Nursing not. Three sections will be discussed

Nursing involves the promotion of
health of individuals’ sick or well, taking into account their age and
background. It is a person centred approach where the patient is placed at the
centre of their care (George, 2013). According to Hall and Richie (2010),
Nursing is not easy to be described due to the fact that patients have
knowledge on when good Nursing care has been delivered or not. Three sections will
be discussed in this essay: section one
will entail the Nursing and Midwifery Code and the guidelines it sets out for nurses
in their role. In addition, a general description will highlight values laid
out by the Nursing and Midwifery Council (NMC, 2015) and the impact this
approach has on compassion care practice. Second section will clearly give feature of one
communication theory/theorist and briefly explain how this theory supports
communication skills. Moreover, emphasise will be on two communication skills
and the impacts these skills have within the area of nursing practice. In section three, particular attention
will be paid to Borton’s (1970) model of reflection and how it is used and also
the importance of reflective practice in nursing.















Section OneA. The NMC Code and how
it guides nurses in their roleNursing
and Midwifery Council (NMC) is the governing body for Nurses and Midwives in
the United Kingdom. It maintains a live register and its aim is to guide nurses
and midwives in delivering a high quality standard of care to patients. The NMC
Code which is effective from 31 March 2015, sets professional standards that
nurses and midwives must follow and achieve to be able eligible to register and
work. The Code is made up of four necessary and effective subjects which are
prioritising people, practising
effectively, preserving safety and promoting professionalism and trust. (NMC, 2015) 1. Prioritise peopleThis theme emphasises on person centred care.
Nurses must put the needs of service users first. Nurses should treat people as
individuals and to maintain their dignity by treating them with respect and
upload people’s human rights. Nurses should
recognise and respect any contribution that people have towards their health
and wellbeing. Nurses must make sure that they receive proper consent from
people before carrying out any action. People’s right to and confidentiality
must be respected at all times (NMC, 2015).  2.
Practice effectivelyThe second theme of the code requires nurses to
demonstrate and proceed with any response they receive in practice and to
reflect on areas for improvement. Nurses must deliver care to the best of their
knowledge and in line with the best available evidence. Communication is a
vital tool on the field as nurses must share their skills, knowledge and any
experiences they have with other colleagues in order to improve the delivery of
care to patients. All steps must be taken by nurses to make sure that all
records are kept securely. (Morgan and Parry, 2017)  3. Preserve safetyThis part of the Code focuses on nurses being
able to take account for their own safety and that of the people they are
caring for. Nurses must be able to acknowledge and work within the limits of
their competence. Concerns should be raised immediately if nurses feel a
patient’s is vulnerable or at risk and they might need support and protection. Nurses must take appropriate steps to keep all
medicines stored properly. They must promote recommended practice in relation
to controlling and preventing infection. (Shepherd, 2016)

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4. Promote
professionalism and trust

last theme of the Code sets a guideline on nurses’ professional boundaries and
behaviours. They must act as role models and sustain the standards and values
outlined in the Code. According to Glasper (2016), nurses must be able to gain
patients’ trust and confidence and must
maintain a required level of health to carry out professional role. A good grasp of research will be
essential in helping nurses develop the assertiveness to emerge from preregistration
courses as critical thinkers who are equipped with the knowledge to deliver care
based on best evidence.
















B. Values based
approach in Nursing

Values are
what is believed to be important in life. They guides one’s behaviour, actions
and judgements to others. It is about distinguishing wrong and right. Values
are inherited from families and cultural beliefs and they change overtime when
in some situations. Professional values challenge nurses with additional consideration
of standard behaviours (Cuthbert and Quallinton, 2013). Wilson & Cooper (2016) findings suggest that values are convictions of what people or social groups consider
right or
desirable. Different individuals place varying
priorities on given values. Beliefs that are stable usually
require educational processes to change. Values
are an important aspect of nursing and it
is crucial to understand what values are before making an attempt to measure
their existence in a field such as nursing. Through agreed frameworks and
competencies skills are measurable however, values and behaviour are less
tangible in their scope to be benchmarked (Scott, 2017).

based nursing is based on data and integrates outcomes of care and nursing
performance. Nurses and responsible for care that they provide. Nursing care
value needs to be designed in such ways that are comprehensive and meaningful
to other professionals (Griffith, 2015). Personal values are those that are influenced by
the upbringing giving by parents, education and life experiences. Nursing
involves caring for other people and as such nurses must acknowledge that there
are also professional values that they must adhere to. Nurses and midwives need
to be aware of different cultures when caring for a patient. They must come to
term and identify the way that different cultures influence healthcare
practices. They need to recognise that approaches to one culture cannot be used
in another culture, and as such they must respect their patients’ cultural
beliefs. Professional values guide the conduct and manner in which nurses and
midwives should behave. (Pappas and Welton, 2015)     

Nurses must be able to make
ethical decisions when they encounter problems during the course of their work.
The Four principles approach may be helpful in the process of decision making.
Nurses can reflect and judge ethical concerns they may have based on this
approach. The principles are classified as: non-maleficence, beneficence,
autonomy and justice. a) Non-maleficence – this principle focuses on not
harming others. Nurses must avoid doing harm to their patients at all cost.
They must do well in the delivery of care and also to help patients recover
from their ailments. b) Beneficence – nurses must strive to bring a
balance of goods over harms. Risks or harms that can be presented by
interventions needs to be checked and weighed against the benefits they will
have for patients. c) Autonomy – this principle highlights the
importance of respecting people’s freedom and choice. Nurses should encourage patients to
make decisions about their care and that decision must be respected. Patients
have the right to refuse medical interventions. d) Justice – this
principle requires patients to be treated fairly and equally and they should be
accorded any right they deserve. (Duncan and Dawson, 2011)

Compassion is an essential to patient
care and compassionate approach is highly important. Compassion is how care is
given based on empathy, respect and dignity. This leads to how people view
their care. Compassion is shown by coordinating the skills and listening to
patients concerns. Nurses and midwives provide care that is based on kindness,
integrity and comfort. They must develop themselves as reflective practitioners.
Nurses and midwives’ compassionate care affects patients’ wellbeing outcomes.
Nurses and midwives have the potential to improve the quality of care across
the health sector. The six C’s of compassionate are: courage, communication,
compassion, care, commitment and competence. All the elements must be present
in the delivery of care in practice (Rankin, 2013).

Maxwell (2017)
referred to compassion as an important tool is the healthcare. The research
suggests that compassion and clinical practice cannot be split and it can
result in a very dangerous route with ethical complications. Competence without
compassion can be brutal and inhuman but at the same time, compassion without
competence can be harmful.



Section TwoA. One communication theory/theoristCommunication is all about
exchanging words with others. It is the basis at the beginning of a
conversation. It is a process by which feelings and information are shared. It
consists of sending and receiving messages either verbal or non-verbal between
two or more people (McCabe and Timmins, 2013). NMC, (2015) states that nurses must use a variety of
verbal and non-verbal communication methods to identify people’s personal and
health needs. It also states that nurses must be able to communicate clearly
and to express themselves effectively.Frank (2013) defined Person Centred Care as an approach that guides all
healthcare professionals in providing the most effective to patients. It
involves putting the patient at the centre of the care and also to involve them
in the decision making regarding their care. It helps in setting realistic
goals and reviewing the provision of care. In the UK a person centred
approach is referred to as the Valuing People white paper, which sets plans in
improving the services for people experiencing difficulty with learning. (Department
of Health, 2001)A person centred model was developed by theorist Carl
Rogers. This model focuses on the importance developing a positive approach
towards a therapeutic relationship leading to an effective remedial treatment.
Rogers discovered three conditions deemed necessary for this model: acceptance
or unconditional positive regard, empathy and congruence. This model involves
putting the patient at the centre of care. Acceptance or unconditional positive
regard emphasises on respecting the patient, being non-judgemental and allowing
the patient to express their feelings and thoughts openly; and also by
accepting and treating the patient as a unique individual. Empathy on the other
hand focuses on communicating with patient and this can be verbal and non-verbal.
Empathy enables the understanding of situations from the patient’s point of
view. Congruence involves providing care to patients in a manner that is real
and present. Congruence allows relationship between the patient and the care
provider to build on trust. It helps patients
to feel valued, self-worth towards their own judgement (Coghlan, 1993).
Person centred care reflects more on the communication between the patient and
care provider which leads to the individual gaining trust. This approach helps
nurses in assuring patients that they have participation in their care. It
makes it easier for healthcare team members to work collaboratively alongside
each other in deciding the best care for the patient. Person centred care
guides nurses towards the inclusion of the patient and the family members
taking into considerations their cultural preferences. (Clarke, Pamela and
Fawcett, 2016)Nursing is enhanced from tradition
based practice to evidence based practice. It helps healthcare workers to
promote evidence based knowledge into patient care. This theory helps nurses to
evaluate changes for continuous progress improvement and also to meet standards
for nursing excellence. Conversation between one on one person is deemed to be
effective in changing people’s views and attitudes. (Hanrahan
et al., 2015)                B. Two communication skills and
their impact within nursing practice 


Empathy is referred to the ability of comprehend and
recognise the feelings of others without being non-judgemental of people’s
actions and behaviours. It is being able to perceive others situations from a
different point of view (Bryan and Venise, 2015). Whereas Brooker
and Waugh (2013) described empathy as a process of understanding
other people’s conditions by putting themselves in that position. It is common
to notice other people’s emotions for example when someone is laughing or
crying. It is an emotional response of other people’s situations or
predicaments. Empathy is considered to be one of the most important skills in

Nurses can have technical knowledge
but the lack of empathy decreases the levels of satisfaction in the care.
Empathy becomes a unique way of experiencing what others are going through.
Patients want their nurses and doctors to shown concern while caring for them.
It is important to examine all the aspects of empathy like emotional,
behavioural and cognitive in different ways when on clinical situations.
(Jeffrey, 2016)

is used in nursing as a skill to share understanding between the nurse and the
patient and to meet patient’s emotional needs. It helps nurses to gain an
insight of what the other person is feeling. Nurses use this approach to
communicate affection and warmth to patients presenting behaviour problems. Empathy has been shown to help nurses to achieve a higher quality of patient-centered education and practice. (Mikkonen, Kyngäs and Kääriäinen, 2015)

According to Marcysiak et al.
(2014), the level of empathy shown by nurses is below the average and it is
confused with sympathy as time. Empathy is a process that requires the
combination of every skill. Furthermore, the author pointed out that people who
have been deprived of empathy tend to develop an aggression towards themselves
and others. Empathy can be a very important feature to the delivering of Person
Centred Care and this in turn can help in achieving patient outcomes.

Clinical decision making


According to Tiffen,
Corbridge and Slimmer (2014) clinical decision making is defined as
finding an alternative or option to a particular situation. It is a complicated
process where all the required information must be collected, evaluated and a
decision will be taken after that.

Clinical decision making is a crucial aspect of
nursing care and for nurses as it helps to promote patient’s health and also to
prevent harm as much as possible. Clinical decision making should include both
the assessment and the diagnosis and also an action plan. It helps to deal with
difficult challenges that arise in the practice and also to practice safely and
efficiently. Nurses make choices and clinical decisions almost everyday of
their practice on behalf of their patients. Nurses use this type of
communication skill as it challenges their clinical reasoning and the ability
to make decision on facts without being bias. Nurses have a responsibility to
explain and justify any decision taken which means that decision making process
needs to be based on evidence. Patients often trust nurses that they will make
a decision that will be good for them other than causing them harm. (Johansen
and O’Brien, 2016)

Nursing as a profession has developed policies
around person centred care and holistic approach, hence patients and their
relatives must be included in the decision process and their views must be
respected. It is important for nurses
to consult, communicate and liaise with other multidisciplinary team when
making decisions as it helps to avoid errors. Clinical decision making in
nursing is used to show that nurses can integrate systemic and intuitive
approach during decision making process. (Standing, 2017)

A research conducted by Thompson, Aitken, Doran
and Dowding (2013) suggested that in order for nurses for be expert in clinical
decision making, it is important that they undergo an improvement training
after registration. Student nurses must be taught to be decision makers which
will improve their decision quality.



Section ThreeBorton’s Model of ReflectionWald and Hedy (2015) defined reflection as the process of
examining, exploring and evaluating something from a different angle and being
able to make judgement. In nursing, reflective practice is used to learn from
experiences in a professional context. It is also used to find alternative ways
of solving problems. Reflective practice can be a source of both personal and
professional development. (Taylor and Dawson, 2012)John Driscoll’s model of reflection was developed by
Terry Borton. This model aids in reviewing events by asking trigger questions
that enable practice development. The three key questions are: what? so what?
and now what? (Stonehouse, 2015)What? This
is used to describe an event in detail and to find out what happened. It
purposefully reflects on aspects of that experience. Nurses use this question
to figure out what really happened. So
what? It is used to provide an analysis of the event. It involves
identifying emotions at the time of the event. It can be used as a tool to
discover any learning that took place during the process. This helps nurses to
make sense of what happened to try to resolve the situation/event. Now what? It highlights actions to be
taken following the event. It helps the nurse to consider alternative steps if
a similar event happens again (Smith el at., 2016).Reflection is important to nurses as it enable them to practice
objectively. Borton’s model helps nurses
to identify and respond to issues and make decisions based on knowledge, and also to make clinical judgement based on
evidence. This
model helps nurses to use communication effectively and also to be an advocate for
their patients. It assists the nurses to develop critical thinking and problem
solving skills. Nurses use this reflection model to identify the phases of the
situations and also what could be done in the future.    (Tan,
Cashell and Bolderston, 2012)  Reflective Practice in
NursingReflective practice is a vital tool
in nursing used to improve clinical knowledge. It is a way of learning through
and from experience in order to obtain ways to improve oneself or practice. It
is considered as an essential tool in continuing professional development.
Reflective practice allows the reviewing of an experience in practice and be
able to analyse and evaluate that particular event. It improves communicating
between multidisciplinary team and patient themselves. It helps nurses to
critically thinking in order to make a decision about a care. Problems within
practice can be figured out and be solved through reflection. (Bound, Keogh and Walker, 1985).A very crucial component of
reflective practice is critical thinking as it provides comprehension and
knowledge to situations in order to make decisions and to improve practice. Self-awareness
can be an essential in nursing when it comes to reflection. Nurses should learn
to control their emotions rather than being carried away by feelings.
Reflective practice helps nurses to keep their skills and knowledge up to date.
(Rogers, 2017)Following Nicol and Dosser (2016) research, reflective models provide guidance to
nurses when writing reflective accounts. It sketches out how the process can be
utilised as a valuable tool when preparing for revalidation. Number of
reflective models are used in different situations in practice and they must be
clear and coherent in order to assist thinking and to be proficient to the best
effect. Reflection gives nurses knowledge of understanding and critical
thinking in order to come to a conclusion and have an action plan for the near
future. It is important not to be bias when reflecting on events or issues but
to be totally honest and taking into account one’s values. Thompson and Pascal (2012) argued that reflective practice should be the
combination of both practice and theory due to the fact that it brings a more
fluid approach. In order to fit reflection in circumstances faced in practice,
there should be evidence based on research, knowledge and theory.


It is through
reflection that nurses begin to put together their personal values and beliefs
and learn from experience. Reflection is used in nursing to identify issues and
to improve practice and also to consider other alternatives (Ellis, 2017). Reflective is considered non-judgemental and is said to uphold
compassion, empathy and dignity. The fundamental element of reflective practice
is the participation of emotional moments with patients and it contributes to a
practice imbued with caring. (Goulet, Larue and Alderson, 2016)

Models of reflection focus on a
reflective cycle from experiences and they action plans and recommendations
towards the end of the cycle. The application of reflective practice should
involve role plays, case studies and simulations which tend to relate close to
reality. It is important to emphasise the importance of emotions in the process
of reflection (Husebo et al., 2015). A study conducted by
Lestander, Lehto and Engstrom (2016) suggested that it is important to reflect
upon experiences as this reinforce the learning and development of student
nurses which in turn support the idea of reflective practice. Experiences that
are difficult to be shared face to face could be reflected using written and
verbal reflections. Reflective practice increases student nurses’ confidence
and enlightens them to take into account action plan and to practice
effectively in the near future. Reflection encourages student nurses to learn
from their peers.

practice is constantly changing as it adds in the learning gained from
experiences. Reflective practice links events together and compares what is
already known and make a decisions on the basis of this comparison. Reflective
practice helps nurses to become expert practitioners due to the fact it
operates from a deep understanding of the total events. Reflective practice
could also be beneficial for patients and service users as it gives better
standards of patient safety and is focused on individual and also evidence
based care derived from their needs. (Jasper,





The NMC (2015)
provides guidelines that nurses must follow in order to be successful in their
career and also to be able to practice effectively. It is the duty of nurses to
implement and evaluate correctly the care that they are providing to patients.
Nurses should make sure that they are up to date with their skills and
constantly find a room to improve their practice.

need to be able to distinguish between their personal and professional values
and the standard behaviour when in practice. Nurses must put patients first
when delivering care and also to treat each person as an individual. Nurses
should treat patients with honesty, respect and dignity.

skills in the field of Nursing is essential for the nurse, patients and other
professionals as they focus on improving and building relationship. Nurses make
decisions everyday as part of their practice thus they should possess an
excellent critical thinking skills and the ability to make decisions. This will
in turn enhance the outcome of the care they are delivering.

The use
of reflection in Nursing is vital and should be adhered by nurses in order to
achieve a high quality of care and to improve patients’ conditions. Reflective
practice helps the nurse to develop both personal and professional areas.
Theorists such as Borton developed models which helps and support nurses while
reflecting in practice. Reflective practice is developed through a repetitive
demonstration while on practice.




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