Nursing Experiences in Clinical Supervision Groups

Introduction

As part of the Group Clinical Supervision 1 Module, this assignment requires nursing students to discuss the work in one of the clinical supervision groups, obtained practices, and outcomes. As one of the students who successfully undertook the group clinical supervision session, I am going to reflect on my experiences and demonstrate my level of knowledge and understanding of the tasks. Notably, throughout this paper, I will strive to stick to the requirements of the updated Code developed by the Nursing & Midwifery Council (2018) which spells out a duty of confidentiality and respect to people’s rights. Consequently, I withhold the true names of all the people and places involved in the group clinical supervision session.

The primary focus of this assignment will be the demonstration of the nursing students’ capacity to learn from practical experiences and reflect on different activities. The review of credible literature enhances a better understanding of reflection practices in the clinical supervision group. Redmond (2016) said that reflective practice is closely connected with the idea of learning from someone’s experience in the sense that an individual thinks about what has been done, what goals and expectations were set and achieved, what outcomes were observed, and what improvements can be made next time. According to Knott and Scragg (2016), thinking about what is happening or has already occurred is human nature. It is important to identify and understand the differences between reflective and casual thinking because reflective practice necessitates a conscious determination to think of the recent events, as well as to develop insights around them. Nursing students should always develop reflective skills since, as argued by Redmond (2016), this practice is characterised by significant benefits in the development of self-awareness. This concept is one of the components of emotional intelligence and the ability to create a better comprehension of other people.

In the nursing literature, self-awareness is described as one of the most significant and essential qualities of a professional nurse. For example, Marlowe et al. (2015) stated that self-awareness has a positive relationship with the nurses’ competencies in their provision of high-quality care, which is attributed to patient and caregiver satisfaction. This understanding contributes to the analysis and guidance of behaviour in genuine ways, facilitating the promotion of interpersonal relationships between patients, families, nurses, and other medical staff. Taking into consideration the promotion of personal awareness, reflection, and the development of nursing and writing skills, a number of benefits of the chosen practices cannot be ignored. They include the necessity to deal with challenging moments that are involved in patient care, the importance of decision-making, and collaboration with a team. It is also noteworthy from my experience that reflective practices make nursing students develop their creative skills and critical thinking, as well as be engaged in different working processes with specific goals and duties being identified.

In line with what different studies report on the process of practice evaluation and the contributions to self-awareness, this assignment will reflect on my placement at the Renal Unit in one of the local hospitals. During my practice, I adopted Gibbs’ model, which is one of the most widely cited approaches to describe and analyse the experiences of healthcare professionals (Barksby, Butcher & Whysall 2015). This model was chosen from the rest of the frameworks proposed in the studies because it entailed an adequate number of questions with the possibility to identify and understand personal experiences and compare theoretical and practical perspectives (Lestander, Lehto & Engström 2016). Being called Gibb’s Cycle, this reflective framework has several crucial steps in the reflective process. They include the description of the initial event, the identification of feelings, experience evaluation, analysis, drawing general and specific conclusions, and the development of a personal action plan (Barksby, Butcher & Whysall 2015). Regarding all these sources, theoretical frameworks, and practices, this project will be divided into seven meaningful sections where the reflection on the events, feelings, and outcomes will be introduced.

Reflection

Initial Experience

Using the Gibbs’ reflective approach, one has to think about the initial experience that serves as the basis for their practice reflection. I continued my practice at the Renal Unit in one of the leading hospitals of the country. It turned out to be a good chance to interact with a wide range of patients, their families, and medial workers with diverse backgrounds. While many events could have possibly warranted an inclusion in this paper, the one that involved a patient who was diagnosed with kidney failure and subsequently was operated stands out among the rest. The patient successfully completed the schedule surgery and was referred to a clinic from where she was supposed to complete her recuperation under careful nursing care.

Every nurse, including me, understood the need for an integrated approach to caring for the patient. The investigation by Abdelkader and Othman (2017) about the necessity for nurses and nursing students to apply five steps in nursing care was used. These steps include the initial nursing assessment, diagnosis, planning of an intervention, implementation, and evaluation (Abdelkader & Othman 2017). Working under the careful watch of physicians and other professionals in caring at the unit, all the nurses were engaged in monitoring vital signs, which was one of the best practices in determining the stability of patients for their dismissal from the clinic after recovery.

Following a successful placement of the patient in the postoperative care clinic, the nurses continued with care, including dialysis. It is one of the most commonly administered therapies for patients with kidney failure and related conditions (Vadakedath & Kandi 2017). Once, the nurse who was placed in charge of the patient called her number with the objective of discussing the dialysis schedule. Unfortunately, her number did not go through despite several attempts that were made. Having wrongfully inferred that the patient did not want anyone to know about her medical condition, the nurse in charge decided to call her next of kin, who was a friend of the patient under dialysis. As one of the components of a patient-centred approach to care, the nurse underscored the importance of involving stakeholders. She discussed the chosen approach to patient care, including the schedules for medication and the therapeutic approaches that could be involved with her family and friends (Redmond 2017). At that moment, the nurse thought that she was on the right path towards ensuring that the patient received personalised care, which is one of the core values of the hospital.

In that situation, several critical aspects of care and mistakes have to be underlined. Firstly, she disclosed the details of the medical procedure that the patient underwent. They included the fact that the patient was placed in a postoperative care at the hospital and that she needed her next of kin to discuss a possible plan of care. After the session, the friend who was invited was overwhelmed by the amount of the information that he received. As a result, he had to call the rest of the patient’s family members and share all the news.

After some time, the patient woke up from her sleep because the anaesthesia that had been administered during the operation procedures had lasted longer than it was expected. She immediately realised that many of her family and friends had tried to call her on several failed attempts, which caused a lot of discomfort and unrest at the unit. Precisely, the patient reacted wildly, expressing her open frustration with the fact that the nurse and the entire hospital had disrespected her right to privacy, which disrupted the smooth flow of activities at the unit for close to thirty minutes. During this time, the head of the department and the nurse tried to engage the patient in fact-giving that they were sincerely apologetic of the outcomes, and that they did not intend to cause such harm and other unpleasant feelings.

Feelings

The second phase of the adopted Gibbs’ model includes the description of thoughts or feelings that a nursing student had during the experience described in the first phase. Several scholars who studied and applied the model developed a series of questions that lead practitioners into talking about their feelings (Lestander, Lehto & Engström 2016). During the whole process, I experienced mixed feelings and was confused by the necessity to support one side only.

On the one hand, I empathised with the patient who was upset with the fact that much her personal and medical information was disclosed to her family and friends. On the other hand, the importance of communication and involvement of a family and friends as a part of patient-centred care was the reason for the nurse to disclose that information. I felt that the nurse was too swift to opt for communication with the patient’s next of kin. In this case, the nurse in charge made only three attempts to call the patient after which she decided to address to one of her friends. I thought that the caregiver had failed to follow all the necessary steps that could facilitate effective communication. A friend was not a family member, and this patient’s information should not be revealed to this individual.

I began thinking about the importance of effective communication in patient-centred care. According to Bauchat, Seropian, and Jeffries (2016) and Epstein et al. (2017), the chosen model of care directs and requires caregivers having relevant communication skills that elicit the true wishes of their patients in addition to recognising and responding to both their emotional concerns and needs. According to the updated Nursing & Midwifery Council (2018) and Standard 7 of the MNC Code, communication has to be developed at a clear and accessible level to meet patient’s needs and consider cultural sensitivities. As any other technical skill, effective communication is a sophisticated process that practitioners should exhibit throughout their careers. The effectiveness of this skill determines the way of how patients often assess the quality of care that they obtain from caregivers through their communication experiences with nurses and the rest of health care practitioners (Baker & Watson 2015). When patients feel that caregivers listen carefully, comprehend their needs, and offer information in clear and respectful ways, they are very likely to report high levels of satisfaction with the care that they receive.

With time, I began understanding the patient and her reaction to the fact that the nurse disclosed her personal information to her best friend without necessarily waiting for her consent. When patients communicate with nurses or any other caregiver but do not receive all the required information to facilitate decision-making, they are likely to report dissatisfaction with the quality of care (Baker & Watson 2015). When such situations happen, the number of complaints to the hospital management increases, and the need to seek for legal interventions arises. In this case, the patient was confused and dissatisfied with the quality of care and required to seek the relevant remedy for the disrespectful treatment that was given by the nurse.

I also cannot refuse the fact that I sympathised with the nurse. I thought that she was compelled into seeking another strategy of communicating with the patient about the nursing interventions that were relevant for her condition. The patient appeared to be incommunicado at the time when the nurse felt that she needed to discuss a plan of care that would be necessary to address her needs. It was evident that she was frustrated with the inability to prioritise communication with the patient, and she could not contact her on the phone. I believed that the patient had to understand the relationships between available time, the importance of interventions, and the necessity to make a decision.

Apart from my own feelings, I felt that the rest of the people concerned with patient care were embarrassed with the outcomes of the attempted communication. Some practitioners blamed the nurse, while others found that the patient was only overacting on a small issue that would have been handled without causing such confusion and panic as she provoked. I tried to understand why some people in the postoperative renal unit thought that the department needed to revise and educate the staff and patients alike on the best practices in communicating on important issues.

Evaluation

The Gibbs’ model of experience reflection directs that the third stage is an evaluation of what worked and what failed concerning the situation. Howatson-Jones (2016) indicated that the author of any reflection has to be as objective as possible and avoid biases from interfering with the quality of the process. Furthermore, it is important to include both the positive and negative aspects of the situation even if it could be difficult to establish such factors. I think that the two things worked during the incidence.

Despite the challenges experienced, the nurse managed to have the patient included in the formulation of a care intervention, which ensured that the type of care given was customised to address her individual needs. The process was necessary considering that the department’s and hospital’s priorities in patient-centred care. According to Mohammed et al. (2016), patient-centred care entails the provision of services with respect for the needs and preferences of a patient. Nurses should always strive to involve patients, their families, and friends in the formulation of any relevant interventions. I feel that the process positively worked for the nurse and the rest of the care team because after an hour, several of the patient’s family members and the friend arrived at the hospital. They were engaged into consultations with the unit members and the nurse about the health care preferences and needs of the patient in her presence, which obeyed the most fundamental principle of patient-centred care.

Another way in which the situation worked was the fact that the nurse and the rest of the unit managed to solve the problem that resulted from the attempted communication. Soon after the nurse realised that the patient was unresponsive in her communication because she was still under anaesthesia, she engaged a friend in active communication to solve the issue and calm the patient. Boin et al. (2017) discovered that hospital units should react to crisis management, including issues that result from communication breakdowns. Therefore, the nurse’s decision could be explained and approved in terms of the chosen study and the situations when the need to hold impromptu meetings between patients, caregivers, and patient’s relatives positively influence problem solving.

While the situation was successful in the two mentioned ways, the primary issue with the communication strategy was patient satisfaction. When I thought that the nurse had tried her best, she had failed to inspire the patient and give the necessary explanations. The thought that the clinical setting was devised to ensure that caregivers were committed to provide the highest quality of care was not properly developed. The issue was that the nurse did not exercise effective communication strategies and explained all the services and decisions to the patient. The affected caregiver did not follow the relevant steps towards strengthening her communicational approaches. Chhatre et al. (2017) reported that it was relevant that the nurse identified all the stakeholders in the situation before she engaged in contacting the family members of the patient. The feeling of dissatisfaction and disappointment of the patient about the lack of respect for her rights rooted in the impossibility of the nurse to take enough time and consult stakeholders within the nursing environment. The nurse did not observe the relevant communicational procedures in handling the patient was a primary failure in the situation.

Analysis

The Gibb’s analysis stage provides practitioners with a chance of making sense of the events that occurred, which only comes with the development of a deep insight into the major issues around the incidence. First, it is needful to contemplate why things went well as reported in the previous section. As indicated, I feel that the nurse was committed to effective problem solving. The nurse wanted to include the patient and her family in decision-making, which is why she attempted to call the dialysis patient and upon failure, she contacted her best friend. According to Harwood, Butler, and Page (2016), patient-centeredness directs caregivers to understand their patients through applying effective communicative strategies and uncover critical issues that impact their health and well-being. When the nurse erred in her attempted communication with the patient and her family, she quickly resolved the issue through engaging the rest of the department leadership. Using a group approach to problem solving was important as this method provided the basis for quality decision-making (Hesse et al. 2015). She wanted to apologise for the inconveniences caused by her earlier conduct and decision.

While I played a trivial role in the process (I was a nursing student), I helped in informing the group about the possible contributions of critical thinking to problem-solving. Precisely, because I worked directly under the nurse, I advised an inclusive approach to deal with the challenging situation. Our goal was to improve the quality of the decisions that we desired to make at that time, and everyone accepted the call for a consultative approach to decision-making. I thought that this approach was successful because all the participants were able to capitalise on our strengths while mitigating the contributions of our weaknesses to possible failure.

General Conclusions

The relationships between the patient and the nurse that described in this situation had a lot of important lessons. The first one concerned the need for proper communication strategies between nurses and patients. As I learned, health caregivers should always be committed to communicating with their patients, especially on important aspects, such as the development of nursing interventions. Most importantly, the scenario taught me the factors that hinder efficient communication between patients and nurses and the ways that I can use to improve my communication strategies. Specifically, as a nursing student, I clarified the importance of collecting the views of different stakeholders before reaching the relevant decisions concerning the nursing interventions adopted for patients.

Firstly, in the intentions to achieve improvements, I should never overlook any of the stages in decision-making as outlined in the patient-centred approach to nursing care. While underscoring the benefits of a collaborative approach to caring for patients, I have to understand how to engage patients and their families in a proper way without breaking ethical rules and hospital standards. The primary issue that occurred during my placement was the situation when the nurse understood the need to involve as many parties in her decision-making procedures as possible. She did not follow all the rules because of the lack of critical thinking, which I, as a nursing student, strive to develop during my practice.

Secondly, this experience taught me about the importance of consulting in teamwork. Previously, I have not mentioned that the nurse was part of a group of caregivers who were selected by the department to care for the patient. The postoperative care department always prepares to handle the care needs of patients after surgery to other forms of nursing care at the hospital. At this point, the nurse simply forgot to talk to the rest of the team, including the department manager. She had to clarify what approaches would be better taken to improve the care outcomes for the patient even when she was in charge of patient orientation. This type of communication and cooperation could help to solve the recent problem. The representatives of the department gathered to reflect on the challenges that were experienced and exposed that day. One of the major topics for discussion was the need to improve teamwork in regards to decision-making.

Thirdly, taking into consideration the complaints of the patient, I developed the insight about the importance of confidentiality in nursing care. I refrained from introducing this subject throughout the reflection because it was a good chance to summarise everything, including a conflict of interests between the nurse and the patient and the scope of services offered in the postoperative care department of the hospital. According to Chadwick and Gallagher (2016), nurses are supposed to stick to the professional code of ethics and govern the disclosure of critical patient information. Despite the fact that it was a patient-centred approach to nursing care at the hospital, it was not enough for caregivers to override the regulations and improve the inclusion of patients in decision-making. Therefore, it is recommended to increase attention to the actual needs of patients and promote confidentiality. Respecting confidentiality is a universal regulation of the code of ethics in nursing (Parker 2017). Following this rule, the patient was able to identify her rights for privacy and the conditions under which the right was disregarded.

In this case, I learned that it was important for the nurse and the rest of the department to obtain the consent of the patient before surgery. The team should have enough experience to understand that in some situations, information has to be revealed to other parties. Unpredictable medical conditions and postoperative outcomes make nurses and the medical staff to work and decide fast. I may have partly underscored the need for effective communication strategies in handling patients. That is why I have to underline another important lesson that I gained during the working process. Proper coordination of activities in a team is a key to success of nursing care and an opportunity to maximise patient outcomes. The whole scenario was characterised by a strong reflection on what nurses have to do, what patients might expect, and when leadership cannot be ignored. Mastering effective communicative strategies helps to mitigate negative outcomes and come with improper coordination among different stakeholders, which this paper significantly highlighted.

Specific Conclusion

The practice experience taught the need for nursing students to realise that they have to be a part of a community during their professional practice. One of the primary demands of being a team member is the necessity to master proper communication strategies (Ting-Toomey & Dorjee 2019). The whole scenario suggests that without proper communication strategies nurses may find themselves in various compromising situations that lead to negative or unpleasant. Relying on the analysis of the credible literature sources and my personal understanding of nursing tasks and duties, I learned that communication in care is a useful tool to improve its patient-centeredness. The lack of proper consulting, as depicted by the case of the nurse in charge of the dialysis patient, could result in conflicts of interests between nurses and patients.

As depicted in the case study of this paper, the significance of communication strategies applies to the promotion of the best standards in patient confidentiality. Specifically, this reflection suggests that proper communicational approaches are the most appropriate ways to deal with the conflicts of disclosure that define the ethical principal of confidentiality. Patient dissatisfaction could be mitigated by the adoption of proper approaches to communication, including cooperation and discussion of different postoperative aspects with the patient and her family. For example, instead of jumping into rushed decision-making that the patient did not want to disclose her health information with anyone, it would be prudent to walk to her room when telephone communication failed. This approach should help the nurse to decide if the patient’s lack of communication meant that she did not want anyone to learn about her health status or if something else was hindering.

Action Plan

Through the prism of this reflection, I was also able to develop several effective strategies for nursing students to strengthen their communication skills. It is not enough to learn some theoretical basics but to improve a personal understanding of communication in a team where nursing care is the major service. Before I transit to professional practice, I would like to become an effective communicator, especially because I wish to avoid the challenges that the nurse faced in the scenario under analysis. I understand that through the mastery of effective strategies of communication, I will deal with the issues that might result in the breach of the ethics of confidentiality. I hope to excel at patient-centred care delivery and get prepared to work as a team member who offers new ideas, follows the already defined standards, and support other practitioners.

Conclusion

This reflection highlights important aspects of the scope of nursing practice. Nursing students need to understand the fact that they should work as a part of a patient care team. The implications of being a part of a care team include the necessity to master and practice effective strategies of communication and develop a range of skills related to both interpersonal and group practices. The case study under analysis underlines the importance of coordination between patients and caregivers to minimise possible conflicts of interest like involving confidentiality. Nursing students should learn the steps of communicating with patients and their families as a fundamental part of patient-centred care. Proper coordination helps practitioners to find themselves in compromising situations with patients and their families. I have identified the need to improve my communication skills because patient-centred care relies on nurses’ knowledge and the abilities to share information among all the stakeholders involved care delivery.

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