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What

Here, I am using Broton’s Model of reflection to outline my personal and professional growth. I was appointed to conduct an assessment of the patient named Maria and provide assistance for her daily life activities. In the current reflection, I complied with NMBA Standard 1.2 to reflect on my experiences, knowledge, actions, and feelings (NMBA, 2023). Maria's situation was complicated one year ago she was diagnosed with colon cancer. She had a stroke history that resulted in left arm and left leg weakness. Moreover, during assessment I observed her impaired cognition, severe pain, and anxiety, which was entirely understandable given the medical history and recent fracture. Considering her social life, I got to know she had been living alone since her husband's passed away; however, her daughters visited regularly. I ensured to follow the NMBA Standard 2.2 to communicate effectively by showing respect for her dignity, values, beliefs and rights (NMBA, 2023). However, her cognitive decline triggered communication challenging and she often appeared confused and agitated and was not capable to answer verbally. This ineffective verbal communication leads to poor assessment and I faced barriers to identifying her issues and concerns and taking consent for palliative care. After assessment, the healthcare team recommended that Maria should be discharged to hospice care due to her cognitive decline and increasing need for assistance to perform her daily living activities.

So, what

This experience of assisting Maria made me realize the significant impact that a patient's personal and medical history can have on their current healthcare needs. Maria’s case highlighted the importance of a holistic approach for patient care. Her cognitive decline and the need for hospice care were clear indicators that her health was declining rapidly, and there was a need to shift her treatment from curative to palliative care. I implicate the NMBA Standards 5.1 and 5.2 to use assessment data and the best available evidence to develop a care plan (NMBA, 2023). I identified three major nursing diagnosis which needs to be addressed, including pain management, actions to prevent falls related to weakness and history of falls, and enhancing her mobility. However, due to her cognitive decline I face difficulties in implementing these interventions. Nurses must have skills to communicate effectively with the patient and their family members to enhance the effectiveness of palliative care (Engel et al., 2023). 

 The case also reinforced the importance of effective communication. The first time I interacted with Maria, I realized that I lacked the skill to perform non-verbal communication with a cognitive impaired patient. Furthermore, I paid much attention to her emotional needs, especially her anxiety. Later, I approached the situation with patience and empathy and adapted to Maria's communication style and needs. It supported me to comply the ICN Code of Ethics 1.3, which states nurses should ensure that the patient receives accurate, sufficient, and timely information in a culturally appropriate manner (Strini et al., 2021).

Obtaining informed consent is a fundamental aspect of ethical and legal healthcare practice (ICN Code, 2023). In the case of Maria, where the healthcare team recommends her discharge to hospice care due to her cognitive decline and growing need including activities of daily living. It is crucial to ensure that the process of obtaining informed consent is handled appropriately (Strini et al., 2021). In the case of Maria, I attempted to follow the ICN Code of Ethics 1.3 and before seeking informed consent, I assessed Maria’s capacity to make decisions (ICN Code, 2023). I provided all the related information to Maria including the pros and cons of palliative care. However, since she was facing cognitive decline, I involved her daughters in the discussion, ensuring they understood the situation and the recommendation for hospice care.

Now What?

Moving forward, I need to continue refining my skills in caring for patients with complex medical histories and cognitive impairments. I must remain attentive to the emotional and psychological aspects of care and recognize the significance of palliative care when it becomes the most appropriate approach. I should also consider involving Maria's family in the care plan and decision-making process. It will ensure shared decision making, transition to hospice care, and support to family members. In my future clinical practice, I will learn how to effectively communicate with patients with impaired cognition. I will follow the ICN Code of Ethics 1.2 to endorse a situation in which human rights, values, culture, religious and spiritual beliefs are respected and considered (ICN Code, 2023). I will find a quiet and comfortable space for the conversation to minimize distraction and ensure privacy, which can help reducing anxiety and make it easier for the patient to focus.

In summary, the care of Maria was a valuable learning experience that emphasized the importance of holistic care, effective communication, and adapting to the changing needs of patients. The case of Maria made me realize the importance of palliative care. In in my future clinical practice, if I again get the chance to deliver palliative care, I will focus on the person’s unique needs and values. It requires a compassionate and interdisciplinary approach that addresses the physical, emotional, spiritual, as well as social aspects of care (Achora & Labrague, 2019). Hagan et al (2019) stated that the nursing workforce must be trained in palliative care skills, especially nurses who work with patients with serious illnesses. I will enroll in the courses and attend webinars to learn key strategies to deliver effective palliative care. I will conduct comprehensive assessments to understand the patient’s physical symptoms, psychosocial needs, and spiritual concerns (ACQHS, 2019). I understand the need for a collaborative approach with other healthcare workers, such as community workers, ethicians, or psychologists, to ensure the best approach for obtaining informed consent in challenging cases. To promote the effectiveness of palliative care I will follow NMBA Standard 6.1, which is to provide comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people (NMBA, 2023). I will administer medications accurately and monitor for side effects, adjusting doses as needed. Lastly, I will ensure to adhere to ethical principles such as autonomy, beneficence, and non-maleficence in decision-making and care.

References

Achora, S., & Labrague, L. J. (2019). An integrative review on knowledge and attitudes of nurses toward palliative care: implications for practice. Journal of Hospice & Palliative Nursing, 21(1), 29-37. https://journals.lww.com/jhpn/abstract/2019/02000/an_integrative_review_on_knowledge_and_attitudes.7.aspx 

ACQHS. (2019). Components of the comprehensive care plan-information for clinicians. https://www.safetyandquality.gov.au/publications-and-resources/resource-library/components-comprehensive-care-plan-information-clinicians 

Engel, M., Kars, M. C., Teunissen, S. C., & van der Heide, A.(2023). Effective communication in palliative care from the perspectives of patients and relatives: A systematic review. Palliative & Supportive Care, 1-24. https://doi.org/10.1017/s1478951523001165 

Hagan, T. L., Xu, J., Lopez, R. P., & Bressler, T. (2018). Nursing's role in leading palliative care: A call to action. Nurse Education Today, 61, 216-219.https://doi.org/10.1016%2Fj.nedt.2017.11.037 

 https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx 

ICN Code. (2023). The ICN Code of Ethics for Nurses. https://www.icn.ch/system/files/documents/2020-10/CoE_Version%20for%20Consultation_October%202020_EN.pdf 

NMBA. (2023). Registered nurse standards for practice.

Strini, V., Schiavolin, R., & Prendin, A. (2021). The role of the nurse in informed consent to treatments: an observational-descriptive study in the Padua hospital. Clinics and Practice, 11(3), 472-483. https://doi.org/10.3390%2Fclinpract11030063

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