Clinical Project

Introduction to Issues Faced During Nursing Practice

Reflection is a process described as thinking about the feelings, conceived thoughts and attaining knowledge about the incidents of the past, current and future. With refection, one can better understand their strength and weakness which can lead to enhanced self-awareness, better work management and positive thinking (Bramhall, 2014). An act of misconduct can jeopardise the well-being and health of the patient and decrease the standard of healthcare services. In compliance with the ICN Code of Ethics for Nurses (2012), nurses work in the organisation's ethical climate and question any unethical activities. This implies that nurses ought to disclose any violation of the professional procedure they conduct or observe. The aim of this journal is to reflect upon three incidents where I experienced issues during nursing practice as a student nurse, using the Gibbs reflective cycle.

Incident 1

Description of the event

While on duty as a student nurse in the special care ward, I had to look after the provision of hygiene care for the patients. While I was helping a patient comb, I noticed that on the enrolled nurse medication administration duty was talking rudely with a patient who did not want to take the medicine as the patient did not feel like it. I noticed her talking to the patient very angrily and the patient began to cry, after which I made a decision to report the incident to the registered nurse. The registered nurse then called for a meeting to discuss the issue with the enrolled nurse.

Feelings

As the enrolled nurse’s shift was about to get over and she had been on duty for a while maybe she was tired and impatient because of exhaustion. I felt awful that since I reported against the enrolled nurse her mistake came into the notice of the registered nurse.

I thought I was merely doing my duty by reporting the misconduct and had I not done so, the enrolled nurse might continue to repeat the mistake she made.

Evaluation

If no step is taken to prevent or stop a co-worker or senior or the management’s misconduct by a healthcare professional, then he or she is regarded as contravening the basic professional commitment for promotion and protection of the wellbeing and health of the patient (Mansbach et al, 2014). I noticed that the enrolled nurse breached the code of conduct and acted according to my instinct at the moment and I felt the right step would be to report it to the registered nurse.

Analysis

Appropriate action should be taken by the nurse to protect patients, their families as well as communities if their colleague or any other healthcare provider imperils their health (ICN Code of Ethics for Nurses, 2012). It was the duty of the enrolled nurse to adhere to the code of conduct and by losing her temper and screaming at the patient she increased the emotional distress for the patient by causing mental trauma to her.

Conclusion

The knowledge about the code of ethics for nurses, understanding of the principles of ethics and being morally sensitive are vital for the decision-making when faced with an ethical dilemma. After contemplating the decisions and analysing the choices I had, I feel I made an accurate decision by having informed the registered nurse.

Plan of Action

In nursing ethical dilemmas are inescapable, I wish to once again thoroughly go through the ICN Code of Ethics for Nurses (2012) along with NMBA code of conduct for nurses (2018). I plan to share the details of the incident and discuss them with my professor so that she can guide me regarding this incident. Next time, I intend to first talk to the individual involved in the breach of the code of conduct.

Incident 2

Description of the event

Once while working in the general ward as a student nurse, I had been saturated with duties that I forgot to maintain hand hygiene while switching between patients. I was recording their vitals and the ward was fully occupied. I had been working since morning without breaks as there were many duties allotted to me due to the shortage of the staff and the ward being full. The Registered Nurse noticed that I skipped the hand hygiene protocol. Even though she did not mention anything to me at the moment she later came to me and scolded me for my negligence.

Feelings

I am always very particular about hand hygiene as I know the hazards of not maintaining hand hygiene. Overburdened with work I did not realize when it slipped off my mind to adhere to the hand hygiene protocol. I am really angry at myself for being so careless. I agree with all the things mentioned by the registered nurse, it is of utmost importance to follow hand hygiene protocol under all circumstances without fail. I still cannot believe I indulged in such negligence and put the patients at risk.

Evaluation

I should have abided by the NSQHS (2017) according to which, hand hygiene is a vital practice to prevent hospital-acquired infections. A frequent issue the patients face when admitted in the hospitals is the great risk of hospital-acquired infections. Hand hygiene is cheap and efficient it also leads to 15% to 30% of the healthcare-acquired infections being avoided (Ataiyero, Dyson & Graham, 2018. I realised I should be rigid with the hand hygiene protocol and be more vigilant with my practice which was also what the registered nurse had explained.

Analysis

This incident made me realise how dangerous our practice could be if we don’t adhere to hand hygiene compliance. Initiatives like My 5 Moments for Hand Hygiene by WHO as well as Clean Hands Count Campaign by Centres for Disease Control and Prevention are working towards increasing hand hygiene compliance. Adhering to them can lead to an improved and consistent hand hygiene practice.

Conclusion

After the incident, I looked for approaches to adhere to hand hygiene protocol and realised the Registered Nurse was right to point out my mistake and hand hygiene should be adhered to at all times. This incident motivated me to think and analyse about how I can improve the adherence hand hygiene protocol even when overburdened with work or in unfavourable situations.

Plan of Action

The steps I take to maintain high standards of hand hygiene protocol are of paramount significance. To be able to do this, I have decided to strictly follow My 5 Moments for Hand Hygiene. I will clean my hands before touching/treating a patient; before aseptic procedures; after body fluid exposure; after touching/treating a patient and; after touching the patient surroundings (WHO, 2020).

Incident 3

Description of the Event

During my posting in the oncology department, I was on rounds with the oncologist and the head nurse, while the oncologist was discussing the reports with the patient’s partner following with a discussion between the oncologist and the head nurse. That is when the patient’s partner pulled me aside and asked me not to disclose the reports to the patient. This was because the patient was certain that the treatment he was undergoing will be a success and it not turning out to be so would affect him drastically. I was taken by surprise and did not know how to react. I assured the patient’s partner that I shall discuss it with the seniors and we shall try to act as per her request. I approached the registered nurse and she discussed it with the oncologist after which they decided not to inform the patient as his condition had been frail.

Feelings

Initially, I felt it was wrong to withhold the reports from the patient as he has the right to know about his treatment and reports and should be able to participate in his treatment planning. However, after considering the frail physical and mental health of the patient, I felt maybe honesty would negatively affect his already poor prognosis.

Evaluation

Ethical dilemmas occur frequently in medical sciences in the profession of nursing (Rainer, Schneider & Lorenz, 2018). Generally, making a decision with respect to ethical concerns demands a choice to be made between either two equally good or poor choices. However, it is a complex process to resolve an ethical dilemma and it can also lead to increased moral distress.

Analysis

As per the Code of Ethics for Nurses given by the ICN (2012), the nurse should ensure that the patient receives sufficient, right and timely details and information in a manner that is culturally appropriate and by withholding information we breached the code of ethics. However, this case was not just about withholding the information from the patient v/s honesty but it required to analyse the long-term effects it could have on the patient.

Conclusion

After weighing the options we had, the decision the oncologist took was likely to cause more benefits than damage to the patient. Cases of terminal illness need to be handled with a lot of maturity and experience and it is difficult to decide the right time to inform the patient about his detrimental condition and sometimes keeping such information from the patient can prove beneficial for him. However, surrogate decision-maker’s consent is essential.

Plan of Action

I realised I am a complete novice when it comes to making difficult decisions and understanding the ethical dilemmas. I intend to ask my mentor to help me train with such issues and information so that I can prove to be of help whenever a complex situation arises. I also intend to be more patient and think thoroughly the next time.

References for Issues Faced During Nursing Practice

Ataiyero, Y., Dyson, J. & Graham, M. (2018). Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. American Journal of Infection Control, (2018), 1-9. doi:10.1016/j.ajic.2018.09.014

Australian Commission on Safety and Quality in Health Care. (2017). National safety and quality health service standards (NSQHS). Retrieved from: https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

Boyce, J. M. (2019). Current issues in hand hygiene. American Journal of Infection Control, 47, A46–A52. doi:10.1016/j.ajic.2019.03.024

Bramhall, E. (2014). Effective communication skills in nursing practice. Nursing Standard, 29(14), 53–59.

Centers for Disease Control and Prevention. (2020). Clean hands count for safe healthcare. Retrieved from: https://www.cdc.gov/patientsafety/features/clean-hands-count.html

International Council of Nurses. (2012). The ICN code of ethics for nurses. Retrieved from: https://www.icn.ch/sites/default/files/inlinefiles/2012_ICN_Codeofethicsfornurses_%20eng.pdf

Mansbach, A., Kushnir, T., Ziedenberg, H. & Bachner, Y. G. (2014). Reporting misconduct of a coworker to protect a patient: A comparison between experienced nurses and nursing students. The Scientific World Journal, 2014, 1–6.

Maurits, E. E. M., de Veer, A. J. E., Groenewegen, P. P. & Francke, A. L. (2016). Dealing with professional misconduct by colleagues in home care: a nationwide survey among nursing staff. BMC Nursing, 15(1), 1-11. doi:10.1186/s12912-016-0182-2 

Nursing and Midwifery Board of Australia. (2018). Code of conduct for nurses. Retrieved from: file:///C:/Users/HP/Downloads/Nusing-and-Midwifery-Board---Code---Advance-copy---Code-of-conduct-for-nurses---Effective-1-March-2018.PDF

Nursing and Midwifery Board of Australia. (2020). Decision-making framework for nursing and midwifery. Retrieved from: file:///C:/Users/HP/Downloads/Nursing-and-Midwifery-Board---Framework---Decision-making-framework-for-nursing-and-midwifery---Advance-copy.PDF

Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19-20), 3446-3461.

World Health Organization. (2020). Clean care is safer care. Retrieved from: https://www.who.int/gpsc/5may/background/5moments/en/

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