Reflection on a Homecare Patient Who Refused Alternative Treatment to Speed Up the Process of Wound Healing

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Reflective Learning Practice in Health Professional Development

Reflective learning practice is one of the core components of health professional development. Without reflective practice, self-growth and learning not only becomes harder but also may lead to job dissatisfaction (Steven, 2016). Reflective learning practice helps to improve critical thinking skills and future performance (Taylor, 2017). The reflective incidence discussed in this essay focuses on a homecare patient who refused alternative treatment to speed up the process of wound healing. Confidentiality has been preserved by removing identifiable information such as place and names. Rolfe Jasper and Freshwater 2011 reflective framework is used to exploring and analysing the incident. Other factors addressed in the essay include managing risk/safe nursing practice, how to incorporate Person-centred care and a summary of my learning from reflecting upon the incident.

Description of the Incident (What)

One of the events that I attended while at the district nursing involved a patient who had been diagnosed with Type 2 diabetes 14 years prior and had recently experienced high levels of body swelling. For close to 10 years the patient experienced multiple chronic wounds near his clavicle on the left shoulder. The wound had remained untreated for quite a long time making it become necrotic and producing foul-smell. However, the patient had decided to seek out professional care at a hospital and was then discharged for home care. The medical records also showed that he was also suffering from severe red blotches and edema.

Incident Management (How)

During a regular visit to the patient's home, I was asked by my mentor Nurse K to change the dressing on the wound. However, when the patient saw that I was instituting the new method of treatment he vehemently refused and became violent. I could hear the patient saying that "I will not take up that kind of treatment because it has and will never work for me, it is expensive and that my family members have advised me not to." The patient did not like this particular dressing and thought that the situation would only get worse. At first, I tried calming him down and suggested to him that using the dressing will help prevent infection and thus speed up the process of healing, but he did not want to continue listening to what I was telling him. He also refused to take painkillers to lessen the pain.

Managing Violence at the Workplace

Registered nurses are more prone to experiencing violence at the workplace (Stevenson, Jack, & O'Mara, 2015). According to Yoo, Suh, & Lee, 2018, a nurse should get away from a verbally violent patient to avoid making the situation worse As a skilled professional, I noted the situation was escalating and I needed to get away for some time to give the patient physical and emotional space. Hardwood (2017) states that when a situation gets difficult, a nurse needs to de-escalate it. After a while, I returned being calm and friendly asking the patient to suggest on what they wanted to be done. Fortunately, the patient was also calm and explained that he was only angry since he had been using the medicine for an extended period of time without any progress. Nurses ought to admit making mistakes to avoid accusations (Durham, 2015). I acknowledged the mistake that had been made and reassured the patient that the current treatment was reliable. I used positive language and avoided making any accusations. The use of language is crucial in managing crises such as the one in this scenario (Rezende & Oliveira, 2015). Throughout the encounter, I maintained my anger and struggled to promote collaboration with the patient (Ramacciati & Ceccagnoli, 2015). He later accepted the dressing and although the rejection by the patient made me feel sorry, I realized that I needed to find a solution that will be helpful for the patient. It was then that I decided to report back to my manager/mentor about the incident.

Discussion on Lessons Learned (So What)

The incidence taught me that establishing effective relationships with clients is paramount in ensuring the success of a treatment procedure. The patient had unsuccessfully gone through several other treatments thus had gradually developed a negative perception towards medication. I understood that the model of care I was using was important in enabling desired clinical outcomes, however, when the patient rejected the medication, I still considered him vulnerable, in a professional sense, and thus offered in greater protection.

Although the patient was violent and unfriendly, I maintained a positive attitude and tried to calm him down. According to Ghadiriran, Salsali, and Cheraghi (2014), keeping a positive attitude is vital in promoting patient adherence to treatment (p.4). The violent reaction from the patient taught me how to approach and help patients who feel hopeless. At the time when the incident was occurring, I was thinking that I am providing an effective intervention to the patient's ailment. While it was my mentor's decision to use saline and ... as part of the wound dressing intervention, I also knew that there is substantive evidence that recommends its use. However, there is a risk of ...

Promoting Professionalism and Patient-Centered Care

According to Jasper, Rolfe, and Freshwater (2001), to promote professionalism, practitioners need to give the best possible care to clients or patients (Jasper, 2001). The professional duty of a nurse is to not only explain the benefits and side effects of an intervention to patients but also collaborate with other professionals and the patient to come up with sustainable solutions that are informed by the tenets of patient-centered care (Fredericks, Lapum, and Hui, 2015, p.396). I made sure that I explained the benefit of the treatment to the patient in consultation with my mentor. To reduce patient vulnerability, I ensured that I had established coordinative care, ancillary services, and frontline patient care together with my mentor.

Patient-Centred Care and Involving Family

Anyone working in healthcare will attest that patient-centered care significantly contributes to the promotion of quick patient recovery (Rosewilliam, Sintler, Pandyan, Skelton, & Roskell, 2015). During such incidences, respecting patient preferences is imperative. Patients have unique choices and values which need to be integrated into the overall patient care to promote autonomy, dignity, and respect (Oakley, Rebecca and Holbery, 2018, p.S3). Although I tried to inform and educate the patient about the importance of the medical intervention that he had rejected, I did not adequately give him time to express his worries and dislikes. To counter such fears, I should have provided precise information on his clinical status, the process of care, progress, and prognosis, and information to facilitate self-care, autonomy, and health promotions.

Ensuring Physical Comfort and Patient Safety

When providing patient-centered care, it is vital to ensure the physical comfort of the patient because it significantly impacts their experience (Delaney, 2017, p.119). The home surrounding was friendly and comfortable for the patient. I also made sure that I assisted him during movement or repositioning. However, his refusal to take pain management medication disturbed my conscience. Therefore, the knowledge that I can bring to the similar situation is providing emotional support and psychological counseling. By offering him alternative options and guiding him about the importance of the dressing, the patient was able to accept the procedures.

Ethical Analysis and Patient Decision-Making

An ethical analysis of the situation will mean that a health practitioner should invoke the principle of beneficence. According to NHS UK, medical practitioners should endeavor to act in the best interest of the patient by preventing harm, promoting good, and removing harm (NHS UK, 2018). In the delivery of care, injuries to be avoided or mitigated include suffering and pain, disability, and disease. When applying this principle, I was able to determine whether or not the medical intervention would remove or prevent harm and promote good for the patient. However, I realized that while I thought it was necessary to dress the patient, I encountered resistance both from the patient and his family members. The family members believed that the good for their loved one was not to use that kind of dressing.

Involving Family and Autonomy

Patient-centered care underlines the importance of involving friends and family in the patient experience (Delaney, 2017, p.119). Therefore, the family members and close relatives and friend are vital stakeholders in patient care decision making, supporting the sick, and providing resources to enable accessibility and adherence to treatment. During the incident, the family dimension of patient-centered care was not adequately applied.

Promoting Patient Safety and Adherence

Another issue that arose from the situation is the controversy about who is capable of making the clinical decision. According to the principle of autonomy, patients have a right to retain control over his or her body. Thus, any actions that attempt to coerce or persuade the patient into making a choice violates the principle (SJU, 2018). Because it was a home visit, and that the patient caregivers and family members were present, seeking their views was paramount. The reason that the patient gave when declining the medication was that it had never worked for him and that he had been advised by the family not to take it. However, I thought that it was necessary to use the dressing to ensure quick recovery of the patient. The principle of respect for autonomy requires that capable patients must be allowed to refuse or accept the recommended medical intervention. In evaluating the patient capacity, it was evident that he can decide on his own. However, his judgment was not fully guided by reliable evidence.

Promoting Patient Safety and Education

Wound care requires the integration of effective patient safety practices (Franks, 2016). Factors that affected the patient safety included hygiene change in balance and pain management (Sood, Granick, Tomaselli 2014, p.520). Therefore, I encouraged him to reposition regularly and always ask for assistance from family members when moving. I evaluated with updated patient compliance and realized that non-adherence was mainly due to financial concerns and perceptions rather than unwillingness to comply. Discussing with caregivers about improving the patient's hygiene and social environment was also vital towards promoting patient safety.


The incident provided a practical learning opportunity for me, my education progress, and my future career. The patient expressed a feeling of vulnerability and powerlessness. Thus, proper coordination of care can significantly help in alleviating such feelings. I was able to learn that patient care is a multifaceted process involving several factors the most important one being the patient-centered approach. When advancing patient-centered approaches, healthcare providers need to establish a continuous relationship with patients and families and ensure that patient's needs, wants, and preferences are respected. However, various factors such as perceptions, attitudes, and finances can impede a patient's judgment hence affecting their adherence to treatment. Therefore, patients and their caregivers need education and support to make a decision and participate in healthcare. The care should not only be coordinated and committed to quality and safety but also accessible.


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October 13, 2023

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