This practice-focused portfolio of evidence aims to reflect on the role and parameters of nursing associated with the NMC standards of Proficiency for the Nursing Associate. In this evidence-based assessment, focus will also be given on different factors that impact on the delivery of safe, evidence-based care practices in alignment with legal and ethical standards and personal well-being. To develop this practice-focused portfolio, Rolfe’s reflective model has been selected. Rolfe’s reflective model is a framework that supports the practitioners to reflect on their feelings, actions, and experiences based on three questions: “What”, “So What”, and “Now What” (Patel and Metersky, 2022). The justification for choosing this reflecting model is, that these three questions can help to surface the learning through the stages of describing an event, and implication and considering the future actional plan as a result of developing new insight (Rolfe and Freshwater, 2020). Therefore, to reflect on my roles and responsibilities in alignment with the NMC standards as a TNA, this reflective model can help me to what I have done or how I play the role of as TNA while providing care and services to the service users, what experiences did I gather from the practice and how I can excel my working proficiency to get a better outcome from the role and responsibilities that I played as TNA.
Reflect 1: Reflection On The Current Role And Parameters Of Practice
As a TNA or Trainee Nursing Associate at NHS, I am working in the Mental Health Field and my role and responsibilities are to adhere to the NMC or Nursing and Midwifery Council standards of Proficiency for the Nursing Associate while providing care and support to the Registered Nurses and service users.
My current roles and Responsibilities:
The NMC Standards of Proficiency for registered nursing associates set up the knowledge and skills that a nursing associate must meet to deliver person-centered care. As a trainee Nursing Associate, one of my most important roles or responsibilities is to support my Registered Nursing workforce to provide person-centered and integrated care at the health and social care setup of NHS (Kessler et al., 2021). Working in the Mental Health Field, my responsibilities as a TNA are to be punctual, be respectful to every nursing personals I am working with and towards the patients, Listen and take advice as a whole, be respectful to every opinion, and be kind and empathetic to the diverse needs of patients. As TNA, I also adhere to the NMC Standards of Proficiency, which are:
To represent skills, knowledge, and attributes while providing care and support to patients of all ages across the health and social care setup (Coghill, 2018).
Reflect on the expectations, and diverse needs, and preferences of the patient and be compassionate to provide effective care based on the patient’s personal needs (Stafylarakis, 2022).
To provide a benchmark for those nursing personnel who return to the practice after a period of absence or career break.
Comparison with role and responsibility of other TNA
To focus on the roles and responsibilities of TNA in different fields, I had an opportunity to talk and work with another TNA from Adult Nursing. While my focus area of working as a TNA is the Mental Health Field, I observed that unlike me the role and responsibilities of the TNA at the Adult Nursing care unit is to recognize the holistic needs of the adult comes from a different healthcare setup. The main difference between our responsibilities as TNAs is specific knowledge and expertise in adult nursing care and mental health field, for example, I as a TNA in Mental Health Field have to deal with psychological and psychiatric medication and I have to understand and acknowledge the nuances of the psychological condition of the patient. On the other hand, the TNA from the Adult Nursing unit must have to recognize the physical needs, financial needs of the person and provide treatment support to help him from recovering physical injuries as well as his mental health status (Stafylarakis, 2022).
An episode of Care that Challenges the parameters of my role
What?
As a TNA in the Mental Health Field, the six parameters that I followed while delivering care and support to the patient as well as to my Registered Nurse during the episode or care are:
Being accountable and professional
Being empathetic and responsible to maintain the values and dignity of others (Taylor and Mehigan, 2022).
Provide and monitor the care (Jackson, 2021).
Working in collaboration
Contribution and Commitment to Integrated Care
Promoting safe and effective care support
At the time of delivering care support in collaboration with my registered nurse, I was being asked to apply the medication to a patient with a mental health issue which I was not competent and confident to administer (Taylor and Mehigan, 2022). This scenario made me anxious, and I developed a sense of inadequacy, a lack of self-confidence, and a range of emotional breakdowns. Despite receiving training, I started lacking self-confidence in my ability whether I can administer the medication to the patient safely or not. This scenario challenged my knowledge and understanding of the NMC standard of Proficiency regarding being confident and competent in delivering integrated care.
So What?
This episode of care highlighted the importance of acknowledging one’s limitations and probable impact on the overall safety of a patient at the healthcare setup. This scenario made me realised about the importance of open communication and developing in-depth knowledge about the administration of medication from the registered nurses and nursing team. Additionally, from this scenario, I also realised that I have to go through some training sessions, where I can develop my skill, knowledge, and confidence regarding the administration of medication and information about different medication applied to the patient with specific needs. These initiatives can help me to develop my proficiency and effectiveness while delivering care support and services.
Now What?
This episode of care made me understand that in order to face such a similar scenario in the future, I have to develop my communication skills. With an effective communication ability, I can interact with the registered nursing team regarding my concerns and can better adhere to the NMC Standards of Proficiency while delivering care and support to the patients (Gee, 2021). During this scenario, I also asked for guidance and further training from my hierarchy to strengthen my competence level as well as my knowledge base related to the administration of different medications to patients with varying needs. Additionally, I also started to engage myself with continuous professional development, so that I can develop confidence and competence levels in different aspects of care practice. In such a scenario, the key parameters of NMC standards of Proficiency like competency, accountability, and delegation come into play (Peate, 2023). As per the NMC standards of Proficiency, I as a trainee nursing associate should be competent and skilled enough to deliver care support in collaboration with a registered nursing team to the patient. Delegation is also important, which means, that in the future, if I face any challenging situation or an episode of care, I should ask for guidance and delegation properly.
Reflection 2: Reflection On The Critical Incident From The Practice That Presented As An Ethical Or Legal Situation
Ethical and legal issues in healthcare
The healthcare sector is governed by a set of regulations, rules, laws, and ethical standards. Laws and regulations are set up to protect individuals while they make decisions regarding their health and well-being (Peate, 2023). These laws and regulations also empahsise the set of roles, responsibilities, and principles of the healthcare professionals in workplace setup. In this scenario, the terms legal and ethical standards are used simultaneously-but there are distinctions between these two terms. Legal standards refer to the laws that are set up by the government, whereas ethical standards do not need any legal foundation. Additionally, legal action applies to individuals who come under the particular set of laws set up by a specific government of a State or country (Bibi et al., 2022). On the other hand, ethical right is voluntary, and it is the personal act of an individual that states whether the perception of an individual is right or wrong. Therefore, in a healthcare setup, the main legal issues are medical negligence, lack of confidentiality, and lack of informed consent (Taylor and Flaherty, 2020). Additionally, some common legal issues that are often evident in any healthcare system are false claims and whistle-blower suits, malpractice in the healthcare system, and tort reform. The common ethical issues in the healthcare system are related to patient confidentiality, the relationship between the service providers and service seekers, and informed consent.
A situation from my practice that involved an ethical or legal dilemma
While working in the Mental Health field as a Trainee Nursing Associate, I came across such a challenge that raised ethical issues in the healthcare system. The situation was like this, a medical procedure was administered to a patient on as urgent basis without informing him or his family prior or asking for his consent about the treatment. This scenario came to light when the patient was in need of complex medical intervention based on his health condition. In such an episode of care, the nursing and healthcare team failed to communicate the details of the process and treatment to the patient and his family due to time constraints and the urgent need for clinical administration. However, in such a situation the autonomy and the right of the patient to make an informed decision regarding his health and well-being were compromised.
Reflection
What?
This particular situation from my practice at the Mental Health Field has led me as a trainee nursing associate to a serious ethical dilemma. This situation unfolded the essentiality of maintaining the principle of Informed Consent while administrating any medical procedures or medication of a patient. This situation also stated that it is earnestly necessary for every nursing team as well as a healthcare team to ask for consent and provide clear information about any medical process, specifically when it is complex and needs urgent administration to the patient and his family (Shah et al., 2021). In this situation, the nursing team failed to communicate the details of the process to the patient due to the immediate need for clinical intervention and time constraints. Therefore, the principle of informed consent, which is also considered as the foundation of NMC standards of Proficiency was being compromised and violated (Varkey, 2021). Additionally, the autonomy of the patient and his right to make informed decisions regarding his treatment, health, and well-being were not being met in this situation,
So What?
Reflecting on this situation, I realised that violation of the informed consent principle not only raises ethical issues but also raises legal ramifications. The lack of transparency in communication and the flow of information, lack of transparency have impacted the rights and ability of the patient to take part in making informed decisions about his care, and well-being process (Millum and Bromwich, 2021). This situation also highlighted the lack of managing the balance between clinical urgency and ethical consideration. In this situation, I felt traumatised as I within the nursing team was responsible for violating the ethics of care.
Now What?
This situation made me realize that in any healthcare system, it is important to prioritise the communication and sharing of information, specifically when it comes to administrating any medical procedure or carrying out clinical intervention for a patient. As a Trainee Nursing Associate, it will also be important for me to follow proactive measures like incorporating the structured communication channel and protocol so that the nursing and healthcare team interact with patients and families in any critical scenario (Millum and Bromwich, 2021). Additionally, as a TNA, it will be my responsibility to take the initiative of informing the patient and family about his treatment process after obtaining consent from the hierarchy and asking for consent from the patient about his treatment setup. This situation also highlighted the change in organistaional and healthcare service provision and empahsises on the role of TNA in terms of proper time management ability and skill, development of proper communication channels and strategies, and adherence to ethical considerations when it comes to delivering patient-centric care (Glaser et al., 2020). In such a scenario, when time constraints and urgency of clinical intervention restrict the sharing of information with the patient, I would ask any other TNA at a similar healthcare unit to inform the family members of that patient and ask them to sign a bond or consent related to the treatment process. additionally, during the complex scenario at the time of clinical administration, I can allow one of the family members of that patient in the medical room to present as a witness to the whole treatment process. I will also try to foster a culture of open communication in the healthcare system with the team. This will include the development of such an environment, where every TNA and member of the healthcare team will feel comfortable expressing their concern about the time constraint and seek collaborative solutions. I also try to encourage the family member and patient to be part of that team, so that in the critical scenario, when it may not be possible to ask for consent from the patient, the healthcare team can communicate with his family and carry out the clinical process without compromising the ethical standards.
In such a challenging situation to manage self-care, I will try to focus on “debriefing”. Debriefing is a technique that includes the structured conversation related to emotional status, and experiences that I may experience while providing service (Patel and Metersky, 2022). I also practice mindfulness meditation, to alleviate stress and strain. Structured conversation and meditation will help me to get rid of mental and emotional breakdowns while facing traumatic or stressful situations as a TNA in the healthcare system (Pietrzykowski and Smilowska, 2021). These practices of self-care can promote emotional well-being, and contribute to my resilience in navigating ethical challenges while working as a TNA in the Mental Health field.
Reflect 3: Reflection On Practice Where I Was Involved In Clinical Decision-Making Making Which Affected The Health Outcome For Service Users
The situation where I was directly involved in the planning and delivery of care that improved the health outcome for the patient and advices that I gave:
During my training at the Mental Health Field setup as a TNA or Trainee Nursing Associate, I encountered such situations, where I had to make clinical decisions and this positively affected the overall health and well-being of a patient. During my training at the Mental Health Unit, I met a patient who was experiencing persistent depression and mental trauma and faced difficulty in managing his stress. He was not even responding well to the conventional therapeutic intervention. Understanding his holistic approach and mental health status, I tried to collaborate with a multidisciplinary team to formulate a customized care plan by integrating cognitive behavioural therapy, mindfulness meditation, and coping strategies (Walter et al., 2020). These interventions had helped the patient to reduce his stress and strain, the coping strategy had helped him to strengthen his behavioural approach and regain the ability to get accustomed to any situation surrounding him. I asked to my registered nursing team to encourage that patient to practice meditation which can help him to reduce his stress level as well as risks related to persistent anxiety (Windle et al., 2020). I also asked them to implement regular physical exercises like walking and running and change his regular diet with protein and fiber-rich meals. This advice and intervention impacted well on overall health and mental well-being of the patient to a considerable extent.
Reflection on my skills, and knowledge as well as behaviour to support the delivery of effective care to the patient and family
Reflecting on my skills, attitude, knowledge, and behavior that supported me to deliver effective care to that patient, firstly I will highlight the importance of effective communication. Considering the overall health and mental status of that patient, I used my communication skills to build a good relationship with the patient to ensure open interaction about the exact challenges the patient used to experience. Open communication would help me to understand the situations and factors that contributed to his persistent anxiety and trauma and restricted him from managing his stress (Windle et al., 2020). Additionally, in this situation, I applied empathy, and active listening skills to develop a therapeutic relationship with the patient and this enabled me to gather a comprehensive understanding of the specific needs, preferences, and concerns of that patient. During this whole process, I also tried to maintain confidentiality and ensure the patient that his conversation would be kept secure and his dignity would be respected. In terms of knowledge, I used evidence-based literature based on mental health. I also adhered to the NICE or National Institute for Health and Care Excellence guidelines related to the management of anxiety, mental stress, and psychological intervention (Shah et al., 2021). By incorporating of evidence-based practices and approaches in the care plan for the patient, I have ensured that the intervention plan is patient-centric and can meet the diverse needs of the individual along with assurance of his overall health and well-being (Taylor and Flaherty, 2020). During this entire treatment process, I tried to remain non-judgemental and kept a person-centered mindset. I also focused on respecting the autonomy and dignity of the patient by involving him in the decision-making process. I also used a collaborative approach, where I tried to involve the patient as well as his family in his care plan so that the patient could gather self-confidence and feel empowered to improve his mental health.
What I would do differently in a similar situation?
In the future, if I face a similar situation, I would like to prioritise effective communication skills, the use of empathy, and active listening skills along with evidence-based practice. However, after recognizing the dynamic nature of psychological health, I would remain flexible to adopt different intervention plans based on the ongoing assessment and feedback from the patient.
Linking the care with relevant policies, procedures, and evidence
Linking to the healthcare service that I delivered during the situation, it also is important for me to adhere to the necessary policies and practices to maintain ethics in the healthcare system (Stafylarakis, 2022). As a Trainee Nursing Associate, when it comes to working in the mental health field, I will try to adhere to the NICE guidelines to assess and treat the mental health condition of the patient (Pietrzykowski and Smilowska, 2021). During the delivery of services to that patient, I tried to emphasizes the person-centered care approach by advocating the collaborative decision-making process and considering the preferences and values of that patient. Additionally, as per the NICE guideline, I tried to position and use psychological intervention as the first line of treatment for that patient in line with the administration of pharmacological treatment to ensure long-term management of the disorder for that patient (Windle et al., 2020).
Feedback from the assessor, practice supervisor, or manager and ask about feedback.
During the training process as a TNA, o discussed this present case scenario with my educators and asked for feedback from my supervisors. During the discussion, I mentioned the decision that I had taken while offering treatment and care services to that patient. I also mentioned the multidisciplinary team collaboration, the use of evidence-based literature to design care plans, and the positive impact on the overall mental health status of that patient (Coghill, 2018). The feedback that I gathered from my educators and supervisor affirmed the effectiveness of using evidence-based practices and highlighted my efficacy and knowledge about the use of evidence-based practices to develop the well-being of the mental health setup of patients with prolonged anxiety and depression. They also provide good feedback on adherence to NICE guidelines to assess and treat patients with mental illness and tailor the intervention plan as per ethical considerations (Walter et al., 2020). Apart from that, their insight and feedback helped me to understand the importance of carrying out continuous improvement and the potentiality of refinement in healthcare practice and skill development while working in the Mental Healthcare field.
Conclusion
To conclude this practice-based evidence portfolio, it can be stated that this practice has helped me to be a compassionate, competent, and confident nursing associate in my future career development. In this assessment, the role that I have been focused on is Trainee Nursing Associate, and my roles and responsibilities were discussed in this assessment in line with the Platform 1 Standards of Proficiency for Nursing Associates. In this reflective assessment, Rolfe’s reflective model has been used to highlight the experiences that I have gained during the episode of care practices and coursework.
References
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