CLINICAL REFLECTIVE PROJECT

Answer

Developing Nursing Practice through Reflection Based on a Medical Ward

Introduction  

This paper offers reflection on a medical ward setting based on the Gibbs’ reflection cycle developed in 1988. Gibbs’ reflection steps including description, feelings, values and beliefs, analysis, conclusions, and action plan are used in this reflective essay. 

Description

            This reflection is based on a case in which a 78-year-old Vietnamese immigrant male, who arrived recently to Australia, was brought to the medical ward for urgent medical attention. His past medical history could not be developed since he did not bring medical records or documents with him. The main challenge was that he only spoke Vietnamese and lacked English language proficiency. No one among the healthcare staff could speak Vietnamese language to help interpret what the client was saying in Vietnamese. On the overview, the patient appeared to be experiencing breathing difficulties and chest pain but these could have been confirmed since it was based on subjective perception of the patient condition.

Feelings

            Standard 1.2 of the Nursing and Midwifery Board of Australia (NMBA) (2016) states that a Registered Nurse (RN) should develop practice via reflection on knowledge, experiences, beliefs, feelings, and actions to identify how these shape practice. There were concerns that urgent healthcare needs of the patient could not have been met since his medical history and chief complaint were not known due to language differences. I felt that it was difficult to deliver person-centred, appropriate, high-quality and safe care to the patient due to the issue of language barrier.

Values and Beliefs

            I am a strong advocate of delivery of person-centred care. In addition, I believe that each and every patient has the right to high-quality, safe, and appropriate care, but in this case, language barrier emerged as the main challenge to delivery of appropriate care. It was difficult for healthcare professionals to engage the patient in a professional and therapeutic relationship as required by Standard 2 of the NMBA (2016), owing to the patient’s lack of English proficiency and lack of Vietnamese language knowledge among the nursing staff members. In addition, Standard 4 of the NMBA (2016) affirms that a RN should conduct assessments in a comprehensive manner was not possible since communicating with the patient was made complicated by a language barrier problem.

Analysis

            In this situation I participated in making suggestions and decisions on how to address the challenge at hand. The main suggestion was the involvement of the patient’s son, who was in the waiting room at the time, as an unofficial language interpreter to help the healthcare team understand patient’s healthcare issues. The son had a fairly good knowledge of English language, and was also competent in Vietnamese. He gave useful information that helped the healthcare staff to develop a care plan for the patient. Through the son, we learnt that the patient has been smoking for more the 45 years and was a known chronic obstructive pulmonary disease patient.

Conclusions

            Standard 6 of the NBMA (2016) requires RNs to provide appropriate, responsive, save, and quality nursing practice. In this case, involvement of an unofficial language interpreter was part of facilitating delivery of safe, responsive, appropriate, and quality care for the patient. The case showed that with increased international migration of people language barriers in care will continue to become a key healthcare challenge (Jaeger et al., 2019). It highlights the need for professional language interpreters to help meet the healthcare needs of immigrant communities (Jaeger et al., 2019).

Action Plan

            The case informed the healthcare staff on the importance of having language interpreters to address language barrier issues. The hospital administration was informed of the same through case reports. According to Jaeger et al. (2019) communication is considered as central to patient-healthcare provider encounter. In cases where language barrier is an issue, such as in this case, language interpreters can enable healthcare staff to take adequate patient histories so as to guide examinations, diagnoses, explain treatment and prevention measures to the patient, and evaluate outcomes (Jaeger et al., 2019).