Written reflection - 1000words linked to either platform 5/6/7 and to a scenario from placement 7
Written reflection - 1000words linked to either platform 5/6/7 and to a scenario from placement 7
Placement 7: Respiratory Ward.
-Model choosing: Driscoll (1994)
In References:
* Please dont forget also to cite and use Nursing and Midwifery Councils (NMC) Platform 5,
*Leading and managing nursing care and working in teams (NMC, 2018)
*NHS ENGLAND (2023)
* Others references
Leading, Managing Care, and Working in Teams (Platform 5)
(Registered nurses provide leadership by acting as a role model for best practice in the delivery of nursing care. They are responsible for managing nursing care and are accountable for the appropriate delegation and supervision of care provided by others in the team including lay carers. They play an active and equal role interdisciplinary team, collaborating and communicating effectively with a range of colleagues.)
---Scenario: Patient in Respiratory Ward at the NHS.
Breaking Bad News (death of family member)---
-In This Scenario, as a student I learn empathetic communication techniques and develop skills associated with breaking bad news to relatives and providing care, also consoling a trouble wife.
As I start my shift a 77 year old man been allocate a side room, he brought to us from emergency department after an unwitnessed cardiac arrest. Team in place couldnt identify the cause and unfortunately and in spite of everything we have done the patient died. My Nurse in charge tells me, the family has just arrived-they are waiting for me in the quiet room. Its important that I need to have an approach to breaking bad news
What: Approach
I have to break the news of loved one`s death. I need to use communication as this is one of my clinical strengths, but in this situation my emotions seems to override my mind, so this been difficult to find the right words.
There are many different approaches to this conversation and none are perfect.
So what: my approach
Get help. It is almost always important to have someone with me for this conversation. I request chaplain and another healthcare assistant available this made a difference soon as I leave the bereaved alone when I called back to clinical duties.
The right location been, in the room Sit down, I In traduce myself and anyone I have with me.
Establish who is in the room
I ask family members what they know about the situation, and I said that I am afraid I have very bad news Smith has moved on. I keep talking to made family understand the situation
I use my body language, use clear understand language, a tissues box, a hand on a shoulder, and a quiet I`m so sorry for your loss.
I provide some information to family, also asking if they have any questions. I find I was unprepared to answer all or some of the family questions.
I sit quietly until the family had time to process their emotions. I remember to step out and leave the room to go and prepare Smith in his bed and by also making sure there is no medical equipment still in place.
I invite the family to spend some time with their loved one.
I remember to care for staff members as well as the family.
What now:
(Introduction)
This reflective essay will explore my personal and professional development during my placement in an Acute Respiratory Assessment Unit. It is based on Platform 5 of the NMC Future Nurse Standards which centres on Leading and Managing Nursing care and Working in Teams (NMC, 2018). It will reflect on an episode of practice and how I made breaking news during my placement (..). It will discuss my leadership and supervision role as a final year student, and delegation to others whilst managing the ward during my shift. The Driscoll (1994) will be applied throughout this reflection.
Example High Grade
Introduction
This assignment will reflect upon an experience during clinical practice in an acute setting. This reflection relates to the Nursing and Midwifery Councils (NMC) Platform 5 leading and managing nursing care and working in teams (NMC, 2018), and in line with Standard 5 of The Code this reflective account does not divulge any information that could identify a patient, service user, colleague, or any other individual (NMC,2018).
Using the Driscoll (1994) reflective model I will explore the incident and reflect upon how I feel this experience can influence my own management, leadership, and teamwork style. I chose this model for its simple approach, using distinct stages (Clinical Educator, 2020), allowing for a clear and purposeful review of the event.
What?
During placement in clinical practice, in an Emergency Department setting, I was in conversation with a nurse who had recently been promoted to a band 6 position. We were discussing how large the department is and I mentioned that I felt I had found it difficult to feel part of the team partly because of the size of the department and consequently, the large number of staff.
The nurse responded by saying that they were so happy to have made band 6 level because in this department, band 5s are nothing and students are worse than nothing. They went on to say that becoming a band 6 had made them a somebody and that everybody in senior management now knew their name and acknowledged them and wanted to speak to them, and that this is the hierarchy within the department.
nobody respects junior members of staff and thats just the way it is.
So, What?
I have experienced negative workplace cultures at times, throughout my training, but my exposure so far has been minimal. The bold nature of this interaction, though, caught me off guard and I did feel unsettled by it (although relieved that the negativity was not just aimed at me but at all those working below the band 6 bracket). Despite feeling this way, I challenged the nurse, but I feel they attempted to gloss over the issues - they implied that this kind of power imbalance was something that should be expected and accepted as part of working in the NHS and in response I explained that this was not reflective of my experience of teamwork at a different trust.
I have encountered similar attitudes in previous employment, so I understand that this isnt a problem limited solely to the NHS (Hartin et al, 2019), nonetheless, negative workplace cultures within healthcare settings have long been recognised (Hawkins,Jeong & Smith, 2019, and Hawkins, Jeong & Smith, 2020).
As nursing students, we are often reminded of the content of the NMC Code (NMC,2018) and the need to develop our professionalism in accordance with the key themes(Smart & Creighton, 2022). The NMCs platforms and related proficiencies (NMC,2018) are aimed at equipping nurses with the underpinning knowledge and skill required for contributory teamwork and yet here I found myself working with an experienced nurse, in a position of leadership, who I felt was unable to role-model tome the principles of working as part of a team. The Code (NMC, 2018) expects registrants to be able to guide support and motivate team members (section 5.6) and also to supervise students in a supportive and constructive way (section 5.8), but this interaction had the opposite effect on me. As a student, I felt useless, unvalued and insignificant within the wider team. I was unprepared as to how to respond in the moment, but it has made me consider and reflect on the need for cohesive teamwork, in healthcare as a whole (Zajac et al, 2021), but especially within emergency care (Jee& Young, 2020).
The NHS Leadership Framework (2011) encourages approachability in leadership and management, and this has been found to be considered a desirable property in leadership, contributing to organisational efficiency (Olanrewaju & Okorie, 2019), yet during my placement, I had now developed a notion that if I needed guidance and support this nurse would not provide it. This vastly reduced my perception of leadership accessibility within the department and I wondered if this might be felt more widely across the department especially by junior staff members. Dasborough etal (2009) examined perceptions of leadership, suggesting that a lack of approachability in leaders could dim the atmosphere of a team climate by making members feel excluded from the team. They went on to consider whether over time, individual member negative emotions will spread to other group members through a process of emotional contagion, negatively affecting the quality of group-level relationships. I can see how this feeling could spread throughout a department, and there is evidence to suggest it could potentially impact patient care (Sauer & McCoy, 2017).
What Now?
The feelings I experienced following this conversation, have made me reflect upon the kind of leader I would like to be in relation to helping student nurses (and wider members of the team regardless of band status) to feel valued and appreciated, to help build a positive workplace culture, and even contribute overall to staff retention(issues with staff retention across the NHS are widely acknowledged (The Kings Fund, 2020), and NHS England (2023) recognises that retention can be improved if staff feel valued).The NHS (NHS Leadership Academy , 2023), and nursing education (Cust, 2019) put a lot of emphasis on building resilience one article, written by the medical director of NHS Professionals, suggested the building of resilience in times of stress, rather than exaggerating problems (McGill, 2020), and whilst I appreciate the need for resilience in nursing, I also find this problematic, in that I feel it can be used to place emphasis on the recipient of negative workplace culture rather than attempting to correct the problem at its root (Chamorro-Premuzic & Lusk, 2017). Numerous studies have been carried out in relation to the impact of negative workplace culture (Carter et al, 2013;Pope, 2017), which I feel indicates the depth of the issue, and whilst some nurses and nursing students, like myself, are committed to tackling this problem, I feel there is wider work to be done, at organisational, trust, and ward/department level to change the situation in any meaningful way.
Introduction
Within this essay, I explore my path of personal and professional maturation during my tenure at an acute respiratory evaluation unit. This essay will emphasize the value of cooperation, leadership, and management in nursing care and further provide the context for this investigation I'll share a specific instance where I had to break important news to the team, illuminating the difficult situation that revolves around controlling my feelings and guaranteeing clear communication. In addition, as a senior, I took on leadership responsibilities, which included assigning work and supervising the entire department as I worked. Using the paradigm developed by Driscoll (1994), I will analyse this experience and its significant influence on my development and proficiency.
What?
While being placed in an emergency department setting in an Acute Respiratory Assessment unit. A 77-year-old man was assigned a side room when I began my shift. He was brought to our attention from the emergency room following an unintentional cardiac arrest. Due to this patient lost his breath and became unconscious which further caused the heart attack (UK, 2023). Sadly, the patient passed away despite everything we had tried as the assigned team was unable to determine the cause. As per my conversation with my charge nurse, "The family has arrived and is waiting for me in the quiet room." I must have a strategy in place for delivering terrible news. I had to inform themabout the passing of a loved one. Since communication is one of my clinical strengths, I must use it, but in this circumstance, my emotions tend to take overtakemy intellect, making it challenging to find the appropriate words. There are numerous methods for having this discussion, but none of them are ideal.
So what?
As a student in this scenario, I gained empathy in communication and learned how to give care, comfort a distressed wife, and impart terrible news to family members. I haven't, however, received much exposure throughout my training yet. I found it to be a difficult circumstance, but with the right support from medical experts, one can get through it. Furthermore, I find that having a companion for this discussion is nearly always crucial. So, I asked for a chaplain and an additional healthcare assistant to be on hand to help them. As soon as I left the grieving person alone and returned to my clinical responsibilities, this started to make an impact. The chamber is the proper place. I take a seat, introduce myself, and say hello to anyone I'm with. I then determined who was present in the space. I remarked, "I'm afraid I have very bad news," and "Smith has moved on" when I questioned family members about what they knew about the circumstances. I continued to explain things to the family so they would understand. I expressed my sorrow with my body language, a tissue box, a hand on someone's shoulder, and a soft "I'm so sorry for your loss." I provide the family with some information and inquire if they have any questions. I discovered that I was insufficiently prepared to respond to some or all of the family's queries. I waited for the family to have some time to gather their thoughts before I spoke. I kept in mind to go out of the room, get Smith ready for bed, and make sure the medical equipment wastaken down. I also extend an invitation to the family to get together with their loved ones. I kept in mind to look out for both the family and staff members.
What Now?
The emotions I felt after this talk have caused me to consider the kind of leader I want to beone who supports student nurses in feeling important and respected, fosters a positive work atmosphere and even accepts help from other medical professionals in difficult situations. As in this scenario, it was very challenging for me to disclose the bad news to family members and other relatives. As a practicing nurse, I should have disclosed such news to family members or relatives with a lot of courage and confidence, because it was my duty to inform the family or relatives about their loss. I should have possessed a quality of leadership by acting as a role model in such difficult situations. Further, it was my responsibility to manage nursing care and I am held accountable for unprofessional caregivers. Nurses are responsible for taking care of their patients and providing the best medication (NMC,2018). Moreover, it was my duty to ensure the best possible treatment was provided to the patient. I should have ensured an active and equal role in interdisciplinary teams. Besides providing care to the patient I am responsible for taking patient observations, administrating medications, attending to hygiene requirements, and assisting with hydration and feeding needs (Respiratory Nursing - Harrogate and District NHS Foundation Trust, 2019). Above all, as a registered nurse I oversee organizing each patient's treatment. As a nurse, I should oversee all the moving components in their work environments, from considering blood pressure to teach the patients about their health and working collaboratively with physicians looking after their health issue. An effective caring approach and a wide range of useful skills and abilities are key to become an excellent registered nurse. First and foremost, giving patients the best diagnosis and treatment should be a core responsibility for all healthcare professionals (Loveday, 2019). Next, I should acquire effective communication as I have to explain different health conditions to patients. Sometimes, there are situations in which I dont have any medical staff or nursing staff to support me. So, I have to make very wise decisions. Furthermore, the nursing field presents an extensive number of unexpected challenges, therefore, todeliver outstanding care, I need to possess sufficient problem-solving abilities to devise workable solutions. This will not only help me but also patients and their family members.
REFERENCES-
Driscoll, M. P. (1994).Psychology of learning for instruction. Allyn & Bacon.
NMC, N., & Council, M. (2018). Future nurse: Standards of proficiency for registered nurses.Accessed on,10, 05-19.
Respiratory Nursing - Harrogate and District NHS Foundation Trust. (2019, May 24). Harrogate and District NHS Foundation Trust. https://www.hdft.nhs.uk/services/cardiorespiratory/respiratory-nursing/
Loveday, H. (2019, July 1). Future nurse: Pre-registration nurse education are you involved? Journal of Infection Prevention. https://doi.org/10.1177/1757177419863468
UK, N. (2023, July 25). Acute respiratory distress syndrome (ARDS). nhs.uk. Retrieved February 12, 2024, from https://www.nhs.uk/conditions/acute-respiratory-distress-syndrome/#:~:text=Acute%20respiratory%20distress%20syndrome%20(ARDS)%20is%20a%20life%2Dthreatening,and%20is%20treated%20in%20hospital.
.
Feedback:
You have identified an appropriate reflective model to structure your work.
You have touched on MDT importance
You have attempted to use literature to support your work.
You have reflected on a relevant and experience on placement
Make better use of your word count
Ensure you identify the NMC platform you are reflecting on
Ensure you refer to confidentiality and reference
Ensure you are writing at the correct academic level your work submitted does not meet this requirement
Re look at the assessment criteria as you seem to be struggling with this in your work
Use a much wider range of current relevant literature to support your work it is largely descriptively
Written and lacks criticality
Include the role of the person who supported you during this situation
Please seek module lead support and see the extensive comments in your work, extensive referencing errors noted please seek support for this using the link below.
I agree with the detailed feedback given. You refer to yourself as a nurse and appear to be discussing leading a team, without reference to supervision which is a requirement. Your work is largely descriptive and lacks the critical analysis and use of evidence that is expected to achieve a pass grade at level 7. Please speak to the marker or the module lead for support prior to your resubmission.
1 consider re wording this is a placement?
2- Proof read - long sentence
3- a senior what?
4- under direct supervision as a student nurse?
5- Be clear to demonstrate your knowledge and understanding here
6- I am assuming this is Platform 5 however this is not included in your introduction
7- where you in ED or another area?
8- What do you mean?
9- Use more professional language please
10- Terminology and understanding needs clarification, if this is a cardiac arrest it does not have to be because of a myocardial infarction
11- write in full initially
12- Proof read work
13- Was there any attempt at resuscitation this is not clear
14- is it your role to determine the cause or treat/manage the situation
15- You should not be doing this on your own?
16- You have not included the role of your PA/PS and what was said
17- Understanding unclear - if you have not had much exposure this is not something you should be doing but you could be sharing this responsibility?
18- did you have this ?
19- as a student it is essential
20- That's quite impersonal
21- I am struggling with this initially re " The chamber" and then the remainder of the work highlighted to understand if this is what you actually said and where your PA/PS was at this time
22- ? asked
23- You should have someone supporting you at this point this is not something you should be doing unsupervised
24- what do you mean?
25- Your work is at times difficult to understand and contextualize
This section is where you should be critically analysing the elements from the scenario you are focusing on to link to your chosen platform. Unfortunately this section is descriptive with no references.
26- consider leadership styles that have been shared with you here
27- You are reflecting here but at Level 7 you need to be analytical. Much of this may be better suited to the So What section or you should use this to consider what actions you can take to improve future practice - what learning and development needs have you highlighted and how will you address them?
28- Descriptive : need furthers critical analysis
29- With support and guidance from your PA/PS
30- Leader nursing care ....31- not as a student nurse you are responsibly
32- Use of reference unclear here, and " best medication"
33- as part of a team in a cardiac arrest situation
34- You appear to have written some of this as if you are a registered nurse?
You are reflecting on a placement experience as a student nurse
35- more appropriate sources available
36- You are a student nurse
37- what do you mean?
38- You are now writing as if you are a student
39- understanding unclear in your role as a student nurse
40- This is a statement what do you mean in this context
41- Descriptive : need furthers critical analysis/ 42- Incorrect referencing & date accessed .Introduction
Within this essay, I explore my path of personal and professional maturation during my (1) tenure at an acute respiratory evaluation unit. This essay will emphasize the value of cooperation, leadership, and management in nursing care and further provide the context for this investigation I'll share a specific instance where I had to break important news to the team, illuminating the difficult situation that revolves around controlling my feelings and guaranteeing clear communication (2) In addition, as a senior (3), I took on leadership responsibilities, which included assigning work and supervising the entire department as I worked (4). Using the paradigm developed by Driscoll (1994), I will analyse this experience and its significant influence on my development (5) and proficiency. (6).
What?
While being placed in an emergency department setting in an Acute Respiratory Assessment unit. A 77-year-old man was assigned a side room when I began my shift. He was brought to our attention from the emergency (7) room following an unintentional (8) cardiac arrest. Due to this patient lost (9) his breath and became unconscious which further caused the heart (10) attack (UK, 2023).(11) Sadly, the patient passed away despite everything we had tried as the assigned team was unable to determine(13 & 14) the cause. As per my conversation with my charge nurse, "The family has arrived and is waiting for me (15) in the quiet room." I must have a strategy in place for delivering terrible news. I had to inform them about the passing of a loved one. Since communication is one of my clinical strengths, I must use it, but in this circumstance, my emotions tend to take overtake my intellect, making it challenging to find the appropriate words. There are numerous methods for having this discussion, but none of them are ideal. (16)
So what?
As a student in this scenario, I gained empathy in communication and learned how to give care, comfort a distressed wife, and impart terrible news to family members. I haven't, however, received much exposure throughout my training yet. I found it to be a difficult circumstance, but with the (17) right support from medical experts, one can (18) get through it. Furthermore, I find that having a companion for this discussion is nearly always(19) crucial. So, I asked for a chaplain and an additional healthcare assistant to be on hand to help them. As soon as I left the grieving(20) person alone and returned to my clinical responsibilities, this started to make an impact. The chamber is the proper place. I take a seat, introduce myself, and say hello to anyone I'm with. I then determined who was present in the space. I remarked, "I'm afraid I have very bad news," and "Smith has moved on" (21)when I questioned family members about what they knew about the circumstances. I continued to (22) explain things to the family so they would understand. I expressed my sorrow with my body language, a tissue box, a hand on someone's shoulder, and a soft "I'm so sorry for your loss." I provide the family with some information and inquire if they have any questions. I discovered that I was insufficiently prepared to respond to some or all of the family's queries(23). I waited for the family to have some time to gather their thoughts before I spoke. I kept in mind to go out of the room, get Smith ready for bed (24), and make sure the medical equipment was taken down. I also extend an invitation to the family to get together with their loved ones. I kept in mind to look out for both the family and staff members. (25)
Now What?
The emotions I felt after this talk have caused me to consider (26) the kind of leader I want to beone who supports student nurses in feeling important and respected, (27)fosters a positive work atmosphere and even accepts help from other medical professionals in difficult situations. As in this scenario, it was very challenging for me to disclose the bad news to family members and other relatives (28). As a practicing nurse, I should have disclosed such news to family members or relatives with a lot of courage and confidence, because it was my duty (29) to inform the family or relatives about their loss. I should have possessed a quality of leadership by acting as a role model in such difficult situations. Further, it was my responsibility(30) to manage nursing care and I am held accountable for unprofessional caregivers. Nurses are responsible for taking care of their patients (31) and providing the best medication(32) (NMC,2018). Moreover, it was my duty to ensure the best possible treatment was provided to the patient. I should have ensured an active and equal (33) role in interdisciplinary teams. Besides providing care to the patient I am responsible for taking patient observations, administrating medications, attending to hygiene requirements (34), and assisting with hydration and feeding needs (Respiratory (35) Nursing - Harrogate and District NHS Foundation Trust, 2019). Above all, as a registered nurse (36) I oversee organizing each patient's treatment. As a nurse, I should oversee all the moving components in their work environments, from considering blood pressure to teach the patients (37)about their health and working collaboratively with physicians looking after their health issue. An effective caring approach and a wide range of useful skills and abilities are key to become an excellent (38) registered nurse. First and foremost, giving patients the best diagnosis and treatment should be a core responsibility for all healthcare professionals (Loveday, 2019). Next, I should acquire effective communication as I have to explain different health conditions to patients. Sometimes, there are situations in which I dont have any medical staff (39) or nursing staff to support me. So, I have to make (40)very wise decisions. Furthermore, the nursing field presents an extensive number of unexpected challenges, therefore, to deliver outstanding care, I need to possess sufficient problem-solving abilities to devise workable solutions. This will not only help me but also patients and their family members. (41)
REFERENCES (42)
Driscoll, M. P. (1994).Psychology of learning for instruction. Allyn & Bacon.
Loveday, H. (2019, July 1). Future nurse: Pre-registration nurse education are you involved? Journal of Infection Prevention. https://doi.org/10.1177/1757177419863468
NMC, N., & Council, M. (2018). Future nurse: Standards of proficiency for registered nurses.Accessed on,10, 05-19.
Respiratory Nursing - Harrogate and District NHS Foundation Trust. (2019, May 24). Harrogate and District NHS Foundation Trust. https://www.hdft.nhs.uk/services/cardiorespiratory/respiratory-nursing/
UK, N. (2023, July 25). Acute respiratory distress syndrome (ARDS). nhs.uk. Retrieved February 12, 2024, from https://www.nhs.uk/conditions/acute-respiratory-distress-syndrome/#:~:text=Acute%20respiratory%20distress%20syndrome%20(ARDS)%20is%20a%20life%2Dthreatening,and%20is%20treated%20in%20hospital.
