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A Reflective Account of an Incident in Practice Related to the Code of Professional Conduct

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A Reflective Account of an Incident in Practice Related to the Code of Professional Conduct

This reflection identifies what I have learnt about the second shared
value from the NMC code of professional conduct:

“You must respect the patient/client as an individual, ensuring that
you promote and protect their interests and dignity irrespective of
cultural and religious beliefs” (NMC 2004).

I will make reference to one incident that I have experienced in
practice using the reflective framework adapted from Gibbs (1988).
Confidentiality will be maintained at all times.

During my placement I helped to care for a long term oncology patient,
admitted with his family in which mum was incredibly competent in
caring for her child, as well as being happy and respondent towards
the nursing staff on arrival. The family were settled into a room with
another family of the same religion, but immediately they closed the
curtains surrounding their bed. The curtains remained closed for the
remainder of the day, and the behaviour was attributed to the
anxieties of the family for their child. The situation over the
following days remained the same, and many of the nurses began to
spontaneously open the curtains. This caused an imminent change in the
family’s behaviour with them becoming increasingly more anxious and
very unresponsive towards myself and the nursing staff, a large
contrast to their mentality on arrival. This prompted me to speak to
mum to discover how she was feeling. She explained that she felt very
uncomfortable sharing a room with ‘that’ family due to her cultural
beliefs within their shared religion of Hinduism. The curtains
remained in situ for the remainder of their stay.

My initial thoughts when the family first closed the curtains were
that they were anxious about their child and simply wanted some
privacy, and when the nurses began to open the curtains I still agreed
with their actions. Allowing the child to remain in the dark all day
was not promoting empowerment of the patient back to good health.
After speaking to mum my feelings changed as it became apparent that
her anxieties were partly down to worries about her child, but notably
initiated from the cultural conflict she was feeling. These conflicts
were caused by the environment that we had placed her in and this
really disappointed me, that an important aspect of her life had been
overlooked. Upon reflection we had no respect for the family’s
autonomy and therefore failed to promote and protect the interests and
dignity of the patient/client irrespective of their cultural and
religious beliefs (NMC 2004).

As the family became withdrawn and unresponsive towards us I became
increasingly worried and upset that a simple lack of knowledge about
the families cultural beliefs was compromising the family centred care
I was striving to achieve. The lack of respect of the client as an
individual meant that care was being compromised:

“A client who experiences nursing care that fails to be reasonably
congruent with his beliefs and values will show signs of cultural
conflict, non-compliance or stress to ethical or moral concern”
(Leininger 1997 p.2-3).

After speaking to mum about her anxieties I felt reassured in my
ability to communicate effectively to diffuse the situation, and happy
that I was able to subsequently make a difference in the care I was
now able to give. The simple acknowledgement of the family’s distress
meant that I gained the understanding and compliance of mum and was
now able to promote justice, and respect the client as an individual.

If I could change the experience in any way I would have liked the
confidence to gain more insight about my families cultural preferences
on admission, therefore avoiding stereotyping them into one particular
religion, causing the subsequent withdrawal of the family that
compromised care.

“When you are caring for a patient from a different culture from your
own you need to respect his cultural preferences and beliefs otherwise
they may consider you to be insensitive and indifferent, possibly even
incompetent” (Lippincott et.al 2005 p.1).

I believe that my family perceived us to be incompetent due to their
non-compliance with care, and if we had not assumed that all members
of the Hindu religion all act and behave in the same way we would have
avoided stereotyping and thus adhered to the code of professional
conduct, respecting the client as an individual. Goold (2001 p.1-2)
states that “everyone has the right to be treated differently, because
treating people the same can be seen as discriminating”. Failing to
recognise their cultural beliefs meant we failed to promote the
interests of my client.

This experience prompted me to research further into Hinduism and the
cultural aspects involved, and has given me the understanding of how
stereotyping people into particular religions can have detrimental
effects on care. Within Hinduism “a caste system exists which divides
society into four social classes, inherited at birth due to karma”
(Bungalia et.al 2003 p1-2). My family were of a higher class and were
therefore in cultural conflict having to share a room with a lower
class family, which culturally they are forbidden to do. We failed to
acknowledge these cultural issues but learning about them has enabled
me to become more beneficent within my nursing care, making it my
responsibility to respect the client as an individual. From this I
have realised that it is incredibly important to establish a good
rapport with my clients in order to give individualised holistic care,
adhering to the code of professional conduct.

In the future I aim to apply the knowledge that I have acquired to
provide more competent, individualised care using in depth assessments
on admission, allowing me to become more sensitive to cultural
diversity.

“The best way to avoid stereotyping is to view each patient as an
individual and to find out cultural preferences using a culture
assessment tool to discover and document them for other members of the
health care team” (Lippincott 2005 p1).

I am encouraged by the number of tools proposed, one example being the
ACCESS model (Narayansamy 1999) which promotes sensitivity towards
patient’s individual cultural/religious and spiritual needs.

Reflection within the code of professional conduct has helped me to
apply my knowledge and a skill in practice to the competencies set out
by the code of conduct, and has allowed me to identify gaps in my
knowledge. It is incredibly important to promote clients as
individuals in order to give competent care. Not respecting clients
cultural values compromises care and takes away client autonomy.

References:

BHUNGAlIA, S, KELLY, T, VAN DE KEIFT, S and YOUNG, M. (2005) Indian
health care beliefs and practices. Indians. Baylor university, Texas (updated
09/2004, accessed 06/2005).

CAMPINHA-BACOTE, J. (2003) Cultural desire: the key to unlocking
cultural competence. Journal of nursing education, 42(6), pp.239-240.

GIBBS, G. (1988) Learning by doing: A guide to teaching and learning
methods. Further education unit: Oxford Brookes University.

GOOLD, S. (2001) Transcultural nursing: can we meet the challenge of
caring for the Australian indigenous person? Journal of transcultural
nursing, 12(2), pp.94-99.

JUNTUNEN, A, DEPARTMENT OF NURSING HEALTH AND ADMINISTRATION (2001).
Professional and lay care in the Tanzanian village of
Ilembula-Leiningers culture care theory. University of Oulu(accessed
06/2005).

LIPPINCOTT, WILLIAMS and WILKINS (2005) Understanding transcultural
nursing, career directory supplement. Nursing, 35(25), pp.14-23.

NARAYANASAMY, A. (1999) ASSET: a model for actioning spirituality and
spiritual care education and training in nursing. Nurse education
today, 19(4), pp.274-285.

NURSING AND MIDWIFERY COUNCIL (2004) Code of Professional conduct.

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