n my third week of simulated practice, my focus was on autism. This allowed me to gain a more thorough understanding of the condition. Autism Spectrum Disorder (ASD) is a neurological condition that affects a person’s ability to communicate and interact with others. Additionally, it can impact their interests, behaviours, and hobbies. It is classified as a spectrum disorder due to the varying intensity and symptoms experienced by individuals. Some individuals with ASD may also have other conditions, such as ADHD, dyslexia, anxiety, or epilepsy. I understand that having autism doesn’t mean you have a sickness or disorder. It means your brain processes information differently than others. Patients are born with it, and symptoms can be noticed early on or later in life. Being autistic is a lifelong condition that can’t be cured like a medical illness, but some individuals may need help with specific tasks.

I want to share a scenario involving a patient with autism based on a case study from my simulated placement. For privacy reasons, I will refer to the patient as Jasmine, as required by nursing and midwifery standards. To integrate theory into practice, I will follow the Driscoll model, which includes three questions about the event, its significance, and how it can inform future actions.

During my simulated placement, I was assigned to work in an intensive care unit. My practice supervisor has requested that I provide a COVID injection to a patient. I introduced myself to the patient and received her permission. Jasmine has reached the age of sixteen. Jasmine was diagnosed with high-functioning autism when she was seven and arrived at the hospital with her mother. Jasmine was standing in the corner of the bed, feeling anxious. So I ask her to sit on the chair, but she sits at the edge of the bed. As a student nurse, I prioritise that patients and families entering the assessment ward deserve to be treated with the utmost care, compassion, respect and understanding of the fearful situation that they find themselves in. I assisted Jasmine in transferring from the bed to a comfortable chair.

To communicate effectively with Austin’s patient, I spoke in simple terms. I informed her that the practice supervisor had requested that I administer the COVID vaccine and asked for her consent. She had concerns about why she needed the injection when her college friends hadn’t taken it yet. I explained that she was at high risk of contracting COVID and that her mother recommended taking the vaccine for safety. After obtaining her consent, I prepared the medication by verifying the expiration date and dosage. I administered the subcutaneous injection in her right arm and assured her that she would feel alright within an hour. However, she still felt numb and asked what to do if it didn’t go away. I advised her that her mother could call the GP for pain relief. I gave Jasmine ample time to express herself and didn’t interrupt her. Communication can be challenging, but it’s essential to keep trying and not let embarrassment interfere. A family member can also help find the best way to communicate if available. As a student nurse, I have learned the importance of building a personal connection with my patients. It is crucial to approach them with care, respect, and compassion while gathering and relaying information. As their advocate, I will stand by them and provide support whenever needed. And I am committed to delivering the essentials of care competently and efficiently.

In addition, I have gained more knowledge on how to manually measure blood pressure and record the results as soon as I hear the first heartbeat. My understanding of the pressure level at which the first Korotkoff sound is detected through simulated practice has dramatically improved. It is important to note that the systolic pressure is determined at this point, while the absence of Korotkoff sounds marks the diastolic pressure.

During Creative Therapy Week, I had the chance to explore different forms of therapy, such as Dance Movement Therapy, Music Therapy, Art Therapy, and Drama Therapy. I learned how innovative therapies can help us express our inner thoughts and feelings through creative means such as art and music. Art therapy, in particular, is a powerful technique that uses creative expression to address psychological disorders and improve mental health. It recognises the healing potential of the arts, allowing patients to communicate, express themselves, and find comfort through artistic expression. As a nursing student, it is essential to approach patients with mental health conditions with respect and acceptance. My experiences taught me how to create a safe, nonjudgmental relationship with patients, allowing for effective communication and comfortable silence. This has helped me better understand their experiences and grow professionally. As student nurses, we must use our internal creative resources to understand better and serve our patients, develop nonverbal communication skills, maintain a nonjudgmental attitude, and understand their unique capabilities and potential. Building trust between patients and their families is also essential, and open communication is vital. By focusing on the patient’s needs, healthcare providers can be resilient to challenges not centred on the patient’s well-being.

Music therapy has been shown to have many benefits, including reducing blood pressure and depression, contributing to self-discovery, heightened awareness, increased self-esteem, and enjoyment of life. Individuals with chronic conditions may benefit from listening to self-selected background music, which can reduce negative behaviours like agitation and aggression and promote positive behaviours like eye contact and smiling. Advocacy for music therapy has helped me understand its positive impact on patients. While it may not improve long-term survival rates for cancer patients, it has been found to have short-term benefits, such as lessening the need for pain medication and reducing rates of depression and sleeplessness in specific individuals. Music therapy is a fast-expanding area in which music interventions are utilised to achieve goals in therapeutic interaction. It has been shown to help patients express their feelings, manage stress, promote well-being, relieve pain, improve memory, and improve communication.

Music comprises two essential elements, rhythm and melody, which are natural human capabilities. Music therapy is a simple and easily accessible treatment that can assist with various health issues, including pain management, emotional regulation, and interpersonal difficulties. Nurses use emotional intelligence, which encompasses personal and social competencies, to provide compassionate care to patients and their families. While nursing courses prioritise cognitive and physical skills, they do not always provide opportunities to cultivate these critical personal and social qualities necessary for effective practice.

Reflecting on the benefits of Art therapy, it is evident that it has aided student nurses and mental health patients in effective communication. Art therapy has enabled a comfortable silence between the two parties, fostering a secure and nonjudgmental alternative. This has helped student nurses overcome their apprehension of speaking while patients can express their emotions and share their experiences. As a result, student nurses have developed a better understanding of mental health patients and have grown professionally by acquiring more efficient techniques for gathering information. Incorporating art therapy into baccalaureate nursing education may improve the therapeutic relationship between student nurses and mental health patients. Art therapy promotes self-expression and fosters trust between the patient and the nurse through comfortable silence. It also helps to improve the communication skills of student nurses. Overall, this placement supports art therapy as a valuable nursing tool and a deliberate communication strategy in nursing education to promote professional development and prepare students for nursing practice demands.

This week, I attended midwifery insight week, where I learned about newborn feeding with a focus on breastfeeding, domestic violence, and sepsis. Through group discussions, I was able to delve deeper into the subject. We discussed the benefits of breastfeeding for both the mother and the baby in the newborn feeding segment, which was incredibly informative. Breast milk is the most nutritious food for newborns and adapts to the child’s nutritional needs as they grow. Breastfeeding also helps prevent short- and long-term illnesses and disorders such as asthma, obesity, type 1 diabetes, SIDS, ear infections, and stomach problems. However, I learned that some mothers with chronic AIDS cannot breastfeed their children because it spreads the disease. In such cases, multidisciplinary teams will provide risk mitigation advice. As a student nurse, I recognize the importance of respecting the mother’s decision and not pressuring her to breastfeed. Instead, I must encourage them to do so because it benefits the baby’s cognitive processes and mental and emotional well-being. To ensure perinatal mental health protection, providing practical breastfeeding assistance and appropriate guidance from healthcare experts is critical. Nurses are essential in providing patients and their families with high-quality, trustworthy, evidence-based information.

Also, we watched a domestic abuse scenario as groups, stimulating practice. A 32-year-old pregnant woman was admitted to the emergency room for a fall. She is 32 weeks pregnant and has had bursts around her face and arms. The practice supervisor has asked the student nurse to take vital signs to check if the patient is okay. The student nurse gained consent from the patient and notified her that she came with her partner, and any time the student wanted to talk to the patient, the partner would not allow the patient to take it, but he would answer the question. Hence, the student recognizes the indicators of domestic abuse. The student escalates to the practice supervisor and says that something is going on with the patient, so the practice supervisor shows up and reassesses the patient.

I learned that the student nurse notes domestic abuse. The patient was terrified of her partner. The patient’s partner was the one to answer all questions and shout at her, Lazy woman. You will stay home for me to come back from work to cook for you. That is why you fall in the kitchen. This is an example of domestic abuse. Take control over everyday life by telling you where you can go, who you can see, what you can wear, and when you can sleep. This would help make the information more relatable and easier to understand for the reader.

The names of the patients and the NHS Trust will be changed to maintain confidentiality.

As a result, I will go over what went well, what I learned, and what I will do differently the next time. Professional relationships in nursing refer to how nurses interact with their patients and other healthcare providers. According to the NMC code of practice, registered nurses must maintain professionalism and trust. Includes adhering to professional values such as honesty, competence, and hard work. The charge nurse directed the student nurse to take the vital signs of a 27-year-old pregnant woman admitted to the ward for the fall. The student approaches a patient to obtain consent, but the patient’s companion refuses to let the patient say so. Her partner began telling the nurse her name was Mary, that she was 32 weeks pregnant, and that she fell in the kitchen. He is concerned because she is sluggish and lethargic; they have been here for two hours, and no one has come to assess them, but he is relieved that a student nurse is here to observe them. The healthcare provider recognized anything that seemed amiss with the partner’s speech and behaviour. The patient appeared uncomfortable and apprehensive, and she only let her companion do most of the talking. Also, the injuries from the fall appear suspicious. At this moment, the student nurse became worried and attempted to communicate with the patient. The patient’s spouse eventually excused himself, and the nurse took advantage of the chance to ask questions to help the patient open up to her. As a nurse, it is critical to focus on your patient to spot any indicators of domestic violence, so safeguarding concerns must be highlighted. In this case, I realized the significance of examining the patient’s general look, mental condition, and posture. This setting made it very simple to recognize indicators of domestic violence since the patient seemed disturbed, nervous, and afraid. I’ve learned how to recognize when a patient is abusing themselves, how to escalate the situation, and how to assist them. I realize that soothing patients and asking closed and open questions are vital since they allow the patient to tell you what happened to her. I learned that I have a personal relationship with my patient and show compassion while obtaining and providing information to her. As a student nurse, I must advocate for, support, and defend patients. I have to make sure I deliver the fundamentals of care effectively. I have learned that Nurses must be cautious and know how to collect information to avoid triggering the patient and complicating matters. I learned that the practice supervisor would refer patients to multidisciplinary teams to safeguard the patient and any information about domestic abuse websites for the sake of the unborn child and the patient’s mental, emotional, and psychological health. MDTs, midwives, and nurses must share information to help mothers and children facing domestic violence and abuse at home and needing urgent care.

Nurses need to understand the relationship between exposure to violence and women’s ill health and be able to respond appropriately.

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.