My nursing practice has been characterized by a marked transition from the general wards to the intensive care unit. Nevertheless, my values have remained intact. Initially, I must admit, I believed that patients had no role in determining the medication or intervention they receive. However, since I came to know about it, in a nursing class, the value of decision-making independence has guided my practice.
I learnt the value in class, thus, my definition of the term is influenced by Fahrenwald et al., who defined decision-making autonomy as the act of allowing patients to make their own decisions regarding diagnosis and treatments, albeit after receiving all relevant information (2005). The value of decision-making autonomy and working with patients under intensive care have shaped my understanding of person-centered care and its relevance to nursing, as a profession and a practice.
In the ICU, it is easy to view the person as just a patient. However, I have deliberately chosen to consider them people who are just momentarily inconvenienced by illness. As a nurse, I am in agreement with Ross, Tod, & Clarke’s (2015) observation that the definition and use of person-centered care has been fluid and varies in distinct research, guidance, policy and daily practice. Still, I concur with the definition offered by the American Geriatrics Society; eliciting individuals’ preferences and values and, once expressed, letting them guide all healthcare aspects, and supporting their practical life and health goals (2015).
However, I find an earlier definition by McCormack, Dewing, & Breslin (2010) quite relevant to practice. They define person-centered care as an approach to nursing practice that is created by forming and fostering therapeutic relationships between patients, care providers and other people who are significant to the patients’ lives.
Drawing from the two definitions, I believe person-centered care is viewing patients as persons with social networks and accomodating their beliefs and values in the provision of care, while developing relationships that enable the attainment of healthcare as well as life goals. In adherence to the value of decision-making autonomy, I always communicate to patients their diagnosis and suggested interventions. To attain the goals associated with the value, one needs excellent communication and people skills, which is one of my strengths in practice.
More specifically, I have demonstrated empathy, which is a person-centered communication skill. In the course of my practice, I try to comprehend and share into the perspectives, current situation and feelings of the persons under my care. That creates a bond of trust, social support and mutual understanding.
The informed patients then get to decide whether they agree with the diagnosis, and whether they are willing to receive the suggested interventions. In case of the ICU, I consult with the patients’ families and let them make the decisions. Human dignity is another value that has influenced most of my decisions in my professional and personal life. As a nurse, I believe it is important to respect all individuals, including the patients, their families and the entire society.
In line with the value of human dignity, I respect patients’ belief systems and consider their natural human values during my interactions with them and their families. However, at times, it is difficult to know some patients’ beliefs, especially in the ICU. Although it is possible to get information about patient beliefs from their families and close friends, I consider it my duty to ensure that the informants do not pass out their own belief systems as the patients’.
Trustworthiness and honesty are important strengths that have enabled me uphold human dignity in my practice. Without being trustworthy, patients and their families would not reveal their secrets to me. Many a times, the secrets are critical to the formulation of interventions.
Human dignity also dictates that I protect patients’ confidentiality during clinical interactions. For instance, I always ensure that I cover all exposed body parts of patients. What’s more, I demonstrate my respect for human dignity through respectful communication with patients’ families and keeping their secrets confidential.
Respecting human dignity calls for mindfulness, which is another person-centred communication skill I believe I possess. Hafskjold et al., (2015) define mindfulness as the art of drawing unique variations by being present in interactions. By being mindful, I am able to observe the happenings and act according to what I notice. Research shows that mindfulness by nurses leads to more satisfied patients (Ross, Tod, & Clarke, 2015).
My practice has also been guided by altruism. My own conceptualization of altruism is in line with the definition of the term offered by Shahriari et al., (2013); focusing on patients as human beings, while striving to promote their health and welfare. In nursing practice, the ICU is ostensibly the most tasking department to work in. It requires working without losing concentration, whether one is on a day shift or night shift. I have often found myself standing next to patients’ beds throughout the night just to make sure they are fine.
Despite the tough requirements, I believe I have exhibited devotion and selflessness the entire time I have attended to patients in the ICU, and even before. Undeniably, sometimes I have felt exhausted by the demands of the job, but my altruistic tendencies have always reminded me that nursing is not just a job, but a calling that requires me to give my all towards the healthcare and welfare of others. To reflect on my professional practice, I use two different strategies; the Gibbs model and John’s reflective framework.
The Gibbs (1988) Model has six stages; description of event, feelings, evaluation, analysis, conclusion and action. On its part, John’s framework has three important elements; bringing the mind home, experience description and reflection (Palmer, Burns, ; Bulman, 1994).Part 2 Wanda formulated a reflection model that requires students to follow a five-step process during reflective practice, also known as the 5Ds structured reflection model (2016).
The 5Ds stand for Doubts/differences, Disclosure, Dissection, Discover and Decision. The learner reflects on whether s/he has any doubts in his/her practice, or whether there are any differences between what s/he did in a clinical setting and what is found in literature. Disclosure entails writing about the experiences or situation on the topic discussed in the doubts section, while the dissection section considers why it happened and the impact.
Discover involves finding additional information from relevant literature and the decision part describes a future plan.5Ds model of structured reflection (Wanda, 2016) The Rolfe model enables students to reflect on their experiences based on three questions; what, so what and now what (Rolfe, Freshwater, ; Jasper, 2001). The first question allows students and nurses to describe the situation, while the second question gives students room to discuss what they learnt, while the answers to the last question identify what the person should do to develop learning and improve future outcomes.
The 5Ds Structured reflection The two models have various similarities and differences. For starters, the two reflective models allow students to explore their experiences while being guided by something. However, in the Rolfe model, students are guided by the questions, while in Wanda model (2016); students are guided by the 5Ds expressed earlier.
A key strength of the 5Ds reflection model is that it focuses on the student as an individual (Wanda, 2016). Consequently, it enables students to decide what they need to learn more about, which makes them more self-directed in their learning. Secondly, it has a positive impact on students’ ability to self-evaluate during clinical practice (Wanda, 2016).
When used by students, it improves their ability to assess their own performance in clinical practice.Despite the apparent strengths, the model also has some limitations. To begin with, the effectiveness of the model can be restricted by students’ characteristics (Wanda, 2016).
For instance, the less motivated students are not suited to the reflective model. As a result, the model is not an effective learning tool for all students. What’s more, the use of the 5D model requires consistent supervision, which is sometimes not possible because faculty members might have workloads that limit their time (Sicora, 2017).Grant, McKimm, & Murphy (2017) posit that the analysis part of the Rolfe et al. framework considers not just the technical-rational knowledge but also other forms of knowledge that might inform the comprehension of a particular situation.
This is one of the strengths of the reflective model since it allows learners explore all knowledge points. However, it runs the risk of leading to superficial reflections (Sicora, 2017). At times, the students might just result to answering the three questions in short answers. That would not help in yielding a comprehensive reflection that would help them learning about their achievements and shortcomings that can help improve their practice. At a personal level, I prefer the 5Ds model.
My preference for the model is informed by my desire to identify my doubts in practice as well as the tasks I perform in a way that is different from dictates of literature. That would help me refine my skills and procedures in practice, while making me a more confident practitioner, particularly in the ICU.
Fahrenwald, N., Bassett, S., Tschetter, L., Carson, P., White, L., & Winterboer, V. (2005). Teaching core nursing values. Journal of professional nursing , 46-51.Gibbs, G. (1988).
Learning by doing: a guide to teaching and learning methods. Oxford: Oxford Polytechnic.Grant, A., McKimm, J., & Murphy, F. (2017).
Developing Reflective Practice: A Guide for Medical Students, Doctors and Teachers. Hoboken, NJ: John Wiley & Sons.Hafskjold, L., Sundler, A. J., Holmström, I. K., Sundling, V., Dulmen, S. v., & Eide, H. (2015).
A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol. BMJOpen , 1-10.McCormack, B., Dewing, J., & Breslin, L. (2010).
Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people. International Journal of Older People Nursing , 93-107.Palmer, A., Burns, S., & Bulman, C. (1994).
Reflective practice in nursing. Oxford: Blackwell Scientific Publications.Rolfe, G., Freshwater, D., & Jasper, M. (2001). Framework for Reflective Practice. London, United Kingdom: Palgrave.Ross, H., Tod, A., & Clarke, A. (2015).
Understanding and achieving person-centred care: the nurse perspective. Journal of Clinical Nursing , 9-10.Shahriari, M., Mohammadi, E., Abbaszadeh, A., & Bahrami, M. (2013).
Nursing ethical values and definitions: A literature review. Iranian journal of nursing and midwifery research , 1-8.Sicora, A. (2017). Reflective Practice. London, United Kingdom: Policy Press.Smith, K. (2016).
Reflection and person-centredness in practice development. International Practice Development Journal , 1-6.The American Geriatrics Society . (2015).
Person?Centered Care: A Definition and Essential Elements. Journal of the American Geriatrics Society , 15-18.Wanda, D. (2016). The development of a clinical reflective practice model for paediatric nursing specialist students in Indonesia using an action research approach. Open Publication of UTS Scholars , 1-288.Wanda, D., Fowler, C., & Wilson, V. (2016).
Using flash cards to engage Indonesian nursing students in reflection on their practice. Nurse Education Today , 132-137.
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