Dignity in My Medical Practice

Introduction

I will be reflecting on a positive experience that I encountered while at my first clinical placement and how I maintained dignity throughout. According to Paliadelis and Wood (2016) Reflective practice among student nurses enables learning and contributes to the development of previous experiences. (Paliadelis & Wood, 2016).

I have chosen to use Gibb’s Reflective cycle to help demonstrate my learning outcomes and enhance my clinical development. The Gibbs ‘ Reflective Cycle was first introduced in 1988, it includes six stages of reflection that allow the reflector to reflect through all stages of an event or experience (Gibbs, 1988).

Reflecting on an event or experience is proven to demonstrate critical thinking of actions, thoughts and feelings. According to Howatson-Jones (2016) Reflection, is a preferred source of continuous learning throughout a Nurses Professional career. (Howatson-Jones, 2016).

Reflective practice was introduced in 2000 among student Nurses. According to Oates (2016) This was proven to be an effective way of learning while recognising one’s strengths weaknesses while learning to improve their skills.

(Oates, 2016).

The Nursing and Midwifery Council policy 2018 states, that in order to maintain privacy and confidentiality a pseudonym name should be used. Throughout my essay, all names, dates and places have been changed in order to protect the patient’s identity. (NMC, 2018).

Description

The event that I will be reflecting on is performing last offices on a gentleman who went by the name of Mr X. This was the first time for me to participate in such a personal, yet honourable moment. According to Zheng, Lee and Bloomer (2016).

When faced with patient death, newly qualified nurses express a variety of feelings, while also reporting the lack of coping strategies and support that is unavailable to them. (Zheng, Lee & Bloomer, 2016).

The patient was receiving care from a qualified Nurse and Doctor when I walked past and noticed the cubicle door open. Not to distress other patients and to preserve the patient’s dignity I closed the door discreetly. Not too long after, the Ward Sister came and asked if I would assist with performing last offices on Mr X.

Having checked that the patient didn’t have any religious beliefs prior to taking part in the event. The Nurse and I washed and dressed Mr X accordingly, while maintaining his dignity throughout. After the preparation of the body, the nurse in charge promptly completed the paperwork while the task of packing Mr X belongings was delegated to me ready for the family to collect. This was done in a sensitive manor while still upholding dignity, respect and confidentiality even after the patient had passed away.

Thoughts and Feelings

Prior to the event, I was sceptical in proceeding with the Nurses requested to perform last offices. This is something that I had never experienced before and cautious on whether my lack of experience would hinder the process. Having recognised my concerns, the Staff Nurse promptly answered my questions I had regarding the process. Having support and reassurance from the start, helped me feel confident in proceeding with the task in hand. On completion of giving Mr X his last respects, I felt honoured to have been given the opportunity to experience this event and assisting Mr X in his final moments.

Evaluation

In my opinion, the process went well and my hesitations before the event were quickly resolved. My fear of not knowing was the catalyst to me achieving my goal in overcoming this event. I was proud of myself in the way I maintained Mr. X’s dignity throughout, the way I handled his belongings was considerate not only to Mr. X, but to the family as well.

To summarise on what could have gone better, would have been if I were to excuse myself from performing last offices and requested training on this subject while also researching on what the process is and what is required each step of the way.

Analysis

Dignity should be a fundamental value that every health professional practices regardless of age, race, gender or nationality. According to Kerchhoffer (2017) Dignity is viewed as a multidimensional concept with every human, being an individual and should be treated with respect, maintain their autonomy, respect their privacy and their right of choice. (Kerchhoffer, 2017).

Dignity originated from the Latin words dignitus (ment) and dignus (worth). (Adib & Aghajani, 2015). Macaden et al. (2017) highlights the importance of dignity training before students commence their first placement. (Macaden et al., 2017). According to Matiti (2015) maintaining dignity is a fundamental process of nursing, it has been stated that there appear to be a few issues that are preventing health professionals from promoting patient dignity. (Matiti, 2015). A systematic literature review by Pringle, Johnston and Buchanan (2015) supports this issue by presenting concerns with maintain dignity when relating to symptom control, environmental factors and staffing issues or lack of. (Pringle, Johnston, & Buchanan, 2015).

According to Loftus (1998) it is common for student nurses to be placed in the position of caring for the deceased patient, with having to experience the complexity that it entails during the process of last offices. (Loftus, 1998). Oliveira ES, Agra G, Morais MF et al. (2016) found that student nurses experience of patient death, can be overwhelming with a personal fear of dying themselves. (Oliveira et al., 2016). According to Chiaravalloti (2018) Nurses need to adopt coping strategies in order to deal with patient death. (Chiaravalloti, 2018).

Kinman and Leggetter (2016) stated that, expressing one’s feelings can help relieve the burden and help eliminate stress that is experienced when dealing with emotional situations (Kinman & Leggetter 2016). According to Akuroma, Eye and Curran (2016) good communication skills can help minimise mental health related issues, that have been proven to occur in Health Professionals. (Akuroma, Eye & Curran, 2016).

Ek et al. (2014) found that nursing students need support and guidance from their practice place mentor, when dealing with patient death. (Ek et al., 2014). Allman (2019) stated that even though our academic essays are important, our mental health and wellbeing is also important for us to progress and achieve our Nursing degree. (Allman, 2019).

Knight (2015) published an article in the Nursing Times that stated, reflective practice has been proven to assist student nurses and other health professionals, with the process of recognising their emotional experiences, while addressing nurses’ feelings to be able to improve in further situations. (Knight, 2015). “We do not learn from experience…we learn from reflecting on experience” (Dewey, 1933, p. 78).

Moon (2018) stated that Reflective practice is a method of learning that assists us in overcoming our weaknesses, it prepares us to be more honest with ourselves and addresses where we need to improve (Moon, 2018). Throughout a nurse professional career, it is a requirement by the Nursing and Midwifery Council (NMC), to revalidate their nursing pin every 3 years. (Nursing and Midwifery Council, 2018).

As stated by Ali (2017) The revalidation consists of four key points, practise effectively while understanding the need to communicate effectively, accurate record keeping contributing to one’s own knowledge and experience. (Ali, 2017). Using relevant and current evidence-based information, is known as best practice. This is where reflection comes into practice, acting on feedback whether positive or negative can improve patient quality. According to Virtino (2017). When communicating with patients, the use of slang words or jargon is forbidden. Using language that patients understand, by using, verbal or non-verbal communication. This is considered best practice. (Virtino, 2017).

The Nursing and Midwifery Council (2018) states that health professionals must be sure to prioritise people, by ensuring that the interests of patients and their needs are always put first. (NMC, 2018). Maintaining dignity and preserving their needs, is paramount to upholding the professional code of practice. Health professionals need to recognise diversity, while acknowledging individual choice, these qualities are what need to be practiced throughout a nurse’s career. (NMC, 2018).

According to Fitzpatrick (2018). The importance of promoting professionalism, is always a fundamental value to uphold. The reputation of the Health professional is vital, for the patient to entrust their physical and mental wellbeing to the professional in charge. (Fitzpatrick, 2018). Implementing this attitude throughout your career is paramount and is set in the code of conduct. (NMC, 2018). Being accountable for your actions and acting honestly, while giving accurate information to patients, will lead to trust and confidence in the profession from patients receiving care.

According to the Department of Health and Social Care (2018) It is the Health Professionals duty to preserve safety, by working within your limits of competency. (Department of Health & Social Care, 2018). The Nursing and Midwifery Council codes of practice (2018) states that patients concern, and welfare must always be a priority while recognising when public safety might be at risk. (NMC, 2018). Practicing beyond your profession is a criminal offence. Regardless if you have been asked to practice outside of your role it is detriment to the patient that they are receiving the most appropriate care that is needed.

According to Caldwell and Grobbel (2013) Reflection alters the way we think, by becoming more self-aware. A quantitative study found that reflection is beneficial to the progress of a student nurse’s education and professional career. (Caldwell & Grobbel, 2013).

Conclusion

This experience has taught me to not be afraid to ask if I am unsure about something and when situations arise which I am not familiar with, such as performing last offices. Having never experienced or dealt with a scenario like this, I believe that I would have benefited from some additional training before I were to experience this event.

During this experience I have learned the importance of maintaining dignity even when the patient is deceased. Having now accomplished this task I am confident that if a situation like this were to arise again, I am prepared and confident to achieve what is needed of me as a student Nurse.

Action Plan

Reviewing literature and acknowledging the emotions that are experienced when dealing with patient death, can help with understanding why we feel this way. According to Hurtig and Stewin (1990) Nursing students need to recognise and accept their feelings towards death, in order to accept it later in their career. (Hurtig & Stewin, 1990).

Understanding grief and how to recognise coping strategies, I believe will alter perceptions on patient death. Further research by Parry (2018) concluded that, specific skills that is needed can not be taught in theory, with student Nurses particularly not feeling prepared enough to face patient death. (Parry, 2018).

Final Conclusion

Reflection has been proven to be beneficial in all areas of professional learning. According to Heyler (2015) Reflective practice acknowledges strengths and weaknesses you might have, using the information and knowledge that was gained can contribute towards improvement in the future. (Heyler, 2015).

Gibb’s (1988) reflective model has proved helpful during my studies, due to its easy to follow, step by step process. The 6 stages of reflection are; description, feelings, evaluation, analysis, conclusion and action plan. This framework has helped me to structure my piece of work and made it more practical to record my feelings. (Gibb’s, 1988).

Gibbs’ Reflective Cycle was developed by Graham Gibbs in 1988. Gibb’s is a common reflective tool that is commonly used by student nurses due to the easy to follow cycle. (Gibbs, 1988).

According to Edwards (2017) student nurses gain a better understanding on their experience, when they have chosen the right model of framework that is suitable to them. (Edwards, 2017). Contrary to that, Rolfe (2014), stated that reflective practice has had a poor impact on nursing education and practice, proposing that this lack of progress has led to an increase in poor interpretation and reflective practice. (Rolfe, 2014).