Introduction

The wholesome purpose of this essay is to illustrate the application of NMC codes of
Professional Conduct with the use of the Gibbs reflective model. As per the NMC codes,
registered nurses and midwives have to follow professional standards whether they are giving
direct care to patients, communities, or groups, or bringing the professional skills and
knowledge to bear over their practice in other defined roles like research, education, or
leadership. It is necessary for the nurse to use the ethical and legal framework assuring
respect, confidentiality, and wellbeing for patient. It is a transitioning stage for the nurse from
being a student to attaining the role of a nurse. There was a sudden experience of a complex
nursing situation handling in the new profession of registered nurse. It is to learn from the
NMC codes that the nurse must act in a non-discriminatory and fair way respecting the
values, customs, and beliefs of the patient and providing best care that demonstrates
sensitivity. This is to learn the reflective practice being a deliberate and an active process for
critically examining the nursing practice. With reflection, the nurse challenge oneself through
self-inquiry. With this refection, one can analyze the experience and define how the nurse felt
and reacted and what all was positive or negative and what was learned actually. The Gibb's
reflective cycle permits the systematic and a structured analysis of the event. It is to learn that
success is not at all final, and failure is not at all fatal. It is one’s courage to continue what all
counts. As a new nurse, it is to attain myriad milestones. The nurse after collective sigh of
relief passing the licensure exam is not enough, this leads led to another milestone to focus on
securing the position and embarking the transition from newly licensed nurse toward the
advanced transition. It will not be smooth at all. This reflection presents an episode of care
where the nurse did make some mistakes and is at point of improving the skills and
proficiency on NMC codes.

The description of the episode of care is the first requirement. During the nurse’s in the …
ward in the morning, she was allocated to the bay of 6 patients by the mentor and all patients
were related to respiratory health problems. This episode of care is closer as it was one of the
most influencing, and the initial experiences during the transition period that presented the
nurse with great learning opportunities (MacLaren, 2018). The nurse focused on 3 patients
properly that surely defined that the nurse was able to properly prioritise people’s code of
NMC and this positively impacted another code of NMC to practise effectively (Sherwood &
Barnsteiner, 2017). The nurse was also bang on supporting and applying the code of
“preserving safety” in this episode of care. It is to reflect that the first responsibility of
handling multiple patients made the nurse nervous and tested the skills (Bryce, Foley &
Reeves, 2017). The NMC codes have been attained, but surely need to learn more. To
maintain the confidentiality and to protect patient identity, three patients have been named as
A, B and C. To assure that the most ill patients are handled first, the nurse took the handover
from the night staff who raised abnormal readings of 2 patients as patient A with hypotension
and patient B with hyperglycemia. The nurse reviewed their medication and vital stats to
define if the raised concerns are true priorities (Winter, 2017). Here, the first code of NMC
defines prioritising people/patients effectively by putting the interests of people/patients with
the use of nursing assessments and techniques (Bryce et al., 2017). The nurse recognized the
needs of all the patients under care through collaborative nursing approach to assure that the
nurse is prioritising the patients in the most appropriate medical format. The nurse assured
that the three patient’s social, physical, and psychological needs are properly assessed and
responded well (Gillen, 2015). It is also defined because prior beginning to do anything; the
nurse focused on prioritising care and began with the morning medication procedure under
supervision with the application of 5Rs (Semple & Cable, 2003).
There was a mixture of feelings with nervousness and excitement at a fluctuating rate. The
nurse might have felt nervous to manage and care three patients at once with two patients
with unstable vital stats (Nursing & Council, 2014). But, the nurse was also excited to handle
one of the key roles in profession as a registered nurse. This was the transitioning phase of
attaining proficiency. It is true that nursing is a rewarding profession, but handling this
episode of care was quite stressful (Carr, 2018). The nurse felt low on self-care as the nurse
was not able to get adequate nutrition, and rest while doing the duties (King, Tod & Sanders,
2017). The nurse felt out of control and anxious during verbal conflict when the other nurse
was not ready to accept mistake, though the nurse was talking calmly (Winter, 2017). The
transition is still going on, where the nurse has to learn several different aspects of effective
communication and escalation skills and techniques. The nurse is still evaluating the
professional practice against the NMC code and standards of registered nurse (Carr, 2018).
When the other nurse tried to get into conflicting situation, the nurse initially felt anxious and
little nervous because of no such experience before (Chadwick & Gallagher, 2016). The
nurse did not practically applied de-escalation strategies and conflict management techniques.
The mentor looked at the nurse and gave her a non-verbal cue to handle the situation with
calm (Nursing & Council, 2014). Thus, the nurse felt confident and little uplifted and
managed the situation without getting verbally uncontrollable and becoming aggressive.
Moreover, patient A also became little agitated once when the nurse tried to encourage the
patient to have some food and saline water (Kennedy, O'reilly, Fealy, Casey, Brady,
McNamara & Hegarty, 2015). Due to patient’s health issues and lack of openness in the
environment, the patient was quite stressed and had disturbed mood. This also made nurse
feeling little stressed once. But, the nurse strongly gathered the energy and continued
effectively (King et al., 2017).

It was essential to explore the positive and negative outcomes of this experience. It was a
necessary evaluation phase. The patient A was in a vulnerable position during the nursing
shift, and lack of adequate nursing administration, care and communication barriers, she was
quite agitated (Nursing & Council, 2015). The positive point was that the nurse applied
effective communication skills and her efforts paid good outcomes. The nurse was able to
resolve this issue with the support of her mentor and her critical thinking (Fisher, 2017).
Patient A was involved in the best solution she needs and mutually reached the conclusion. It
definitely took some time, but worth the efforts. Another positive thing experienced in this
episode of care is that patient B was culturally a diverse patient (King et al., 2017). She was
an Iranian and 65years old lady. She was quite stable in her vitally statistics and her insulin
dosage was administered as required because of her hyperglycaemic health problem (Curtis,
2014). But, she was hesitant to interact with the nurse and even was not making an eye
contact. The nurse noticed this and immediately analyzed patient’s record document and
found about her language problem in speaking English (Longtin, Sax, Leape, Sheridan,
Donaldson & Pittet, 2010). The nurse decided to involve non-verbal cues and gestures to
interact with her and to build up her confidence and relationship. It was good step because the
nurse was not known about Iranian language (Carr, 2018). Simultaneously, the nurse called
for interpreter to be in the ward as soon as plausible for making it easier for her to
communicate with health professionals. The nurse challenged her inner core towards the
Iranian religious beliefs and healthcare values (Nursing & Midwifery Council, 2015). Here,
the NMC code of practice effectively was again presented in this scenario. The nurse put in
her 100% to communicate with the patient clearly (MacLaren, 2018). She even made an
external search online to know about general healthcare terms Iranian people use and general
interactive phrases. She took reasonable steps in meeting her language needs with the
provision of an interpreter (Chadwick & Gallagher, 2016). The nurse paid heed to the cultural
sensitivities as much possible. The nurses did not speak much until and unless she was not
sure to avoid misunderstanding or any harm to patient B’s cultural values. She made use of
most simple English terms and sentences (Ion, Smith, Nimmo, Rice & McMillan, 2015). She
was surely able to act in a compassionate and a sensitive manner with strong affirmation to
her own beliefs of adhering to the Code of Professional Conduct. With the good side, the
nurse also encountered a bad side of this experience (Peate & Wild, 2018). Yes, it was more
of a learning experience for her as per observation. The nurse keep the negative aspects aside
because for a nurse everything moment in learning (Ion et al., 2015). It was when one of the
nursing colleagues went into verbal conflict with the nurse on a matter that was to be
discussed to ensure proper professional conduct (Whitehead, Owen, Henshaw, Beddingham
& Simmons, 2016). The nurse was dutiful to question her colleagues and stop them if they
are going against the professional ethics and duties. She simply followed the NMC code of
prioritise people (Rowe, 2017). The nurse was completely of the view that she needs to
assure that her patient’s social, physical, and psychological needs are properly assessed and
responded well. she paid attention to every factor that could have resulted in patient’s
hypotension issue (King et al., 2017). She recognized poor oral health to be factor in
promoting hypertension and compassionately communicated this with her colleague to make
her aware of the problem and resolve the issue collaboratively. But, the nurse behaved
unethically and against the professional norms (Whitehead et al., 2016). Patient A was
vulnerable and the nurse advocated for the patient and challenged the poor practice. The
nurse’s efforts end up into verbal conflict. She was not that experienced in handling this due
to lack of negotiable and conflict management skills. Rest of her experience was full of
enthusiasm and positivity (Nursing & Midwifery Council, 2015).

The whole situation has been analyzed and reflected over nurse’s actions and her
righteousness and effectiveness on NMC codes of professional conduct (Peate & Wild,
2018). For patient A, the nurse decided not to administer diuretics tablet even though it was
prescribed in medication chart, because patient A’s blood pressure was very low as per vital
signs. Diuretics decreases blood pressure (Moncur & Lovell, 2018). The nurse even informed
my decision to the nurse. The nurse tried to apply the NMC code of practicing effectively in
line with the best available evidence. The nurse also communicated the decision clearly to my
colleague and supervisor (Peate, 2018). Nurses are taught in the nursing studies that they
need to the best medical step to provide relief to the patient, no matter if the prescribed
medication has to be halted with valid reason. But, it needs to be documented and informed to
the immediate nursing supervisor and colleague (MacLaren, 2018). The nurse even stood
perfect on the NMC code of preserving safety by putting the action of not giving diuretics
without delay because the nurse believed that there was greater risk to patient A’s safety
(Nursing & Midwifery Council, 2015). Furthermore, the nurse assessed BM of patient B and
then administered the insulin dosage under supervision. After the medication round, the nurse
decided to conduct the assessment of every allotted patient (Gillen, 2015). The nurse first
assured that the nurse needs to be aware of the target saturation levels of every patient,
certainly the patients with the health issue of COPD (Skirbekk, Hem & Nortvedt, 2017).
They should have the target SpO2 level about 88-92%. The nurse assessment revealed that
Patient A was still hypotensive as her blood pressure reading was 92/54 mmHg (Skirbekk et
al., 2017). Further, the nurse investigated to the core and found that the patient had a poor
oral intake which can be contributing towards her hypotension (Sherwood & Barnsteiner,
2017). The nurse communicated this with the nurse who was on prior shift and the nurse took
me wrong and took my words against her nursing ability. This also led to verbal conflict. The
nurse was applying the NMC code of preserving safety for the patient (Snelling, 2016). The
nurse has learned and she was legally obliged to raise and escalate the concern about the
patient safety or the care level of people under her responsibility in the healthcare setting. The
nurse is ethically and professionally dutiful to make use of available channels for her
guidance and she did the same (Skirbekk, Hem & Nortvedt, 2017). The nurse tried to avoid
the verbal conflict and escalated the issue with her mentor (senior nurse/supervisor). The
nurse found that even the nurse who did not pay heed to patient A’s oral intake responded
lightly by stating that diet has nothing to do with patient’s hypotension and even the nurse
should not bother (Nursing & Council, 2014). The nurse is legally obliged to raise her
concerns immediately because the nurse was being asked to practise beyond her duty,
training, and experience (Traynor, Stone, Cook, Gould & Maben, 2014). The nurse tried to
communicate with the earlier nurse in a calm way and tried to make her aware of the duties
the nurses owe, but it end up into verbal conflict (Vaismoradi, Jordan & Kangasniemi, 2015).
It is analyzed that the nurse’s communication skills and escalation skills are underdeveloped
and she was not able to handle the situation effectively (Morton, Fontaine, Hudak & Gallo,
2017). After informing the authority, she encouraged patient A to drink salty water to try to
increase her blood pressure to reach the normal level. In the same episode, the nurse found
that patient C was having an abnormal heart rate with 168 beats per minute along with low
saturation of oxygen at 86% (Shepherd, 2016). The problematic thing was that patient C was
also suffering from COPD. Again, the nurse’s NMC code learning pushed her to inform it
immediately to the senior nurse and the nurse also escalated this matter to the Doctor (Peate
& Wild, 2018). The doctor immediately prescribed IV fluids for patient C and this helped in
increasing her rate of oxygen. The nursing skills and knowledge also pushed her to do
patient’s ECG. To keep everything stable for every patient under her duty of care, the nurse
monitored them frequently to keep track of their health and record any changes in the
observations (Vaismoradi, Jordan & Kangasniemi, 2015).

Conclusion of the episode of care-based experience is that the learned several new aspects of
nursing and this reflective helped the nurse in analysing her strengths and weaknesses. The
nurse has learned that she needs to focus on enhancing her ability to negotiate and be able to
reassure every person in the surrounding (Snelling, 2016). The nurse should have assessed
the cultural background of the patients before nursing or caring them. Thus, the nurse would
have called the interpreter before and prevented patient B’s shyness and non-communication
(Carr, 2018). The nurse effectively tried to work in interests of every patient under care and
professional around her. The nurse even tried to play the role of an advocate for the patient
(Vaismoradi et al., 2015). It could be stated that the nurse did fail somewhere as per analysis,
but the nurse is truly involved in learning fro every mistake and experience (Moncur &
Lovell, 2018). It is because nursing is consistently a transitional profession with new and
unique challenges with sudden occurrence and impact (Nursing & Midwifery Council, 2015).

It is right to apply the action plan for enhancing the skills that were lacking during this
episode of care. Irrespective of the location, the nurse needs to endeavour to be aware of the
possible issues that could arise because of the circumstance, or professionals’ misguidance or
misinterpretation (Nursing & Council, 2015). The nurse needs to enhance the communication
skills, escalation skills, conflict management skills, and teamwork skills. These are the
nurse’s key learning needs analyzed and demonstrated through the reflective practice
(Morgan & Parry, 2017). These learning needs must be attained within 6 months to have a
smooth transition. This is achievable through constant attending of workshops, certified
courses, in-depth research work, consistent training, mentorship, and handling more such
cases with supervision (King et al., 2017).

Conclusion
It is quite evident from the reflection that it is necessary to ensure best nursing professional
support and team work with most effective communication skills. At times, the nurse needs to
escalate the unprofessional conduct and make the situation effective with aligned skills and
abilities. This reflective essay has been valuable and is able to demonstrate the ethical
practice fully in compliance with the NMC codes in a fair and non-discriminatory manner. In
spite of the personal beliefs, the nurse was able to handle the culturally diverse patient in
standard and professionally appropriate manner. The nurse is willing to learn as much as she
can with full support and adherence. The essay clearly explored and analyzed the episode of
care of three patients with respiratory problems and the way nurse applied the NMC codes.

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Appendix

Reflective Account

What was the nature of the CPD activity and/or practice-related feedback and/or event
or experience in your practice?

I was allotted a bay of 6 patients by my mentor and I cared and handled 3 patients with
respiratory problems. 2 of the patients were having unstable vital statistics with the problem
of hypotension and hyperglycaemia respectively. I handled one patient from a culturally
diverse background with positive outcomes with the involvement of an interpreter and my
external search about the patient’s cultural values, general healthcare terms and phrases. I
even managed handling the patients with effective prioritisation, but when I escalated one of
the nurses’ unethical behaviour towards the hypotensive patient, this led to verbal conflict
where I was not able to negotiate properly and manage the situation. The mentorship support
and feedback was positive.

What did you learn from the CPD activity and/or feedback and/or event or experience
in your practice?

I learned that not all nurses are equal at acceptance level. One’s negotiation skills and conflict
management skills must be proficient to be a strong nurse and a nursing leader. The
transition from a nursing student to a registered nurse is not smooth and is fully challenging
with new milestones on way. I have learned that I need to assess every patient’s cultural
background prior caring them. I must be good at escalating the issues and be an effective
advocate for my patients.
How did you change or improve your practice as a result?

I am fully focused on enhancing my escalation/de-escalation skills, teamwork skills,

communication, and conflict management skills in next 6 months. I will be looking forward
for my mentor’s support and training. I will also attend the associated workshops and
seminars to attain the best skills to have a smooth transition in my nursing profession.

How is this relevant to the NMC Code?

Prioritise people- To put the interests of patients according their urgency and requirements. It
is to preserve patient’s dignity and respect and recognize their health needs at the best.

Practice effectively- The experience was to communicate clearly with the conflicting nurse
and to provide best language support for the culturally diverse patient. The entire case was
based on providing better understanding about patient and personal needs.

Preserving safety- I took steps to keep every patient safe and secure as much as possible with
my nursing practice skills by escalating the issue of poor oral intake of the patient due to
nurse’s negligence and ignorance.

Action Plan

Identify Strategy for Resources for Date Outcomes

learning achievement support for
needs Review

Escalation ▪ To learn to ▪ Internet 1st May ▪ Reduction in

skills document connection 2018 escalation
and de-brief incidences
the ▪ Mentorship
experiences support ▪ Proficiency in
and de-escalation
▪ Workshops skills
responses
during ▪ Funds to
escalation attend
situations workshops
within 1
▪ Online
month.
learning
▪ To attend 2 material
de-escalation
skills
workshop
within 2
 months.

▪ To study and
analyse 5
case studies
of escalation
procedures
during last 6
months
within 2
months.

Conflict ▪ Conflict ▪ Reflective 1st June ▪ Reduction in

management management journal 2018 workplace
skills skills and template/doc conflicts
techniques ument
training from ▪ Expertise in
mentor and ▪ Workshops conflict
senior nurse. management
▪ Funds for skills
▪ Attending 2 workshops
conflict ▪ Expertise in
▪ Mentor negotiable
management training and
skills skills
support
workshops ▪ Proficiency in
and 2 ▪ Cases reflective
seminars journal
within 3 maintaining
months. skills
▪ To handle
and resolve 2
conflict
management
cases in
nursing
within 1
month.

▪ To maintain
a reflective
journal and
analysis.
Teamwork ▪ Getting ▪ Social plan Monthl ▪ Efficient
skills involved in and y team work
more social activities review
activities like with team ▪ Efficient
some outing, members team spirit
informal ▪ Leading more
discussion ▪ Role-play
activities nursing teams
sessions, and
workplace ▪ Nursing ▪ Improvement
lunch team in team
together with projects performance
professionals
and ▪ Mentor
colleagues support
fortnightly.

▪ Participation
in role-play
activities
fortnightly.

▪ To lead 3
teams in
nursing area
every month.

Effective ▪ Getting ▪ Certified 1st April ▪ Certified in

communicati certified in course 2018 communicati
on skills communicati and on skills area
on skills and ▪ Reflective after
expertise journal every 2 ▪ Proficiency in
within 3 document/te months reflective
months. mplate thereaft journal
er maintenance
▪ To maintain ▪ Conference, skills
a reflective seminar,
journal. workshop ▪ Becoming a
public
▪ Attaining 3 ▪ Funds for speaker
experiences attending
of public ▪ Better
speaking n communicati
conferences, on with
seminars, or nursing
workshops colleagues
and
within 4 professionals
months.