This assignment will reflect on and critically research an incident from a clinical setting whilst using a style of reflection. This allows me to analyse and seem sensible of the incident and pull conclusions relating to personal learning outcomes. The incident will be referred to and analysed, accompanied by the process of reflection applying Driscoll’s Reflective Model (2000) as it facilitates critical thinking and in-depth reflection which will help me to build up learning objectives for future years. To adhere to the Nursing and Midwifery Council (NMC) (2015) Code of Carry out, confidentiality will be taken care of therefore the specific will be regarded throughout as Ben.

Reflection is thought as a process of explaining and expressing from our very own experiences and helps to develop and increase our skills and expertise towards becoming professional practitioners (Jasper, 2003). I’ve chosen to utilize the Driscoll’s Reflective Model (2000) as a guidance since it is straightforward and encourages a apparent description of the problem which will let me look at the knowledge and distinguish how it made me feel, asking that which was good and bad, and what I can uncover (Sellman and Snelling 2010). Wolverson (2000) features this as a significant process for all nurses desperate to improve their practice.


Ben was born prematurely following an emergency caesarean section, whereby he received prolonged resuscitation and experienced serious hypoxic-ischaemic encephalopathy (HIE). Relating to Boxwell (2010), infants with severe encephalopathy have a 75% threat of dying with coma persisting, or progressing to mind death by 72 time of life. There was a realisation that continuing treatment could be causing Ben harm for the reason that it was unlikely to restore his health or ease suffering. Boxwell (2010) further claims that survivors of HIE carry an almost certain risk of poor neurological outcome. It really is this period when consideration should be directed at withholding and/or withdrawing treatment, subsequently re-orientating treatment to compassionate attention. I was educated by my mentor that there would be a multi-disciplinary doxycycline cheapest price team (MDT) meeting to discuss and justify your choice to withdraw treatment.

I was invited into the MDT assembly by my mentor to both witness and actively participate in the discussion if I felt confident enough. The MDT contains two paediatricians, a paediatric registrar, the neonatal sister, and myself, a paediatric college student nurse.A� The Royal College of Paediatrics and Kid Health (RCPCH) (2004)A� recommend that members of the health care team need to feel area of the decision-making process for the reason that their views should be listened to. At the time, I was hesitant to contribute due order microzide hydrochlorothiazide online to my know-how, understanding and experience surrounding the clinical and ethical matter. Nevertheless, I was reassured that greater openness between disciplines will facilitate better understanding of individual roles and enhance the impression of responsibility (RCPCH, 2004).

We considered what was legally permitted and expected, but also at that which was ethically ideal. In considering quality of life (QOL)A� determinations, it was important to refer back again to the ethical foundation associated with surrogate decision building, which may be the standard of best curiosity. Some experts argued that Ben got no prior QOL on which to bottom a judgment. THE KIDS Act (1989) provides an overall statutory framework for the provision of children’s welfare and offerings but makes no specific provision regarding withholding or withdrawing treatment (RCPCH, 2004). It does however state that the welfare of the kid is paramount which is further supported by The United Nations Convention on the Rights of the kid (1989). Document 3 under this legislation states that actions affecting children will need to have their ‘best pursuits’ as a primary account (RCPCH, 2004).

The NMC (2015) framework governs the protection of criteria of practice and professional carry out in the pursuits of individuals, acting as a guide to ethical practice within nursing. The principle of non-maleficence is probably the hallmark ideas of ethics in health care which prohibits healthcare pros from doing any actions that may result harm to the individual. Also paramount, is the goal to restore health and relieve suffering, promoting very good or beneficence. In Buy the theory of beneficence, nurses will be obliged to protect, prevent harm and maintain the best interest for patients (Beauchamp & Childress, 2001). Those involved would have to be conA?A�A?dent in their ability to appreciate the ethical dilemmas they confronted, and had to ensure they were alert to the underlying ethical rules to aid their contribution to the debate.

The decision to withdraw life sustaining treatment should be made out of the parents based on knowledge and trust, but ultimately, the clinical crew carries the duty for decision making, as a manifestation of their moral and legal responsibilities as health care professionals. It is not uncommon for father and mother to look indecisiveness, shame or guilt about the decision to palliate their neonate, particularly if the results of the neonate’s condition is usually uncertain (Reid et al, 2011). However, the ultimate decision to withdraw intensive treatment was made out of the consent from both father and mother, and this was clearly recorded in his medical notes, as well as a written consideration of the Buy procedure and factors leading to the decision.

So What?

Parents impending the loss of their infant encounter a complex emotional a reaction to their situation, typically among anticipatory grief, shock and misunderstandings (Gardner and Dickey, 2011). They could also experience Purchase feelings of profound loss, related not merely to the imminent loss of the youngster but also to a lack of their goals, aspirations and position as father and mother (Gardner and Dickey, 2011). Parents are fundamental in the decision-making procedures around neonatal palliation and since it is they who will be the most significantly influenced by these decisions (Branchett and Stretton, 2012), neonatal EOL care places a specific focus on caring for parents. Developing a adaptable, transparent and family-centred good care plan is essential, and in order that their choices are met, father and mother should take a key role in this technique (Williamson et al, 2008). Spence (2011) recommends a holistic approach is taken to clarify the family’s wants, desires and needs in order to efficiently advocate for infants.

Whilst most parents desire to be involved in decisions and preparing around EOL care for their baby, some may find this responsibility overwhelming (Williams et al, 2008). Despite this, we exposed the father and mother to a range of options which they synthesised in order to make the best decisions for his or her family. However, it had been important for the neonatal nurse and I to realise that extremely emotive situations could cause significant deficits in parents’ ability to comprehend and practice such information (Williams et al, 2008). As competent nurses, it is our responsibility to supply nursing treatment that advocates for our clients’ rights in life and death, showing value and dignity towards them and the relatives. We advocated for Ben by protecting his rights, being mindful of his needs, ensuring comfort and ease and safeguard, and by participating in the ethical discussion to ensure a collaborative perspective of ethical negotiation (Spence, 2011).

The National Association of Neonatal Nurses (2015) suggests that palliative care will include comfort measures, such as for example kangaroo care, an ongoing assessment of soreness using an appropriate pain assessment instrument and written care ideas to control discomfort, pain and other distressing symptoms such as seizures using the least invasive effective way of administration. As the parent’s wanted to be there at time of loss of life, the neonatal nurse ready the relatives for what they would observe as life-sustaining treatment was discontinued. This included informing them of gasping and different noises, colour improvements, and cheap website to order periactin stating that Ben may continue to breathe and also have a heart rate for minutes or hours. This is an fundamental aspect of palliative care, and the family members with the possibility to ask questions. However, a study conducted by Ahern (2013) stated that nurses generally express anxieties surrounding how to support parental grief and how exactly to put together them for the imminent death of their infant. Parental preferences were as well assessed, incorporating whom they hope present, whether they

want to hold the infant, and whether they wished to take part in any rituals or memory-making activities.

Although my mentor required the lead purpose in planning the infant’s EOL care, my contribution centered on memory-making activities. Although this is normally nurse initiated, making recollections is increasingly recognised as an assist in parental coping and grieving (Schott, Henley and Kohner, 2007). Even so, McGuinness, Coughlan and Power (2014) reported that instead of physical keepsakes, father and mother and families rather appreciated other activities and gestures that demonstrated respect for his or her needs, including having period alone with the infant and being motivated and supported to provide care with their baby. I asked the father and mother if they would like photos to be taken, and even though parent’s declined photography, I offered to take some to keep in the medical records in case they decided they might like them at a later date which they appreciated (Mancini et al, 2014).A� Not surprisingly, the parents were acceptant of the offer to keep items that were linked to Ben’s care, including his wristband, blankets and hat.

Throughout preparing Ben’s EOL care, the effectiveness of the therapeutic relationship in achieving the family’s needs was achieved by showing empathy, and by doing so I obtained the individuals trust, and respect. Carl Rogers (1961) has influenced the change from a process- to a person-centred and holistic watch of nursing good care, with the adoption of Rogers’ ‘core conditions’ (Bach and Grant, 2005). Rogers recognized unconditional positive regard, genuineness and empathy as required conditions for helping someone change effectively through an excellent therapeutic romance. This wasA� attained through both proficient nursing know-how and utilising interpersonal connection expertise. According to Jones (2007), there is little exploration in nursing literature that discusses interpersonal expertise, particularly in nursing education. There is also a critique that nursing education is often removed from the realities that students experience during their medical practice (Bach and Grant, 2005). I felt self-confident and guaranteed that my interpersonal expertise would bring positivity throughout a very difficult time, supporting them Pills through the grieving method. I acknowledged that both parent’s appreciated my forward-thinking and empathy towards the existing situation. Being empathetic in this situation required my capability to be understanding not only of the parent’s beliefs, values and ideas but also the significance that their situation got for them and their connected feelings (Greenberg, 2007).

Egan (2010) identiA?A�A?es certain non-verbal expertise summarised in the acronym SOLER that can help the nurse to produce the therapeutic space. I did this by resting facing the relatives squarely, at a slight angle; adopting an open Buy up posture; leaning slightly frontward; maintaining good eye call, without staring and presenting a calm open posture. To enhance the communication through these abilities, I used active-listening skills to ensure a successful interaction through methods that facilitated the conversation. I did this by using noises of encouragement, demonstrating that I was hearing and assimilating the info provided by the parents. This was also done by summarising, paraphrasing and reflecting on the thoughts and statements. Effective make use of reA?A�a�sective skills can help exploration, build trust, and communicate acceptance and understanding to the average person (Balzer-Riley, 2004). Geldard and Geldard (2005) state that it is often the paralinguistic factors of speech rather than what is essentially said that betray authentic feelings and emotions.

Now What?

As EOL approached, Ben was extubated on the neonatal unit and used in the bereavement suite whereby my mentor continued to supply one-to-one care.A� I had not been present throughout the final palliative care stage as I wanted to respect the family’s privacy. At this stage, I held emotions of helplessness, sadness and anxiety, therefore I took a while to reflect on what had happened. It’s important that nurses recognise and confront their own feelings toward death to ensure that they are able to assist patients and families in EOL concerns (Dickinson, 2007).

Nurses often encounter sadness and grief when working with the deaths of people, and without any support, can suffer distress (Hanna and Romana, 2007). Debriefing is a beneficial intervention made to help nurses to explore and process their experiences. Irving and Long (2001) advise that debriefing demonstrates a significant reduction in stress and greater use of coping strategies through conversation in a reminiscent vogue to let their thoughts out. Through reflection, I have come to the realisation and knowing that patient death can be an integral portion of nursing practice in palliative attention settings. I’ve recognised that support from all participants of the MDT have got positive implications for nursing learners coping with stressors connected with patient death.

Furthermore, the experience helped me learn the importance of both verbal and non-verbal communication. As an aspiring nurse, I must continuously improve my communication abilities because I will be interacting with more varied patients down the road. I have been able to utilise my understanding of ethical principles with regards to withdrawing treatment, thus integrating theory into practice.


To conclude, the care and attention that patients receive gets the direct potential to boost through reflective practice. Becoming a reflective practitioner will help me to focus upon understanding, skill and behaviours that I should testmyprep develop for effective medical practice. Reflection helps to make sense of complicated and tough situations, a medium to learn from experiences and therefore improve performance and patient care.

Reference List

Ahern, K. (2013) What neonatal intensive treatment nurses need to know about neonatal palliative care and attention. Advanced Journal of Neonatal Care. 13(2), pp. 108-14

Bach, S. and Grant, A. (2005) Communication and Interpersonal Expertise for Nurses. Exeter: Learning Matters

Balzer-Riley, J. (2004) Communication in Nursing. Mosby, MO: Mosby/Elsevier.

Boxwell, G. (2010) Neonatal Intensive Care Nursing. 2nd Edition. New York: Routledge

Branchett, K. and Stretton, J. (2012), ‘Neonatal palliative and end of life care: What father and mother want from pros’, Journal of Neonatal Nursing. 18(2), pp. 40-44.

Dickenson, G. E. (2007). End of existence and palliative care problems in medical and nursing universities. Death Studies, 31, pp. 713-726.

Driscoll, J. (2000) Practising Clinical Supervision. London: Balliere Tindall

Egan, G. (2010) The Skilled Helper: A problem management and opportunity production approah to helping.9th edition. Pacific Grove, CA: Brooks/Cole.

Geldard, D. and Geldard, K. (2005) Practical Counselling Expertise: An Integrative Approach. Basingstoke: Palgrave Macmillan

Greenberg, L.S. (2002) Emotion-focused therapy: Coaching customers to work through thoughts Washington, D.C: American Psychological Association

Hanna, D.R. and Romana, M. (2007). Debriefing after an emergency. Nursing Management. 8, pp. 39-47.

Irving, P. and Long, A. (2001). Crucial incident stress and anxiety debriefing following traumatic existence experiences. Journal of Psychiatric and Mental Wellness Nursing. 8, pp. 307-314.

Jasper M (2003). Beginning reflective practice. Cheltenham: Nelson Thornes

Mancini, A good., Uthaya, S., Beardsley, C., Hardwood, D. and Modi, N (2014) Practical assistance for the administration of palliative good care on neonatal unit. London: Royal College of Paediatrics and Child Health

McGuniess, D., Coughlan, B. and Power, S. (2014) Empty hands: supporting bereaved mothers through the quick postnatal period. British Journal of Midwifery. 22(4), pp. 146-52.

National Association of Neonatal Nurses (2015) Palliative and End-of-life Look after Newborn’s and Infants. Chicago: National Association of Neonatal Nurses

Nursing and Midwifery Council (NMC) (2015). The Code: professional specifications of practice and behaviour for nurses and purchase vantin medication midwives. London: NMC

Reid, S., Bredemeyer, S., van den Berg, C., Cresp, T., Martin, T., Miara, N., Coombs, S., Heaton, M., Pussell, K., and Wooderson, S. (2011) ‘Palliative good care in the neonatal nursery’. Neonatal, Paediatric & Child Health and wellbeing Nursing. 14(2), pp. 2-8

Royal School of Paediatrics and Kid Wellness (2004) Withholding or Withdrawing Lifestyle Sustaining Treatment in Children: A Framework for Practice. London: Royal College of Paediatrics and Child Health

Schott, J., Henley, A. and Kohner, N. (2007) Pregnancy damage and the death of a baby: suggestions for professionals. 3rd Edition. London: SANDS

Sellman, D. and Snelling, P.C. (2010) Becoming a nurse: A textbook for professional practice. Harlow: Pearson Education

Spence, K. (2011) Ethical advocacy based on caring: A style for neonatal and paediatric nurses. Journal of Paediatrics and Kid Health. 47, pp. 642-645

Williams, C., Munson, D., Zupancic, J. and Kirpalani, H. (2008) ‘Supporting bereaved parents: Practical techniques in providing compassionate perinatal and neonatal end-of-life good care’. Seminars in Fetal and Neonatal Medicine. 13(5), pp. 335-340.

Wolverson, M. (2000). ‘On reflection’. Professional Practice. 3(2), pp. 31-34

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