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Reflection on Communication in Intensive Health care Setting


My recognized learning need is boosting my potential to converse articulately and assertively with the multidisciplinary team (MDT) people, as I portrayed lack of assertiveness and competences in interacting with other medical experts on my earlier clinical practice experience. Hence, it is vital to boost this identified facet of my practice as it compromises patient safety and limits my professionalism. Thus, I will critically reflect after the recognized learning need and exactly how it impacts on my patient's attention, my personal and professional development as a nurse. Furthermore, I am going to critically reflect and analyse about how the training need recognized was met in my own final year placement. To be able to structure my reflection, I've made a decision to use Gibb's (1988) reflective model which involves description, feelings, evaluation, analysis, summary and action plan (Gibb's 1988). I will apply relevant parts of this model when required.

Also, relating to the Medical and Midwifery Council (2008) Code of professional conduct, confidentiality shall be preserved in the essay and all titles and trust identifiers will be private to protect personal information. Additionally, In reference to the Post- registration education and practice (PREP) guidelines (2011), I've spent 52 hours using different databases to research for relevant articles and government procedures to permit me to write the essay. The conclusion of the article will discuss my reflection skills and acknowledgement of my level of assertiveness and competence, exhibiting my personal and professional development.

As a student nurse, I go to scientific areas to get experience and acquire key medical skills that will improve my nursing practice. For the final stage of my second year placement in the year 2013, I was allocated to a rigorous care setting where treatment and monitoring was presented with to critically sick patients. I mainly assisted and worked with my scientific practice mentor. I had been caring for an intubated patient within my move under strict supervision from my mentor. Although I have been caring for the patient for the duration of my shift, I was unprepared to pass on the required patient details to the relevant health care professionals. The incident happened when my mentor insisted I implemented her to the MDT appointment where a band of professionals collaborated jointly to make decisions regarding that specific patient's treatments and advancements (Richards & Edwards, 2012). I thought I was just associated her to observe the inter-professional collaboration that was taking place. Alas, my mentor asked me to handover the patient I have been caring for to the MDT.

As an outcome, I instantly became stressed and shaky, to the point that I struggled to articulate my first sentence coherently and I was unable to speak assertively with the MDT users. Although I effectively delivered the essential patient's information, I instantly panicked and provided confusing information about the patient's known reasons for admission and care and attention plan. However, it was clear to both my mentor and the other members of staff that we was flustered and needed assistance. My mentor then needed over and continued with the patient's information. As a result, I felt I was intimidated by the hierarchy, I sensed nervous, embarrassed and upset by my very own inability to communicate effectively with the MDT. I thought that I could not be a professional nurse easily let my nerves block the way of my nursing care and attention. Also, I thought frustrated when my mentor put me on the spot and I possibly could not connect effectively. Later on I also felt that she had not given me adequate time to settle my nerves and create myself before the MDT assembly. On searching the books, I realised that feeling nervous is a natural effect for student nurses when interacting with other clinicians and even experienced nurses were once stressed students (Cardillo, 2010). This made me feel less humiliated and provided me the impression that everyone has experienced these thoughts at one level or another. However, other literature will not support this notion. Actually, several recent studies also show that the knowledge of nervousness could be due to the student being frightened rather than committed in undertaking duties (Youngberg, 2014). In my own case, I did so not feel it was through insufficient commitment. Confidence includes experience; however, being ready and organised is the main element to my little by little becoming more confident. Hence, to avoid this repeating itself, I'll start planning myself mentally presuming I must handover patients' good care to other clinicians.

As I mirrored on the occurrence, I realised I lack assertiveness in connecting with the MDT and I did not have enough confident to create an appropriate inter-professional working as it's the key to patients improvements (Royal School of Medical (RCN), 2010). Also, reflecting back, I realised that we was really concerned about the communication issues I experienced in the MDT appointment. Many analysts advocate the value of maintaining a highly effective communication among the list of MDT as it is a fundamental nursing skill which plays a significant role in the development for scholar nurses (Moss, 2008). I realised i had a need to improve upon this learning need as my inability to connect assertively and effectively with the MDT impacted on my medical care to the patient because not heading in-depth rather than providing the appropriate patient information limited my nursing care to the patient.

The concept of poor communication among the MDT is highlighted in a phenomenological review by Leonard, Graham and Bonacum (2011), where in fact the authors explored communication failures as the leading factors behind inadvertent patients injury. The article was of particular interest if you ask me as it emphasised on sustaining improvement for learner nurses in communicating on the list of MDT since it compromises patient's safety, and the necessity for improvement. Additionally it is relevant as it sufficiently discusses the issues surrounding my identified learning need and the need for improvement. In the article, the authors proposed that effective communication among the MDT is essential for delivering high quality care and attention and safe of care to patients. Also, the factors the authors raised is a very significant issue to consider, because the in 2014, RCN confirmed that communication issue have been recognized as adding to a large number of patient safety incidents in britain. Thus, they might need all nurses and trained student nurses to effectively side the care of patients over to another clinicians, with a precise communication and co-ordination to boost patients' quality of treatment.

Although Sharif and Masoumi (2010) qualitative research declares most second season medical students often experience stress and nervousness when interacting with other clinicians compared to final calendar year students, which there may be somewhat of contract on, I highly believe my experience reflects more on Leonard, Graham and Bonacum's (2011) findings when i was unable to communicate assertively with the MDT during the meeting, which tied to nursing development. It impacted on my scientific ability after i failed to provide the accurate patient information to the MDT. This led to creating confusion to the other health care professionals as what I mentioned about the individual didn't match with the information the MDT possessed on the patient handover sheet. Leading to one of the health care professionals requesting if am providing them with the appropriate patient details which resulted in a breakdown in the inter-professional cooperation (Vincent, 2011). This does not simply impacted on my medical care to the patient but also impacted on my own and professional development. As stated by the Dougherty and Lister (2011), a good nurse is the one who knows what he or she is doing as there is an expectation that nurses and trained nurses must show assertiveness and competencies in carrying out duties. There is a reflection to this approach to my personal and professional development recognising that being assertive and competence will not just signify how you carryout responsibilities, but understanding the explanation behind it and the impacts it may have on patients (Experts, 2014).

This demonstrates how relevant and essential it is to speak assertively with the MDT as reflecting again on my learning need, not having the ability to collaborate inter-professionally with the MDT limited my professional development and hindered my patient not receiving a high standard health care from me. Although Leonard, Graham and Bonacum's (2011) findings sufficiently outline and provide insights into the importance of being assertive on the list of MDT, the results of their study do not show the significant upsurge in the development of patients' care because of the little bit of sample size the authors used. The data was accumulated from a medium size clinic where performance of the reporting system might be different from other clinics. This was regarded as a weakness, but I sensed the article was helpful as it is relevant to my learning need and reminds me of how poor communication impacts negatively on patients safety (Burnard & Gill, 2013).

Also, in a qualitative research by Krautscheid (2012) the author explored the need for bettering communication among other clinicians for pupil nurses, setting up them for practice. In this article, the author determined that most college student nurses have a great deal in connecting effectively to other healthcare professionals, which should not be in order it compromises patients treatment. There is an agreement upon this research even though a study by Burton (2013) recognized that not absolutely all student nurses' presents insufficient assertiveness in their training but I feel my medical experience reflects more on Krautscheid (2012) findings as my inability to converse assertively with the MDT limited my medical development because it impacted on my medical ability as i didn't show a competence labor force to the other clinicians in the MDT meeting, which also limited my nursing care to the individual as I did so not deliver a high standard of attention to the patients' development. For example, if high-quality health care is been sent to patients by the methods caring for them, it increases the chance for patients to benefit from therapeutic medical (Freshwater, 2007) as data demonstrates that this does contributes to the highest amount of patient health care (Scott, 2008). Therefore, by not connecting assertively with the MDT limited my own and professional development as the issues surrounding it was not being confidence, prepared, proactive and not portraying a precise level of competencies hindered my patient not obtaining a fantastic standard of health care from me.

As a result, not providing the appropriate information about the individual to the MDT affected the patient's good care. Youngberg (2014) affirms that effective professional medical practice involves occasions where critical information must be communicated accurately with a team as a nurse, checking out ineffective communication in a teamwork will not only sets patients safety at risk but also demonstrates not being competence. Consequently, this highlights the must become more assertive and competence in communicating with the MDT as student nurses also plays a essential role in the multidisciplinary team approach to patient good care (Miller, 2009), and effective engagement enhances patient end result (Hughes & Quinn, 2007). Although Krautscheid (2008) research shows insufficient detailed information on how to effectively deal with miscommunication, its qualitative design allows understanding into the need of improving communication among health care providers. I came across the results of the thematic examination linked to my very own clinical experience including the feeling to be nervous. The writer provided a relevant and a valid article as a sizable test size of 285 student nurses was used and got significant results that have been inherently repeatable. This article was helpful in reminding me how important effective communication implements the areas of patient safety. Hence, it is significant to enhance on my determined learning need.

On reflection it was clear that my lack of assertiveness in my ability, when placed on an area by my mentor added to my feelings of inadequacy. Through reflection and what my mentor have enabled me to clarify that my weakness was not skill or knowledge level. But my inability to converse articulately and assertively with the MDT through the meeting was anticipated to being intimidated by the hierarchy. This resulted in a lack of assertiveness, and assurance in my level of skill and professional medical knowledge, which also enabled me to know the need to change my practice. Furthermore, following the incident, I received feedbacks from my mentor who stated I should become more proactive in the future, show a competence workforce and create a tool that will permit me hand in the care and attention of an individual accurately in the foreseeable future. As explained by Western (2012), teamwork is essential if good care is carried out efficiently in scientific areas as effective communication creates a positive contribution to patients' results.

Thus, I decided to action anticipate this reflective experience to develop my nursing knowledge in my final year professional medical placement. I viewed various nursing publications and government plans detailing how to connect effectively with the MDT and use the advice I gained to map out how to take action. As shown in Watts (2011) phenomenology study, student nurse can further develop their skills in understanding and making use of latest research evidence by looking into journals, clinical guidelines and plans to permit them develop their skills. NMC (2010) further supported this statement stating that, trained nurses and nurses need to keep upgrading their basic knowledge and skills, and become fully prepared and work effectively to deliver essential care to patients.

Therefore, to develop my self confidence and talk assertively, I adapted the Situation, Background, Examination and Advice (SBAR) tool which was publicized by the Institute of Medical Improvement in the year 2004. I select this tool since it has shown to be an efficient communication tool (RCN, 2014). It was also seen to be an easy to keep in mind method that enabled me to style conversations and also to clarify what information should be communicated between people of the team and how. This was a relevant tool to conform as it aided me develop teamwork and have confidence to provide safe quality health care. Also, there is a good facts to suggest that communication enhances when nurses used organised format such as SBAR (RCN, 2014). This year 2010, the National Patient Safety Company recommended that effective communication among MDT is a key factor in boosting clinical practice and patient final result. Therefore, the National Institute for Health insurance and Care Excellence (NICE) (2010) reinforced these findings and suggested that medical and medical staff should use the SBAR tool in structuring patients' specialized medical information to other clinicians, backed by written plan as this will prevent professional medical providers from providing unclear patients' records and miscommunication of patients' details. As a result, they released these rules for nurses and medical personnel to stick to in order to enhance patients safety as communication failures causes inadvertent patient harm. This is a trusted guideline as it is a countrywide policy and discusses the need to adapt the SBAR tool.

Upon using the SBAR tool, I became proactive and wanted the assistance of my first last year medical mentor to determine my communication skills and knowledge platform as it is something I won't to boost on. By doing this, I could reinforce my communication skills & most notably developed my self-confidence as I ensured that we was always prepared, organised and in a position to successfully speak assertively with other clinicians during my third year professional medical placement while completing the necessary skills unassisted to become more independent as a final calendar year student nurse. Webb (2011) commentary that you of the fundamentals of good nursing works well communication between clinical staffs as failing to communicate effectively with the MDT destroys the fragile nurses' inter-professional romance. Because of this, through reflection, practice and the use of my mentor and knowing of factors that impacts my assertiveness in communicating with the MDT, and the adaptation of the SBAR tool, I was able to confidently and assertively talk to other clinicians.

As seen in O'Daniel and Rosenstein (2011) review, to enhance the power of nursing students, they need to have a solid focus to build up skills that will improve their own professional id. This is significant as this process means that student nurses become aware of their own competencies, and causing assurance in their value as a team member. Reflecting on my recognized learning need and adapting the SBAR tool have made me attempt to protect my patients from damage and have increased me as a nurse. Furthermore, I feel I've become more assertive in interacting with other clinicians as assertiveness is an important behaviour for a nurse, which is necessary for effective inter-professional communication (Cardillo, 2010).

This suggests to the principle Nursing Officer's (2012) 6 C's which expresses communication is central to successful human relationships and effective team working. Thus, bettering on my capability to talk assertively with the MDT is essential and have made me a committed nurse who would like the very best for those her patients, and provide them the very best of care and not to put them in danger. This is in accordance to the NMC Code of Professional Do (2014) which claims nurses are accountable for their practice. Thus, they need to maintain professional knowledge and competence and take action to identify and minimise risk to patients. I believe after reflecting on my discovered learning need and enhancing onto it, I am now an improved nurse as I've learnt how to do things differently, and deliver the most up to date evidence based treatment to enhance my patients treatment and my nursing development.

Reflecting back again on my last year clinical experience, I have now identified a fresh learning need which needs development. In mention of the PREP (2011) guidelines and the NMC Code (2008), nurses have to be responsible and accountable for keeping their skills and knowledge up to date through carrying on professional development, and must aim to enhance their performance to improve patients' safety and treatment. Thus, my new identified learning need is usually to be able to develop more capable in recognising and addressing issues associated with patients care. This is essential to develop as in line with the NMC (2014), all nurses must be fit to practise and show professionalism when you are in a position to identify and talk about ethical difficulties that relates to patients and decision making about their care, and function within regulations to aid with appropriate solution. Therefore, it is vital to develop upon this.

This article has critically mirrored and analysed on a personal learning experience from a scientific practice. The key points that contain been mentioned in the essay are that of the value of communicating assertively with the MDT and exactly how student nurse and nurses can improve their communication skills and maintain assertiveness to enhance patients' safety. This is because we as nurses must definitely provide a rare metal standard of care for our patients. Thus, upon improving on my recognized learning need, I have been able to enhance my medical practice in order to provide safe health care to my patients.

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