This essay will critique and reflect on my personal and professional development in my first years as a Trainee Nursing student. I will explain how I will continue to develop my knowledge and nursing skills once registered. The three standards of the NMC (2018a), which I will focus on, are: Being an accountable professional, promoting health and preventing ill health and working
in teams. I have chosen these three domains since I feel I have excelled more in them whilst working with patients, colleagues, and healthcare professionals. I will highlight some of the challenges I may have encountered in each and how I plan to deal with them as I continue to learn to improve my practice. As expected under the Nursing and Midwifery Council (NMC,2018b), I will not reveal the names of healthcare professionals. Where reference is made to any of these, I will use pseudonyms. I will also provide evidence for achieving the domains shown in my portfolio.
In the past one years, I have worked in several healthcare settings, including community and acute wards. Working in these settings involved applying skills and knowledge to
support patients’ healthcare outcomes and recovery from diseases and illnesses. Providing safe and quality patient care demands that nurses integrate several clinical skills whilst working with colleagues and patients. Such an opportunity offers a chance to learn and enhance one’s skills and knowledge (G Laser, 2017; Stonehouse, 2021). One of the responsibilities that I was involved in was promoting health and preventing ill health. Nurses are important in supporting patients to improve and maintain their overall health and well-being (Glasper, 2017). In the first years, I actively prevented and protected diseases and ill health by engaging patients, which allowed me to learn more from such interactions.

As part of our course, we were required to submit an essay on promoting health and
preventing ill health, which helped clarify how I executed this role. In the task that I
submitted. I explored the patient’s health needs relating to his physical, psychological, and social dimensions. I also considered how the patient’s holistic needs would be met to enhance the health and well-being of the patient. Some aspects I thought to promote health and prevent ill health were the social determinants of health and how these could be met. I educated the patient on medication, coping skills, and risks to his health, including how these could be overcome or minimised. (Glasper, 2017; Stonehouse, 2021). One of the things I learned was the need to integrate multiple health promotion approaches to support behaviour change. One of these was a behavioural change, which seeks to persuade individuals to take responsibility for their health using preventive services. I also learned about self-empowerment models that focus on enhancing one’s abilities using their strengths to control their health and the environment in
which they live.
I also learned that patients might have unique perspectives about their
healthcare needs. The role I assumed was supporting patients to make informed choices, and I realised this might not be an easy task. Respecting patient autonomy implies allowing them to make decisions I may disagree with based on my knowledge, understanding and current evidence. (Glasper, 2017; Stonehouse,2021). As patients exercise their autonomy, they can make choices that are not good for their health. However, I ensured that I provided them with all the information available while seeking help and support from other healthcare professionals to support patients make decisions that benefit them. The different standard that would be of interest is being an accountable professional.

Being an accountable professional requires nurse associates to communicate effectively using various skills and strategies with patients, colleagues, and other healthcare professionals (NMC,2018a). I have worked with different patients in healthcare settings and worked within the tenets of the NMC (2018b). One of the aspects of communication that I have embraced in the first year is maintaining confidentiality in line with the dictates of the NMC (2018b) code. Effective communication is integral in healthcare as it helps share information in ways that can be understood and acted upon as part of care provision (Bibi et al., 2022). However, before straining this course, I was Unaware of the important role of communication within teams or when working with patients. I also encountered problems in developing rapport with patients. I also faced challenges in communicating with members of the multidisciplinary team. However, I realised that my lack of communication skills was mainly based on a lack of confidence. Benner (1984) indicated that novice practitioners may not demonstrate mastery of key skills, but with learning and support, they can do so with time. Indeed, as part of the OSCA, we were taught the importance of using early appropriate communication tools such as the situation, background, and assessment.

During placement, I could also recognise signs of deterioration with the help of the NEWS 2chart (Royal College of Nursing, 2022). The NEWS 2 chart is a recognisable framework that can escalate care to senior healthcare professionals for quick action and response to minimise the risk of deterioration (Harris, 2021; Royal College of Nursing, 2022). Nurse associates can provide valuable data by using the NEWS 2 scores by escalating this using the SBAR communication tool as they fill the gap between registered nurses and support workers (Muller et al., 2018; Peate,2019).
On reflection, my communication knowledge has improved, making me more confident to practice effectively. I also appreciate that I have developed key skills in assessing patients using models such as the ABCDE approach advocated by the Royal College of Physicians (RCP) for evaluating critically ill patients. I have also learned more about relevant legislative
and ethical frameworks such as autonomy, beneficence, non-maleficence, and justice underpin safe and effective patient care. I have the confidence to deliver safe care to my patients while advocating for their needs.

The last domain that I settled on is working in teams. Whilst working as a healthcare assistant, I was paired with a nurse. Although the nurse’s student role is often underrated, they offer an important supportive role within multidisciplinary settings (Hickman and Leary, 2020). Nurse students are integral in interdisciplinary teams, collaborating and communicating effectively with other healthcare professionals to meet patient needs. This role includes demonstrating awareness of one’s position, responsibilities, scope of practice within the team and assigned duties and functions. During lectures, we were introduced to the importance of team working in healthcare. We were educated on the part of the team working to improve patient healthcare outcomes and reduce harm (Peate, 2019). Every time patients visit healthcare settings or are admitted, they expect quality care that meets their needs (Peate, 2021). Harris (2021) indicates that such consideration is impossible if healthcare professionals fail to collaborate as a team providing unique perspectives, ideas and skills that meet the patient’s needs. I demonstrated effective communication skills whilst working with diverse members or groups, which is vital in achieving the best patient outcomes (Peate, 2021).

In conclusion, this essay has provided a critique and reflection on my personal and professional development over the first year as a student nurse. After finishing my current course, I have explained how I will continue to develop in the key areas. I can note that the first year has provided me with a vital opportunity to provide care to patients that meet the tenets of the NMC (2018b) code. Specifically, I have demonstrated how I have communicated effectively, demonstrated my accountability in practice and the ability to work in teams. I have explored current evidence on why these domains and their preparation are critical in enhancing patient outcomes. I will continue strengthening my skills to demonstrate accountability and professionalism across these domains. I will improve these skills and competencies to deliver quality and safe patient care.

This reflective essay seeks to demonstrate the role of advocacy and effective communication in nursing practice. I will use a case study of a patient I met while on placement. I will refer to the patient using the pseudonym Margaret to maintain confidentiality as required by the Nursing and Midwifery (NMC 2018b). I will also not reveal the name of the NHS setting or nurses responsible for her care (NMC 2018b). I will structure my reflection using the Driscoll model (2007) to integrate theory into practice. Driscoll (2007) was chosen since it is simple to use or follow, especially for novice students (Nicol and Dosser 2016). The Driscoll (2007) model has three questions describing the event, explaining its importance, and how it informs future practice.

I was allocated to work in an NHS Trust during placement. On my first day at the acute ward, I came across Margaret, a 76 years-old woman of African origin. Margaret had come to me complaining that she could not understand the prescriptions for her medication. She stated facing difficulties understanding her care plan because a staff nurse spoke to her in a dark accent or language. I apologized to Margaret for the poor care. Consequently, I looked for the concerned nurse and asked her to clarify Margaret’s instructions. Moreover, I listened to her instructions, which I repeated with Margaret until she was satisfied.

Margaret’s case made me upset and embarrassed about the initial care. As part of the nursing team, I felt I had failed to give her effective care. NMC (2016) standards of medicine management state that a staff nurse must ensure that a patient or family member understands all medical prescriptions. The nurse can ask the patient whether they understood all the instructions (Kim and Park 2017). However, in Margaret’s case, the staff nurse did none of these, which caused the patient to come to my aid.

Moreover, NMC (2018b) holds that communication skills are essential for nursing practice. Lotfi et al. (2019) conceptualise communication in nursing as exchanging information between a patient and a clinician. Although communication can be either verbal or non-verbal, nurses should communicate clearly nonetheless (Oliveira and Tariman 2017; NMC 2018b). In this case, nurses should ensure their patients understand or are actively involved in their case (Oliveira and Tariman 2017). The essence of effective communication is that the speaker receives the recipient’s correct feedback. (Lotfi et al., 2019). Furthermore, it is important that nurses understand the patient’s level of education and ability to understand visual signs (NMC 2018a).

However, as Lotfi et al. (2019) noted, communication can be hindered by factors such as education level, language use, accent, and attitude. Therefore, nurses should use language that a patient can understand. Effective communication ensures the patient understands and can follow what has been stated as part of their treatment plan (NMC 2018b). Moreover, nurses should relate well with patients to create a positive attitude so that a patient can be compliant with the medication recommendations (Kim and Park 2017). In Margaret’s case, the staff nurse failed to recognize that her accent was barring her communication with Margaret.

In person-centred care, the nurse combines individual expertise and evidence with the patient’s values, opinions, and culture to arrive at a treatment plan (Ghane and Esmaeili, 2020). Patient- Centre care places the individual at the Centre of their care (Oliveira and Tariman 2017). Therefore, any decision arrived at or implemented is one that the patient approves or agrees with, as opposed to one implemented without their knowledge or contribution (Abbasinia et al., 2020). However, in Margaret’s case, she was not involved in planning her treatment; hence she could not understand her care plan (Oliveira and Tariman 2017). Nonetheless, I acted as Margaret’s advocate by consulting the nurse to ensure Margaret understood her prescription.

Advocacy in nursing refers to a situation where a nurse agitates for a patient’s rights whenever they are violated (Jarpe et al., 2019). NMC (2018a) outlines that nurses can represent a patient in search of justice, especially when the patient lacks capacity or is absent from family members. This can occur in courts or by voicing a patient’s concern to the hospital management for action. Jarpe et al. (2019) noted that a nurse advocate helps patients get quality care and be protected from staff mistreatment. Although I did not report Margert’s case to any authority, the action I took to ensure that the nurse concerned clarified the instructions qualifies me to be an advocate.

This reflection experience has enabled me to understand the need to integrate essential nursing skills into practice. It has taught me the practical application of theoretical strategies for mitigating communication barriers. Moreover, I have appreciated the role of advocacy in improving patient safety and satisfaction. As part of my action plan, I will strive to understand more about the common barriers that hinder nursing care communication (Ghane and Esmaeili 2020) to improve my future practice. Similarly, I will study more on the principles of person-centred care as outlined by NMC. This will ensure I can always assess whether the care complies with them. Lastly, I will study the NMC (2016) standards of medicine management guidelines and understand the procedure of drug prescriptions to ensure I can administer medicines better.

In conclusion, this essay has reflected on the importance of effective communication and advocacy in nursing practice. Accordingly, I have used a case study of Margaret to show how accent (a communication barrier) can affect service delivery, especially if a nurse does not confirm whether a patient has understood the prescriptions. Similarly, I have outlined various approaches as articulated by the NMC that underpin medicine management, nursing communication, and person-centred care. I have always learnt to enquire whether a patient is comfortable with my way of communicating with her.