well-fulfilled life for the shortest period available, and die with their dignitaries intact (www.nhs.uk).

Since death is inevitable evitable to patients with terminal illnesses, palliative care is required to make patient experience quality life care and reduce their suffering by introducing them to all necessary physical, psychological, spiritual, and medical support that will help to make them comfortable (WHO, 2003). Palliative treatment is provided by a team of multi-discipline which involves doctors, nurses, therapists, psychologists, social workers, and others depending on the need for them and the nature of the illness or the place of treatment death as decided upon by the patient and the patient’s relative at the end of life care.

One of the major ways of administering quality health care at an end of life care is that the patient is given their desired place of death. A place of death connotes the desired place a patient will love to be during the period of treatment and at the time death will knock on them. Most patients preferred dyeing at home than in the hospital (Teggi, 2020), critics have pointed to so many reasons why patients preferred place of death should not be honored while many professionals in health are in support of allowing the wish of patients to be treated and died at home be honored for the hospital to have enough space that will accommodate continuous intake of fresh victims of illnesses.

This study will be examining the most preferred place of death for patients at the end of life care, consider the various factors that influence and determine the place of death for patients at an end of life care, and to note the role of nursing practice in influencing, preparing, and fulfilling patient’s preferred place of death.

Identification of issues, prepared place of death for a patient of end-of-life care

Palliative care is a form of treatment made available to make life comfortable for patients with terminal illnesses by managing their pains and symptoms, with the provision of psychological, social, and spiritual support for them. One of the major palliative care available for patients of terminal illness is end-of-life care; this care is for people who are in the last sphere (months or years) of their life. End-of-life care helps the patient to live and enjoy living through quality health care until they die. End-of-life care also allows patients to wish on the preferred place they want to receive care and they would want to be at the time of death to be taken into consideration when planning for suitable palliative care to manage patients’ terminal illness till death (www.nhs.uk).

There are three major places in which a patient of terminal illness can choose as a place o death, i.e. where to receive treatment and die, which are the hospital, care home, and home. Patient choice of place of death can be influenced by their family, caregivers, nature of the illness, and the required palliative care team suitable for the patient, to give the patient a well deserve attention and quality healthcare that will make living comfortable for the shortest period of leave for such patient to die. The concern of health practitioners is how to consider patients preferred place of death and still be able to give such patients the necessary physical, social, and spiritual support required by end-of-life care.

Sama Jamshidi, Jan S. Parker, and Seyedehnestaran hashemi (2020) found out that a hospital environment may have a potential impact on the lives of patients and it could contribute to positive health outcomes. Sama et al further asserted that a patient’s psychological state can influence the process of healing, recovering, and response to treatment. Several scholars and health professionals have opined that patients’ environments have an immense impact on their health conditions and outcome. It is inarguable that how comfortable a patient can be during treatment could be influenced by the patient’s environment (Uirich, 2001). Therefore, in deciding the place of death for a patient the comfort of the patient and the impact such an environment will have on the overall care of the patient should be put into consideration.

This study focuses on the preferred place of death for a patient of end-of-life care. Notably, it is not all patients with a terminal illness need end-of-life care but palliative care is meant for all terminally ill individuals. End-of-life care is majorly meant for patients that are aware of the fact that they have few days or months to live irrespective of the level of health care they are exposed to. This study is been carried out to determine the most suitable place for patients of end-of-life care, the right and comfortable place the patient can be receiving necessary medical aid, psychological support, spiritual help, and other assistance needed by the period of death.

A patient preferred place of death, if the choice of the patient is honored, has a psychological impact on the patient by making the patient feel important and invulnerable. Patient care and patient response to care are likely to be influenced by their preferred place of death. Research shows that a patient whose preferred place of death is honored seems to be comfortable and cherish every moment they spent receiving care. This overall, makes the nursing practice easier and helps nurses establish trust and connection with the patient. Therefore, how effective an end of life care is for a patient depends on the role the nursing profession played in making sure that the patient’s preferred place of death is honored.

The rationale for the choice of topic

The topic of this study is selected because it forms part of the basis for palliative care in which the nursing profession plays an active role in executing it. Patient preferred place of death have an immense impact on making patient of end of life care comfortable and it determine the success of and end of life care. Research and empirical evidence show that most patients of end-of-life care preferred to die at home and healthcare providers must support patients who preferred to pave death. While supporting patients’ choice of place of death, which might be to die at the hospital, care home, or private apartments, the health care provider is expected to give quality health care to patients no matter the challenges the environment might pose to them.

This study is then necessary to understand the various choice of place of death, why most patients usually chose to die at home rather than care home or hospital, and to identify the role of the nursing profession in fulfilling the desire of the patient coupled with quality healthcare delivery at the patient’s preferred place of death. The relevance of this study to the nursing practice is inevitable. The nurses are the intermediary between a patient, the hospital, the relative of the patient, and other health providers. The nursing practice connects all parties through communication and liaison to ensure that patients of end-of-life care are comfortable and have access to quality health care.

Since the nurse must manage the patient’s pain and attend to the patient’s psychological, interpersonal, and spiritual needs by liaising with other caregivers and the patient’s family to make sure the patient’s wishes are honored it becomes imperative for this study to be carried out for a better understanding of the way nurses can help make sure patient preferred place of death is respected.

The role of Nurses at an end of life care

The looming actuality of a patient’s loss of life can essentially be extraordinarily tough for both patients and family contributors to accept, which is quite significant in a typical hospital setting. This is the time when many difficult choices specifically have to particularly be made concerning mostly redress that will advantage the patient in their ultimate weeks or months, regularly bringing excellent of existence issues into play, or so they thought. It is at this time that nurses step in to supply guidance for victims of incurable illnesses and families confronting those challenging selections and helping them adapt to painful realities. The Nurses are often instances the sole source of support at this refined time in a subtle way. Families are regularly confused, scared, and overwhelmed at this juncture in a major way. They particularly are receiving statistics from doctors about medications, redress, and timelines, however, the family of victims of terminal illness often appear to nurses to particularly lean on for emotional aid as soon as the doctor delivered their messages and left the scene for the family. Therefore, nurses are there to help the affected person and household as they warfare to specifically modify to the truth they’re facing, which is quite significant. The nurse’s principal duty is to the affected person and makes certain their kind of needs are honored, most especially their preferred place of death. These for the most part needs are always not by the family’s wishes, for all intents and purposes contrary to popular belief. That’s where the function of a professional nurse receives tricky in a generally major way. They have to kind of hold a focal point on the patient’s preferences and respect their autonomy whilst at the identical time supporting the household as they navigate a procedure they’ve probably never been thru before, which generally is quite significant. Nurses need to be professional in pain administration to make sure their patients continue to be as satisfied as possible. In addition to disorder management, they particularly have to also generally attend to the psychological, interpersonal, and religious desires of the affected person as well. No other expert inside the hospital putting wears pretty so many hats as the hospice nurse in a big way.

A professional nurse is the center of attention completely on end-of-life care, offering hands-on nursing care without rest – both in a facility or in the patient’s home. Not only do they control pain and pretty other symptoms, but they also aid in the procedure of death with dignity. Because every affected person and family both have a unique viewpoint concerning end-of-life needs, it will generally become the job of the nurse to make cultural assessments and adjust care accordingly. A nurse’s role at an end of life care is to provide respite care for household individuals who need a break, order splendid scientific materials mostly wanted through the patient, perform affected person assessments, create a format of care for all caregivers to follow, provide touchy care and emotional support, arrange for religious guide offerings from priests, provide crisis care that alleviates signs and symptoms to result in alleviation maintenance in a kind of big way, act as a mediator between the household and patient, prescribe medications or treatments, and generally supervise or manage scientific care.

Apart from the role stated above, the nurse also frequently sits down by their patients’ side, hold their hand and look them in the eye, share tales about developing up, and is normally just mostly there for them in a subtle way. This is done to make the patient feel special. The demise process essentially is regularly actually long and bewildering, lonely and painful, frequently instances undignified, and fraught with the unknown, which essentially is fairly significant. Nurses soar into the fray to grant that significant connection and essentially ease the transition from existence to death.

Honoring the patient’s prepared place of death

The experience of a patient during the care process and with healthcare workers such as the nurse is a standard that determines a patient’s exposure to quality healthcare. Since the nurse spends a lot of time with the patient, they influence patient access to care and serve as the link that determines the interrelationship patients have with their family and caregivers. The nurse must consider various factors that will affect the effective delivery of care to patients at their preferred place of death.

Whether a nursing practitioner is going to ensure that the patient’s preferred place of death is honored or not should heshe should subject the quest for a choice to the nature of the illness the patient is suffering from. The level of damage an illness has done to a patient and the necessary team needed to manage the patient should form the basis on which a nurse decides the selection of the patient’s place of death. Patient mobility is another key factor to be considered, many a time patients’ care requires extra hands that will take care of their feeding, mobility, and cleaning because the illness made them suffer paralysis. The family most time prefers such a patient to stay in the hospital in contrast to the patient’s wish to be receiving care from home, it is the duty of the nursing practitioner attending to such a patient to convince either the patient or the family to accept one of the choices made by the nurse after considering the best place that will make the patient more comfortable. At times, patiently make choices of their preferred place of death based on memories they which to keep or their psychological attachment to their home, or the feeling of staying around their loved ones at the time of death. Also, the patient’s family seems to believe they know the best for their relative by deciding on their preferred place of death for the patient, the nurse must see through all reasons and try as much as possible to harmonize different views and factors in favor of the patient’s access to comfort and necessary care at the end of life care. Likewise, the nurse is subjected to make sure the patient preferred place of death will give room for all hands that will care for the patient and easy access to the patient.

Introduction

This assignment explores the concept of professional values and professional practice including safeguarding that is required to support the role transition from healthcare support worker to Registered Nurse (RN). It also highlights and discusses the key roles and duties of a healthcare support worker needed for the transition to an RN. The key concepts of professional values and professional practice discussed in this assignment include safeguarding and preserving safety, practicing effectively, prioritizing people, and promoting professionalism and trust, care, compassion, competence, communication, courage, and commitment (NMC code 2015).

In the United Kingdom, attrition from conventional pre-registration nursing programs continues to be significant and, once trained, new staff nurses face a number of difficulties in adjusting to their new position (Gould, Carr, and Kelly, 2006). A potential alternative, strongly advocated by the current administration, is to move existing healthcare assistants to pre-registration services (Gould, Carr, and Kelly, 2006). This process involves having the requirements before applying for a university to study nursing. Before becoming an RN, healthcare assistants must have successfully completed a nursing program of education that is approved by the Nursing and Midwifery Council (NMC, 2019). The premise is that, because of their previous caring experience and exposure to working in the National Health Service (NHS), the healthcare assistants will be more committed to completing training and will undergo role transition more effectively (Gould, Carr, and Kelly, 2006). Professional development is a process starting during undergraduate education and continuing throughout working life. A new role transition has been described as difficult (Pennbrat, et al 2013). Therefore, making the transition from healthcare assistance to a registered nurse is challenging and demanding. Such challenges are fear of failure, financial and or family constraints, clinical incompetency, and lack of personal preparedness as they transit toward a new role and more complex nursing role (Webb, 2011).

Professional practice necessitates competence in terms of knowledge and technical skills (Dall-Alba and Sanberg, 1996). This necessitates not only a broad base of knowledge but also the depth of knowledge in a specific area of practice, as well as the desire and ability to continue developing that knowledge base and sharing it with others, as well as critical thinking in decision-making (Dall-Alba and Sanberg,1996).

The Nursing and Midwifery Council (2015), clearly reflect the importance of humanized care for everyone who will need the service from the health and social care sectors. The role of a healthcare assistant in the United Kingdom has been central to ensuring that patient care is provided and ensuring that the people we support are our first priority (Scammell, 2016). Therefore, the role of a healthcare assistant in a care home setting required for the smooth transition to a registered nurse involves preserving the safety of the people they support to live a fulfilled and independent life using the Person Centred Active Support (PCAS) approach (Beadle-Brown, Hutchinson and Whelton, 2012; Scammell, 2016).

This role involves treating people with dignity and respect, providing care as required without delay, and recognizing the diversity and individual preferences (Beadle-Brown, Hutchinson, and Whelton, 2012). According to Beadle-Brown, Hutchinson, and Whelton (2012), this professional value is significant in the reduction of challenging behavior and self-stimulating behavior among people with learning disabilities. This role is demonstrated in the professional standard of practice required of registered nurses. For instance, RN is required to respect and uphold the dignity of patients by treating people with compassion, and kindness and recognizing people’s contributions and care choices (NMC, 2015).

Another professional value and professional practice needed in the transition from a healthcare role to an RN is preserving the safety of people (NMC, 2015). Safeguarding is described as a means of protecting the health and well-being of children, young people, and vulnerable adults from abuse, harm, and neglect (Care Act, 2014). According to Cusack et al. (2016, p. 1), safeguarding is the protection of human rights to live from torture, inhumane, or degrading treatment. Thus, for the smooth transition from a healthcare role to a registered nurse, it is imperative that these rights are recognized and protected when delivering care (Kozier, 2008). Registered nurses are required to ensure the safety of their patients and the public by immediately raising concerns whenever they come across circumstances that put people at risk of harm, danger, or neglect (NMC, 2015, p.13).

The Nursing and Midwifery Council (NMC) and Care Quality Commission (CQC) jointly developed a protocol, this includes shared information, risk-related activity, safeguarding people, an operational model for staff in both organizations, the duty of candor and ensuring the delivery of high care quality in the health sector (CQC, 2017). The aim of this is to prevent harm and reduce the risk of abuse or neglect to vulnerable adults with support needs and to everyone who uses the health and social care services. As a healthcare assistant transiting to a registered nurse, the well-being of the people is very important, therefore promoting their health and safety is paramount.

Safeguarding vulnerable people is a core priority of health and social care professionals (DH, 2011a). Nurses have a key role in the protection of vulnerable adults (Straughair, 2011). Nurses have a duty to recognize the signs and symptoms of abuse and act on any concerns, safeguard all patients, and also provide additional measures for patients who are less able to protect themselves from abuse or harm (Straughair, 2011; DH, 2011). Nurses make patient care their primary concern and ensure that protecting vulnerable adults is an inherent part of everyday nursing practice (NMC, 2008; NMC, 2015).

Kozier (2008) states, as healthcare assistants, the needs of the service users are recognized and attended to; their care and safety are delivered in high-quality care support. Meanwhile, nurses ensure that those receiving care are treated with respect, promoting their rights, preserving their dignity, and showing compassion and kindness (Culloty and Joshua, 2020). Healthcare assistants who intend to become registered nurses must be able to grow and develop in order to meet the demands of a changing healthcare system. Having acquired fundamental skills and training which includes NVQ level 3 in Health and Social Care (Adults) and other relative skills such as record keeping, administration of medication, safeguarding, and communication which serve as a basis for pre-registration into the nursing course to make a smooth transition and competency in the career ahead to become a registered nurse (Hasson, McKenna, and Keeney 2013). Healthcare assistants’ experiences facilitate nursing students’ pathway to RN (Arrowsmith, 2016).

Healthcare assistants need to know the importance of dignity in the lives of the people they support, irrespective of the situation in which they find themselves. Self-awareness of knowledge, skills, and attitude is a prerequisite for supporting patient dignity (Matiti, Cotrel-Gibbon, and Teasdale 2013). Self-awareness aids us in relating to others. It allows us to identify our strengths and areas for improvement, which leads to increased competence (Cook, 1999; Jack and Smith, 2007).

According to Rassin (2010), cited in Moorley, (2019) an example of values is to protect human dignity and be respectful to people. Therefore, our professional values are rooted in our personal values and these are influenced by family, culture, environment, and our religious beliefs as well as ethnic attributes. The awareness, acquisition, and development of your professional values is a gradual process that evolves throughout your personal and professional lifetime (Moorley, 2019). Nurses always maintain professional relationship boundaries with their patients at all times while delivering care and treatment. Nurses ensure that the care standards are met and promote self-esteem. To ensure safety while working in the healthcare sector, working within your limits of competence, make use of your ‘duty of candor’ and raise concerns immediately whenever you come across situations that can put the service users or the public safety in danger (NMC, 2015).

As stated by Feng and Tsai (2012) and Haggins et al. (2010) education preparation programs may not always equip students with the necessary skills and knowledge for independent qualified practice. The work-based knowledge and skills acquired by the healthcare assistant is a prerequisite skill that enables them to transition to registered nurses (Hasson, McKenna, and Keeney 2013). Additionally, the concept of trust is important in healthcare because health and healthcare, in general, involve an element of uncertainty and risk for the vulnerable patient who is reliant on the competence and intentions of the healthcare professional (Sutcliffe, 2011).

As a support worker, performing your duties with honesty and integrity at all times is very important, treating individuals fairly without any act of discrimination, bully or harassment is necessary for the healthcare sector (Gould, Carr, and Kelly, 2006). It is also very important to always work within professional boundaries with the service users including their families. Registered nurses take the lead in providing evidence-based, compassionate, and safe nursing interventions (Moorely, 2019). They ensure that the care they provide and the delegate is person-centered and of a consistently high standard. They support people of all ages in a wide range of care settings. They work in partnership with people, families, and carers to assess whether care is effective and whether the objectives of care have been met in line with their wishes, preferences, and outcomes (Moorely, 2019; Culloty and Joshua, 2020).

Registered nurses constantly reflect on their practice and keep abreast of new developments in nursing, health, and care (Moorley, 2019). They act professionally at all times and use their knowledge and experience to make evidence-based decisions about care (Culloty and Joshua, 2020).

Conclusion

The role transition of a healthcare assistant to a registered nurse which is the highlight of this assignment has been discussed in detail thereby unraveling the importance of the NMC code of conduct (2015), safeguarding, and prioritizing the need of service users. Furthermore, it has identified the specific and unique aspects of learning and skills acquired as a healthcare assistant which is required to transition to a registered nurse and equally highlighted the barriers the healthcare assistants will experience in the journey ahead.

References

1. Bosley, S. and Dale, J. (2008) Healthcare assistants in general practice: practical and conceptual issues of skill-mix change, British Journal of General Practice, 58 (547), pp 118-124. doi https:doi.org10.3399bjgp08x277032Print copy: Care Quality Commission (CQC) (2012)Â The state of health care and adult social care in England in 201112. London:Â The Stationery Office.
2. Care Act 2014, c.23. Available at: https:www.legislation.gov.ukukpga201423section1enacted (Accessed: 31 March 2021).
3. Chapman, A. and Law, S. (2009) ‘Bridging the gap: an innovative dementia learning program for healthcare assistants in hospital wards using facilitator-led discussions’, International Psychogeriatrics, 21(S1), pp.58-63. Doi: 10.1017S1041610209008680
4. Cusack, P., McAndrew, S., Cusack, F. and Warne, T. (2016) ‘Restraining good practice: Reviewing evidence of the effects of restraint from the perspective of service users and mental health professionals in the United Kingdom (UK)’, International journal of law and psychiatry, 46, pp. 20-26. doi:Â https:doi.org10.1016j.ijlp.2016.02.023.
5. Cook, S.H. (1999) ‘The self in self-awareness’, Journal of advanced nursing; J Adv Nurs, 29(6), pp. 1292-1299. doi: 10.1046j.1365-2648.1999.01014.x.
6. Dall’Alba, G. and Sandberg, J. (1996) ‘Educating for competence in professional practice’, Instructional Science, 24(6), pp. 411-437. Doi: https:doi.org10.1007BF00125578Department of Health 2011, c.8. Available at Safeguarding Adults: The role of health services – GOV.UK (www.gov.uk) (Accessed: 5 April 2021).
7. Dean, E. (2017) ‘Unlocking the NMC code of conduct’, Nursing Standard, 31(32), pp. 15-15. doi: 10.7748ns.31.32.15.s16.
8. Draper, J. (2018) ‘Doing it for real now’- The transition from healthcare assistant to newly qualified nurse: A qualitative study, Nurse Education Today, 66(7), pp. 90-95. doi: 10.1016j.nedt.2018.04.008
9. Duchscher, J.B. (2008) ‘A process of becoming: The stages of new nursing graduate professional role transition’, The Journal of Continuing Education in Nursing, 39(10), pp. 441-450. doi: 10.392800220124-20081001-03
10. Duchscher, J.E.B. (2009) ‘Transition shock: The initial stage of role adaptation for newly graduated registered nurses, Journal of advanced nursing, 65(5), pp. 1103-1113. Doi: 10.1111j.1365-2648.2008.04898.x
11. Feldon, P. (2017)Â The Social Worker’s Guide to the Care Act 2014.1st edn. Cornwall: Critical Publishing.
12. Gould, D., Carr, G. and Kelly, D. (2006) ‘Seconding healthcare assistants to a pre-registration nursing course: Role transition to qualified practitioner’, Journal of Research in Nursing, 11(6), pp. 561-572. doi: 10.11771744987106068497
13. Hancock, H., Campbell, S., Ramprogus, V. and Kilgour, J. (2005) ‘Role development in health care assistants: the impact of education on practice’, Journal of Evaluation in clinical practice, 11(5), pp. 489-498. Doi: https:doi.org10.1111j.1365.2753.2005.00569.x
14. Hancock, H. and Campbell, S. (2006) ‘Developing the role of the healthcare assistant’, Nursing Standard (through 2013), 20(49), pp. 35-41. Available at: https:search.proquest.com (Accessed: 7 March 2021).
15. Hasson, F., McKenna, H.P. and Keeney, S. (2013) ‘A qualitative study exploring the impact of student nurses working part-time as a health care assistant’, Nurse education today; Nurse Educ Today, 33(8), pp. 873-879. doi: 10.1016j.nedt.2012.09.014.
16. Peate, I. (2012) The student`s guide to becoming a nurse. 2nd edn. Chichester, West Sussex: John Wiley

As a nursing student and a future registered nurse, it is significant to ensure Indigenous cultural respect within the clinical environment by reflecting the REM framework. Firstly, it is important for me to practice cultural humility in the respect component, which is a lifelong process of self-evaluation, reflection, and learning to advance a deeper understanding of how an individual’s life experiences influence their understanding and interaction with others (Yeager and Wu 2013). Moreover, cultural humility is a significant step to equalize the imbalance of power inherent in relationships between professionals and patients and aims to advance partnerships with people and groups advocating for others (Waters and Asbill 2013). Institutionalized discrimination in the healthcare system directly impacts access to and outcome of healthcare for Indigenous Australians (Australian Indigenous Doctors’ Association nd). Discrimination in the healthcare setting can directly result in poorer self-reported health status, postponement of seeking care, social mistrust, distrust of healthcare providers, and evasion of healthcare setting. Furthermore, discrimination has been considered a vital health determinant of Indigenous Australians involved in a high prevalence of psychological distress, which is a risk factor for anxiety and depression, and escalates the commitment to unhealthy behaviors (Marwick et al. 2014). Therefore, personal, cultural, and institutionalized discrimination leads to poorer healthcare outcomes and inequalities. Hence, as a registered nurse after graduating, I will try to provide cultural respect to all people, especially the Indigenous people by active listening, hearing, valuing, and tolerating Indigenous perspectives; demonstrating respect in being heard and in the sharing of their knowledge, being, and doing.

Secondly, I will use person-centered care (PCC) which is respectful of and responds to, the preferences, needs, and values of patients and consumers to ensure cultural safety(Tucker et al. 2011). Through empowering clients to share their needs, cultural values, and preferences related to health care; healthcare professionals can be aware and responsive to cultural sensitivity through involvement in attitudes and behaviors and advancing clinic features and policies recognized as significant by culturally diverse patients (Tucker et al. 2011). Thus, patients and their families can cooperate with healthcare workers to improve healthcare outcomes in a culturally sensitive manner (Purdue Northwest 2017). Furthermore, by using the PCC approach to patient cultural respect, nurses can ease patients’ anxiety about negative health experiences, build stronger therapeutic relationships, and advance trust with patients and their families (Purdue Northwest 2017). Thus, patients will be satisfied with provider care and interact well with healthcare workers, which positively impacts patients’ possibility of following recommended treatment plans directly influencing health outcomes (Tucker et al. 2011).

As a registered nurse, it is significant for me to concentrate on the Indigenous patient’s needs, preferences, and culture. Indigenous Australians have preserved cultures in many different ways than non-Indigenous Australians. This cultural distinction has effects on both policy and practice. Therefore, practitioners need to engage Indigenous clients in the planning and implementation of the care service and identify clients’ pressing needs through effective communication, such as thoughtful listening and sharing (Robertson and McDonald 2011). Furthermore, it is critical for healthcare professionals to efficiently equalize consultation with implementation. Additionally, practitioners have to certify cultural competence while providing healthcare services to Indigenous clients. Moreover, practitioners should apply cultural awareness and cultural sensitivity and not concentrate on their own personal construct of identity and well-being while providing care services to clients (Robertson and McDonald 2011).

There are several philosophies for working through partnerships, such as empowerment, independence, humanity, equity, trust, and respect. It is significant for partners to respect each other in partnership. Through respecting each other, healthcare professionals can work collaboratively, build trust and strengthen relationships with clients, and maximize the accomplishment of partnership working association. Furthermore, through the empowerment philosophy, clients can be empowered to actively participate in the decision-making process, emphasize their needs, cultural preferences, strengths, and abilities, as well as advance their self-efficacy and hope. Thus, healthcare workers can identify the strengths and expertise of clients which are the principles of strengths-based strategies to facilitate optimal health (Sustaining Community 2016). In terms of independence and equity philosophies, clients have autonomy to decide the treatment care plan and self-regulate their necessities, as well as have opportunities for well-being and accessibility to health services. Hence, by working through partnership, healthcare workers can identify clients’ needs, cultural identities and preferences, strengths, and capacities to develop and implement specific strength-based strategies for the client to meet their needs, and likewise work with and maintain their strengths, and assist them in developing new strengths.

As change agents, nurses have to concentrate on three major roles visionary such as communicating, advising, coaching, and providing feedback to bring changes to the healthcare setting; facilitator educating people on what change is needed; and ideal person bringing change, helping solving problems and research.

Nurses can empower patients and build confidence by being fully transparent with patients, such as explaining the drug and its rationale. The open conversation helps build a therapeutic relationship.

Nurses should engage patients in decision-making by introducing, eye contact making, effective communication, active listening, and ensuring their choice and respect.

Historically nursing is seen as a vocation-oriented profession directed toward the physical, spiritual, and psychosocial needs of a patient (Dawson, 2006). Modern nursing appears to be at a critical crossroad as nursing makes up the largest part of the workforce in modern health care thus, health care resource needs to be used effectively and efficiently (Scott et al., 2014). Nursing covers a wide variety of daily activities within one scope of practice hence it is difficult to classify a nurse’s role in any single capacity. However, nursing at regional, national, and international levels appear to have similarities in their functional roles within society (Browne et al., 2018). Like Nightingale whose legacy has created and shaped our relevant twenty-first-century nursing and practice, we need to study the cultural, social, and economic concerns, with emphasis on their impact on health and nursing (Beck, 2010a). She evoked empowerment for nurses to grow and enhance their practices, and to think outside the permitted domains, therefore paving the path for and recognizing the importance of professional identity. Beck (2010a) writes that Nightingale adapted herself in response to her time but was ahead of her time through her innovation and commitment to developing a personal identity for herself and a professional one for nursing.

Professional identity has been described as how a person views themselves within their own professional roles, influenced by their values, characteristics, traits, beliefs, and experiences (Browne et al., 2018). Andrew (2012) further claims that not alone is it the person’s individual attributes but also the perception of their colleagues, public image, and environment that influences one’s individual perception of professional identity. Phillippa et al, (2018) categorized these traits as the self, the role: what do I do, and the concept: where do I do it. They note that these traits are interlinked as neither one alone can define personal professional identity, as the individual’s unique characteristics gained and learned through life experience, education, and work environment all aid in pursuing a professional identity. However, Hollip (2013) illustrates that it is a continuous developmental process as, with time, confidence grows thus further scope of practice develops. For instance, a student’s nursing professional identity begins with the start of the nursing program, evolving throughout one’s career influenced by education, practices, self-reflection, colleagues, and the work environment (Browne et al., 2018). These influences have aided in the establishment of continuous education, standards, and practices thus helping to unite and ground nurse theory and practices to develop nurse’s professional identity (Tinler et al., 2017). Browne et al. (2018) suggest that nurses and student nurses who have developed a firm professional identity are more flexible when faced with change and challenges in the workplace.

As Phillippa et al. (2018) suggest the role refers to boundaries one faces in one’s practice which can enhance, empower or inhibit professional identity. These boundaries can be caused by one’s self or environment. Health systems and the public image of nursing vary thus impacting the role of the nurse within modern society nursing (Ten Hoeve et al., 2013). Health and educational systems are said to be failing modern nurses causing a loss of their professional identity by impossible idealized

expectations about their duty in nursing, due to staff shortages, increased workload, and with no clear definition of what the nurse’s role in 21st century is (Austin, 2011). As public opinion of a nurse’s role and job varies dramatically from that of what the organization’s expectation of their employee is, this, in turn, causes nurses to struggle to develop a professional identity as they are torn between the public perception and the organizational constraints (Tinler et al., 2017). This has resulted in nurses becoming passive contributors to the care they provide thus resulting in poor job satisfaction and a lack of public and personal identity (Sellman, 2011). However, he notes if the self strives to achieve respect and professional identity this can lead to the nurse developing a sense of worth and meaning. For example, Dawson (2006) suggest that nurses working in specialized areas such as intensive care, become more autonomous, expanding on their basic nursing role resulting in changes in one’s self-image, and embracing change to develop their personal and professional identity, within their field and the wider medical profession. The contemporary nurse’s role needs to continuously adapt to the changing population needs (Timmins, 2002).

The concept refers to the organization’s role that impacts upon a nurse’s professional identity through policies, protocols, framework, and the concept of caring (Browne et al., 2018). The concept is entwined with the outward image of the nurse influenced by stereotypes and the public’s perception. The stereotypical image of the nurse maintained by the public has been sculpted by the media portraying nursing in the traditional image of one that is caring, empathetic and compassionate (Ten Hoeve et al., 2013). This image remains despite nursing progressing into the 21st century as a professional role obtained through education and further advanced post-education (Hollip, 2013). In comparison to many years ago, nurses were seen to be subordinate to the doctor with basic knowledge and skills thus, the influence of Nightingale, establishing the first nursing school in the 1860’s has developed nursing as a separate professional identity (Beck, 2010b). This paved the way forward in establishing the new scope of practices, and new roles which are governed by organization, to provide and enhance the standard level of care. However, organizational influence can impact the role of the nurse, for these policies, procedures, and targets all influence the professional identity of the nurse (Browne et al., 2018). Austin et al. (2009) discuss how the organization influences nurses and states that nurses suffer ‘compassion fatigue’ due to set targets established by the organization. Austin (2011) further suggests that the organization looks at nursing as a customer service model. Although this may be seen to enhance the efficiency of the health service i.e. decreasing waiting times, meeting metric targets, and ensuring practices are standardized, it does impact the nurse’s role by taking the focus away from that of a person-centered approach, to one of the tasks orientated and routinized like that of the customer service model. Austin (2011) further develops this customer service model by suggesting that while nurses deliver very good care, they are disoriented for this model doesn’t allow the nurse to respond to suffering with true compassion as they are trying to meet the targets. This in turn has a bearing on the self-identity as professional identity is interlinked, so one needs to be aware of one’s self, role, and concept to have an impact on developing a professional identity (Melody, 2014).

To conclude professional identity is strongly influenced by how we see ourselves, how others perceive us, and how we are viewed in society (Browne et al., 2018). Nurses need to develop their own sense of professional identity by taking pride in their contribution to modern health care (Sellman, 2011). Professional identity plays a key role in evolving nursing practices in the 21st century as there is a positive correlation between the image of nursing and the decision of students to choose a nursing career (Scott et al., 2014). As nurses are currently working in an increasingly multicultural healthcare setting with both patients and healthcare professionals coming from diverse backgrounds, professional identity is more than ever essential to the survival and evolution of nursing in the 21st century.

Professionalism in Nursing

The definition of a nurse is someone who cares for the sick, old or young; someone who is able to provide medical assistance. They provide care to patients in hospitals, clinics, and many other healthcare facilities. They work as a part of the healthcare team with; physicians, surgeons, technicians, assistants, and many more professionals, to ensure that their patients are getting the utmost care needed to ensure that they leave the healthcare facility, fit and healthy. Nurses work on the front lines of health care; they are not in the background or behind the scenes; they work face-to-face with patients in their highly hands-on profession. While doing a number of tasks, it is a nurse’s duty to maintain professionalism while in the workplace.

The first trait a nurse must possess is compassion. The definition of compassion can mean having sympathy and wanting to help a person who is going through a difficult time. Compassion comes from that moment when you can see the world through another person’s eyes. In healthcare, many believe that compassion can start to be felt when people begin to love their work and who truly understand why they do what they do. In many healthcare facilities, compassion can be seen when patients are treated with dignity, respect, and empathy; through communication skills and actions. It can be particularly powerful when a patient is feeling vulnerable, in physical or psychological pain, especially when they are afraid. Patients do not want to be treated as a number; they want assurance that the professionals around them care about what’s happening, what they can do about it and most importantly, keeping the patient informed as to how they’re doing it. This kind of information empowers patients to deal with their illness in the best way possible. However, compassion isn’t just about talking to patients; it is also about making them feel safe, in a clean environment where they can feel at home. The most valuable gift that can be given in a healthcare environment, is time. Time to allow the patients to speak about what matters most to them and most importantly, time for the staff to listen. When genuine interest without being judgemental by staff is shown to the patients, this empowers the patient to make decisions about future steps that will be taken. If enough attention is focused on things that matter most to the patients, trust will be gained, which is something all healthcare workers must gain from their patients. Once this trust is in place, it can do various things; improve clinical outcomes, improve financial outcomes, empower patients to improve their quality of life, and most importantly, improve the morale of staff.

Another essential trait a nurse must acquire in order to accomplish professionalism in nursing is teamwork. One of the key elements to success is teamwork. In healthcare many professionals work interdependently to achieve a common goal; patient treatment. Some benefits of teamwork are; improves the quality of patient care, reduces length of stay, and reduces workload issues between health care workers. Operating as teams ensures that the workplace is more enjoyable as well as a reduction in safety issues. A key component of teamwork is communication; when roles are clear among team members, there is less confusion about patient treatment plans as well as patients are able to experience greater clarity about their treatment and expected outcome. A great amount of explicit communication must be implemented. This can be achieved by a variety of written documents and of course verbal notes and conversations. Teamwork can also be very critical as it can produce a better environment; always make sure that the members apart of your team that is working have one vision and are aware of the goals that you are trying to reach. By doing this it creates a much better atmosphere for your team as well as patients.

A final component that is under the branch of professionalism in nursing is accountability. The high-intensity environments in a healthcare facility require everyone in an organization to be accountable. Staff should be engaged and should be able to make and keep commitments. Providing the best patient care requires everyone to be accountable for their behavior and their commitment to a culture of nursing excellence. A nurse can be accountable to their profession as they represent the largest group of providers in the healthcare industry. It is a nurse’s responsibility to practice within their scope of practice and not beyond. One way a nurse can be accountable to their profession can be to participate as members of professional organizations. Nurses are also accountable to their patients; patients put their trust in nurses when they enter the healthcare facility as they believe their nurse is educated and will provide competent care for them. It is important to realize that patients can and should be able to make their own decisions when possible. Respect is another important factor for patients as everyone has individual differences, such as religion, spirituality, and cultural difference. Advocacy is also important because patients are not always going to advocate for themselves, either because of a lack of knowledge or being physically unable to speak for themselves. Nurses can also be accountable to the health care team. Nurses bring their skills as well as specialized knowledge to the situation that is presented to them, and the nurse shares this info with the other members of the health care team. The healthcare team then collaborates to come up with the best treatment for the patient. The nurse should perform the assigned nursing tasks, competently and when scheduled. The nurse is held accountable for any task that is delegated to unlicensed assistive staff. Nurses are also accountable to themselves; nurses must have personal standards, and whilst developing these personal standards nurses must be true to themselves. Furthermore, nurses are accountable for themselves while taking care of their personal, physical, mental, and spiritual health. Often nurses find themselves busy taking care of everyone, they tend to forget about themselves. The biggest problem with accountability is unclear job descriptions; this happens when issues arise in the workplace and nurses will say it is the doctor’s responsibility and vice versa. This problem stems from unclear job descriptions, the more detailed job descriptions are written for all healthcare professionals, the more accountable they can be held. Another way to hold nurses accountable is to hold regular and honest performance evaluations. These frequent performance evaluations will remind nurses how they are supposed to be performing and can help keep them on track to attain peak performance.

This essay will allow me to critically reflect on an episode of care that occurred during my placement. Hannigan defines reflection as a way of being thoughtful, innovative, and critical of our own practice when it comes to nurses and student nurses reflecting on their practice (Hannigan, 2008). Reflection is about being self-aware and critically evaluating our response to situations during practice (Finlay, 2008). Especially for student nurses as they develop their skills and knowledge during placement. Reflecting on episodes of care allows students and qualified nurses to have the opportunity to reflect on their work and gain new knowledge about different situations (Balla et al., 2009). To critically and thoroughly reflect on the episode of care that I have chosen I will use the Gibbs (1988) model of reflection. This has 6 stages of reflection, allowing me to analyze and evaluate the event thoroughly in each stage and allowing me to break down each stage easily (Balla et al., 2009). I chose this model compared to Schon`s reflection framework (1983) as Schon noted that there were only two components to the reflective practice; reflection in action and reflection on the action which does not allow me to thoroughly evaluate and be critical of the situation as well as it not allowing for thoughts and feelings to be reflected on (Greenwood, 1993). Gibbs’ model will allow me to have an insight into what my strengths and weaknesses are allowing me to develop my skills and knowledge if a similar situation occurs. To keep to the NMC code of conduct I will be maintaining the dignity and confidentiality of the patient by using the pseudonym Mr. Hill to protect his personal information as well as not naming the trust or ward to maintain their confidentiality also (Nursing and Midwifery Council, 2018).

Whilst on my second placement during my first year in a mental health hospital in a men`s acute inpatient ward, I was dispensing and administering medication under the supervision of the nurse in charge. To continue developing and practicing my clinical skills I had to administer medication to Mr. Hill, a 35-year-old patient with avoidant personality disorder, dependent personality disorder, and depression and who was under assessment for paranoid schizophrenia. Mr. Hill who was sectioned under section 2 of the mental health act was in seclusion at the time of needing his medication due to a previous incident of self-harm, suicidal ideation, and aggressive behavior. When going to give him his medication I was told to place the medication tot on his desk so that he could get it himself. He refused to take his medication saying he would not cooperate with staff till he had spoken to his doctor about being discharged. I attempted to explain to Mr. Hill that it was important to take his medication as it included metformin which was important to take due to his diabetes. This was due to it being my duty of care to inform him of why the medication would benefit his health as the NMC code of conduct states that a nursing professional must balance the need of acting in the patient’s best interests whilst respecting their right to refuse medication (Nursing and Midwifery Council, 2018). Mr. Hill still refused to take his medication and threw the medication at me whilst becoming aggressive and shouting, `you`re trying to poison me with that blue pill. This blue pill he was referring to was the 1mg of lorazepam that he was prescribed. Both I and the nurse in charge left the room and went back an hour later to try to attempt to get him to take his medication again. This time he was allowed to come into the clinic to allow him to witness me dispensing his medication straight from the packet so that he could see what the medication was. Mr. Hill accepted his medication this time stating that he was sorry for how he behaved previously. The nurse in charge debriefed me after the situation giving me their opinion on the incident as well as advising me not to take what Mr. Hill said when he was angry personally.

After reading the patient information and background of Mr. Hill and reading about his potential risks, it made me aware that due to his diagnosis he may exhibit different behaviors in different situations meaning that his behavior can potentially become unpredictable. Due to this awareness, I wasn`t worried about administering the medication to Mr. Hill, especially as I had built a good therapeutic relationship with him before this incident occurred. Having a good therapeutic relationship with patients, especially in mental health nursing is the cornerstone to helping patients to improve (BROWNE, CASHIN, and GRAHAM, 2012). I felt pleased when Mr. Hill accepted to take his medication, as even though I was a student nurse I had been able to build rapport and trust with Mr. Hill that he wanted to accept his medication as well as being pleased that the plan to show him the medication being administered worked to gain his trust back in staff. However, during the incident, I felt intimidated when Mr. Hill was throwing his medication and shouting as I believed I had done something wrong. In addition to this, I also felt disappointed that Mr. Hill had suddenly begun to distrust the staff that was working with him and felt like the NHS had failed him due to his feeling this. This temporarily knocked my confidence in handling difficult patient situations as I was not prepared for this situation due to my lack of experience in handling these situations. However, after the nurse in charge debriefed me on the situation, I realized that it was not my fault that Mr. Hill was feeling this way and that it was due to his unpredictable behavior that caused his mental health condition.

The positive that came from this incident that occurred was that I was able to apply the communication skills that I had developed from clinical skills and experience effectively in a situation when dealing with a difficult patient, especially within a mental health setting. This improved my confidence as I know I can communicate with patients in a variety of scenarios. This incident also allowed me to identify how committed I am to helping the patients as I experienced how much of a difference I could make to a patient. I stayed calm and professional throughout the incident as I respected the patient`s choice to refuse their medication as well as balanced the patient’s best interests. This means that I can identify the codes a nursing professional has to follow in practice (Nursing and Midwifery Council, 2018). I was also able to use and develop my practical skills of dispensing and administering controlled drugs to patients alongside their normal medication whilst under the direct supervision of the nurse in charge in addition to demonstrating and developing my pharmaceutical knowledge around controlled drugs and their usage. This improved my confidence in my knowledge and skills significantly when I was being praised by the nurse in charge for what I knew and how dedicated I was to develop my nursing knowledge and skills.

The aspects of this situation that I need to improve on are that I was unsuccessful in administering the patient`s medication to them at the first attempt due to his beliefs about the staff and his medication. This made me aware that I need to be prepared for what the possible reactions of patients may be in different situations so that I know what the best route is to go down to help these patients. Due to my lack of experience and knowledge as I am a student nurse, I was thinking more about what was in the patient’s best interests, which in this situation I thought was getting him to take his medication, rather than acknowledging what the patient wanted and how I could have eased their frustration at the time of the incident. Due to the debrief from the nurse in charge and wider reading I understood that I must look holistically and critically at the outcome of what action I am about to undertake so that I am aware of what the consequences may be (Daly, 1998). I am now aware that I must also be cautious especially in an inpatient mental health ward as a patient may exhibit unpredictable behavior or even aggressive behavior due to their symptoms.

Patients who had been diagnosed with personality disorders are seen to experience interpersonal difficulties and poor self-concept. This means that these patients may feel distant from their feelings and may experience distress when they identify that they are experiencing a strong emotion (Gordon-King, Schweitzer, and Dimaggio, 2018) which is why Mr. Hill may have reacted to us in the way he did due to the string emotions he had been feeling whilst being in seclusion. Those who were diagnosed with depression exhibit psychological symptoms such as irritability, suicidal ideation, and self-harming which were the reasons why he was in seclusion to start with (NHS Choices, 2021). Mr. Hill could potentially have been experiencing a severe depressive episode at the time which can lead to paranoid delusions such as believing that we were trying to poison him with his medication (Mind.org.uk, 2019). This is likely as he had a history of experiencing severe depressive episodes during past hospitalizations. The NHS also recognizes that those who are diagnosed with paranoid schizophrenia experience paranoid delusions where they may feel that they are being harassed or prosecuted by those around them as well as recognizing that a patient`s behavior may be disorganized and unpredictable (NHS Choices, 2021), which links to why Mr. Hill`s behavior changed so suddenly from what I had seen before. As Mr. Hill`s behavior is unpredictable when not being treated it is important for him to adhere to his treatment plan which combines the use of medication and therapeutical treatments such as cognitive behavioral therapy. It is important for patients to adhere to their treatment plan as it proves to have positive outcomes for those with serious mental health conditions. Through research, it was found that adherence to medication among mental health patients was at 50-60% which is low as nonadherence leads to a higher chance of relapse as well as a higher chance of readmission to the hospital (Angell, 2006). If as nursing professionals we do not encourage and empower medication adherence among patients through shared decision-making strategies within the multi-disciplinary team as non-adherence can lead to a poor quality of life for the patient (Issues in Mental Health Nursing, 2016).

It`s a nurse`s role and responsibility to apply their knowledge and skills from their experience and academic work to help treat every patient that they come across in their career. Balancing a patient`s best interest and a patient`s personal choice is a skill that is required by nurses which includes respecting the patient`s choice to refuse to take their medication as Mr. Hill did (Nursing and Midwifery Council, 2018). Being on a mental health ward, a nurse’s most important function is to have interpersonal interactions with patients. This enables a nurse to enhance a patient’s personal development, autonomy, and psychological growth by forming therapeutic relationships with patients (RUNGAPADIACHY, MADILL, and GOUGH, 2004). In addition, it is now believed that caring for mental health nurses in the 21st century should include emotional intelligence and resilience as this can assist mental health patients to recognize negative experiences and start to look at these experiences with positive outcomes (Warelow and Edward, 2007). This means that a patient will be able to improve their condition in a positive environment as well as allow the nursing professionals to work in the same positive environment. These nursing responsibilities and attitudes will help Mr. Hill whilst he is in the hospital and after discharge as he will be able to understand what the necessary steps are to help himself get better and improve his symptoms so that he is able to live in the community with a good quality of life.

Being a student nurse, it is important that I develop my learning through experience on placement as well as in theory as there`s a high possibility that I may come across a situation like this again and so many other student nurses. Student nurses must be able to make judgments professionally about their practice theoretically. This shows that learning through experience will help student nurses to develop their knowledge and skills to make them ready to be qualified nurses as it allows nurses to understand that they to achieve a solution to a problem which is a major part of the cognitive theory of learning (Callery, 1990). In Mr. Hill`s case, this would be identifying and achieving a solution to getting him to take his medication. In order to improve on an existing skill a student nurse must deliberately practice their skills in different situations which is important within the cognitive theory of learning. The cognitive learning theory of learning is an internal process (Aliakbari et al., 2015) which is important as it allows the student to predict what the best solution would be to help the patient in different situations.

In conclusion, this episode of care has taught me that balancing a patient`s best interests and their health is hard when it comes to a mental health patient as there are different situations that need to be considered when it comes to a patient`s treatment plan and interactions with professionals. I now know that it is best to listen to what the patient wants and needs before taking any action as difficult situations may be able to be prevented by just listening to a patient. It may have been more suitable to ask the nurse in charge for advice on the situation immediately after Mr. Hill refused to accept his medication rather than telling him the benefits of taking his medication due to my lack of experience in this field of nursing as well as me not knowing the patient as well as the staff that were on the ward. I am aware that I was not prepared for handling the different and unpredictable reactions of patients with a range of mental health conditions before this episode of care. It would have been better to read through every patient’s notes thoroughly before helping to attend to them medically as well as trying to build a strong therapeutic relationship with every patient beforehand as well.

If a similar situation was to arise again during my placement or nursing career, I would examine the situation thoroughly thinking about patient risks and history, and then think about what the appropriate action to take would be as well as ask for advice from superiors and more experienced staff about what they suggest that I do. Therefore, I will increase my knowledge and skills by doing wider reading about mental health conditions and how these patients may act in different situations.

Personal development plan

Personal development plans help to stimulate growth, performance and learning within the clinical practice (Employee motivation for personal development plan effectiveness | Emerald Insight, 2013). A personal development plan is essential for learning development within a professional environment as it encourages us to consistently develop our knowledge and skills through set goals. Using a personal development plan as a nurse is essential as it`s a systematic way to identify what your personal development needs are as well as being an encouragement for learning throughout your career as a healthcare professional and encouraging further development (Personal development planning, 2015). Using the SMART acronym, I will identify a set of goals and learning needs that were not fully met within my first year which was not achieved due to various circumstances that acted as a barrier to my learning during my year 1 placement. These goals and learning needs that I have identified are;

• Increase my knowledge of the types of mental health conditions
• Increase my pharmaceutical knowledge of common mental health medication
• Increase my knowledge of the major side effects of antipsychotics
• learn the process of admission and discharge in mental health hospitals
• develop my skills in care planning for different patients and their needs
• improve my confidence in communicating how a patient has been during multi-disciplinary team meetings

These goals and learning needs will be met by the end of the second year as it will allow me to follow my development plan with enough time to fully achieve these through further experience on placement as well as through the development of my knowledge within the theory. From these identified learning needs, I will be mainly focussing on learning the process when admitting patients onto a ward as well as the process for when patients are being discharged by producing a plan on how I will meet this learning need by the end of the second year. This was my chosen learning need as I did not get much exposure or experience with admitting and discharging patients due to my lack of confidence in communicating with new patients as well as not having enough experience in the workings of the steps that need to be taken when both admitting and discharging patients. I intend to develop my knowledge around the process of admission from a nurse’s point of view such as what information is required to get from the patient when they are first admitted, if any physical observations need to be completed and how what level of therapeutic observations they require is decided. I will also develop my understanding of what actions need to be taken when discharging a patient such as how well their medication adherence be monitored if any information is needed before they leave and how it is determined where they are allowed to be discharged such as supported living or a parent`s house.

To show evidence that I have achieved this learning need from my personal development plan, I will record this learning need within my PAD document so that when I go to placement my mentor is aware that this is something that I would like to achieve as well as ensuring that staff members log comments within the document about how I performed these tasks with what my strengths are and what I need to improve on during admission and discharge. If I am unclear as to why a step within admission or discharge is being undertaken, I will ask the staff member that I am working with to explain this to me so that I have a deeper understanding of why there are certain steps that need to be completed during admission and discharge. I will also reflect on my experiences when learning about these processes so that I can learn from my own experiences. I can only log these experiences in my pad documents due to confidentiality surrounding the patients and staff that I am working with (Nursing and Midwifery Council, 2018).

To demonstrate that I have achieved this goal I will ask my placement supervisor if I can complete an admission or discharge under their supervision and once this has been completed ask to complete one independently and ask my supervisor to double-check my work during each step of the process as well as communicating with the multi-disciplinary team managing the care of the patient to gain more information about the patient that I am admitting or discharging. I aim to have achieved this learning need by the end of my last placement in the second year as this goal will require continuous practice within all my placements meaning that this time frame is the most suitable to achieve this goal.