SNPG902 Identifying Reflective Journal and Understand Major and Minor Themes Assessment 2 Answer

Executive Summary 

The purpose of the assignment is to focus on the major and the minor themes while practicing in the given set up. As a nursing student who is working in aged care the main challenge is how to communicate with the medical team and coordinate with the patients, to guide them. The communication barrier is the major theme as communication is being used regularly in the workforce while the minor problem is the conflict cause, the problem in the two way communication, and how to handle it swiftly.

Introduction

Through the assignment, the main purpose is to identify the reflective journal and understand the major and minor themes. As a nurse, I have experienced communication is a key through which we can better handle experience at work (Odberg 2020).  Due to the constant conflict in communication, I often feel angry and anxious which causes mismanagement in the daily work schedule and in productivity. But from a personal point of view, the problem can be faced is of how to present one own viewpoint and manage the conflict through the effective communication. Through effective communication the nurse can help to manage and coordinate with the patients, multi-disciplinary team and other nurses in an effective manner.  The challenge of communication is faced in the three weeks of the individual weekly entries which were noted down and subsequently analyzed in the individual weekly entries, presented in the form of diary for further analysis, which would be helpful to draw personal insights from the incidents (McCord, 2020).

JOURNAL ENTRIES

As a registered nurse the problem in the aged care nursing home, is managing the non-English speaking elderly patients and working with the team members. As I am in charge of the team of six members to provide appropriate care to the patients, the conflicts faced is the lack of coordination to manage the elder patients and facing language barriers. The team members were unable to understand the direction, guidance, failed to follow the guidelines, and even failed to follow the procedure. The elderly patient who was residing within the closed vicinity was facing the trouble to communicate due to the non-English background and was unable to detail the problems to the fellow nurses.

The use of Rolfe's model of reflection would be focused on the three elements "what', 'so what' and 'now what'. At the initial stages of the practice, as a nurse, the major hold of the issues and the experience would be described. In the second phase, the focus would be on the theory, knowledge, and on the practitioner opportunity which can be shared adequately with the learner’s opportunity along with the experience, while having effective communication. In the last phase, being a practitioner, the focus would be on the actions, identification of the routes, and improved ways of having effective communication and overcoming the situation 

16^th April 2019: The elderly aged 63, from China, was in the vicinity, which was not fluent in English, but can speak Chinese fluently. It became difficult for me and for the other team members to understand what he is trying to explain. The problem was of lack of communication, barrier faced as the major challenge and to proactively resolve it.

Moreover, once there was a conflict that happened in between the elderly patient and the nurse when the elderly patient became stubborn of not having the medicine and the nurse was unable to understand what the problems which the patient is facing and how to control the situation. This further lead to the conflict in between the senior nurse and the junior nurse, as the senior nurse intervened and shouted at the junior nurse to stand near by to see vital points. Due to this, the duty of the patient care came to me and I have to personally intervene due to my nonreactive behavior and listening power while communicating rightfully.

 25 April 2019: During the third week, another major conflict happened between the nurse’s management and the patient family, who complained of food quality. Even after intervening and showing all the adequate plans, as the family also spoke fluent Chinese, were unable to understand the plans. Soon the senior nurse, translator and me, intervened and listened to the family patiently, heard their plans in their Chinese language, and noted down the points. It was about the food diet, as he was Chinese he wanted to have Chinese food rather than opting for Western food which was bland. As per the nursing direction, we should not get attached to the patient and their family while providing the proper adequate care plan, as while getting attached, it would lead non-abidance by the treatment plans. With this, the patient was given a special diet plan and omitted the lactose intolerant food and other food products as the substitutes.  .

1^st May 2019:  Further, the patient who was ill handled started to scream, while the junior nurse became nervous and petrified. The further problem was how to calm the patient in his original Chinese language, as communication was a barrier. During this time, we held patient hands and placed hand on the forehead to assure him proper care while saying in English.  The translator translated the conversation. Subsequently, the patient became in control and the junior nurse in duty was told to check for the patient main vital points and the time table, before disturbing him. At first, the junior nurse became un-keen to hear, and then the nurse was reminded of her duties and how she should be best placed in the interest of the team to work compassionately and collaboratively with the team while taking care of the patient. Here the team communication and therapeutic communication was used to overcome the problem.

REFLECTIVE ANALYSIS OF JOURNAL

I have conducted a reflective analysis of the situation in three weeks and included the major and the minor themes which can be linked with the analysis and include the theoretical evidence.

Week 1: In the first week, as the patient and the nurses collaborate to work in the multi-cultural work environment. The problem of the multi-cultural team working is to understand how patients from different backgrounds and nurses from the diverse background are placed together to work in a common platform to overcome the communication barrier issue. The problem can be irritating, frustrating as there is a lack of communication, in the coordination, understanding each other problems, and how to step up to overcome such problems. The Chinese patient can speak native language; can become overall challenging experience in how to provide therapeutic care and proper support. 

Week 2: During the second week, the major problem which was observed was coordination and collaboration, which can be done with effective communication. As we spend time with the patient, we become emotional, but I felt lost, angry, and frustrated when I was unable to provide adequate care to the patient even after spending so much time interacting. In the end, the patient family helped to understand the patient's allergic reaction, and then we handled the situation compassionately and with the effective care to handle the negative energies. With the translator intervention, it helped in the two way communication plan. Further, the problem when working  with the patient and with the translator, helped us to know about the allergic reactions which he was facing while getting treated, as he became lactose intolerant and even have to be given the specific diet plans to overcome the allergic reactions. All the problems were resolved with the intervention of the translator and discussing with the patient family patiently

Week 3: In the last week, the problem of the conflict was solved direct intervention and understanding the situation. The patient conflict with the nurse and the nurse’s in-between clash was handled with care, patience, calmness, and perseverance. The importance of remaining positive helped to handle the situation.

LITERATURE REVIEW

The literary theories while understanding communication importance in the elderly patient aged care unit and how to improve consistently can help to handle the situation. Madhuvu (2020) has explained in the lack of communication can lead to mismanagement that can cause a lack of coordination. Communication is a vital part of the nurse’s role and the theories emphasize using therapeutic communication which is a particular part of the nursing and the major problem faced is communication and the minor theme which is faced is of the conflicts, anger, and the miscommunication (McChord, 2020). Odberg,  (2020) The problem for the nurse is to have smooth conflict-free communication and to have therapeutic communication can help to resolve the problem of presence, listening, and to have a better perception, caring and the disclosure, acceptance, empathy, activities. Further, through the use of effective communication, it is important to facilitate the development of a therapeutic relationship which can help to overcome the barriers between clients and colleagues. As per the Havery et al, (2019), management theories are interpreted through the classical management theory, along with the behavioral management theory and even examined as per the modern management theory. Hector (2019) has mentioned how the classical management theory is identified with the task execution and output maximum production that would-be employees. Depending on the behavioral management theory the understanding of the social environment can be identified in terms of the human elements (Hunter, et al, 2019). Holme et al (2020) has identified the modern management utilized that can be interpreted in the scientific methods along with the systems thinking. To further Dexter et al   (2020) and examine the three types of management theories that can be based on the requirements along with the incidents. Behavioral management theory during week 1 and week 2 can be interpreted through multi-cultural ethics and how there can be a better new work environment. Modern management theory to further understand how there can be week 3 that can further examine new changes that can further be avoided in terms of future situations and conflicts.

Holme (2020) through effective communication, it helps to foster the relationship between the nurse and the patient. Dexter (2020) to foster communicator can help to information nurses to adopt a planned, holistic approach through which it can help the therapeutic relationship. Lee (2020) has mentioned one of the instances, the problem of the communication can cause conflict in the nurse and the patient. In my view the problem faced by the nurse, was the direct flow of the information which was exchanged which can help to nurse to adopt a free planned, holistic approach and it would help to develop the therapeutic relationship.

Hunter et al  (2020) mentioned as Maslow’s hierarchy theory, it was essential to motivate the patient during the second week and also provide guidance while understanding and collaborating to bring the best care. Lucchini (2020) has updated the theory helps to understand what can be the needs and the outcomes at the bottom level and what can be the motivational force while taking care of the patient sensitively to achieve the one common goal.

SUGGESTIONS

As per the evaluation of the three weeks reflection, it is important to understand the cross-cultural communication. As a suggestion, it is important to have a bilingual language, vicinity translator and to use signs language when it is required to communicate. The nonverbal communication such as facial expressions, face, and even the body behavior can be understood, where the patients have a non-English background to provide care, and even understand his challenges were difficult points for me. During the treatment, we tried to interact with each other, sits beside him, and even noted down the pain areas to develop the treatment plan. The problem also lies in the lack of communication between the nurses, as there was a lack of coordination, miscommunication, low training and non-abidance, and the protocols. In my opinion, in such a situation while taking care of the non-cultural patient the bilingual nurses and the translator should be hired, who can take care of the situation regularly. During my first day, understanding the short terms, following instructions and cross-cultural communication has been a major problem for me. With the patients, to provide therapeutic care, one needs to have effective communication, which can be followed and understood by the patients.  It’s not a challenge for me only but for the other team members who are trying to coordinate and work with the other team members to overcome the communication with the elderly patients. These are the required steps that have to be associated with the practice while engaging in effective commination. The purpose of the reflection model is to overcome the self-awareness problem and how it would help to develop a better relationship by understanding the concrete steps to improve communication, foster a bond and even attain communication during the state of personal and professional growth Hector (2019).  

Conclusion

To conclude, communication can be challenging in any scenario, specifically in the aged care set up where the patients has to be handled with the proper manner and with an engaging communication. Communication can be a barricade and at the same time through an effective communication, the patient and the nurse can build bond. Through the proper communication such as listening and the two way communication, it would help to foster a good care and can help to bond with the people within the vicinity.