Palliative Care Nursing Reflection

INTRODUCTION

The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010) was a further development from ‘Better Health, Better Care’ (Scottish Government 2007). In this reflective account I wish to concentrate on the peoples priorities for the people of Scotland outlined within this document, the ultimate aim is to provide the highest quality of care. It has as their objectives that care given should be consistent, person centered, clinically effective and safe and equitable with patients receiving clear communication with regards to conditions and treatment (Scottish Government 2010). Hubley and Copeman, (2008) state communication skills are paramount in healthcare to ensure that tailored advice is delivered effectively.

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This reflective account is based on an experience from my 3rd year management placement. Using Gibbs’s Reflective Model (1988) I aim to outline what occurred throughout the incident which involved providing clear communication and patient centered care and how this can be linked to the Quality Strategy in relation to the people’s priorities. This reflective model has been selected as it enables reflection on practice in a structured way allowing one to identify critical learning and development from their experience to enhance future practice (Bullman and Schutz, 2008). This scenario will consider how this incident will aid in my transition from student nurse to staff nurse.

To comply with patients’ rights to confidentiality and in accordance with the Nursing and Midwifery Council (NMC), (2010) I will use the pseudonym Mrs Wade.

DESCRIPTION

This reflection involves a 78 year old lady Mrs Wade who was an inpatient on the ward for 10 days after being diagnosed as having a cerebral haemorrhage. This had left Mrs Wade with a left sided weakness and aphasic. It was during this time it was established that Mrs Wade was also suffering from a perforated bowel and after discussion with her family from the medical staff it was decided that Mrs Wade was for no further active care and was to remain in the wards single room for palliative care.

Feelings

During my three years as a student nurse I had been involved with the care or palliative patients. However, I felt I still lacked confidence in this situation in communicating with patients and families. I had been involved in Mrs Wades care from admission as I had been her admitting nurse and I felt I had established a good patient / nurse relationship which in accordance with the Nursing and Midwifery Council (2008) allows for patient centered care. This is a difficult time for the Wade family and as stated with in The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010, p6) I would strive to provide care that was both caring and compassionate.

Evaluation

The negative aspect of this situation was that I was dealing with a palliative care patient and that it was inevitable that my patient would die.

The positive aspect that I could draw from this was I was being put in a situation as a 3^rd year student on my final placement and this would give me an experience that I could learn from.

Jones (2012) advocates that it is essential in nursing to have good communication skills. This is also advocated by Dougherty and Lister (2008) who states that communication is an integral part of maintaining a high quality of record keeping which is regarded as a vital standard of practice by the NMC (2008). Communication and written care records aid to establish a continuity of care. A holistic approach for continuity of care is exceptionally important when caring for palliative care patients as nurses have a crucial role in care provision (Hill, 2011). It is important to note that any information that is given to Mrs Wade and her family is given in an open and honest manner and to ensure that they understand and give opportunity to ask questions (NMC, 2008). As Mrs Wade was a palliative care patient it gave rise to effective teamwork within the multi-disciplinary team to ensure all Mrs Wades needs were met as well as her families to ensure continuity of care whilst showing clinical excellence.

Analysis

The World Health Organisation (nd) describes palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

A holistic approach was taken in planning Mrs Wade care incorporating physical, psychological, social, emotional and environmental needs. These needs are not only imperative to the patient but also had to include all Mrs Wades immediate family in who she had requested to be involved (Dougherty and Lister, 2008). Within the ward I worked active care plans and patient care plans are reviewed daily and updated accordingly to ensure the patient receives the best possible care (NHS Greater Glasgow and Clyde, 2014)

Jones (2012) states that it is essential in nursing to have good communication skills. This is also reiterated by Dougherty and Lister (2008) who states that communication is an integral part of maintaining a high quality of record keeping which is regarded as a vital standard of practice by the NMC (2009). Communication and written care records aid to establish a continuity of care. Communication also incorporates the ability to listen and support and ensure understanding (NMC 2008).

In addition to caring for Mrs Wade I was also given the opportunity to be involved in meeting with the multi-disciplinary team which in Mrs Wade’s case involved the palliative care team for the hospital. This again reiterated the importance of good communication skills and accurate record keeping to ensure that all participants in Mrs Wades care knew exactly what was happening (SIGN 20??). In terms of communication I felt I was gaining confidence especially with the family members as I had built up a rapport which was both professional whilst being friendly and trusting (MacLeod et al 2010).

Mrs Wade as well as any patient within our care should receive care outlined by the people’s priority. Patients receiving palliative care should be made comfortable and pain free and to be cared for in a safe and clean environment (Scottish Government, 2010 p6).

Reflection from this incident has made me aware of the level of involvement each member of staff from health care assistants through to consultants play in the care of patients. This was shown through the numerous times I was involved in multi-disciplinary meets, re-assessment of care plans to ensure the highest standard of evidence based care was given to Mrs Wade (NMC 2009).

CONCLUSION

The outcome was positive in the aspect that a holistic approach to Mrs Wade’s care was taken in accordance with The Scottish Government’s Initiative (2010) on patient centered care. I felt empowered by incorporating the use of the SBAR framework in effective collaboration with the multidisciplinary team aided clear communicating in accordance with The Scottish Government (2010). This resulted in a consistent continuity of care for Mrs Wade.

ACTION PLAN

A result of this significant event was that it gave me the experience of dealing with a delicate situation. As stated by Scheffer and Rubenfeld (2000) “Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge^”. I was also given the opportunity afterwards to reflect on my role and the role each member of the team took in the care of a palliative care patient.

I feel for future development I will take responsibility for my own learning in areas where I felt I lacked knowledge. In this situation I had assumed that Mrs Wade was recovering from her CVA, however I was unaware that the effect a CVA has on the brain can result in continence issues and result in bowel perforation. I believe that in the future and with more experience I will be aware of complication resulting from a CVA and although I would not expect to be an expert I would be better equipped to deal with similar situations in the future (RCN 2013).

OVERALL CONCLUSION

On reflection of my own experience and in using this to aid in my transition from student nurse to staff nurse I feel I have enhanced my own knowledge on palliative care (Dougherty and Lister, 2011) whilst reiterating the importance of good communication skills. It also highlighted the importance of having the confidence to acknowledge one’s own lack of knowledge and be able to admit to this and where to seek guidance to ensure that the correct protocol is followed to ensure patient safety at all times and to provide continuity of care. I feel that the care given to this patient is in line with the initiative of The Scottish Government’s Healthcare Quality Strategy for Scotland (2010).

In relation to how this incident reflects on my transition it shows that on graduating as a staff nurse I will immediately assume the role which includes leadership, delegation and supervision. Once NMC registered, a host of expectations are placed upon you. The RCN (2010) reported that newly qualified staff nurses feel unprepared and overwhelmed by their new responsibilities, making the period of transition very stressful rather than exciting and truly enjoyable. However, I hope to overcome these feelings by immersing myself in the knowledge that I will adhere to all policies and guideline by The Scottish Government (2010) to ensure the best possible care and service to all.

References

McLeod Deborah L, Dianne M. Tapp Moules, N., Campbell M E Knowing the family: Interpretations of family nursing in oncology and palliative care European Journal of Oncology Nursing Volume 14 issue 2 April 2010 Page 93-10 http://www.sciencedirect.com/science/article/pii/S1462388909001124

NHS GGC http://www.nhsggc.org.uk/content/default.asp?page=s1458