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Integrated Nursing Concepts 1

Introduction to Reflection

Reflection is considered as one of the most effective strategy for gaining learnings from self or practice of others (Johnston, 2017). Occupying proper cues and judgments within the nursing profession can lead to greater decision making skills in the students. This assignment is focused on considering and reflecting to the learnings gained by me throughout the semester. The learnings that are discussed in this assignment involve the “Integrating Nursing Concepts 1”. In this reflective piece two specific learning experiences that enhanced my ability to identify cues and formulate judgement’s relating to communicating activities of living and care are discussed. These activities are based upon a 15 year old girl suffering from leukemia and a man suffering from pain and agitation from alcohol withdrawing. It uses the Roper-Logan-Tierney model for nursing in addition to the cues and judgements from the clinical decision-making framework followed by the Borton’s model of reflection for the assignment.

Essentials of Care

It is important for the nurses in the healthcare department to fulfill the requirements of the patients and provide them with the best possible care. The essentials of care is basically a framework that is developed to evaluate the required care which is to be provided to the patients (Santana et al., 2018). The framework is defined as a program for identifying improvements that have an impact over the safety and quality of the patients in the healthcare. It is focused on better experience for the staff members, families, care providers and the patients. Essentials of care focus on the needs of the patient that values the contributions from the people involved in care while supporting ongoing review through relevant research and evidence based practice (NSW government, 2020).


Week 2's workshop focused on teaching students to maintain a safe clinical environment for both nurses and patients. Students formed groups with one another and engaged in three roleplaying activities encompassing three cases between nurse and patient, all experiencing different activities of living. We repeated each activity accordingly so students could alternate their roles, to understand further the importance of individualized empathy in every therapeutic interaction.

One of the scenario's involved a 15 year old girl that had been in the hospital for two months with leukemia, just recently contracting an STI. The patient seemed unphased by contacting an STI; however, expressed the discomfort she had experienced in the hospital during her stay. The patient, when speaking to me, asked not to disclose that she had been seeing her partner in the facility when they were not there. I reassured the patient however had to inform her I could not do anything without more experienced staff and parental presence. The other members of my team communicated in the same way, as we all followed our intuition aided by the workshops content.

(Hayes, 2019) work titled "Mr Sharman case scenario 1" and "Mr Sharman case scenario 2" both distinguish the difference between holistic and task orientated care while illustrating the profound impact both can have on the patient. In the first video, demonstrating holistic care, the patient communicates that he cannot get comfortable, feels irritated and wants to drink alcohol. The nurse, when first addressing the patient asks to speak personally with him and delicately addresses the cause of his pain being alcohol withdrawal. In "Mr Sharman case scenario 1", the nurse entered the room abruptly and was purposefully loud in her tasks, the nurse began to ask invasive, uncompassionate questions that insinuated the patient was an alcoholic.

So What

Learning Experience 1

As the objective of the week 2 workshop was teaching students to maintain a safe clinical environment, I set out to gather cues that would help me to eliminate potential hazards preventing patient safety. The patient's lack of awareness on contraception, nonchalance about contracting an STI indicated the need for adequate sexual education. It also made me alter the scope of assessment for the patient's needs, now as there was a deeper issue concerning the patient. When inquiring about how the patient was feeling, the patients requested I refrain from informing her parents about her current circumstance. I was confronted with the issue of upholding both autonomous and parental rights, an issue that is highly prevalent for health care workers today. (Santa Maria et al 2016)

Although these cues identified a potential safety risk to the patient, it revealed possible dissatisfaction the patient's personal life. This necessitated me to reflect on the patient's circumstance and quality of life, in comparison to an average 15-year-old adolescent, whereby the activities of living and life in general for both are dramatically different. Activities that are significantly altered due to the patient's illness and stage in lifespan include "Expressing Sexuality" and "Working and Playing" as patient's with illnesses present highly dependant on the indepdendence/dependence continuum and thus the communication of these activities are hindered due to their autonomous nature (Roper, et al 2016) There were a number of factors that prevented the patient from engaging in these AOLS, including the patient living in a hospital environment with limited privacy (environment) certain psychosocial factors (psychological impacts of her illness, psychological impacts as an individual) and the general autonomous nature of these activites (Roper, et al 2016).

Learning Experience 2

Both videos adequately distinguish the correct/incorrect way to communicate with patients when there is a sensitive topic to be addressed. At the beginning of the first video clip that demonstrated holistic care, the nurse immediately used individualized care to begin her assessment of care by asking how he was feeling and asking questions regarding pain.

Both videos demonstrate how communication as an activity of living can be altered for patients who's circumstances demand efficient communication at all times. This is particularly evident for patients who cannot communicate at all, are suffering temporary cognitive impairment (Roper et al, 2016), which in this instance is caused by alcohol withdrawal.

The nurse demonstrated communication skills by being able to withdraw necessary information for the patient’s care without upsetting the patient, building rapport and remaining empathetic. This was evident when the nurse asked how many drinks per day the patient would normally have to see the severity of the circumstance. The nurse, to identify the symptoms of pain the patient was feeling, asked a series of questions each answer serving as a cue to inform the next question. The nurse was aware that due to the patient's agitated state his communication ability impacted the reliability of the cues that were being collected, and was evident when the nurse would continually confirm information from the patient. The collection and analysis of these cues allowed the nurse to understand the full context of the patient’s situation, assisting the nurse to be able to formulate her judgement in the communication of care. (ie. administering diazeapam)

Now What

Learning Experience 1

This patient scenario is significant for my future nursing practice as not only has it introduced me to the potential interactions I will have with adolescent patients who are terminally ill, but has informed me of the impacts that inconducive environments can have on patients and lastly the facets involved in providing safe care to adolescents.

Providing sexual education isn't just crucial for adolescents but also patients who have illnesses as treatment can cause sexual side effects and psychosexual delays in adolescence (Zhou et al 2015). Thus there needs to be appropriate support for terminally ill patients to communicate this activity of living.

(Hoybye, 2012) states that in some instances, adolescent cancer patients can feel as if they do not have space to express themselves or have privacy in their rooms, discouraging the patient to practice AOLS autonomously and safely. Terminally ill patients have also reported in research to feel ostracised in life when expressing attitudes towards their illness i.e interrupted life plans, disrupted careers and school paths (Vaughn, 2016). Thus hospital life should nurture the adolescent experience by merging both hospital and the patients everyday life to promote a sense of similarity among peers and momentum in adjusting to life. An example of how this could be achieved is through reducing administrative tasks and task stacking to encourage patient privacy (Erickson et al 2017)

Learning Experience 2

In order to effectively assess and care for patients that are unable to communicate, individualized care and understanding the patient's circumstance is imperative in helping to gather cues to formulate judgements for care when the patient cannot provide information (Burbach et al 2014). This could be achieved by contacting the patient’s support network to establish certain behaviours that could serve as cues, or incorporating objects/sentimental tokens that can be referred to as a short cut for communicating needs. In order to gather cues and communicate care, I now know that I must continually educate myself in pathology/disease. As this will enable me to identify cues such as pathological symptoms that are vital in the detection of patient stability, in particularly "the deteriorating patient" (Orique et al 2019)

In the second video, The nurse conveyed a task-orientated mindset that greatly influenced her style of questioning, this caused the patient to misinterpret the questions as accusatory and took personal offense. The nurse did not pick up on this cue to alter her communication style and continued to upset the patient, significantly adding to his stress. This widely reflects the patient dissatisfaction that is present in the health care system today due to the implementation of task-oriented care as opposed to patient centred care. (Gluyas, 2015) Seeing the impacts of miscommunication on this patient further instilled my belief of individualized care and the need for continued effort to develop communication skills.

Conclusion on Integrated Nursing Concepts 1 

Groups of students were formed with one another and they were engaged in three roleplaying activities. These activities were encompassing three different cases between nurse and patient and all these cases experienced different activities of living. The first case discussed the issues of a 15 year old girl with leukemia and was recently diagnosed with an STI. The second case included a patient that was feeling pain and irritation from alcohol withdrawal. After collecting cues from the first experience it was noticed that the patient’s lifespan activities such as “expressing sexuality” and “working and playing” were significantly changed. The learning experience 2 revealed the correct way of communicating with a patient for a sensitive topic. Asking questions that can bring up cues for another questions was used by the nurse to communicate with the agitated patient. The first incident bought up learnings regarding dealing with adolescent patients while the second incident taught me the importance of task-oriented mind frame and recognition to the condition of a patient while communicating.

References for Integrated Nursing Concepts 1 

Bober, S. L., Nekhlyudov, L. Zhou, E. S., (2014). The primary health care physician and the cancer patient: tips and strategies for managing sexual health. Translational Andrology and Urology, 4(2), pg 218-231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708119/

Burbach, BE. Thompson, SA. (2014). Cue Recognition by undergraduate nursing students: an integrative review. Journal of Nursing Education, 53 (9) pg 73-81. https://www.researchgate.net/publication/264640531_Cue_Recognition_by_Undergraduate_Nursing_Students_An_Integrative_Review

Derouin, A., Guilamo-Ramos, V., Jemmott, L. S., Maria, S. M., Villarruel, A,. (2017). Nurses on the Front Lines: Improving Adolescent Sexual and Reproductive Health Across Health Care Settings. American Journal of Nursing, 117(1), p42-51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513155/#

Despins, L. Erdelez, S. Orique, S. B., Wakefield, B. J., Vogelsmeier, A. (2019). Perception of clinical deterioration cues among medical surgical nurses. Journal of Advanced Nursing, 75(11). https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.14038

Erickson, S. M., Koltov, M. McLean, R. M., Rockwern, B. (2017). Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper for the American College of Physicians. Annals of Internal Medicine, 166(9) pg 659-661 https://www.ncbi.nlm.nih.gov/pubmed/28346948

Gluyas, H. (2015). Patient-centred care: improving healthcare outcomes. Nursing Standard, 30(4) pg 50-59. https://journals.rcni.com/nursing-standard/patientcentred-care-improving-healthcare-outcomes-ns.30.4.50.e10186

Hayes, C. (2019, August, 7th) Brett Steel – case scenario 1. Youtube. https://www.youtube.com/watch?v=n3aiBSiXKus&feature=share

Hayes, C. (2019, August, 7th) Brett Steel – case scenario 2. Youtube https://www.youtube.com/watch?v=VOIXooM5VAo&feature=share

Hoybye, M. T., (2012). Healing environments in cancer treatment and care. Relations of pace and practice in hematological cancer treatment. Acta oncologica, 52(2)

Johnston, C. (2017). Reflective practice. Teaching Business & Economics, 21(1), 19-21

NSW Government. (2020). Essentials of care. Retrieved from https://www.health.nsw.gov.au/nursing/culture/Pages/essentials-of-care.aspx

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person‐centred care: A conceptual framework. Health Expectations, 21(2), 429-440. https://www.ncbi.nlm.nih.gov/pubmed/29151269

Tierney, A. J., Logan, W. W,. Roper, N. (2019) Expressing Sexuality. In A. Holland, K. & Jenkins, J. Applying the Roper , Logan , Tierney Model in Practice. (3rd edition, pg 285-415). Elsevier. https://www.elsevier.com/books/applying-the-roper-logan-tierney-model-in-practice/holland/978-0-7020-4658-2

Tierney, A. J., Logan, W. W,. Roper, N. (2019) Working and Playing. In A. Holland, K. & Jenkins, J. Applying the Roper , Logan , Tierney Model in Practice. (3rd edition, pg 355-385). Elsevier. https://www.elsevier.com/books/applying-the-roper-logan-tierney-model-in-practice/holland/978-0-7020-4658-2

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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