Transition to Nursing

This is the case study of a farmer who has presented to the outpatient department after a fall and was found by a neighbour. This reflection is based on the identification of the socio-cultural factors that lays an important role in designing Jim's care plan. This reflection is written based on Gibb's reflective framework that is a theoretical model used by most of the health care professionals. The six stages of Gibb's reflective cycle are description, feelings, evaluation, analysis, conclusion and action plan that helps in appropriately shaping the reflection (Gibb, 1988). This reflection portrays the learning of the Registered Nurse from the incident based on Jim’s case study.

Description: During my clinical placement where I was working as a Registered Nurse, there was a patient Jim a 65-year-old farmer. He presented to the Outpatient Clinic following a fall from a building. The treatment was given to him and after some time, I learnt that he was not following instructions. I learnt that he was moderately deaf and had not been hearing the education provided by staff in the multidisciplinary team. While I was taking care of him, I realised that there is something wrong and I am facing some difficulties in taking care of him.

I was missing out on considering something and later my colleague made me realise that I was missing out the consideration of socio-cultural factors that is the understanding of the health of farming culture that is their social interactions and other aspects that plays a very important role in designing a care plan of the patient. I felt that something was missing because when I was designing his care plan I observed that he was not following the instructions may be because some things were restricting him.

He was from a very poor family and was the primary caretaker of his 85-year-old mother who was diagnosed with early-onset dementia. He was a farmer and earned his living from there. He was extremely poor and he had no source for power, sewerages and water. They both relied on their self- grown and cultivated food from the farms and also he smokes 20 cigarettes per day. He often uses heavy machinery and sharp elements still he does not wear protective gear. His father also died in a farming accident and his social life is also not- existing. He is the captain of local CFA but has no time to talk to anyone because he has to take care of his mother.

Feelings: I was shocked to learn that I missed on the very important aspect of patient-centred care. I did not even realize after learning about his condition that states that he was not following the instructions of the medical professionals. I was disappointed because I never thought that I would miss out on something as important as the socio-cultural factors despite knowing the history of the patient. I was very well aware of the patient's history and background but still, I was disappointed with my performance as a nurse because I did not consider the socio-cultural factor of his farming culture while designing the care plan for Jim. While I was exploring the case study of Jim, there was a shift in my feelings because as I was reading about his socio-cultural factors, I was feeling sadder.

Evaluation: I wanted to carry out patient-centred care so I step forward and applied RLT model of nursing to identify the socio-cultural factors so that I could design a highly patient-centred care plan (Williams, 2017). I wanted to learn about those socio-cultural factors that influence his activities of living. I wanted to learn about those socio-cultural factors that influence his activities of living of the farmers (de Boer et al., 2017).The socio-cultural factors are very important to be considered because they have a direct impact on the patient not abiding by their care plan (Gilbert &Kerridge, 2019).

The application of RLT model helped me in learning about the socio-cultural factors that the patient Jim was Anglo- Australian and belonged to a different culture (Wilson, Woollands& Barrett, 2018). I realised that there is a gap in my competency and I need to learn more about the application of RLT model so as to cater a holistic care to the patient. The patient was from Anglo- Australian culture, I realized that I was culturally incompetent in learning about the cultures of the patient. The autonomy and the rights of the patients must be always respected and there should be no discrepancy in this.

Analysis: The socio-cultural factors are becoming increasingly relevant in the healthcare domain (Busfield, 2017). These are the structural determinants and these conditions have a huge impact on the life of the patients. These external factors are critical to understanding the health of the patient and their care because these factors are important to be considered to understand their health outside the four walls of health care institutions (Corin, 2017). This provides better outreach and understanding the life circumstances of the patient, improves their relationship and also helps in delivering patient-centred care. Patient-centred care can be delivered by addressing these socio-cultural factors and designing the plan in a manner that is safe for the patients where patients is the centre of care process (Flo et al., 2016).

The health equity can be achieved only by addressing the social determinants of health and it has a direct impact on the delivery of patient-centred care (Giger, 2016). The cultural variation plays a very important role in human nutrition thus this must always be considered when designing a care plan for the patient. They do not get the same nutrition as people of other culture gets and they have different environmental health. The role of cultural competence is significant thus the nurses must always have competency skills so as to cater culturally safe care to the patients.

Conclusion: The conclusion drawn is that the nurses must always consider the socio- cultural factors while designing the patient-centred care plan for the patient. This is very important because of its potential benefits that help in achieving better patient outcomes. There are social factors that need to be addressed like the living environment and the geography that plays an important role in the current health status of the patient. The cultural factors like Anglo- Australian culture of the patientand the other cultural factors also play an important role when designing the care plan of the patient. The patient has no time for social life and rest thus this is also an important consideration in the care plan.

Action plan: In future, I will take care of the fact that the socio-cultural factors play a very important role in the care plan because the patient care is dependent on the access to food and work, community venues and the opportunities for socialization (Warren et al., 2016).

These changes will help the patient in improving his health conditions and this can be best addressed using multidisciplinary team members (Pusa et al., 2019). In future, I will always remember that these changes benefit the other stakeholders also so this should be incorporated while designing the care plan for the patients. The patients who are farmers must always tell the health care professionals of their culture so that the nurses can respect that and consider that while designing the care plan (Taylor et al., 2018). I will always remember to emphasize on the aspect of their nutrition as it is important to be considered while designing a care plan for the patient who has Anglo- Australian culture and has a farming background. I will use RLT model and will also consider the autonomy and rights of the patient.

References for Transition to Nursing

Busfield, J. (2017). The concept of medicalisation reassessed. Sociology of Health & Illness, 39(5), 759-774.

Corin, E. (2017). The social and cultural matrix of health and disease. In Why are some people healthy and others not? (pp. 93-132). Singapore: Routledge.

de Boer, B., Hamers, J. P., Zwakhalen, S. M., Tan, F. E., Beerens, H. C., & Verbeek, H. (2017). Green care farms as innovative nursing homes, promoting activities and social interaction for people with dementia. Journal of the American Medical Directors Association, 18(1), 40-46.

Flo, E., Husebo, B. S., Bruusgaard, P., Gjerberg, E., Thoresen, L., Lillemoen, L., & Pedersen, R. (2016). A review of the implementation and research strategies for advance care planning in nursing homes. BMC Geriatrics, 16(1), 24.

Gibbs, G. (1988). The reflective cycle. Kitchen S (1999) An appraisal of methods of reflection and clinical supervision. Br Journal of Theatre Nursing, 9(7), 313-7.

Giger, J. N. (2016). Transcultural Nursing-E-Book: Assessment and Intervention. United Kingdom: Elsevier Health Sciences.

Gilbert, G. L., & Kerridge, I. (2019). The politics and ethics of hospital infection prevention and control: a qualitative case study of senior clinicians’ perceptions of professional and cultural factors that influence doctors’ attitudes and practices in a large Australian hospital. BMC Health Services Research, 19(1), 212.

Pusa, S., Dorell, Å., Erlingsson, C., Antonsson, H., Brännström, M., &Sundin, K. (2019). Nurses’ perceptions about a web‐based learning intervention concerning supportive family conversations in-home health care. Journal of Clinical Nursing, 28(7-8), 1314-1326.

Taylor, C., Lynn, P., & Bartlett, J. (2018). Fundamentals of Nursing: The Art and Science of Person-Centered Care. United States: Lippincott Williams & Wilkins.

Warren, C. R., Burton, R., Buchanan, O., &Birnie, R. V. (2016). Limited adoption of short rotation coppice: The role of farmers' socio-cultural identity in influencing practice. Journal of Rural Studies, 45, 175-183.

Williams, B. C. (2017). The Roper-Logan-Tierney model of nursing. Nursing2019 Critical Care, 12(1), 17-20.

Wilson, B., Woollands, A., & Barrett, D. (2018). Care Planning: A guide for nurses. Singapore: Routledge.

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