UNIVERSITY OF CAPE COAST

COLLEGE OF HEALTH AND ALLIED SCIENCES

SCHOOL OF NURSING AND MIDWIFERY

BSC MIDWIFERY

LEVEL 400

FIRST SEMESTER

2023/2024 ACADEMIC YEAR

NUR418: COMMUNITY/ PUBLIC HEALTH PRACTICE

TOPIC: A REFLECTIVE JOURNAL

BY:

MARY TAKYI NYARKOA

INDEX NUMBER: SN/MDF/MHH/22/0003

SEPTEMBER, 2024
REFLECTIVE WRITING ON A PUBLIC HEALTH NURSE NOT PROVIDING
EDUCATION OR INFORMATION ON SIDE OR ADVERSE EFFECTS OF
HORMONAL FAMILY PLANNING TO A CLIENT.
INTRODUCTION

Reflection is considered as an effective way in increasing teachers ability to present good

learning material, build better teacher-student relationship and also develop classroom
management skills ( Ahmadi & Yanuarti ,2020, March).

A reflective diary is a type of diary in which students express their honesty, self-discovery,
and self-improvement in order to improve their learning practice quality (Sudirman,
Gemilang, & Kristanto, 2021).

A reflective diary can gain students’ perspectives by expressing and sharing what they have
been through during the lessons as writing can store aide-memoires, present arguments,
demonstrate knowledge and explicate experiences ( Ahmadi & Yanuarti ,2020, March).

The reflective writing also motivates students to improve their learning. By encouraging
students to write their own journals or diaries, students can understand their own problems
during the lessons, pay attention to the lessons, increase their memories about the subject and
the teacher does not have to ask her students one by one (Ahmadi & Yanuarti ,2020, March)

According to Sudirman, Gemilang, & Kristanto (2021), reflective journals were useful for
students to make critical reflections and self-discovery responses to writing topics. The
students learned to focus on writing components such as order, unity, coherence,
cohesiveness, content, and organization of ideas through reflective journal writing. Writing a
reflective journal necessitated their ability to reformulate thoughts, provide details, and solve
problems.

Self-reflection helps students to express emotions and feelings to reliving and to identifying
problems and also, to understanding themselves better. Further research should be focused on
the importance of the students' self-reflections in their professional and personal growth
(Reljić, Pajnkihar & Fekonja, 2019).

As I embark on this reflective diary, I find myself drawn to profound avenues of care and
compassion intricately woven into tapestry of the experiences I have shared with people in
the community. This collection of reflections serves as a testament to the deeply impactful
journey of providing care for people in the community. Each encounter I had has left an
indelible imprint on my professional and personal narrative,

Within these pages, each reflection serves as a testament to the profound responsibility and
priviledge of providing compassionate, informed, and holistic care to the public. Through
these narratives, I seek to unravel the layers of empathy, understanding, and insights that have
germinated from these moments, gifting me with wisdom, humility, and an enriched
understanding of human experiences.

This assignment forms part of the academic and professional requirements of the student
midwife of the University of Cape Coast. As expected by the student midwife, she is to
undertake a clinical attachment in her facility at the Public Health Unit . The student is also
expected to have practical experiences under the guidance of a specialist in their areas of
speciality This is to enable the student midwife to put into practice the knowledge obtained in
the classroom. Gibbs Reflective Model was used for the reflection of experiences. This
clinical practice took place at the Volta Regional Hospital, Hohoe. The hospital is a regional
hospital located in Hohoe, Volta Region. It started on the 5th of April, 1935 as a small clinic
by a son of a German missionary, Dr. Huppenhaver. The clinic was officially commissioned
as a hospital on 21st December, 1952 by the late DR. Kwame Nkrumah with 40 beds and 6
cots. Since then , a lot of development have taken place in the hospital. Presently, the hospital
has a bed capacity of 178 and also serves as a referral facility for very ill patients from other
clinics, health centers and hospital within and outside the municipality ( neighboring regions
inclusive) . The facility also receives patients from Togo. It’s vision is “ Excellent Health
Care Delivery, Healthy Life For All”. It’s Mission is to provide a 24 hour quality health care
services to exceed the expectations of their clients. The clinical practicum started on 5 th
August ,2024 and ended on 15th September, 2024 under the preceptorship of Mrs Evelyn
Morkli.

During my clinical practice at the Public Health Unit, I aimed to achieve four key objectives:
1.Gain experience in conducting health assessments, screenings, and patient education in a
public health settings.
2. Develop and deliver a health education workshop on a specific public health topic such as
mental health and sexually transmitted infection prevention.
3.Gain insights into the challenges and opportunities facing public health in the current
context.
4. Develop a deeper understanding of the public health system and the role of public health
professionals in promoting community health.
Through a varieties of learning activities including clinical presentations, observations,
assignments and discussion, l started the journey of learning, acquiring knowledge, shaping
attitude and developing my practical skills

This write-up is about observing a public health nurse not providing comprehensive
information about the side effects of hormonal family planning method to a client.

Providing information about the side effects or adverse effects is essential for patient safety,
informed decision-making, legal and ethical compliance, and overall medication safety. It
empowers patients to make informed choices, manage their health effectively, and work
collaboratively with their healthcare providers.

Patients need to be aware of potential side effects to proactively manage their health. This
allows them to recognize early warning signs, seek timely medical attention, and potentially
avoid complications. Knowledge of potential risks enables patients to make informed
decisions about whether the benefits of a drug outweigh the risks for their individual
situation. Understanding potential side effects can increase patient adherence to treatment. If
patients know what to expect, they are more likely to continue taking medications as
prescribed.

Providing information allows for a more collaborative approach to treatment decisions.

Patients can discuss their concerns and preferences with their healthcare providers, leading to
more personalized care. Patients can weigh the potential benefits of a drug against the risks,
allowing them to make an informed choice about whether the treatment is right for them.

Providing information about side effects is a fundamental part of obtaining informed consent.
Patients have the right to know the potential risks and benefits of any treatment before
making a decision.

Healthcare providers have a legal and ethical obligation to ensure that patients are fully
informed about the potential side effects of medications.
CHAPTER ONE

This chapter reviews relevant literature on the concepts pertaining to providing

comprehensive information about side effects or adverse effects.

LITERATURE REVIEW

It has been known that adverse effects represent the main factors in determining acceptability
and compliance with any hormonal contraceptive method ( Sabatini, Cagiano, & Rabe, 2011).

Gillam et al ( 2011), states that educating patients or providing comprehensive information

about side effects is an ongoing nursing responsibility . The intervention is intended to
significantly increase patient awareness on side effects or adverse effects.

Providing information about the side effects is essential for patient safety, informed decision-
making, legal and ethical compliance, and overall medication safety. It empowers patients to
make informed choices, manage their health effectively, and work collaboratively with their
healthcare providers.

The Nursing and Midwifery Council of Ghana code of professional conduct (2004, section 8)
states that as a nurse “ you must act to identify and minimise the risk to patients and clients”.
As a student midwife learning how to provide family planning services under my mentor’s
supervision, this also applies to my own practice.

REFLECTIVE WRITING ON PRACTICUM LEARNING EXPERIENCES

This reflective diary aims to provide detailed account of services provided to the people by

the public health professionals. The diary will focus on how a public health nurse did not

provide a comprehensive information on side and adverse effects of hormonal family

planning. As a health professional, I have had the privilege to observe this incident.

DATE: 8/8/2024
What happened:

On 8th August, 2024 at 10:00am, Madam A.M, a 30 year old Para 2 all alive, arrived at the
Public Health Unit beaming with smiles. She was warmly welcomed and made comfortable.
Her purpose of visit was to access family planning services. I was working under the
supervision of my mentor, observing how to provide various family planning method. I
observed a public health nurse providing Madam A.M with information about hormonal
family planning methods. The nurse briefly explained the various options but failed to discuss
potential side effects in detail. Madam A.M, visibly hesitant, asked about possible risks
associated with the chosen method, but the nurse simply reassured her that it was safe and
effective without delving into specifics.

What were you thinking and feeling:

I felt a sense of unease and disappointment. The public health nurse’s lack of thoroughness in
explaining potential side effects felt irresponsible and undermined the client’s right to
informed decision-making. I felt concerned for the client, who seemed to be left with
unanswered questions and potential anxiety. I also felt a sense of frustration, as the interaction
highlighted a missed opportunity for empowering the client to make a truly informed choice.
I could not approached the nurse during her interaction with the client but confidently
approached her after the client had left. I took her aside and spoke to her about the
importance of providing comprehensive information about side and effects of the hormonal
family planning and she assured me of not repeating same mistake again.

What was good and bad about the experience:

Good:
• The nurse provided information about the different options available, allowing the client to
explore her choices.

Bad:

• The nurse’s lack of transparency about potential side effects or adverse effects undermined
informed consent and left the client feeling uncertain and potentially misinformed.

• The nurse’s approach prioritized efficiency over patient education and understanding,
neglecting the client’s right to comprehensive information.

What sense can you make out of the experience:

Gillam et al (2011), states that educating patients or providing comprehensive information

about side effects is an ongoing nursing responsibility. The intervention is intended to
significantly increase patient awareness on side effects or adverse effects.

Providing information about the side effects is essential for patient safety, informed decision-
making, legal and ethical compliance, and overall medication safety. It empowers patients to
make informed choices, manage their health effectively, and work collaboratively with their
healthcare providers.

The Nursing and Midwifery Council of Ghana code of professional conduct (2004, section 8)
states that as a nurse “you must act to identify and minimise the risk to patients and clients”.
As a student midwife learning how to provide family planning services under my mentor’s
supervision, this also applies to my own practice.

This experience highlighted the critical importance of thorough and transparent

communication in healthcare. It shows the need for healthcare professionals to provide
patients with comprehensive information about potential benefits and risks, allowing them to
make informed decisions that align with their personal values and preferences. This incident
also revealed a potential gap in the nurse’s understanding of patient-centered care and the
importance of empowering clients through education and open dialogue. This experience has
taught me the importance of acting assertively with colleagues in a sensitive and respectful
manner, in order to safeguard patient’s well-being.

What else could you have done:

At the time, I was an observer and didn’t feel comfortable intervening directly. However, I
could have:

• Offered to provide additional resources such as brochures and information to Madam A.M
after the consultation, ensuring she had access to comprehensive information about the
chosen method.

• Approached the nurse in a respectful manner during the interaction with Madam A.M,
expressing my concerns about the lack of detailed education and highlighting the importance
of patient-centered care and asking her to offer me the privilege to continue with the
education given to Madam A.M.

If it arose again, what could you do:

• Directly engage in the conversation, offering to provide the client with detailed information
about potential side effects and addressing her concerns openly.

• Advocate for the nurse to revisit the discussion with the client, ensuring she receives
comprehensive information and feels confident in her decision.

• Highlight the importance of informed consent and comprehensive education during staff
training and discussions, emphasizing the need for patient-centered communication in
healthcare.

CONCLUSION

This experience has reinforced my commitment to patient advocacy and informed decision-
making. I recognize the critical role that healthcare professionals play in providing accurate
and comprehensive information, empowering patients to make informed choices about their
healthcare. I will strive to promote a culture of open communication and patient-centered
care, advocating for thorough education and empowering patients to take control of their
health.

ACTION PLANS

I will advocate for mandatory training for all healthcare professionals on education and
communication strategies, particularly during provision of family planning services. I will
strive to adopt a patient-centered approach in my own practice, actively engaging with
patients, addressing their concerns, and providing comprehensive information. I will also
identify and utilize readily available resources like brochures to provide patients with
additional information about family planning services and potential side effects.

REFERENCE

Chebet, J. J., McMahon, S. A., Greenspan, J. A., Mosha, I. H., Callaghan-Koru, J. A.,
Killewo, J., ... & Winch, P. J. (2015). “Every method seems to have its problems”-
Perspectives on side effects of hormonal contraceptives in Morogoro Region, Tanzania. BMC
Women's Health, 15, 1-12.
Sabatini, R., Cagiano, R., & Rabe, T. (2011). Adverse effects of hormonal contraception.
Journal für Reproduktionsmedizin und Endokrinologie-Journal of Reproductive Medicine
and Endocrinology, 8(1), 130-156.

Gillam, S. W., Gillam, A. R., Casler, T. L., & Curcio, K. (2016). Education for medications
and side effects: a two part mechanism for improving the patient experience. Applied Nursing
Research, 31, 72-78.

Nursing and Midwifery Council (2004). The Nursing and Midwifery Council code for
Professional Conduct : Standard for Conduct, Performance and Ethics London: Nursing and
Midwifery Council.

Ahmadi, D., & Yanuarti, E. (2020, March). Reflective writing: Students’ diaries to improve
the teaching and learning process. In 2nd Social and Humaniora Research Symposium
(SoRes 2019) (pp. 521-524). Atlantis Press.

Reljić, N. M., Pajnkihar, M., & Fekonja, Z. (2019). Self-reflection during first clinical
practice: The experiences of nursing students. Nurse education today, 72, 61-66.

Sudirman, A., Gemilang, A. V., & Kristanto, T. M. A. (2021). The power of reflective journal
writing for university students from the EFL perspective. Studies in English
Language and Education, 8(3), 1061-1079.