CENTRE FOR NURSING STUDIES

BACHELOR OF NURSING (HONS.)

WRITTEN ASSIGNMENT
REFLECTIVE WRITING

COURSE NAME
LEADERSHIP IN NURSING

COURSE CODE
NRS559

LECTURER : DR. SITI KHUZAIMAH BINTI AHMAD SHARONI

GROUP : DEGREE SEM 7
STUDENTS’ NAME :
NUR AZIEMAH BINTI MOHD ZAMRI 2017415056
 TABLE OF CONTENT

CONTENT PAGE NUMBER

1.0 Introductiton 3

2.0 Gibbs’ Reflective Cycle

2.1 Description 4
2.2 Feeling 5
2.3 Evaluation 5-6
2.4 Analysis 6-7
2.5 Conclusion 7
2.6 Action plan 7-8

3.0 References 9

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Introduction

The aim of this assignment is the need to write reflective writing based on the incident
that have occurred during the clinical practice. In nursing education, studies have been
focused in reflective practice as a teaching technique to encourage a learning approach
rooted in students' experience, in order to minimize the gap between nursing theory and also
practice. (Dube and Ducharme, 2015).

For this assignment, I would like to emphasize the importance of communication. With
the intention to get a point across, effective communication also known as verbal speech or
other methods of transmitting information, and if neither party understand the intent of the
transmitted information, communication cannot be effective (Ratna, 2019). All works requires
effective communication especially if it is involving someone else’s life at the end of the lines.
In addition, communication is not only verbal but also non-verbal, such as head or facial
agreement or disagreement, eye contact, tone, volume, dress and appearance, timing and
setting (Aelita et al., 2019).

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Description

The event occurred in the morning when the doctors make their rounds to see the
patients and delivered information towards the nurse in charge about the plan management
for the patients. Communication is very important in transferring important information
especially that involves other people condition. If communication is being transferred
incorrectly, the lives of the patients will be at risk. Besides, wrong management also can be
performed towards the patients if the information that being state is wrong.

In this instance, the situation arouses when a doctor who was supposedly to do dressing
on one patient postponing his tasks and went outside the wards without do the dressing on
the patient. The nurse is not allowed to do dressing on the patient on the patient because
specialist doctor instructed the doctor in charge of the patient to do it. Then, the nurse called
the doctor in charge to ask the doctor about the dressing, he said that he will came back to
the ward at 11.00 in the morning to do the dressing. However, the doctor did not come back
at all even though the clock has pointed to 1.30 in the evening. Moreover, the patient has
foot ulcer fourth stages, and it is very unethical and unprofessional for the doctor to leave his
patient. The patient condition during that time was not good because he was being left with
his wound exposed, even though the nurse in charge ask me to monitor the patient and
ensure that his leg was keep wrap with the sterile dressing towel, the patient keep moving
around and sometimes dangle his feet at the bed side.

At 2.00 in the evening the nurse in charge received a call from the doctor who was
supposedly to come back to ward at 11.00 am and do the dressing by himself after she has
pass over report to the other nurse in charge for evening shift. The doctor asked the nurse to
do the dressing on behalf him instead because he was busy now and unable to come back
to the ward. Even though the nurse’s shift supposedly has ended, she went to the procedure
room to prepare for the dressings. When the next day arrives, the patient who was usually at
the fourth cubicle has been transferred to the sixth cubicle that was at the end of the ward.
The causes of the transferred was because the patient wound has been infected and he was
having high fever and inflamed wounds. In response to this, I as a nurse student carried out
my task as usual during that shift and later, I discussed about the incident with clinical
instructor on various action that can be taken and use this experience to be reflected on.

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Feelings

The initial feelings that I felt during that incident was confused, shock, surprised and
finally angered. We also have been taught to prioritize the patients first in any situation
because they depend on us as health care workers to improve their health. As a student
nurse, we were taught to deliver information correctly and act accordingly to the information
that was being stated because incorrect information is not only put risk on ourselves but also
the lives of patients that was being taken care of.

Moreover, when someone who has a lot of experiences of works and in a higher levels of
position tells an information that is incorrect which need to be avoided as much as possible
especially among health care workers can be appalling, stupefied and also intolerable
experiences that need to be remember. Feelings of shocked came when the patient is being
left for a long of time with his wound exposed. Although the patient does not make any fuss
about his wound that is not being bandages yet, but the hope and anticipation look he gives
every time he saw a dressing trolley is being pushed to another patient is quite
heartbreaking. Feelings of angered starts to seep in me when the nurse that was almost
done with her shift receives a call from the doctor. If the doctor himself is unsure whether he
able to do the dressing, he should not say that he will come back and do it in the first place.
It was like give hope to the patient who was patiently wait for the doctor to come and
patched his wound up and to the nurse who believe that the doctor will come so she focused
on her other other tasks. However, to leave the patient hanging and uncomfortable is an
irresponsible act that should be avoid and ashamed of as a healthcare worker.

Later, emotions are more relief when talking to the clinical instructor because it seems
that the nurse has the right decision to take when the patient condition is considered first.

Evaluation

The experience shows that as a nurse sometimes the unexpected can happened
without warning even though all the steps and prevention of such event have been done so
readiness is a must. This is not only giving a negative experience but also a positive one that
can be learned from. The negativity arises from witnessing the ineffective communication of
the doctor towards the nurse. Effective communication requires the expression of the
content and purpose of the transmitter to the receiver, provided that the receiver has
interpreted the message and that there are certain variations between the receiver and the
transmitter (George & Alexandru, 2017).

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 On the other hand, the positivity arises from the nurse that can do the dressing that
have been assigned to her suddenly without any complaint and delayed any longer. In
addition, although her shift nearly ended and she can passed the task to the nurse that in
charge for the evening shift or declined the doctor request, instead she do it by herself as
she do not want to troubled her colleague and make the patient suffer and uncomfortable.

Communication is all about the confidence and acceptance of others, their emotions and
thoughts that are different and that from their point of view, have the same intellect (George
and Alexandru, 2017). Not all the doctors are able to communicate effectively especially with
nurses. This is where health workers, particularly nurses, need to be used. Any formal
response and action may be taken by the nurse, the patient or the superiors to the doctor.

Analysis

There is much to be to be take note out of this experience and learned through all the
situation that happened. Strong communication skills help establish respectful and
productive relationships with patients, their families and employers, because they also help
to display personal leadership, overcome disputes and inspire others (Aelita et al., 2019).
Correct information and effective communication are a very important that needs to be taken
into consideration as a student nurse. An individual with good communication skills can
handle any unforeseeable professional situation. (Pereira and Puggina, 2017). The
information and communication are very important because it also can put the patients’ life
at stake, and it hold high risk in health professions compared to the others. Good
communication skills of healthcare practitioners have also been shown to be associated to
greater patient empowerment (Aelita et al., 2019). Poor communication with any member of
healthcare can interrupt a patient's understanding of health issues. (Ratna, 2019). Thus, it is
important to ensure that all the information given is correct and communication between two
sides or more can be carried out effectively.

Rationally speaking, not all communications are able to be carried out perfectly. There
are people that are unprofessional with their work but there are people that can be at their
best when unexpected situation occurs. Healthcare practitioners have little or no formal
instruction about how to communicate with patients and their family members, as well as a
lack of communication skills on treatment objectives (Wagner et al, 2018). To be able to act
accordingly and correctly to a certain situation is a necessary nursing experience. This
incident provided a good example in which there are many kinds of action that can be

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choose from and that is why it is literally supplied with a great source that was needed for a
good reflective practice.

Finally, the most importance thing is having the guidance and advice of the clinical
instructor during this experience. It is obvious that the clinical instructor is a someone that
able to points out which kind of action that is wrong to be done to a patient and to the nurse.
This was the first incidents where the acts of professionalism and communication was being
taken lightly and responsibility was being passed to other person without taken into
considerations about other people feelings and situation. The valuable lesson is the clinical
instructor’s advice on how to respond professionally and emotionally if the same incident
occur in the future.

Conclusion

It is as clear as a day that the path of action that was choose was not a great one.
However, make a report to the superior might have been more appropriate action that can
be taken as a lesson. It was quite fortunate that there is no anything bad that happened
because the situation could have been worse.

Moreover, to have a talk and consult with the clinical instructor was the correct choice
because communicate and ask opinions from the person who has many experiences and
comfortable to talk to can have many new things to be learned from.

Action plan

If the incidents rose again, what would you do? The answer to this question is, have
confident to confront and question the doctor about his situation that cause him to leave his
responsibility and neglect his patient well-being. In this cases, by saying “please explain to
me about the situation you are in that prevent you from coming into the wards and take care
of the patient” would helped to identify whether the doctor is in a really tight situation or not.
In the future, if this situation happened again the first action that can be taken would be wise
to question the doctor whereabouts at the time being that prevent him to come back to the
wards as confirmation that he did not ditched his responsibility.

However, if this failed, the next step that can be taken is to contact the superior and
clarify the situation. If the nurse is unaffected by the intervention of the doctor, it can happen
more than once. It is important for the manager to take note and aware of the situation that

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happened so that immediate action can be taken and prevent more problems in the future.
When the superior has been notified, the work atmosphere and patient safety can be
assured.

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References

Bucăţa, G., & Rizescu, A. M. (2017). The Role of Communication in Enhancing Work
Effectiveness of an Organization. Land Forces Academy Review, 22(1), 49–57.
https://doi.org/10.1515/raft-2017-0008

Dubé, V., & Ducharme, F. (2015). Nursing reflective practice: An empirical literature
review. Journal of Nursing Education and Practice, 5(7).
https://doi.org/10.5430/jnep.v5n7p91

Helyer, R. (2015). Learning through reflection: the critical role of reflection in work-based
learning (WBL). Journal of Work-Applied Management, 7(1), 15–27.
https://doi.org/10.1108/jwam-10-2015-003

Pereira, T. J., & Puggina, A. C. (2017). Validation of the self-assessment of communication

skills and professionalism for nurses. Revista Brasileira de Enfermagem, 70(3), 588–
594. https://doi.org/10.1590/0034-7167-2016-0133

Ratna, H. (2019). The Importance of Effective Communication in Healthcare Practice.

Harvard Public Health Review, 23.
http://harvardpublichealthreview.org/healthcommunication/

Skarbalienė, A., Skarbalius, E., & Gedrime, L. (2019). Effective communication in the
healthcare settings. Management, 24, 137–147.
https://doi.org/10.30924/mjcmi.24.si.9

Wagner, L. M., Driscoll, L., Darlington, J. L., Flores, V., Kim, J., Melino, K., Patel, H. D., &
Spetz, J. (2017). Nurses’ Communication of Safety Events to Nursing Home
Residents and Families. Journal of Gerontological Nursing, 44(2), 25–32.
https://doi.org/10.3928/00989134-20171002-01

Wain, A. (2017). Learning through reflection. British Journal of Midwifery, 25(10), 662–666.
https://doi.org/10.12968/bjom.2017.25.10.662