Description

The incident I will be reflecting on occurred whilst I was placed on the oncology ward during my
first year of qualified nursing. We had an elderly service user on the ward, who had been
admitted due to stomach cancer. Upon his arrival, we read his notes which highlighted that he
had significant learning difficulties, meaning that he also had problems with verbal
communication. The main areas of reflection are how both myself and the other nurses used
communication to calm the patient and show compassion, as well as how we adapted our care
to address their individual needs. A nurse came onto the ward with three members of the public,
who were viewing the ward as part of a job advertising process. When the nurse entered the
patients bay, she informed the members of the public that the service users in that bay were
currently receiving radiotherapy treatment. Upon hearing the nurse’s words, the service user
became overtly distressed and began crying, shrieking and hitting his head backwards against
his pillow –it took time; however, another nurse managed to calm him down by talking in a
soothing manner.

Feelings

Prior to the incident occurring, I was mindful that the nurse was showing the three members of
the public around the oncology ward, as part of a job advertising process. At the time of the
incident, I had only been working on the oncology ward for six months so still felt slightly
unsure of my position within the team. Ultimately, I did not feel confident or experienced
enough to deal with this situation independently. I think that my increased level of anxiety
meant that I struggled to intervene, however it is still clear that both my colleagues and myself
should have intervened more quickly to ensure that the patient was dealt with effectively.
Moreover, I was very surprised when the nurse failed to take into consideration the individual
needs of the service user during the visit of the ward, as the distress caused to both the service
user and the members of the public was very unnecessary.

Evaluation

In hindsight, the experience had both good and bad elements which have led to an increased
understanding of the service user experience and my role as a nurse practitioner within the
oncology team. My role was to give physical examinations and evaluate the service user’s health,
prescribe and administer medication, recommend diagnostic and laboratory tests/read the
results, manage treatment side effects, and provide support to patients – this includes acting in
their best interests. I feel that I did not fulfil the latter responsibility completely. This duty to
protect service user’s full confidentiality and ensuring that the nurse who was showing the
members of the public around the ward was aware of the service user’s communication
difficulties and resulting anxiety was not fulfilled. Our failure to act as a team, by sharing
information and stepping in before a situation escalated, shows that there was a low level of
group cohesiveness (Rutkowski, Gruder and Romer, 1983).
Analysis

According to the Nursing Times Clinical (2004), people with learning difficulties often have a
struggle with adapting to new situations, which means that there is a potential for problematic
behaviour when dealing with something outside of their comfort zone. Nevertheless, as
suggested by the Nursing Times Clinical (2004), healthcare staff should be aware of how to
effectively interact with people who have a learning disability and this can be aided through
regular and valuable reflection. Prior to admission into the hospital, it is advised that
professionals find out about the patient's communication and their likes and dislikes; address
any potential fears either through discussion or by allowing the patient to visit the ward to meet
the nursing staff (Nursing Times Clinical, 2004). Moreover, the day to day communication
towards patients with learning difficulties should involve patient-centred/holistic care in
addressing patient needs, which incorporates both verbal and non-verbal forms of
communication. Therefore, professionals should make eye contact, look and listen, allocate
more time for the patient, be interactive and communicative, remain patient and in some cases,
enable any professionals who may have had experience with people with a learning difficulty to
care for the patient (Nursing Times Clinical, 2004).

MENCAP states that one of the most common problems when accessing healthcare for people
with learning disabilities is poor communication (n.d). This can be aided by offering the service
user an advocate to communicate on their behalf and by providing information in a variety of
ways including visual. They further this with the notion that healthcare professionals should
equally value all people, adapt their service so that it meets different needs and understand that
each individual will have different needs (MENCAP, n.d). The Nursing and Midwifery Council
(NMC) (2015) further this in 'The Code', which states that all registered nurses and midwives
must abide by the professional standards which are to: prioritise people, practise effectively,
preserve safety and promote professionalism and trust. Therefore, the incident whereby another
nurse did not take into consideration the individual needs of the patient does not abide by the
professional code of conduct; ultimately, they did not recognise when the patient was anxious or
in distress and respond compassionately, paying attention to promoting the wellbeing of the
service user and making use of a range of verbal and non-verbal communication methods
(NMC, 2015). Compassion is one of the '6cs' introduced in 2012 - which are the values and
behaviours that are viewed as the quality markers of a health and care service - these being:
care, compassion, competence, communication, courage and commitment (Department of
Health, 2012). The 6Cs carry equal weight and should be a part of all service delivery - ensuring
that patients are always placed at the heart of the provision (DoH, 2012).

Conclusion

From this experience, I am now more mindful of the importance of being assertive and exert
professionalism in practice (and not feel as though I cannot do something because of my
position within the team or length of experience) if similar situations were to arise in the future.
The insight I have gained from this experience means that I am now more aware of the
implications of not acting immediately and the importance of acting in the best interests of the
patient, even when this may take courage. Strong working relationships between healthcare
professionals should also be given a greater emphasis within the oncology ward, so to increase
levels of group cohesiveness (Rutkowski, Gruder and Romer, 1983).

Action Plan

In the future, I aim to be more proactive in dealing with a situation face on regardless of my role
within the team or level of experience; this includes dealing with a stressed service user,
ensuring that information is passed on to the relevant staff and intervening when I believe that
is a risk to a service user’s health or mental wellbeing. Moreover, I will address the needs and
alter how I approach a patient with learning difficulties in the future by ensuring that I use the
different methods of communication and undertake some independent research on their
specific needs; the information of which I can use in my nursing practice.

I will not assume that other members of staff will always be aware or mindful of the individual
needs and/or triggers of a service user, and I will not presume that other members of staff will
always act in a wholly professional way. I will continue to undertake regular professional
reflective practice, using the on-going model proposed by Gibbs (1988). I also aim to
consistently and confidently implement the principles and values as set out by the National
League for Nursing, relating to the individual needs of service users, these being:

 To respect the dignity and moral wholeness of every person without conditions or
limitation.
 To affirm the uniqueness of and differences among people, their ideas, values and
ethnicities. (National League for Nursing, 2017, n.d).

These are furthered by the National Health Service (NHS), which was created out of the ideal
that quality healthcare should be available to all and should meet the individual needs of
everyone.

Reference List

Boud, D., Keogh, R. and Walker, D. (1985) Promoting reflection in learning: a model. In D. Boud,
R. Keogh and D. Walker (eds.) Reflection: turning experience into learning. London: Kogan Page.

Department of Health (DoH). (2012) Compassion in Practice. London: Department of Health.

Gibbs G (1988) Learning by Doing: A guide to teaching and learning methods. Further Education
Unit. Oxford Polytechnic: Oxford.

Jasper, M. (2013) Beginning Reflective Practice. 2nd edition. Andover: Cengage.

Kolb, D. (1984). Experiential learning: experience as the source of learning and development.
New Jersey: Prentice Hall.
MENCAP. (n.d) Communicating with people with a learning disability. Online. Available
at: https://www.mencap.org.uk/sites/default/files/2016-
12/Communicating%20with%20people_updated%20(1).pdf

National Health Service (NHS). (2015) Principles and values that guide the NHS. Online. Available
at: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx

National League for Nursing. (2017) Core Values. Online. Available

Nursing and Midwifery Council (NMC). (2015) The Code. London: Nursing and Midwifery
Council.

Nursing Times Clinical. (2004) Managing the needs of people who have a learning disability,
Nursing Times 100 (10) pp. 28-29.

Oxford Brookes University. (2017) Reflective writing: About Gibbs reflective cycle. Online.
Available at: https://www.brookes.ac.uk/students/upgrade/study-skills/reflective-writing-gibbs/

Rutkowski, G. K., Gruder, C. L., & Romer, D. (1983). Group cohesiveness, social norms, and
bystander intervention, Journal of Personality and Social Psychology, 44(3), pp.545-552.

Zeichner, K. and Liston, D. (1996) Reflective Teaching: an introduction. New Jersey: Lawrence
Erlbaum