Safe and Effective Practice Essay Sample

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Safe and Effective Care Reflective Journal Essay Sample

Introduction

The essay will utilise Gibb's (2007) reflective tool to reflectively analyse my experiences of interprofessional working and service user involvement in clinical practice. Sian Nicol and Dosser (2016) define reflective practice as an individual's ability to scrutinise his/her own actions and engage in the process of self-growth and continuous learning. According to Koshy et al. (2017), reflective practice in nursing is critical for effective and person-centred, and evidence-based practice. The nursing students are required to continuously reflect on their knowledge and perceptions about service user care to improve challenge and improve knowledge and skills for safe and effective practice. Bulman and Schutz (2013) reiterate that reflective learning allows students to internally examine and explore concerns triggered by personal experience, resulting in creating and clarifying meaning regarding self and challenging conceptual perspectives. In this essay, Gibb's reflective model has been selected as a reflective tool because it is simple to remember and easy to use structure. Gibb's reflection model is also easy to apply and can improve personal efficacy in nursing practice.  The model has six stages; Description, Feeling, Evaluation, Analysis, Conclusion, and Action Plan.

The service users and practitioners involved in this reflection will be anonymised to conceal their identity and privacy in line with the privacy and confidentiality requirements of the Nursing and Midwifery Council (NMC, 2018).

Description

In my placement, I was assigned a role of a shift coordinator. My supervisor supported me in delivering in that role. As a shift coordinator, my roles and responsibilities encompassed allocating responsibility to all staff on shift, supervising staff, responding to calls, receiving and delivering handover. I also participated actively in the zoning meeting. The facility was understaffed and had limited resources. The understaffing made nursing practice very exhausting and emotionally draining as nurses had to constantly move between service users trying to provide safe and effective care. I employed effective communication to coordinate working and improve efficiency in practice.

During the shift, I discussed with the multidisciplinary team (MDT) about two service users for which I had care along with my supervisor. I was also allocated to the deaf ward, where I used British sign language (BSL) and an interpreter to communicate with the service users. At first, I doubted my ability to communicate with service users with hearing problems. However, one of the nurses encouraged and supported me. Besides, the MDT expressed their confidence in me in handling such a situation. Eventually, I managed to form a therapeutic relationship with the service user and offered an episode of care. The supervisor commended my efforts and provided me with positive feedback, which meant a lot to me regarding my competency.

Feeling

I was a little nervous when I was the first scheduled to take the shift coordinator's role. This was because I was going to work with diverse practitioners with varying levels of experience. I was anxious and feared making a mistake and did not want to disappoint my supervisor for trusting me with such a role. Moreover, I feared that other practitioners, especially registered nurses, would not give me a chance to allocate them responsibility and monitor them. Nevertheless, I was also excited because this was a new role with the opportunity to demonstrate my leadership skills and work with multidisciplinary teams and service users to improve care safety and effectiveness. The experience of providing episodes of care to service users with hearing difficulties in the deaf ward was also challenging and insightful. For a moment, I doubted my capability. Talking with the service user and involving him in his care was amazing. The deployment of BSL and interpreter eased my effort to communicate with the service user and form a therapeutic relationship with him. 

I understood that how I carried out myself and made decisions would affect how team members perceived me and jeopardise my reputation. I think my colleagues also understood that they were being put under a student with no experience with the role of shift coordinator. Moreover, some of the members doubted my abilities and thought that I would make numerous mistakes before the shift end.  Besides, I knew that the only way to ensure safe and effective practice to all service users under our care was to collaboratively work with inter-professional teams to brainstorm, set a common goal and respectfully work with each other to realise our team goal.

It was an enlightening moment working with the multidisciplinary team in ensuring better and effective care. The team members upheld professional values throughout the shift. Regardless of their age and experience, the nurses related with me in a non-judgemental, sensitive, and caring manner. After the shift, most team members congratulated me with some confessing that I performed beyond their expectations. Regarding the care to a patient with a hearing problem, the team members argued that I made the whole scenario appear simple and easy. My supervisor was also impressed.

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The whole experienced expanded my knowledge and understanding of the role of a shift coordinator. It also helped me appreciate the role of leadership in streamlining the operations during shifts and ensuring everyone's health and safety in the health facility. Most importantly, the experience helped reaffirm my communication, team working, and leadership skill. I now believe that the shift was successful because we collaboratively worked with multidisciplinary teams and collaborated with the servicer users.

Evaluation

NMC (2018) indicates that nurses should understand that their behaviours can influence the behaviour of others. Rehman et al. (2020) also argued that leaders' behaviour and traits impact the behaviour and attitude of his/her followers. According to Lee, Idris, and Tuckey (2019), leaders use their behaviour to help them direct, guide, and influence that attitude and work of the team. I successfully utilised my skills and knowledge from theoretical learning to provide effective leadership during the shift.  Gladstone (2011) cited that working in a group broadens one's understanding of diverse issues, thereby contributing to professional learning and development. Teamwork and effective leadership entail listening, sharing information, inspiring, and motivating others to deliver safe care to service users.

Based on Tuckman's stages of group formation, forming, storming, norming, performing, and adjourning, I would say that the group was respectful and non-judgemental to me despite having doubts about my abilities in the forming stage (Gladstone 2011). However, we successfully overcame the initial negative barriers and stigma and worked collaboratively to enhance the quality and safety of service users' care. I was also impressed by how we employed effective communication skills. NMC (2018) emphasise the need for nurses to employ effective communication while talking to colleagues. Nurses must also clearly communicate to the service users by meeting individual language and communication needs, providing any possible assistance to people in need to assist and communicate with individuals in a culturally sensitive manner.

The next thing that I consider went well was the deployment of BSL and interpreter while providing episode of care to service users with hearing impairment, which improved his involvement and improved his safety.  I received positive feedback from my supervisor and colleagues. Moreover, the experience of providing episode of care was educative and immensely contributed to my self-confidence and self-esteem (Stone 2020). Previously, I worked under my supervisor to work and worked in teams to assess, diagnose, plan, implement, and monitor care. The delivery of the episode of care was insightful and motivating. The episode of care enhanced coordination and communication among the multidisciplinary teams. It also helped reaffirm the respect, honesty, communication, and delivery of person-centred care.

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Generally, my performance of the role of a shift coordinator went well. The multidisciplinary team members were cooperative and enhanced the communication process to ensure that every team member understood and perform his/her role. Despite the successes during the shift, one major problem that all team members experienced and complained of was workload. According to Gladstone (2011), the facility was understaffed and reduced the efficiency and effectiveness of the multidisciplinary team to deliver optimum and satisfactory care to the service user. The interprofessional team members felt fatigued at the end of the shift because most of them worked throughout the shift without a single break. Thompson (2021) attributed to fatigue and exhaustion that results from understaffing to safety issues in a healthcare setting; nevertheless, all our service users received safe and person-centred care.

All the multidisciplinary team members made a significant contribution to the service user's safety and effective care. For instance, the interpreter enhanced communication with service users in the Deaf ward. According to Feo et al. (2017), effective communication is fundamental to developing the therapeutic relationship with the service user. NMC (2018) indicates that nurses must take reasonable steps to meet individuals' communication and language needs by providing possible assistance to people who require communication support to provide personal or other people's information. The BSL application and use of interpreters contributed to the delivery of person-centred care (Rogers, Ferguson-Coleman, and Young 2018). Moreover, the team members acted collaboratively with the service users and assessed their needs, concerns, and preferences to enhance their care quality. I also received positive feedback from my supervisor, which helped reaffirm my confidence and motivation in nursing practice.

Analysis

Doody et al. (2017) posited that service users, their families, and carers are useful and often introduce essential knowledge when invited in the health and care process. Moffatt et al. (2017) also acknowledged that service users are experts in how their health condition impacts their physical, mental, and social wellbeing. Ellis (2018) argued that service users, when involved in their own care, bring different perspectives. According to Ofori-Atta, Binienda, and Chalupka (2015), the service users are experts in their health, and nurses should employ co-production to improve nurse-service user relationships. Co-production, according to Buckley, McCormack, and Ryan (2018), entails the engagement of service users in the delivery of health services as equal partners of health practitioners.  Moffatt et al. (2017) asserted that service user involvement interventions should focus on improving service user-clinician communication. During the shift, I worked alongside a multidisciplinary team to employ patient-centred communication tools, BSL, to assist the service user in communicating with us. The BSL application improved my engagement with the service user, including the development of trust and confidence in nurses.   

The deployment of BSL as an evidence-based communication tool in the deaf ward helped the service user ask numerous questions effectively addressed, thereby improving his health outcomes. Moreover, Gladstone (2011) asserted that implementation of effective communication tool improves practitioners' communication behaviour and service user knowledge and satisfaction thereby positively impacting health outcomes. The BSL and interpreter helped us to customise communication to service user's circumstances, including health literacy. Jansen et al. (2018) defined health literacy as a service user's ability to obtain, comprehend, and apply health information to make the right health decisions. The effective communication helped us involve the service user in his care by obtaining his consent and explaining to him detailed information of every procedure, including the risks and benefits, to promote his autonomy. This improved our therapeutic relationship with the service users and enhanced his involvement in shared decision making and care planning (Ellis 2018) based on the detailed subjective and objective information about his health condition.

Effective communication also enhanced the delivery of person-centred care. Buckley, McCormack, and Ryan (2018) define person-centred care as the development of the therapeutic relationship between the service user and practitioner based on mutual trust, understanding, and collective knowledge. Ofori-Atta, Binienda, and Chalupka (2015) further argued  that person-centred care is a holistic approach tailored to meet service user needs, wishes, and concerns while taking into account social aspects of individual life, including culture, diversity, sexuality, disability, age, gender, and religion. Additionally, NMC (2018) requires nurses to employ a wide range of verbal and non-verbal communication techniques to understand better and effectively respond to individual's personal and health needs. By embracing co-production, the service user was empowered to control his health and care by sharing power, decision-making, and responsibility. The service user was actively involved in his care to promote his medication adherence. He was also provided with detailed information regarding his health to promote his autonomy and clinical decision-making.

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Newell and Jordan (2015) cited that person-centredness comprises respect for an individual’s beliefs, preferences, values, and needs. NMC (2018) also encourages clinicians to recognise and respect people's contribution to their health and wellbeing. The co-production empowered the service user to share in decisions regarding his treatment and care. Turner et al. (2018) suggested the need to obtain consent from the service user to involve his family and friends. Ofori-Atta, Binienda, and Chalupka (2015) claimed that the involvement of service user's families and carers improves the quality of subjective data and provides the service user with social support from familiar people, thus improving adherence and recovery. The service user and his family were given education and information regarding his health condition and management of his health to improve coping, compliance, and recovery. The needs, concerns, and preferences of the service user were accommodated and integrated into the care plan to foster the delivery of person-centred care.

Woo, Lee, and San Tam (2017) noted that the quality of care and nature of service user outcomes are influenced by nursing. The nursing staffing levels, thus, impact the safety-focused outcomes and care quality. Ellis (2018) argued that the nursing functions such as monitoring service users' health status, treatment, and integration of service user care to avoid gaps in health care directly affect service users' safety.  Effective performance of nursing functions requires adequate staffing levels with clinical knowledge and expertise required to conduct these interventions and the ability to effectively utilise vernal and non-verbal skills to communicate and coordinate care with interventions (Gladstone 2011) from other members of the interprofessional team.

The understaffing of nurses in healthcare facilities impedes the delivery of safe and effective care. Graham, Kothari, and McCutcheon (2018) noted that nurses' understaffing contributes to nurses working for long hours than are recommended. The low service user to practitioner ratio contributes to many nurses working long hours, leading to burnout. Moffatt et al. (2017) also attribute understaffing in health and care facilities to increasing medical errors. As such, the right evidence-based approaches are required to implement change and promote adequate staffing levels in healthcare.  The understaffing undermined operations during shifts. Some of the nurses worked throughout the shift without taking any break. This left them exhausted and demoralised. However, there was no safety issue.

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Murray, Sundin, and Cope (2018) argued that effective leadership is critical for service user's safety. Kavanagh (2017) stipulated that service user safety entailss taking necessary measures to protect the service users from harm, preventing errors, learning from errors, and developing a culture of safety. The involvement of service users and their family facilitated service user's safety and prevented harm (Grist, Porter, and Stallard 2018). Leadership and inter-professional working help me effectively streamline and coordinate interventions to ensure that healthcare teams remain in the areas where they were zoned to provide continuous support and monitoring of all service users. Effective communication was also used to coordinate operations and provide all service providers which the necessary support to discharge their duties.

Moreover, the collaborative practice and involvement of inter-professional working improved service user's access to quality and safe care. Pollard, Bugler, and Hayes (2016), Ellis (2018), contended that collaborative work involving service users and their families facilitates shared decision-making. Besides that enhanced communication technique, shared decision making in a collaborative working provided detailed information in promoting evidence-based care (Ofori-Atta, Binienda, and Chalupka 2015). The objective of collaborative working enabled us to increase patient's knowledge, and understanding to suitably meet their needs, goals, and circumstances. Moreover, Gladstone (2011) argued that collaborative working enhances care quality and stimulates evidence-based practice and improves the delivery of safe and effective care.

Ellis (2018) stated that group formation entails forming where individual’s actions and behaviours are driven by the desire to be accepted by others and avoid conflict. In the forming stage, the interprofessional team members meet to discuss strengths and challenges and agree on common goals.  The interprofessional team comprised individuals from diverse clinical backgrounds. The team members discuss diverse issues and shared knowledge, experience, behaviour, language through collaborative participation. My engagement with professionals from diverse fields, cultural, and social backgrounds was insightful and educative. I learned the importance of cultural and emotional competence as a means to effective communication and inter-professional working. 

Secondly, in the storming stage, we discussed service user care issues and developed a plan to enhance communication and independent working (Newell and Jordan 2015). The team members were proactive and discussed openly and respectfully discuss each individual's perspective and idea. This created an open dialogue where I learn to listen, share ideas, and brainstorm ideas to improve service users' health and safety. The discussion and sharing process helped me gain new perspectives and ideas that I had not imagined before. The discussion and sharing helped us to understand the individual’s responsibility.

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Additionally, in the norming stage, as a shift coordinator, I provided the leadership to the team members (Gladstone 2011). I undertook the leadership role as a shift coordinator. I performed my diverse roles, including allocation of responsibility to all staff on shift, supervising staff, responding to calls, receiving and delivering handover.  Our team collaboratively worked alongside me to provide an episode of care to a service user. We effectively communicated and performed as a unit. The knowledge we learned and feedback from my colleagues and supervisor improved my commitment and passion for nursing practice.

Conclusion

Reflective practice is essential in developing insight into personal learning and professional development. The analysis of my experiences as a shift coordinator helped me to utilise diverse skills that I had theoretically learn, including communication skills, leadership skills, and team work. The experience I gained in delivering episodes of care also enhanced my communication skills. However, I also noted gaps in areas of my professional and learning development that require improvement.

These include cultural and emotional competence, communication skills, and leadership skill. I believe that improvement in these areas will reinforce my competence in future practice.

Action Plan

To improve in my future practice, I intend to conduct more research and use my mentor’s guidance to improve my cultural and emotional intelligence by December 2021. I also intend to undertake intensive research and attend conferences, seminars, and trainings to improve my communication and leadership skills by December 2021. 

References

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