Adult Nursing bsc (Hons) Essence of professional Practice
Module Number: 92565
Exploring the 6 c’s: An examination of the evidence and personal reflection
Submission Date:
This assignment will examine the importance of 3 of the 6 c’s of care regarding nursing, with evidence to back this up in the form of published literature. The 6 c’s of care are; communication, care, commitment, compassion, competence, and courage. The 3 c’s that will be explored in this assignment are; communication, competence, and compassion.
Communication is important as it is needed to gain informed consent, to reassure and comfort the patient, and can be used as a primary method of finding out what the patients’ health and personal needs are.
It is important for a nurse to be competent in order to be able to provide their patients with the NMC’s standard of care. In order for nurses to be deemed as competent, they must complete a nursing course, and undergo certain training.
A personal reflection from an incident the author has experienced since becoming a student nurse will also be included, and shall be linked to communication. The incident mentioned is the procedure of brushing an individual’s teeth during a skills for practice session at the university. The author will then voice how what they have learned from their reflection, will help them during future clinical practice and how their knowledge will be applied.
Personal reflection
Within the skills for practice module of my nursing course, we were given the opportunity to brush another colleague’s teeth, and have them brush our own. This was to be carried out as if the colleague was my patient in a healthcare setting. I found this activity to be quite anxiety provoking, stressful and altogether uncomfortable. I believe this was due to the fact that it was a very invasive procedure which I hadn’t carried out before, as well as the fact that I was unfamiliar with the colleague I was practising with. During the activity, I found myself worrying and overthinking things such as; ‘am I doing this right’ and ‘what if something goes wrong’ etc. This nocked my self-confidence and made me start to panic. Despite this, I tried my hardest to remain professional with my patient, and not let my insecurities have an effect on my performance. This was quite a personal achievement for me, because confidence is something I struggle with daily. If I was in this situation again, I would provide myself with reassurance by calmly going through the procedure step by step in my head to reassure myself that I am competent, and that I know what it is that I need to do. I would do this three times during the day of the procedure. Another one of my goals is to carry out some relaxation techniques before starting the procedure, to prevent me from panicking halfway through.
During this activity, communication was essential to build some form of trusting relationship with the patient, so that they felt as comfortable as possible with me in their personal space, and vice versa. Upon reflection, I think it would be helpful for me to look into the boundaries regarding conversing with my patient, as I am aware that it is unprofessional to delve into their personal life, but I am unsure exactly what the limitations are. I will achieve this by researching and taking notes on professional communication standards.
Communication is also important to gain informed consent and to reassure the patient and keep any distress to a minimum. Upon reflection, I recognise that I may not have communicated enough with the colleague as if they were my patient. Although I gained their consent and informed them of what I was going to do, I feel as though I could have done more to reassure them and make them feel more comfortable during the procedure. If I were to carry out the procedure again, I would try to explain it in more detail, and make sure that the ‘patient’ had no concerns and felt as comfortable as possible. I have set myself a goal to practice informing a patient of a procedure with one of my friends/family, three times a week. Despite this, I was satisfied with the fact that I ensured I gained the informed consent of my ‘patient’ before starting the procedure. If I didn’t communicate effectively enough and inform the patient thoroughly, the patient may have declined the procedure, as they didn’t feel they knew enough about it to go through with it, or because they were unaware of the pro’s and con’s. Alternatively, the patient could have agreed to the procedure, thinking it entailed something other than what it did. This could result in them feeling betrayed by the health staff. This would have had a large impact on their likelihood to agree to important procedures again, having an effect on their long term care. Before I started my nursing course, I didn’t realise just how important informed consent was. As this is gained through effective communication, this also shows the importance of communication within a health care setting.
During reflection, I recognise that I may have been further in the ‘patient’s personal space that what was necessary. This is because I could feel my self leaning into the patient while carrying out the procedure, as a method of channelling my concentration. The way my body language was communicated could have made my ‘patient’ feel uncomfortable as I was closer in their proximity than needed. They may have also started to question why I was closer to them than needed, which could have made them feel insecure in my care. Taking this into consideration, I realise that my body language was inappropriate, and to improve on this I have set myself a goal to look into, and practice other methods of channelling my concentration, and to work on obtaining an upright, professional posture. I will also take more consideration about the distance in which I am from my patient. Looking back, I also feel that my facial expressions could have caused the ‘patient’ concern or discomfort, as I involuntarily frown when I am concentrating. This could have been perceived as me being unhappy or confused with what I was doing, which could lead to the ‘patient’ believing that I am incompetent, or that I simply didn’t want to carry out the procedure. This is likely to give the patient a sense of insecurity, and they may start to doubt me as a professional, and my ability to carry out the procedure safely and effectively. Even though I lacked confidence, I still felt as if I was competent enough to carry out the procedure, and despite the frown, I was excited to be trying something new and was quite happy to be doing the procedure, but because of my facial expressions, I doubt that this was portrayed. Therefore, if I was to carry out this procedure again, I think it would be important for me to be more aware of my facial expressions in order to avoid the risk of giving mixed signals to my patient, and again if possible, find other methods of channelling my concentration. I have set myself a goal to practice having a more neutral facial expression when concentrating on something. I believe my reflection shows the importance of the non-verbal methods of communication. When it comes to communication, the main focus is on the verbal form, but body language and facial expressions can sometimes communicate across a lot more than what words do, especially if the situation restricts the verbal communication, which my experience did.
Looking back on the situation, I have taken into consideration that the environment could have had an impact on the outcome of the procedure. I realised that because there was around 15 of us in the room, the noise levels where fairly high. This may have prevented my ‘patient’ from relaxing, and it also created a communication barrier, as there were several occasions where we could not hear exactly what the other person had said. I feel like this made it harder for me to provide reassurance, as they could not always hear what I was saying. I felt like this was frustrating for both me and my patient. If I were to carry out this procedure again, I would suggest to my patient that we move to a quieter room to carry out the procedure. They can then decide if this is what they would like to do. My goal here is to effectively plan ahead and take all factors into consideration.
Before, and during the procedure, I was quite nervous due to the newness of the activity and the unfamiliarity to the colleague. Upon reflection, I see that this knocked my confidence, which may have caused me to be less professional as a result. Even though my nerves may have had an effect on my performance, a positive outcome is that I managed to carry out an activity that was out of my comfort zone. This was an achievement for me, as it is usually something I struggle with. Doing this activity has enabled me to broaden my academic learning style, and has made me realise that I am able to succeed if I put my mind to it. I think reflecting back on this experience will give me the confidence to complete further procedures that would otherwise make me feel anxious. I have set myself a goal to carry out a task each day that is out of my comfort zone, in order to boost my confidence and help me to control my nerves.
Overall, my reflection has taught me that communication is vital when carrying out any procedure involving another person. This is because in order for the procedure to run smoothly, the patient needs to have provided their informed consent, they need to be able to trust you, and they need to feel comfortable. In order for any of this to happen, you need to have communicated effectively with the patient. You need to have provided them with all the relevant information regarding the procedure. You need to have reassured the patient, and however much possible, you need to have built a trusting relationship. This should then lead to the patient feeling comfortable in your care, and comfortable going through with the procedure. My reflection has also taught me that verbal and non-verbal communication are just as important as each other, and they work hand in hand. Therefore, I now realise that you must communicate effectively via both forms, in order for them to both be effective. For example, if your verbal communication is good, but your body language and facial expressions are communicated poorly, the overall communication will still be poor.
As a result of my reflection, I have created myself some smart goals.
My first goal is to have completed two tasks which I deem to be out of my comfort zone each week, for the next upcoming month. I will record the task I have set out to do, and when I expect to have done it by. Once this recorded time has been and gone, I will reflect back, and note whether or not I completed the activity, and how I felt in doing so. I hope to achieve a confidence boost from this goal, with the expectation of improving my self-confidence during procedures I may have to complete for university/practice.
Another goal I have set, is to complete 3 role play scenarios a week, for two weeks. These scenarios will be regarding a health care procedure that I may have to complete. During the first week I will practice with my friends and family so I feel comfortable with what I need to do, then the next week, I will practice with people on my course that I am unfamiliar with. I aim to have improved on my communication skills and my ability to be able to effectively explain a procedure and gain informed consent by the end of this goal. I will record this goal by stating the procedure I will be explaining, and getting the individual that I am explaining it to, to give me feedback which I can reflect on.
My final goal is to explore some different relaxation techniques to find one that suits me, such as controlled breathing, and thinking positively. I will then use this technique before carrying out a task that is out of my comfort zone, or before completing a procedure. My expectation from this goal is to keep my anxiety at a minimum to avoid panicking and becoming distressed during a procedure. I will measure the effectiveness of this goal by keeping a diary of each procedure I do over the next two months, and whether or not each technique has helped me, in order to find one that works for me.
Importance of communication
There are many reasons why communicating effectively is important as a nurse. Communication is needed to gain informed consent from your patient for a variety of things, on a daily basis. If you try to gain consent without fully informing your patient first, they may agree to something in which they don’t understand or actually want. Alternatively, they may decline a procedure because they haven’t been fully informed on it. For example, they are unsure about the side effects. Andrew McDonald (2016) reports that 56% of patients that took part in a study stated that they were made aware of the side effects of the treatment provided, this suggesting that 44% were not. This is crucial as you should always have the patient’s best interests at heart, and the procedure offered could be live changing. It is also important to be conscious of the way in which you are communicating with your patients and remember not to confuse them with jargon. Andrew McDonald (2016) reported that another study carried out, found that only 68% of patients easily understood the doctors explanation of their condition, treatment or tests. Therefore the doctor must not have been communicating properly (may have been using jargon etc.) which is unacceptable. Relating to this, the royal college of Nursing (2016) states that ‘Misrepresentation of information will invalidate consent’. They also say that the nurses responsibility to inform the patient is as important as their responsibility to carry out diagnosis and treatment. If the consent is voided due to lack of communication, the health care facility will be facing legal action. Communicating with the patient can also be a primary way of gathering information about the patient’s symptoms. Although further tests may be needed, just asking the patient what is wrong with them can be a massive help, and can allow a diagnosis to be conducted quicker. Gap medics blog (2014) backs this statement up by saying that nurses who are good at communicating are more able to gather information about a patient, which results in quicker diagnoses and more effective treatment plans. This also applies to emergency situations and can help to determine the severity of the incident, by communicating with the patient you know that they are conscious and responsive. The quicker a diagnosis can be made, the better chance the patient has to receive treatment and recover so anything that can help to speed this process up is important. McCabe and Timmins (2006) cited in Pearson Education (2012), agrees with this statement as they believe that effective communication is essential in achieving higher recovery rates, providing patients with a sense of safety and protection, and improving satisfaction levels. With effective communication, patients are also more likely to stick to their treatment. A nurse’s role is to support, reassure, and comfort their patients as well as care for them, and without effective communication skills, this may not always happen. This is because in order to do this, more than just verbal communication is needed. Many types of non-verbal communication play vital roles too. Such the nurses body language and their facial expressions. It is also the nurse’s responsibility to provide their patients family and friends with support and reassurance. McCabe and Timmins (2006) cited in Pearson Education (2012) agrees, saying that effective communication reassures the patients relatives that their loved ones are being cared for and treated appropriately. They say that these skills are considered to indicate good practice. It is very important as a healthcare member of staff to communicate between your colleagues, to ensure that none of the patient’s care needs/requirements are missed out, resulting in them not being met. For example, the night staff must communicate with the day staff to find out if there has been any changes to the patients’ health or their routine during the day. One reason why documenting all the things you do for the patients in your care is so important, is so it can be used as a method of communicating with your other colleagues. If information is needed about your patient, they can refer to this documentation. According to the parliamentary and health service ombudsman (2011) Ineffective communication is one of the two most frequent complaints received from patients and their carers. This concludes that communication is very important within a healthcare setting.
Importance of competence
It is very important for a nurse to be competent at what they do, to ensure that the care they provide is safe, and effective for each patient. There is a certain set of skills a person must obtain in order to become a nurse. Such as; communication skills, or the ability to be patient. Also, before a nurse is classed as fully competent, there is certain training they must undertake. For example, before a nurse is able to move a patient, they must complete moving and handling training. There is a theory and practical side to this. This is to ensure that the nurse does not injure themselves, or their patient by trying to pick them up, or move them incorrectly. It also informs the nurse on when it is unacceptable to move a patient. For instance, if the patient had a spinal injury. This training provides a basic level of competence that all nurses require. Pam Dickerson and Kathy Chappell (2016) agree that educational programs are needed to ensure that nurses have the necessary knowledge, skills, and abilities to provide a NMC level of care. A health care setting would be promoting bad practice if they didn’t put their hired nurses through specific training to boost their competence. The Nursing & Midwifery Council (N/A) sets out guidelines which nurses should meet to remain on the nursing register. The NMC have stated four main areas in which they believe nurses should be competent. These being; professional values, communication and interpersonal skills, nursing practice and decision making, and leadership, management, and team working. Within these areas, there are two aspects. The first is the competencies that all nurses across all fields must know and demonstrate. The second is the specific competencies of each field that an individual nurse is registered in. In order to be legally registered as a nurse, the individual must be fully competent, and follow these rules. This suggests that if an individual is not deemed to be fully competent, they will not be allowed to become a nurse, which shows how important it is to be competent as a nurse.
When caring for a patient, in order to safely administer their medication and reduce the risks of making a medical error, a nurse must follow the 5 rights. The nurses neighborhood (2008-2016) says that in order to keep your patient safe, and prevent them from harm, nurses must follow the rights of medication administration. These rights are; right person, right time, right dose, right drug and right route. If they are not competent in doing this, the individual receiving the medication could end up severely poorly. This has been agreed by Pam Dickerson and Kathy Chappell (2016) who believe that competence can ensure that the care provided is safe, high-standard and based upon evidence.
Reference List
Parliamentary and health service ombudsman (2011) Listening and Learning: The ombudsman’s Review of complaint handling by the NHS in England 2010-2011. London: The stationary office.
Gap medics blog (2014) Importance of communication in nursing Available @ http://uk.gapmedics.com/blog/2014/09/03/importance-of-communication-in-nursing/ [01/12/16]
Pearson Education (2012) Effective Communication Skills for the ‘Caring’ Nurse Available @http://www.pearsonlongman.com/tertiaryplace/pdf/ros_wright_effective_comm_skills_for_the_caring_nurse_aug2012.pdf [01/12/16]
The royal college of Nursing (2016) consent Available @ https://www.rcn.org.uk/get-help/rcn-advice/consent#Consent must be ‘informed’ [01/12/16]
Andrew McDonald (2016) Improving communication with patients in the NHS Available @https://www.mariecurie.org.uk/globalassets/media/documents/policy/campaigns/the-long-and-winding-road.pdf [04/12/16]
Nursing & Midwifery Council (N/A) standards for competence for registered nurses Available @ https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-competence-for-registered-nurses.pdf [08/12/16]
Pam Dickerson and Kathy Chappell (2016) Principles of Evaluating Nursing competence Available @ https://www.td.org/Publications/Magazines/TD/TD-Archive/2016/02/Principles-of-Evaluating-Nursing-Competence [08/12/16]
The nurse neighborhood (2008-2016) The 5 rights of medication administration Available @ http://www.nurses-neighborhood.com/5-rights.html [08/12/16]