The nursing philosophy encompasses the belief and value system on which the nursing practice is based. It guides the clinical practice and defines the identity of an individual as a nurse. It is the nurse's belief that motivates to work for longer hours, without being offered any resilience. The beliefs cause for persistent efforts in caring for the patients and work as a compass for clinical decision making and patient management. A nurses' philosophy can evolve over a period based on the experiences in clinical practice.
My philosophy of nursing is to provide emotional support to the patients as they undergo difficult situations. As per the NMBA, (2016), the role of the nurse is to establish a therapeutic relationship with the patients. Therefore, whenever I sense a patient feeling anxious before the surgery or before having a radio diagnostic procedure, I provide them assurance by holding their hands or even offering them a few words of comfort. By developing a personal nursing philosophy, I understood nursing theory aided in forming a new perspective for me in providing care to the patients. For instance, the theory of Human Caring by Jean Watson states that nursing practice includes “holistic care and a transpersonal relationship with each patient” (McCutcheon et al., 2017). For this purpose, it is essential for me to be careful in fulfilling my own needs and to be centred. I realised that by first taking care of myself will I be able to take care of the patients emotional as well as physical needs.
SMART goals are used to define a Specific, Measurable, Attainable, Relevant and a Timely goal. The main aim of SMART goals is to improvise on the skill of goal setting in the nursing care practice. Being specific is to define the exact goal, for instance- developing skill cultural competency. Measurable- This is defined as setting a time duration for achieving the goal. I would learn about different cultures and their value system and beliefs by connecting with the aboriginal community people for minimum of 06 months. Attainable- It is defined by the practicality of the goal. Achieving cultural competency is a practical and achievable goal. It is a skill which takes time to be developed and does not occur on its own. Relevant- This aspect of goal setting refers to its use in clinical practice (Stonehouse, 2017). As per the NMBA, (2016), it is the role of a nurse to exhibit cultural competency while treating the patients. I should be aware of their religious and traditional belief system. As per a research conducted by so and so, it is deduced that cultural competency offers a platform for building a therapeutic relationship. Target- This refers to the target date- For instance, I have decided to connect with people various aboriginal backgrounds for 6 months.
The SMART goals can further be classified into short term and long-term goals. The short-term goal would include acquiring knowledge of people from different communities and background daily. To interact with a minimum of 2 people each day from different nationality or a community. To gather more information on their culture and belief system by reading books which are related to them or by reading articles online. The long-term goal would involve a continuous practice of understanding the belief system of an individual and respecting their values. A nurse needs to consider the patient's autonomy. Which means the patient has the right to choose a specific treatment or deny a treatment based on his or her value system. As a nurse, it is vital to respect the decisions of the patient related to their health.
Reflection is a process of re-visiting the past experiences to draw relevant learnings pertaining to the situation in the past. In nursing practice GIBBS model of reflection offers an effective mode of pursuing the activity (Beam et al., 2016). It involves 6 steps, namely 1) Description: this refers to describing the situation. It may include details such as who all were present in the situation, what was the background, what the reason for me to be there, etc. 2) Feelings: this aspect of the reflection refers to the feeling I went through at that moment, the emotions which triggered and how they were triggered. What kind of emotions I felt, for instance, Was I angry?, or felt inadequate? Identification of the right feelings is very important so that learning can occur. For an effective reflective process, the nurse must make honest and transparent decisions. 3) Evaluation: It refers to examining the good as well as the bad outcomes of the situation or the experience. 4) Analysis: It is the process of analysing the whole situation and understanding without bias or preconceived notions. 5) Conclusion: This specifies the learning and trying to approach the situation from a new perspective, asking them questions such as, "what else could I have done to prevent the situation?" 6) Action plan: The last step focuses on the present. It emphasizes on asking the relevant question such as, "what would I do, if the same situation arises again?".
The healthcare profession is very complex as it involves dealing with the actual lives of people. Any mishappening can lead to risking of patient's life, consequently, it is also one of the most vulnerable professionals, therefore, the process of reflection plays a key role in offering self-correction and means to improvise our practice in a clinical setting. It decreases the chances of re-occurrences of the same medical error done before. Thus, reflective practice in nursing is very crucial for providing continuous improvement in care to patients and to improve clinical outcomes (Arnott, Paliadelis, & Cruickshank, 2018).
As a nurse I have realized the importance of having a patient-centred approach in nursing practice. As per the NMBA standard 5 statement 2, “In standard 5, statement 2: "together constructs nursing practice plans until contingencies, options, goals, procedures, outcomes and timeframes are agreed with the relevant persons (NMBA, 2016).” I read about the concept of patient centered care while treating a patient suffering from mental health illness. The patient was having a sad appearance and was looking pale and weak. I felt that I must initiate the conversation and though I felt that I broke the ice, but the patient’s anxiety did not decrease, I realized within a few minutes that the patient is not comfortable to speak with me in English language. I empathized with the patient and I arranged for a translator to help her communicate with me. It reduced the patient’s anxiety and she began to feel calm. Thus, by applying patient-centred care I learned that it is essential to provide effective care to the patient. Now, the patient was able to express her health concerns and was happy that she could understand the treatment plan.
Later on, my supervisor encouraged me to read more about the patient centered care, and after my research I found that it has been treated as a crucial part of nursing practice and this was due to the eminent work o " Luxford et al., (2011). He stated the eminent work of Gerteis who is known to identify 7 dimensions of PCC, which include, “respect for patient’s values, needs & preferences; co-ordination and integration of care; information, communication & education; emotional support and physical comfort; alleviation of fear and anxiety; involvement of friends and family in providing the care; smooth transitions and care of continuity (Better Health Channel, n.d; Mitchell, 2010).” As my knowledge and experience increased, I practiced the 7 principles of patient centered care in my clinical practice and noticed significant improvement in health outcomes of all my patients. The major change which I noticed was the improvement of compliance of patients related to the treatment goals and medical management. It also greatly impacted development of therapeutic relationship between the patient and me.
Reflective practices focus on the critical thinking skills of a nurse. As a nurse it allowed me to identify the challenges while dealing with the patients in a clinical setting. During the academic years, as nursing students I believe we do not get adequate exposure of dealing with the patients and as soon as they I entered the working environment, I suddenly felt a lot of pressure to deal with patients in a clinical setting (Ardian, Hariyati, & Afifah, 2019). I was anxious and overwhelmed. Many fresh nurses who started working with me felt prone and vulnerable to make mistakes in their journey of being professional nurse and developed learnings by reflecting on the past mistakes. The process of reflective thinking helped me to healthily deal with my emotions and to draw their learnings from it. It also helped me in forming good decision-making skill and to develop critical thinking ability. Reflective thinking offers various improvement opportunities, as a part of self-directed learning in their respective clinical domains.
The ongoing advancements and rampant changes in the guidelines opine the fact that nurses must engage in continuous learning and professional development programs, despite resisting the change. It is vital to the nursing practice that the nurses embrace and adapt quickly to new situations. Reflective thinking ensures safe clinical practice, increase reliability and accountability of the nurses, by investing their professional, clinical and theoretical development (Campbell et al., 2018). The practice of reflective thinking enabled me to re-visit the experience from a fresh non-judgemental perspective, to ask questions which seeks out truth and knowledge, to reach a valid conclusion and make meaning out of it; it helps in the advancement of the nursing education, to mentor themselves and treat the patients with a holistic approach. It underpins the value of empathy towards the patient, bridge the learning gap and reach professional standard or professional ability to deliver care to the patients.
As a nurse, the job offers many opportunities to interact with the patients as we form the front workforce of the hospital. During my practice as nurse, I thought of the impact my communication had on the patients. Within a few months I realised that an effective communication has a profound impact on the patient-nurse relationship. It deepens the understanding of the condition of the patient. An effective communication includes factors such as, “being a good listener; having the ability to counsel; considerate people can build trustworthy bonds and team-building skills. They value relationships and form strong bonds based on genuine care for each other (Schroeder, 2013).” A thoughtful communicator, can offer comfort to patients by counselling and empathizing with them. With the application of these learnings, I have realized the importance of how the therapeutic relationships are developed or formed between the health caregiver and the patients. It offers motivation to the patients to be compliant with the treatment goals and medication management, especially for patients need prolonged treatment. For example, patient dealing with debilitating diseases such as cancer. The role of effective communication in building therapeutic relationships leads to better healthcare outcomes. It also helps the care provider to provide culturally safe environment to the patients and work out the treatment plan in a holistic manner (Arnott, Paliadelis, & Cruickshank, 2018).
As a nurse, skills of good communication can be developed by active listening. This will improve the understanding of the patient’s needs. According to the research done by Hertog & Niessen, (2019), "It is a challenge faced personally by all nursing staff. However, the importance of active listening in the process of healthcare delivery cannot be ignored. The healthcare professional needs to work with the patient in partnership to understand and comprehend their health issues and feelings. Active listening helps in remembering important information. It also helps in having a detailed knowledge of the patient which is essential in providing effective care to the patient. It avoids malpractice by focusing on the details and avoids medical errors. Listening is an important component of communication. It forms the basis of an effective communication practice and most of the nurses argue that it is not time-consuming but time-saving.
It was also reinforced by Yoost & Crawford (2019), who noted that active listening is efficient in building rapport with the patient and helps in providing tailored care or personalized care. Furthermore, paying attention to the patient helps in the identification of patient preferences and enhances the quality of life of the patients. Active listening skills can be developed by, removing all the patient-related prejudices from one's mind. The nurse must see every patient differently." However, there can be certain issues which can be hindering for an effective and meaningful way of communication. These include Overthinking, which leads to an inability to focus on the patient, and to make well-informed decisions for them. Shortage of time, due to an increase in the healthcare burden on the nursing staff, it is difficult to find enough time for the nurses to listen and efficiently talk to the patients. The nurses must be supervised while they try to establish communication with the patients in a clinical setting.
Refection is an integral part of nursing care practice, it aims to draw learning from the past mistakes, thereby, reducing the chances of re-occurrence of the same mistakes in the future. It is an essential part of the nursing curriculum and involves 6 main steps, which are description, feelings, evaluation, analysis, conclusion and action plan. Each step of the reflective cycle aids in the process of learning and improving the clinical nursing skills. On reflecting upon concept of PCC, and on reflecting on the concept of communication and collaborative association it can be said that It offers motivation to the patients to be compliant with the treatment goals and medication management, especially for patients need a prolonged treatment. For example, patient dealing with debilitating diseases such as cancer. The role of effective communication in building therapeutic relationships leads to better healthcare outcomes. It also helps the care provider to provide culturally safe environment to the patients and work out the treatment plan in a holistic manner.
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