I am a registered midwife and a nursing and midwifery lecturer and advisor. I was asked by an institute of medical sciences in Colombo, which collaborates with Birmingham City University, Durham University and Bristol University among others, to design a module tailored to the needs of student nurses in Sri Lanka. When designing the module, I knew that one day, the student nurses would very likely go on to practice on the world stage, beyond their nation's borders.
I was asked to do this as I had lived in Sri Lanka for over 3 years at the time, and had therefore gained experience of the country's healthcare system, as well as being a qualified midwife in my birth country, the Czech Republic, and a registered midwife in the UK.
The main aim of the module was to make students aware of the wider role of the nurse globally, the need for effective communication with the soft skills of kindness, compassion and empathy at the heart, and themselves in the mirror as future health practitioners, identifying their strengths and how to better themselves. In recent decades, it has been increasingly recognised that soft skills (sometimes referred to as emotional intelligence) play an important role in healthcare education, and must be developed alongside other professional skills (Dolev et al, 2022).
Traditional lecturing of bare facts to learn by heart was replaced by five, 2–hour interactive workshops, with theory and practical activities interlinked, group work and proper allocation of time for self–reflection. The latter was aimed at each student becoming an emerging reflective practitioner who feels responsible for their own actions and learning, a critical thinker, a team player with discipline and values that Florence Nightingale would recognise, and a strong communicator.
The outline for each of the workshops was as follows:
- The role of the nurse and expectations placed on them when seen through the different lenses of patient, relatives, doctors, other colleagues and themselves
- Professionalism and responsibility for one's own actions
- Discipline, including self–discipline in relation to individual professional development, life aspirations and dreams
- Communication skills and teamwork
- Peer assessment and individual presentations.
Assessment of the module was conducted in two parts, with the student at the centre of the learning experience, rather than subjecting them to a typical 2–hour written test. Part one was a written reflective account of 1000 words about any event in their life, using a health–related reflective cycle to analyse and evaluate their feelings and behaviours, making plans for future learning and life and highlighting any specific learning points and changing behaviour as a result. This was uploaded to a shared document made available to anyone who wished to read it, but which was especially aimed at other healthcare students to further enhance their own learning. It also had value for members of the public to read stories through healthcare students’ eyes.
Part two was a short presentation in front of their peers, highlighting any specific learning from their written work. The aim was to develop presentation and communication skills and be able to express their thinking and learning, sharing it with an audience.
Each part had a marking grid with detailed guidance that was explained to the students well ahead of their assessment. It was discussed at each workshop, giving them total transparency, with plenty of time and multiple opportunities to understand what was going to be expected of them. Marking was done by lecturers and peers – another new skill for them to experience, requiring them to be objective and honest, as well as transparent and shouldering responsibility.
The students’ feedback on the whole module was very positive, with verbatim comments shown in Box 1 and sample reflections outlined below.
Box 1.Student feedback on the module
- ‘This module is very important for our lives. I got to know how to work with patients, how to face incidents and how to improve my presentation skills (eye contact, body language)’.
- ‘We learned how to work as a team, how to share with others and how to work peacefully. We wrote a reflective account to solve problems using the reflective cycle and shared our personal experience’.
- ‘These sessions are very useful in my life. It changed some of my attitudes and bad behaviour, increased my personality and improved my communication skills. I liked the group work and games’.
- ‘Through the teaching on this module, I learnt that learning can be achieved through different forms, be it via means of a presentation or even an article writing. Moreover, it defeats the idea of usual learning through books alone and encourages students like us to absorb learning better. The activities such as the plays, word games and much more, that it was incorporated during the lectures, made learning intriguing and something we looked forward to every Thursday evenings. During the times we were asked to come forward and voice out our opinions regarding a certain matter, I noticed how patient Mrs Rennie was towards those students who had stage fright and it truly taught me the importance of giving everybody a chance in order to feel included. Mrs Rennie's constant emphasis on teaching us how to be excellent future nurse leaders will always be carried with me as I step into my career and one that will follow throughout it’.
- ‘Your kindness and persistence towards ensuring we gained sound knowledge through your module will always be appreciated, Miss Rennie’.
Sample A
Description
This report is a personal experience from the year 2020. At around 1pm in the afternoon, as my friend and I were walking to class near the main crossing, I was involved in an incident. A man was lying on the ground in the middle of a busy main road that day; nobody tried to help him get to his feet. Just about everyone was enclosed; the man was bleeding.
My friend and I wanted to help that man, but no–one around in the area would let us. However, when we questioned why, everyone said that it was a shooting so do not inquire. Everyone said that by going to help, we would eventually have to face the problems that we do not have. After hearing those stories, my friend was very scared. After that, my friend really lost the desire to help. Even though I really wanted to, my friend did not let me help after that. My friend said ‘let's go now’ and took me along. Even after going to class, I felt that I could have helped.
Feelings
As soon as I saw that opportunity, I wanted to help the injured man. Everyone around that person said not to go and help him. I was really angry with all of them at that time. Finally, my friend also did not want to help that man, so I felt a little scared. But we went to classes without helping that man. Even after the classes, I thought that I could have helped. I still regret what happened that day. Even today, I feel that I did a bad thing then.
Evaluation
I could have helped that person without listening to what they were saying at that time. When I think about it, I remember the words in front of the prison, ‘prisoners are human too’. Actually, the people who were there at that time were wrong; the reason I say that is that no matter how much that person did wrong, no–one tried to help him when he was injured.
Conclusion
The lesson that I learned from this is that it is not over until someone else comes along. I think that if I believe that I am doing the right thing, then what others say will not matter.
Action plan
If I had to do the same thing again, I would not care about other responses, and I would do the best thing at that moment. I would always help the injured person, whether they are a good or bad person. Whatever the case, maybe I will not be scared, and I will accept the challenge. By associating with different people in society, I will bring great and lots of experiences and get correct answers to all the questions. I learned from this that I do not think what other people say.
Sample B
Description
The incident I will be reflecting on occurred while I was placed on the oncology ward during my first year of qualified nursing. We had an elderly service user on the ward, who had been admitted for stomach cancer. On arrival, we read his notes, which highlighted that he had significant learning difficulties, meaning that he also had problems with verbal communication.
The main areas of reflection are how both me and the other nurses used communication to calm the patient and show compassion, as well as how we adapted our care to address their individual needs. A nurse came onto the ward with three members of the public, who were viewing the ward as part of a job advertising process. When the nurse entered the patients’ bay, she informed the members of the public that the service users were currently receiving radiotherapy treatment. On hearing the nurse's words, the service user became overtly distressed and began crying, shrieking and hitting his head backwards against his pillow. It took time, but another nurse managed to calm him down by talking in a soothing manner.
Feelings
Prior to the incident, I was mindful that the nurse was showing the three members of the public around the oncology ward, as part of a job advertising process. At the time of the incident, I had only been working on the oncology ward for 6 months, so I still felt slightly unsure of my position in the team. Ultimately, I did not feel confident or experienced enough to deal with this situation independently. I think that my increased level of anxiety meant that I struggled to intervene; however, it is still clear that both my colleagues and I should have intervened more quickly to ensure that the patient was dealt with effectively. Moreover, I was very surprised when the nurse failed to take into consideration the individual needs of the service user during the visit of the ward, as the distress caused to both the service user and the members of the public was very unnecessary.
Evaluation
In hindsight, the experience had both good and bad elements, which have led to an increased understanding of the service user experience and my role as a nurse practitioner in the oncology team. My role was to give physical examinations and evaluate the service user's health, prescribe and administer medication, recommend diagnostic and laboratory tests/read the results, manage treatment side effects and provide support to patients. This includes acting in their best interests. I feel that I did not fulfil the latter responsibility completely.
This duty to protect service user's full confidentiality and ensure that the nurse who was showing the members of the public around the ward was aware of the service user's communication difficulties and resulting anxiety was not fulfilled. Our failure to act as a team, by sharing information and stepping in before a situation escalated, shows that there was a low level of group cohesiveness.
Analysis
According to Brittle (2004), people with learning difficulties often struggle with adapting to new situations, which means that there is the potential for problematic behaviour when dealing with something outside of their comfort zone. Nevertheless, as suggested by the Nursing Times Clinical (2004), healthcare staff should be aware of how to effectively interact with people who have a learning disability, and this can be aided through regular and valuable reflection.
Prior to admission to the hospital, it is advised that professionals find out about the patient's communication preferences, and their likes and dislikes;, in order to address any potential fears either through discussion or by allowing the patient to visit the ward to meet the nursing staff. Moreover, day–to–day communication with patients with learning difficulties should involve patient–centred/holistic care in addressing patient needs, which incorporates both verbal and non–verbal forms of communication. Professionals should make eye contact, look and listen, allocate more time for the patient, be interactive and communicative, remain patient and, in some cases, enable professionals who have had experience with people with a learning difficulty to care for the patient.
Conclusion
From this experience, I am now more mindful of the importance of being assertive and exerting professionalism in practice if similar situations were to arise in the future. The insight I gained from this experience means that I am now more aware of the implications of not acting immediately and the importance of acting in the best interests of the patient, even when this may take courage. Strong working relationships between healthcare professionals should also be given a greater emphasis in the oncology ward, to increase group cohesiveness.
Action plan
In the future, I aim to be more proactive in dealing with a situation face on, regardless of my role in the team or level of experience. This includes dealing with a stressed service user, ensuring that information is passed on to the relevant staff and intervening when I believe that there is a risk to a service user's health or mental wellbeing. Moreover, I will address their needs and alter how I approach a patient with learning difficulties in the future by ensuring that I use different methods of communication and undertake some independent research on their specific needs I can use this information in my nursing practice. I will not assume that other members of staff will always be aware or mindful of the individual needs and/or triggers of a service user, and I will not presume that other members of staff will always act in a wholly professional way.
I will continue to undertake regular professional reflective practice, using the ongoing model proposed by Gibbs. I also aim to implement the principles and values consistently and confidently, as set out by the National League for Nursing, relating to the individual needs of service users: ‘to respect the dignity and moral wholeness of every person without conditions or limitations’ and ‘to affirm the uniqueness of and differences among people, their ideas, values and ethnicities’.
Sample C
My life experiences related to my nursing career
Life is like a river flowing through obstacles and challenges. We all have ups and downs in our lives and many experiences gained through it. I have had many experiences in my life so far. I got those experiences in good and bad ways. After that, I did not have such a beautiful time at school. After completing school, I was employed. There, I understood society well. But later I realised that a job is not a support for my future. Since then my turning point was choosing nursing.
Ever since I was a child, I dreamt about nursing. Based on my strong desire and love for it, my parents also showed further interest. As a result, after seeing an advertisement in the newspaper, my father suggested this career for me.
Description
I learned a lot here. I never thought that I would be able to work in a hospital like this. After coming here, I learned, in many situations, what life means and how to face the day. Also, I now understand that nursing is much more complicated work than we thought. We have to sacrifice a lot of things together.
People who come to us are in a lot of pain. We will not catch them. But sometimes I meet people who feel like I do. They really give credit to us and give credit to our parents. Then I feel very happy. Sometimes things happen in many situations that we cannot bear. At that time, we feel like giving up everything, but on the other hand we forget it. Because the advantages here are well known.
One day, when I was on morning duty in the ward, I went to a room to inquire about the wellbeing of a patient. I came to know that the patient had not been washed. I hastened to wash the patient and did not forget to massage her back as she was bedridden. One thing that struck me was that one day, we will have to face everything alone. We cannot say exactly when that will be. At that time, if others can do something for that lonely person, that will be our greatest happiness.
Another thing I understood is that you should treat yourself and others equally. For any reason, it is not good to bother others because of oneself, to put others down. We all spend our days with a purpose in mind. Every day we have a goal, a challenge. It is self–defeating to work in a way that hinders the success of that thing.
To put it another way, I learned how we must deal with emergencies. For example, for 2 or 3 days, I found myself in emergency arrest. One happened when I was checking the patient's blood pressure. The doctor was there so I did not feel scared. However, I realised that at times like that, you cannot do anything when you are worried and scared.
The way the nurses worked there was very commendable. Their dedication and that of the medical staff saved a life that would otherwise have been lost that day. Friends and relatives of the patient's family thanked them a lot. Is there any more happiness?
Feelings
I think that this is not just one job. A place where there are people who can sacrifice their whole lives for others, are strong–minded and can accept any challenge. It is like a team here. Everyone is trying to give one lifetime to breathe together. I feel happy when I think about it.
And there is one more thing that cannot be forgotten. That was my nursing school. I first learned about nursing from this school. Our favourite place in nursing life is this nursing training school. Through this, we practise many things. In addition to theoretical knowledge, we also get practical knowledge while acquiring skills in the lab. I really want to thank my nursing school for the gifts it has given me and my friends.
We work alone here most of the time. Stayed in a hostel away from home. So there we learn how to face life alone. We do not have dignity all the time. So we need to know how to move forward in life. This place is a perfect example of that.
And we do not work in one place, we change to practise at different wards. Therefore, I think it will be a good help in our future work. The hospital staff is also very good. They tell us things we do not know, looking out for us.
I used to be very afraid to walk alone in the dark. Wherever I go, someone must come. But not now. I got used to it because of night duty services. Actually, there is no fear now. You can go anywhere in the hospital at night.
Action plan
I would like to say that I have learned a lot in this nursing life. I still have a lot to learn. Life is never good to stop at one place, we need to move forward. Obstacles and challenges can come as many as you like. But we only get one life. This nursing profession is the best example of that. Sacrifice a thousand things for someone you have never met. You learn a thousand things for someone you have never met. And do a thousand things for someone who has never met.
Conclusion
I pray that all the nurses in the world and all those who are waiting to become a nurse will be healed mentally and physically. Because they are truly the people who heal others, and they need to be healed to take care of the sick. The nurse is a true hero. A silent hero. They heal you. They call you fondly. They take care of you. You will forget their name. But do not forget their actions. In the hospital, they are like hearts, and they will give you room to breathe.
I am happy to be a nurse. I love it even though I am still a student nurse. I will heal many people, will be with them in their sorrow. My loved ones will give up. But allowing them to be happy with their loved ones. A nurse is always selfless. Never hope about gifts or vouchers. What is needed is comfort. Finally, thank you very much, all nurses.
Conclusions
On reflection, I feel that the module achieved its professional objectives by challenging the students in a was that was healthy but crystal clear, and was innovative in the way that it was delivered to the learners and with them actively at its heart. I also found that the embryonic soft skills developed will carry the students well in the wider scope of their lives; this was not intentional, but is a bonus.