George Brown College, School of Nursing

Practical Nursing Program

Reflective Journal Recordings
Student ID# Clinical Instructor Rani Thakoordeen Date .
Professional Standard Select 1 professional standard from CNO professional standards with 1 indicator that relates to the described event (E.g. Accountability,
5a: found in clinical performance evaluation tool):
Standard: Ethics
Indicator: Identifying ethical issues and communicating them to the health care team
LEARN framework: Look back, elaborate and describe: Look back at a recent meaningful and relevant practice event that you personally experienced within
the last 2 weeks. Briefly describe what happened: experience, event or change in your practice that was significant to you. Analyze the outcomes: Identify key
issues then compare and contrast the situation with what you have learned in nursing. Use supporting scholarly nursing literature. Revise the approach: Based
on the analysis, decide what you will continue to do and what you will change in the future. New perspective: What is your learning plan with defined actions
or strategies for the practice improvement?
Look back: After watching the CNO videos on abuse prevention, the part that really stood out to me was when one of the nurses said that nonverbal abuse is
not always easily identifiable but it is, however, as abusive as anything else we would deem as abuse. The nurses went on to discuss the importance of reporting
such incidents when they occur, whether that is by advocating for the person being abused in the moment or reporting afterwards to a larger regulatory body
such as the CNO. This is a matter of ethics. Abuse is an ethical issue that needs to be identified and communicated to the health care team.

Elaborate: Abuse comes in many forms. It is easy to identify the outwardly obvious forms of abuse that may include some sort of physical altercation or verbal
assault which would likely be faced with condemnation and consequence in any workplace. It is often the more subtle forms of abuse such as neglect and
nonverbal behaviour that can be overlooked but can be just as hurtful and damaging. The CNO defines abuse as the misuse of power or the betrayal of trust,
respect or intimacy in the therapeutic relationship and they define the different types of abuse as neglect, physical, verbal/emotional, financial or sexual (CNO,
2011). I resonated with the nurse in the video who told the story about the morbidly obese client who needed to have two beds soldered together. She said she’d
never seen a client receive abuse to that extent before and it’s a case that sticks with her that she keeps coming back to years later and she wishes she had done
more in the moment. The health care team was giving the client looks and constantly making comments and jokes but the nurse didn’t participate because she
knew it was wrong. At the time, she felt she did enough and was not guilty because she didn’t participate but she said if she could go back she would do things
much differently, because she now knows that being a bystander who does nothing is no better than being the person who is being abusive. This story resonated
with me because it is not uncommon and I have found myself in similar situations before. It can sometimes be easier to tell yourself, “it’s better to not get
involved”, or “it’s not my business”, but when it comes to abuse, the easy way is not the ethical way.

Analyze: The CNO states that “nurses, as self-regulated professionals, implicitly promise to provide safe, ethical care, and nurses are obliged to refrain from
abandoning, abusing or neglecting clients, and to provide empathetic and knowledgeable care” (CNO, 2019). This statement stands out for me because I
compare it to how I mentioned previously that I resonated with the nurses’ story because I have found myself in similar situations. The difference is that the
similar situations I found myself in happened before I made the decision to pursue a career in nursing, which doesn’t make it better or okay and it’s still
something I’d like to improve upon, but it didn’t happen in a professional health care setting where I implicitly promised to uphold certain practice standards. As
a nurse who belongs to the CNO and holds a license to practice, there are certain expectations and practice standards that one needs to adhere to and promote.
Making the decision to not speak up for or advocate for a client who is being abused because you do not want to get involved or because it is the easier thing to
do, is no longer ethical or acceptable.

Revise: The CNO document for the practice standard of ethics recommends using the nursing process to work through ethical situations in nursing practice.
They say that it is a viable approach for examining situations involving ethical values due to its familiarity to nurses (CNO, 2019). This approach can be a
helpful tool to implement when confronted with a situation involving abuse while practicing because sometimes, especially when confronted with abuse that is
S121 Reflective Journal Recording for ALL Semesters Revised 2018-2019
 George Brown College, School of Nursing
Practical Nursing Program
Reflective Journal Recordings
less outwardly identifiable such as neglect, emotional and nonverbal abuse, it can be difficult to precisely identify the issues causing the ethical situation due to
the fact that they may be complex, moral and value laden situations that are not easily understood and dealt with (CNO, 2019). The approach recommends
beginning by performing an assessment/description of the situation that clearly states the ethical concern regarding the abuse that has occurred and to pay close
attention to all aspects of the situation, taking into account clients’ beliefs, values, wishes and ethnocultural backgrounds and to examine not only your beliefs,
values and knowledge, but also those of others (CNO, 2019). The nurse would then develop an action plan that takes into account factors drawn from the
assessment, options and consequences and implement those plans by carrying out the actions with the sensitivity, good communication and interpersonal skills
necessary while keeping all who are affected informed (CNO, 2019). The last step in the process is evaluating the outcome. When faced with an ethical situation
involving abuse and all of the other steps previously mentioned have been followed, it is important to determine if the result was satisfactory and to reassess and
re-plan if the results were unsatisfactory. For example, you’ve witnessed abuse towards a client from another nurse and you advocate for the client in the
moment but the other nurse does not react well to your intervention. In this situation, you will need to determine what are the next steps in resolving this
conflict. These situations and the following processes can happen very quickly while taking place in the moment when you’ve decided to take action and not
participate as a bystander and many ethical dilemmas occur when there is not enough time to consider the issues properly (CNO, 2019). This is why it is
important to consider policies and guidelines for subsequent situations and decisions, and revise them as necessary (CNO, 2019).

New Perspective: Doing this reflection will now be a part of my ethical foundation and be something I will have behind me when a situation involving abuse
arises that will give me the courage to advocate for the person being abused or to report the situation. At the end of the day, it’s all about delivering the best
client-centered care possible and that is done by developing a therapeutic nurse-client relationship and advocating for your client, which may sometimes involve
identifying complex ethical issues and communicating them to the health care team.

References:
College of Nurses of Ontario (2019). Ethics. CNO. Retrieved Feburary 5, 2022, from https://www.cno.org/globalassets/docs/prac/41034_ethics.pdf.

College of Nurses of Ontario (2011). Preventing client abuse. CNO. Retrieved Feburary 5, 2022, from https://www.cno.org/globalassets/docs/ih/47008_fspreventabuse.pdf.

College of Nurses of Ontario (2018). Professional standards, revised 2002. CNO. Retrieved Feburary 5, 2022, from https://www.cno.org/globalassets/docs/prac/41006_profstds.pdf.
Self- Evaluation: Outstanding, Competent, Acceptable, Unacceptable, Unsafe: Competent

Clinical Instructor’s feedback and recommendations related to your self-reflection and your performance in clinical:

I have reviewed the Clinical Instructor’s comments _____ (initial)

Over the term, the student should address all competencies from the semester clinical evaluation tool.

S121 Reflective Journal Recording for ALL Semesters Revised 2018-2019