The Aim of this reflective essay is to reflect upon an example

The Aim of this reflective essay is to reflect upon an example of practice when person-centred care was delivered using the reflective model of Gibbs (1988) (see appendix 1). I will ensure that the confidentiality of patients and organizations employed in this essay is maintained using the principles placed in the code of conduct for health care workers and adult social care workers in England (2013). All names and places are kept confidential throughout this essay and the use of a pseudonym (Sharon) is used to refer directly to the patient. This is to stay in line with the NMC code of conduct (2018). Furthermore, I will discuss the impact on Sharon and her family, the participation of the multi-disciplinary team (MDT) and my role in this team.Nursing is a practice- centred profession and the willingness to learn from previous experience is vital to the development of practice by nurses ( Oelofsen 2012). Reflection is important for nurses to analyse and critically evaluate the experience of practice so that they can learn from it. Which is emphasised by Wilding (2008), who states that Reflection requires self- consciousness, understanding and evaluation; it is, therefore a skill that needs to be developed, evolved and retained.As stated above I will utilise Gibbs (1988) reflective model, which contains six steps and each step in the cycle is linked to a key question. The reflection of this essay is structured using these six key stages and thus beings with a description of the occurrence recorded. There are a variety of reflective models such as Bound, Keogh, and Walker (1985), Casement (1985) and Driscoll (2007). Depending on the intended purpose, these models of reflections are useful in different scenarios. This is highlighted by Bullman and Schutz (2013), who states that this model has been chosen because it enables reflection on practice in an organized way that allows us to acknowledge important professional development from our experience in order to promote better practice. The reason I chose to use this reflective cycle because it will improve my practice continuously and knowledge from my experience for improved and enhanced practice. By reflecting on the Gibbs model, I was able to assess the suitability of my actions and improve the quality of care as a professional. Also, I think that using this reflective cycle helped me to make sensible judgments regarding my actions (Brotherton and Parker, 2013). descriptionSharon age of 80, bed bound patient who lives with the son was admitted to the Acute medical unit (AMU) via Accident and Emergency department (A&E). Sharon Presented to A&E with the complaint of jaundice, weakness, loss of weight, fever and severe pain all over her body. Sharon had Past medical history (PMH) of type 2 diabetes, heart failure, alcohol abuse, and bilateral legs amputation, due to pressure ulcers. On the admission, vital signs were taken, which showed very low blood pressure (BP), high respiratory rate (RR), fever, and techy cardia. Since admission, Sharon deteriorated progressively. After monitoring Sharon’s vital sign and pain score, I escalated it to the nurse coordinator who informed the doctor and involved MDT. MDT includes consultant, doctors, intensive care specialist nurses, Palliative specialist nurses and pain management team. According to DH (2001), MDT involvement is required to ensure patient- centred care and respect their dignity and privacy, leading to positive and quality of care of patient experience. This is also underpinned by Abdulrahman (2011) who states that MDT teams are able to improve the quality of life of patients with serious illness to ensure that patients receive the best quality care. As Sharon was deteriorating progressively doctor involved the consultant on duty. After reviewing Sharon, the consultant decided to book an urgent magnetic resonance imaging (MRI) to discover the cause of progressive deterioration. In the meantime, Sharon was monitored closely and continuously. After reviewing Sharon’s MRI result, she was diagnosed with Hepatocellular carcinoma (HCC). According to Amos, et al (2017), HCC is a malignant liver cancer caused by uncontrolled growth of abnormal liver cells. It is an unknown state of human health in which patients arrive in the hospital late in the terminal stages. Initially plan was to admit Sharon to High Dependency Unit (HDU), in case of further deterioration Sharon was still for resuscitation and active treatment. Unfortunately, due to no bed capacity in HDU Sharon was admitted to AMU. I was allocated to Sharon to provide her person-centred care also to communicate and inform other healthcare professionals on arisen of any further deterioration. When I provided person centred care, I pertained the 6Cs of the nursing present in a legal document published by the Department of Health (2012). Those ‘6Cs are care, compassion, courage, communication, competence, and commitment. These core values are key to improving the care cultural (Department of Health, 2012). In this case, all these values were important, particularly the care and compassion that I and my colleagues delivered during her hospital stay.feelingsSince she’s been admitted to the ward, I and my colleagues treated Sharon and her family professionally, but at the same time, we were compassionate and friendly; also, we’re thinking the situation from Sharon point of view. This is emphasised by Lloyd (2010) who states that all caregivers must show compassion and sympathy for the misery of their patients. Sharon was distress and devastated due to the increased level of pain. The consultant broke the shocking and heart-rending news to Sharon of her diagnoses in presence of her family (with the consent of Sharon). This is underpinned by Rao (2008), who states that consent is a mutual communication between the patient and doctors with an expression of permission and authorisation choice to act in a particular way. The situation was distressing for us as healthcare professional as well as Sharon and her family. Not only a terminal diagnosis affects the patient. This also affects the people closest to them who deliver care for while struggling with their own pain.Evaluation Sharon has been closely and continuously monitored for 24 hours, but there have been no signs of improvement. Considering Sharon condition, age and her past medical history a decision was made by the consultant and MDT with consent and choice of Sharon and her family to start End of the life care pathway for Sharon. End- of- life care can be used in a holistic way that involves supporting the patient and their loved ones during the dying process. This is emphasised by (Rizk, 2018), who state that death is an inevitable aspect of life that often necessitates end- of- life care in a medical environment. Palliative care specialist and pain team were involved to reduce the suffering of Sharon and her families also carry out treatment of physical, spiritual and psychological distress signs experienced by Sharon. This is underpinned by Rome, et al (2011), who states that palliative care aims to reduce patients’ and their families ‘ suffering by fully assessing and evaluating their treatment. When death approaches, the symptoms of individuals may need more help because of their poor health. This is also supported by Kelly and Morrison (2015) who state that palliative care is multidisciplinary care that aims to improve the living of seriously ill and dying patients. Furthermore, palliative care must be accessible to the individual needs and requirements of the dying person the National Institute for Excellence in Health and Care ( 2017). As Sharon was living with her son and he was struggling to support her and maintain his own busy lifestyle, he requested for hospice bed and wanted his mother end of life care to be carried in the hospice. communication with individual and health professional can acknowledge care preferences, such as preferential care, advance care plans, and examine their goals and wishes, current and predictable care needs and any religious, cultural, or social preferences, likes and dislikes all of which are kept in their treatment plan. (ref) In addition, the development of relationships between health professionals, individuals, and their family is essential for the experience of a quality person- centred care. ( (Manley, Hills and Marriot, 2011).AnalysisPerson-centred care is not just about providing information or whatever people want. It is also about considering the needs, wishes, family situations, social conditions, lifestyles and values of people; see the person individually and cooperate in the development of adequate strategies. This is underpinned by the American Geriatrics Society Expert Panel on Person‐Centred Care (2015), who state that The Institute of Medicine recognized and described patient- centred care as one of the six pillars of quality healthcare; provide care that respects and responds to individual patient desires, values and needs and ensures that patient beliefs link to all clinical important decisions. Accordance to Taylor( 2015), patient- centred care emphases the individual history, ethics, beliefs, preferences, current situation, future goals and how logical they seem to be about what happens to them. In addition, it enables the future development of therapeutic relationships between professionals, Individuals and others who are important for them in their life and that these relationships are based on mutual trust, acceptance and the exchanging of collective experience (McCance, Slater, and McCormack, 2009).Although I and other health professionals provided a good End of life care in accordance with the above- mentioned objectives, consequently, she deteriorated and increased the pain level. At this stage, it was extremely important to in place personalised care. In order to provide person centred care the NICE guidance, 2015 and guidelines set out in one chance to get it right – 5 priorities for care of the dying patient ( Leadership Alliance for the care of Dying People, 2014), were in placed (see appendix 2).

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