Foundation of Nursing Practice

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The traditional way through which of assessing if a particular clinical condition or treatment of a patient has changed, thus it is nowadays done by running clinical evaluation, blood tests, as well as other laboratory tests. Despite these measures undeniably giving us some extent levels of the patient’s information they tend to provide virtually no information on the disease process from a social and personal context. Hence, the need for evaluating the foundations of nursing practice concerning the patients conditions provides insights of such processes as well as the overall care of the patient (Brooker and Waugh, 2007).

However, this piece of reflection will be mainly focusing on my experiences attained on the community matrons nurses team practice placement that lasted for a period of six weeks. Moreover, the reflection will be carried out according to the Gibbs cycle model in which the reflection is set out in varied categories such as the individualized healthcare, communications and interpersonal relationships with the patients, as well as the organisational design of services delivery in the healthcare centre (Leahy and Kizilay, 1988). Hence, the use of the Gibbs cycle will allows me to reflect on the impact of the foundation of nursing practice module into my future nursing profession in a more structured and effective manner (Bolton, 2010). The last part of this reflection is reflecting on the influence of this module content and practice toward the development of my nursing career (Risjord, 2009).

This essay is involving a discussion of the concept of individualised care with a specific patient during my recent placement with the community matrons nurses team on a geriatric ward whereby I was given the responsibility of taking care of Mrs. X, who is a 83 years old lady. Mrs X had been admitted in the ward for two weeks originally with chest infection. She was very ill on admission but had no relatives from whom we would have gathered her history. However, she responded reasonably quick to the chest pain treatment. Moreover, as she became more lucid, it was discovered she had developed mild stroke which left her with an expressive dysphasia whose history was not possible to determine.

In addition, we also discovered that Mrs. X developed a mild Type II diabetes mellitus since she was actually putting out smaller and consistent sugar levels in her urine in conjunction with mild elevation of her blood sugar levels. Therefore, her care plan required the mobilisation with the physiotherapist, receiving speech therapy because of her dysphasia, seeing a dietician in order to get advice on the ways of dietary controlling her Type II diabetes mellitus as well as seeing the social work team who would assess her for discharge.

Moreover, in order to effectively provide individualised care a number of interactions had to be put in place. Hence, I as the nurse in charge of her I was supposed to have a proper understanding of the medical elements regarding to the patient case as well as good understanding of the patient as a person as well as other circumstances (Kozier, 2008). This was very crucial in helping to allow good individualised care formulation in absence of any inappropriate decisions likely to be done on basis of incomplete understanding of the patient’s situation (Wall, 2010).

The case of Mrs. X was more complicated due to her expressive dysphasia. However, in the nursing context there was no need for the “interpersonal processes” in order to establish rapport as well as empathy. However, as due to her condition at first it was very difficult for verbal conversation. In addition, the situation was not helped since she seemed not to have any close relative from whom we could get information (Bolton, 2010). Therefore, it was beyond just deciding what was best for her medically, but trying to engage with her at the empowerment and education level with an aim of understanding her situation and feelings to enable us provide individualised care. However, we applied the Roper Logan & Tierney nursing care model to Mrs. X’s situation of requiring dietary advice because of Type II diabetes mellitus which had been newly diagnosed. Hence, with an aim of providing an individualised care as well as taking into consideration the extent to which the aspect of her inability to verbally communicate interfered with other factors of her daily living. Therefore, it was in this respect that the individualised care concept became clearly apparent (Hogston and Marjoram, 2006).

For a patient who is average, filling out the dietetic referral slip as well as letting the dietetic department to take over would be simply appropriate. Moreover, for the purpose of implementing the concept of an individualised care, it was therefore necessary to establish that Mrs. X understood why she required dietetic advice in order to fully understand what was being said as well as explicitly understanding everything that was being said and also making sure the dietetic department was aware of the patient situation (Brooker and Waugh, 2007). This approach was crucial in allowing us to assess both the negative and positive aspects of our decision as well as assessing on whether Mrs. X would ultimately be capable of taking care of dietary (or diabetic) care in the long run.

Moreover, in providing this individualised care, I found as a nurse it is was very important to have as much empathy as possible towards the needs of the patients (Leahy and Kizilay, 1988). It was also crucial to appreciate the fact that, in Mrs. X case, the imposing of the dietary restrictions would be perceived by the patient as just another (iatrogenic) restriction upon her lifestyle which is already severely restricted. Hence, the need for adequately explaining the decision would be very crucial at that point (Bolton, 2010).

In addition, the other crucial aspect of individualised care, is engaging in the process of reflection (Isetta, 2008). This is mainly because it is generally comparatively easy towards making clinical decisions, however the key towards ensuring that they are usually the correct and accurate decisions for that particular patient Mrs. X required reflecting upon them as well as adequately considering all of the aspects of the patient’s case, without impinging upon her decision making process (Kozier, 2008).

On articulating the ethical as well as professional issues that mainly impact on nursing there is in this reflection to consider confidentiality as the selected ethical issues involved in daily dealing with the my patient Mrs. X. therefore, depending on the NMC 2008 there are various ethical issues that should be considered when dealing with a patient. However, considering confidentiality which is among the main ethical factors when dealing with a patient. Hence, it is of significant importance whilst taking any patient details whereas it is also important that informed consent is acquired from every patient since they have the right of keeping their caring need private but the situation leads to revealing of the private information which needs to be confidentially handled (Wall, 2010). Therapeutic relationships, diagnosis and treatments of Mrs. X involved disclosure of numerous personal as well as occasionally painful feelings, to me as the nurse responsible for her care. Hence, I was required to maintain the highest levels of confidentiality about the patient’s condition which thereby led to the patient trusting me as her nurse (Brooker and Waugh, 2007).

However, as Mrs. X expressive dysphasia continued to improved it was possible for her to express her feelings through verbal communication. Therefore, during the periods when we would be communicating I would assure her that any information revealed who be kept confidential in order to probe her for more information which would be vital in facilitating her treatment (Bolton, 2010). Moreover, although at times when I wanted to talk to the patient privately I would draw the curtains around the bed and lower my voice in order for other patients not to hear what transpiring in the conversation even though this was often faced challenges for this particular patient who had communication difficulties. However, upon reflection I am realising that I was supposed to look for room that is quite where we would discuss private matters particularly with patient Mrs. X who had communication or even waited till the bay was quieter as well as when most of the other patients were out of the room or busy.

Nurse-patient relationship is usually perceived as a key therapeutic tool for an effective patient care. However, communication a very important role in establishing therapeutic relationship. Therefore, various forms of communication such as asking questions to probe for more information, giving the patients the chance to express their feelings, or even embarking on a process of reassuring the patients through the means of touch will also lead to an important patient care, as well as increasing the satisfaction of the patient and well being (Bolton, 2010). Hence, I as a nurse I was a central figure towards the patient care while at the same time I was also the one who was best placed in providing much of the psychological care to the patients and particularly Mrs. X a task that demanded excellent interpersonal skills towards facilitation of the forming of a therapeutic relationship with patients while at the same time communicating more effectively them and other health professionals (Ochs, Castaldi and Perry, 2000).

Communication in the sense of healthcare centre usually covers diverse things such as touch, play, as well as enthusiasm. Touch was also very crucial since it showed that while talking I was listening to the patient hence it would be used to mean different things, and it can also be used as a silent language in the context of non verbal behaviour (White, 2005). Therefore, in the case of Mrs. X I was using touch once in a while as a way of affectionately transmitting warmth. Hence, while in the wards I would often use touch at times when the patients anxious or upset to cool their worries off. However, some patients were not comfortable with the use of touch hence I exactly knew the boundaries with the patients I dealt with at individual level.

Moreover, therapeutic relationship can be regarded as the relationship between nurse and patient and is it mainly based on the needs of the patients for care assistance as well as guidance. Hence, it is a relationship that is actually solely established solely towards meeting the patient’s medical needs thus, it is therapeutic in nature (Bolton, 2010). Therefore, therapeutic and interpersonal relationships are usually at the centre of nursing practice, hence the existing relationship between nurse and patient can frequently used in providing the energy, motivation as well as acting as a source of strength for continued treatment or facing difficulties during life threatening situations (Ochs, Castaldi and Perry, 2000). However, there are various ways of establishing a therapeutic relationship thereby gaining the patients’ trust and respect and I did various things that ensured good therapeutic relationship with Mrs. X as well as other patients. Hence, listening to the patients and possession of qualities such as concern, care, respect, empathy and compassion were very crucial in ensuring that I established and maintained a strong therapeutic relationship (Watson, 2009).

Moreover, the organisation as well as delivery of the care in practice management at Community matrons nurse team was effectively organised and it ensured that all the nurses both employed and those who were on placement would actually get adequate time to attend to their patients (Bolton, 2010). However, the care delivery was organised such that every nurse had a schedule of the patients to attend to, however, he or she was not restricted to such particular ones hence they would attend to other cases such as emergencies. Also, the care organised in a way to minimise the number of patients who attended my patients because the schedules were changed after every two weeks. Thus, tasks were allocated according to the working schedules which reiterates on the primary care required by the patients (Moon, 2004). Moreover, team nursing was also embraced in the entire team whereby we could help each other whenever help was needed.

The foundations of nursing practice module and the placement practice helped me to develop professional interpersonal skills due to a variety of experiences acquired by engaging with patients, their relatives, colleagues as well as the other health welfare practitioners (Kozier, 2008). The interpersonal skills I developed involves the interpersonal aspects of communication as well as the social skills that I will be supposed to use as a nursing professional in the future. Hence, in looking back I feels that my interpersonal skills have developed from the usual everyday relationship to the level found in a medical setting (Hogston and Marjoram, 2006).

I have also learnt the proper way of listening as well as talking to staff, patients, and also my family members which was a very daunting task for me as a first year adult nursing student at the beginning but I after the placement I feel that I have developed this as well as confidence in myself which has come from personal experience (Bolton, 2010). I also hope that I will further continue future development of these interpersonal skills which will be very crucial in helping patients in whatever situation I find them. Moreover, I also need to making all the patients feel equal while attending to their needs with the desired privacy and dignity as well as cooperating with their personal needs separately (White, 2005).

I have also refined my nursing practical skills since I was involved on dealing with various patients on daily basis. Hence, as a first year student I believe these skills will go a long way in making to become a competent nurse (Watson, 2009). Moreover, in the future and after gaining this knowledge through this reflection I will undoubtedly approach the provision of nursing care much more carefully in future better than I can now (Bolton, 2010). Also, I am now capable of visualizing very many diverse situations in which I am likely to find myself and trying to emulate better chance s of acting professionally in them. Finally, I have also gained enormous insights into most of the fundamental aspects of nursing (Moon, 2004).

In conclusion, it was evident that Mrs. X‘s case was a fortunate happy ending. This is because after establishing a cordial therapeutic relationship with her she accepted the advice of a dietician and she actually proved to be remarkably adept in the management as well as manipulation of her dietary needs (Bolton, 2010). It also apparently became clear that her state of confusion and dysphasia, was as a result of her hyperglycaemia. Thus, as her hyperglycaemia continued to improve returning her blood sugar levels to levels that were more normal swiftly became more communicative. Thereby making the prior referred interpersonal interactions more easier and certainly meaningful (White, 2005).

Moreover, the aspect of ethical issues in the nursing profession becomes investable especially confidentiality when dealing with patient’s personal information hence the need for therapeutic relationship leading to trust was very crucial (Isetta, 2008). This was also achieved through excellent communication skills both spoken and non verbal that ensured cordial relationship were maintained with the patients.

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Reference List

Bolton, G. 2010, Reflective practice: Writing and professional development, 3^rd ed. Thousand Oaks, CA: SAGE Publications. Inc.

Brooker, C. and Waugh, A. 2007, Foundations of Nursing Practice: Fundamentals of Holistic Care. St. Louis, Missouri: Mosby.

Hogston, R. and Marjoram, B. Eds. 2006, Foundations of nursing practice: Leading the way, 3^rd ed. Hampshire, UK: Palgrave Macmillan Publications.

Isetta, M. 2008, “Evidence-based practice, healthcare delivery and information management”, Aslib Proceedings, vol. 60, no. 6, pp. 619-641.

Kozier, B. 2008, Fundamentals of nursing: concepts, process and practice. New York: Pearson Education.

Leahy, J.M. and Kizilay, P.E. 1988, Foundations of nursing practice: A nursing process approach. Philadelphia: Saunders.

Moon, J.A. 2004, A handbook of reflective and experiential learning: theory and practice. Oxon, OX: Routledge Flamers.

Ochs, G., Castaldi, P.A. and Perry, A.G. 2000, Fundamentals of Nursing. St. Louis, Missouri: Mosby.

Risjord, M.W. 2009, Nursing knowledge: science, practice and philosophy. Hoboken, NJ: John Wiley & Sons, Inc.

Wall, S. 2010, “Critical perspectives in the study of nursing work”, Journal of Health Organization and Management, vol. 24, no. 2, pp. 145-66.

Watson, J. 2009, “Caring Science and Human Caring Theory: Transforming Personal and Professional Practices of Nursing and Health Care”, Journal of health and human services administration, vol. 31, no. 4, pp. 466-82.

White, L. 2005, Foundations of nursing, 2^nd ed. Cliffpark, NY: Thomson Delmar Learning.

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