Reflection can be defined as the professional tool or framework that provides the opportunity to the nursing students to analyse their practice quality, discover the strengths and the weaknesses of competence (Paterson & Chapman, 2013). In this reflection assignment, I will be focussing on the experience that I have gained while providing care to an elderly aboriginal woman suffering with chronic rheumatoid arthritis. This reflection will take the assistance of the Gibbs reflection cycle in order to describe the event, explore my feelings with this unit, evaluation of the entire working scenario, and analysis of the experience concluding with a plan of action.
As a part of my first working experience, I had been given the opportunity to care for an aboriginal women suffering with chronic rheumatoid arthritis who presented in the health care facility with acute pain, joint stiffness, unsteady gait and extreme fatigue. In order not to breach the confidentiality of the patient under the health privacy laws, she will be addressed as Emily in the reflection essay. Emily had been very weak, frantic and had been suffering with acute pain when she had presented to the emergency department. I had been given the responsibility to handle the patient and perform primary pain management. However, when I approached her for the analgesia, she became very frantic and tried to shove me away from her. She had been speaking in aboriginal and native language which I could not understand. I repeatedly tried to calm her, however, she could not understand and she got increasing anxious and started screaming. I had to inform my supervisors and I had been told by my supervisors that the manner I approached the patient with had not been culturally competent. I had to leave the room.
In order to reflect on the entire reflection scenario I would like to mention that I have mixed feelings regarding the entire experience. First and foremost, this had been the first opportunity for me to handle an aboriginal patient and I had no prior knowledge regarding how to handle a culturally diverse patient. Along with that, when I approached the patient I had attempted to greet her with a simple hello and went straight ahead to prepare the intravenous analgesic to inject to the patient as instructed by my supervisors. However, the patient became frantic by just looking at the syringe in my hand and she started profusely started refusing the analgesic treatment that I had approached her with. While contemplating, I would like to mention that I myself had been very nervous while handling a culturally diverse patient and as she became frantic I lost my composure and rationale. Even after desperately trying to calm her down, Emily became more and more frantic and as a result my supervisor had to cut in and ask me to leave the room immediately. I had felt extremely demotivated and depressed at my first encounter with a culturally diverse patient being so negative. Along with that I felt incompetent as well as I had not been able to relieve the pain that the patient had been feeling and only added to her discomfort and fright.
It has to be mentioned that the evaluation can be considered as the most important step of the entire reflection cycle, as it gives the opportunity to the nursing student to discover the good and bad aspects of the experience (Paterson & Chapman, 2013). In my case, this experience had been an eye opener for me while handling the aboriginal patients and what communication approach to take. The bad part about the entire experience had been the fact that when the patient had been in acute pain, I could not offer her any relief and I could not do justice to my responsibilities due to my lack of skills of cultural competence and cultural safety. The only good part regarding the experience had been my realization regrading the skills i would have to enhance. According to the cultural safety framework for aboriginals and Torres Strait islanders, the care priorities will need to be aligned with the cultural norms and expectations of the indigenous patients (Rix et al., 2015). I failed to diligently follow the cultural safety guidelines while attending Emily, which she interpreted as negligence and discrimination directed at her. I have understood that I would have to take cultural safety and communication training within this unit to enhance my skills so that I can avoid such incidents.
In order to analyse the exact reason behind the errors that has occurred in the experience, my lack of knowledge regarding culturally safe practice can be highlighted as the most significant one. The aboriginals have a very different understanding of health and wellbeing. Their traditional healing concepts are very different from the contemporary modern health care techniques (Baker & Giles, 2012). Hence, it is very important for the care professionals to communicate effectively the need for different care activities and attain consent before approaching with any treatment procedure. Hence, I lacked knowledge regrading the need for establishing a comfortable and mutually respectful therapeutic relationship with the patient before proceeding with any care activities. I did not attempt to introduce myself to the patient and engage in therapeutic communication to understand her issues and grievances before approaching her with the pain medication. Along with that, key elements of culturally safe communication, such as eye contact, gestures, use of silence and body language are crucial in establishing comfort and respect in the therapeutic relationship between the nurse and the culturally diverse patient (Raman et al., 2017). I had failed to appropriately and optimally use these components of culturally safe care and effective communication, which further aggravated the patient.
On a concluding note, it has to be mentioned that the reflection exercise gave a wonderful opportunity for me to revisit the first encounter I had with the aboriginal patients. After this experience I now realize that I should have engaged in a therapeutic and culturally safe communication with the patient in the presence of a language expert in order to better understand the ideas and expectations Emily had from the health care team. Along with that, with the help of the translator, I should have clearly stated the need for the analgesic injection, how it could have benefitted her, and taken her consent before approaching her with the medicine.
Plan of action:
Based on the discovery of my weaknesses and my lack of culturally safe communication, I would attempt to discuss with my supervisor regarding my options with communication and cultural awareness training within my unit as the first initiative of my development plan. Along with that, I would also attempt to culturally competent communication courses and nonverbal communication training programs to help enhance my nonverbal communication skills and my better clinical reasoning within the next 3 months. Along with that, for a nursing professional working in culturally diverse care setting, attaining a general idea regarding their cultural norms and traditions is very important (Durey, Thompson & Wood, 2012). Hence, I would like to enrol in a cultural awareness development program to better understand the traditional concepts of healing and wellbeing to serve the culturally diverse patient with more effectiveness within the coming 6 months.
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