Reflective Practice; End of Life Care and Assertiveness
反思性实践；生命终结与自信
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医疗report代写 This reflection will be focusing on my experience and skill as a nurse in providing holistic care and End of Life Care during my..
[Author's Note] 医疗report代写
Reflective Practice; End of Life Care and Assertiveness
Reflection One
This reflection will be focusing on my experience and skill as a nurse in providing holistic care and End of Life Care during my clinical placement. In the reflection, I will apply Rolfe's reflection model.End of Life Care (EOL) for "Andrew"Several clinical methods have been suggested to help EOL patients have a less traumatic and painful death experience.
All through execution of these techniques, I must engage in deep thought in accordance with Rolfe's reflection model, which involves the questions "What?", "So What?" and Now What?" (Nelumbu, 2015). This reflection model appealed to me because it is simple and straightforward to apply in clinical settings.
译文：[作者注]
反思性实践； 生命终结与自信
反思一
这种思考将侧重于我在临床实习期间作为护士提供整体护理和生命终止护理的经验和技能。 在反思中，我将应用Rolfe的反思模型。针对“ Andrew”的生命终止（EOL）建议采用多种临床方法来帮助EOL患者减少创伤和痛苦的死亡体验。
在执行这些技术的过程中，我必须按照罗尔夫的反思模型进行深入的思考，该模型涉及以下问题：“什么？”，“那又是什么？”。 而现在呢？”（Nelumbu，2015年）。这种反射模型之所以吸引我，是因为它在临床环境中应用起来既简单又直接。
Essentially,
the "What" aspect of this case relates to the situation I encountered during my placement. In this case, I was assigned to work with a palliative care team for cancer patients, where I met a cancer patient, Andrew (not his real name). Andrew's cancer had progressed to the point that evidence-based medical methods were needed to ensure he enjoyed the remainder of his days.
In "So What," I will examine how I made crucial decisions to enable Andrew to receive holistic EOL care. According to Rolfe et al. (2001), at this point, the person should concentrate on addressing what was learned from the situation, as well as steps that need to be taken to strengthen the situation. I began by assisting the patient in establishing treatment goals since these were likely to affect EOL care outcomes.
As Kane et al. (2014) point out, clinical decisions, especially those made in life-threatening diseases, are often influenced by an individual's beliefs and desires. Such principles and ambitions, I expected, would be expressed in Andrew's medical care goals. I created questions for Andrew to answer, and we discussed the responses and options together.
译文：本质上，
本案的“什么”方面与我在安置期间遇到的情况有关。在这种情况下，我被指派与癌症患者的姑息治疗团队合作，在那里我遇到了癌症患者Andrew（不是他的真名）。安德鲁的癌症已经发展到需要以循证医学为基础的医疗方法，以确保他度过余生。
在“那又怎样”中，我将探讨如何做出重要决定，以使安德鲁能够获得全面的EOL护理。据罗尔夫等人。 （2001年），此时此人应该集中精力处理从情况中学到的知识，以及为加强这种情况而需要采取的步骤。我从协助患者建立治疗目标开始，因为这些目标可能会影响EOL护理结局。
正如凯恩（Kane）等人。 （2014）指出，临床决策，特别是那些危及生命的疾病的决策，通常会受到个人信仰和欲望的影响。我预计，这样的原则和野心会在安德鲁的医疗目标中体现出来。我为安德鲁提出了要回答的问题，然后我们一起讨论了答案和选项。 医疗report代写
For example
he might decide whether he wanted to die at home or in a hospital, as well as who he wanted by his side (Wright et al., 2010). Understanding Andrew's care priorities helped me match the care I offered to what he and his family felt was most important.
Similarly, I recognised that the probable cost of treatment that Andrew's terminal illness would entail could cause his family to doubt their capacity to adequately help him until EOL (Totman et al., 2015). Insufficient social support may be harmful to a patient's health, leading to increased stress and a faster deterioration in cognitive function (Bøen et al., 2012; Seppala et al., 2013).
People on the EOL treatment team must strive to avoid such conditions from happening by assisting and improving the patient's family's capacity to care for chronically ill members by evidence-based psychosocial education (Cabaniss et al., 2015; Visser et al., 2015). As a result, I gave Andrew's family (wife, two teenage children, and parents) techniques to help them strengthen their emotional bond with him.
I instructed family members to maintain healthy physical contact (i.e., maintaining eye contact, touching, and firmly clasping hands). These techniques demonstrate and articulate their affection for Andrew in a meaningful manner.
译文：例如
他可能会决定要死在家里还是在医院，以及他想陪在谁身边（Wright等，2010）。了解安德鲁的护理工作重点有助于我将我提供的护理与他和家人认为最重要的护理相匹配。
同样，我认识到安德鲁患上绝症可能带来的治疗费用可能会使他的家人怀疑他们有能力充分帮助他直到EOL（Totman et al。，2015）。社会支持不足可能对患者的健康有害，导致压力增加和认知功能更快恶化（Bøen等，2012； Seppala等，2013）。
EOL治疗团队中的人员必须通过基于证据的社会心理教育来协助和改善患者家庭照顾慢性病患者的能力，以努力避免此类情况的发生（Cabaniss等，2015; Visser等，2015）。结果，我给了安德鲁的家人（妻子，两个十几岁的孩子和父母）技巧，以帮助他们加强与他之间的情感纽带。
我指示家人保持健康的身体接触（即保持眼神接触，触摸并牢固握紧手）。这些技术以有意义的方式证明并表达了他们对安德鲁的感情。
As a nurse
I also realised that it took a multidisciplinary approach to offer Andrew comprehensive EOL care. In other words, it was essential to include other professionals from the outset. The Professional Code of the Nursing and Midwifery Council (NMC) mandates that health care practitioners aim to provide coordinated and integrated personal care customised to fulfill patients' needs and desires (NMC, 2015).
This meant that I had to collaborate with social workers to provide Andrew with psychosocial assistance and support. Given their broad experience and connections in the field, I believed that social workers in the community were capable of finding different people who could support Andrew and his family. Local care services include these networks (i.e., home care nurses).
EOL patients who are adequately supported by the community have a reduced risk of experiencing complications and usually have improved health outcomes than those without access to community support (Epstein et al., 2010; Levesque et al., 2013).
译文：作为护士 医疗report代写
我还意识到，它采取了多学科的方法来提供安德鲁全面的EOL护理。换句话说，从一开始就必须包括其他专业人员。 《护理和助产士理事会专业守则》（NMC）要求卫生保健从业者旨在提供定制的，满足患者需求和愿望的协调和综合的个人护理服务（NMC，2015）。
这意味着我必须与社会工作者合作，为安德鲁提供社会心理援助和支持。鉴于他们在该领域的广泛经验和联系，我相信社区中的社会工作者能够找到可以支持安德鲁及其家人的不同人。本地护理服务包括这些网络（即家庭护理护士）。
与没有社区支持的患者相比，得到社区充分支持的EOL患者发生并发症的风险降低，并且通常可以改善健康状况（Epstein等人，2010; Levesque等人，2013）。
I also felt that it was vital to help Andrew fulfill his spiritual needs.
The incorporation of existential themes into the medical profession encourages medical practitioners to provide spiritual care and encouragement for EOL patients (Lucchetti et al., 2012; Puchalski et al., 2014). Notwithstanding, some patients may need additional spiritual support from professionals, including chaplains or religious leaders.
Since he recently moved from Christianity to Islam, Andrew needed such spiritual assistance. Due to my lack of Islam knowledge, I thought that I was not the best person to help Andrew fulfill his spiritual requirements adequately. Indeed, this issue highlighted the importance of a multidisciplinary EOL approach.
Therefore I instantly connected Andrew with Sister Asha (not her real name), who understood different concepts of the Islamic faith. I wrote down everything that Andrew considered most significant for him as a Muslim to make sure that Sister Asha would properly help him fulfill his spiritual needs.
It is vital to get this knowledge since research suggests that EOL individuals can be anxious about ways in which they want their spiritual needs met (Wynne, 2013; Grossman et al., 2018). Some people may satisfy their spiritual needs by visiting a holy place. Others may need clinicians to help them do what they see as vital to their disease progress. For example,
译文：我还觉得帮助安德鲁满足他的精神需求至关重要。
将存在的主题纳入医学界鼓励医学从业者为EOL患者提供精神护理和鼓励（Lucchetti等，2012; Puchalski等，2014）。尽管如此，有些患者可能需要专业人员的额外精神支持，包括牧师或宗教领袖。
自从他最近从基督教搬到伊斯兰教以来，安德鲁需要这种精神上的帮助。由于缺乏伊斯兰知识，我认为我不是帮助安德鲁充分满足其精神要求的最佳人选。确实，这个问题突出了采用多学科EOL方法的重要性。
因此，我立即将安德鲁与阿莎修女（不是她的真名）联系起来，阿莎修女了解伊斯兰信仰的不同概念。我写下了安德鲁作为穆斯林对他最重要的一切，以确保阿沙修女会适当地帮助他满足他的精神需求。
获得这些知识至关重要，因为研究表明EOL个人可能会对他们希望其精神需求得到满足的方式感到焦虑（Wynne，2013; Grossman等，2018）。有些人可以通过参观圣地来满足他们的精神需求。其他人可能需要临床医生来帮助他们完成他们认为对疾病发展至关重要的事情。例如， 医疗report代写
the nurse could help Andrew develop a prayer schedule and locations.
Asha could also work together with Andrew's family so that they could exchange insights on what was best for him when he was sick.
I also realised that Andrew could achieve a terminal condition faster than predicted due to many issues with organ failure on the basis of my own knowledge from past placements. In such circumstances, Andrew could have demanded the cessation of supportive counselling. Thus, it was crucial to educate the family about the possibility of this occurrence.
My communication focused on signs suggesting that Andrew was nearing EOL and how the family could help him satisfy his final desires. In this way, I encouraged the family to expect death while being hopeful for better outcomes or experiences for Andrew. I was also providing the family with coping mechanisms to reduce the impacts of grief after Andrew's death.
译文：护士可以帮助安德鲁制定祷告时间表和地点。
阿莎还可以与安德鲁的家人一起工作，以便他们就生病时对他最有利的问题交换见解。
我还意识到，根据我过去的工作经验，由于器官衰竭的许多问题，安德鲁可以更快地达到终末状态。 在这种情况下，安德鲁可能会要求停止支持性咨询。 因此，至关重要的是要教育家庭这种情况的可能性。
我的交流侧重于迹象表明安德鲁正在接近停产，以及这个家庭如何帮助他满足他的最终愿望。 这样，我鼓励家人期待死亡，同时希望安德鲁能够获得更好的结果或经验。 我还为家庭提供了应对机制，以减少安德鲁去世后悲伤的影响。
Ultimately, in this final step (Now what), 医疗report代写
I will evaluate what I hope to do in the future to strengthen my learning and achieve results in similar scenarios in the future. Principally, I found that I had issues with the spiritual beliefs of Andrew because they were ambiguous and contradicted modern science. In retrospect, I realised that failure to connect with Andrew at spiritual levels was because I am a Christian, and he was Muslim.
In the future, by learning cultural skills, I will avoid such situations, which will allow me to look after individuals from diverse cultures. To improve this ability, I intend to engage with more individuals and expand my partnership with professionals from various disciplines (Deane & Fain, 2016; Arnold & Boggs, 2019).
I also hope to have more transparent conversations with patients in order to obtain a deeper understanding of their viewpoints, values, and desires.
译文：最终，在最后一步（现在是什么），
我将评估我将来希望做些什么，以加强我的学习并在以后的类似情况下取得成果。 基本上，我发现我对安德鲁的精神信仰有疑问，因为它们是模棱两可的并且与现代科学相矛盾。 回想起来，我意识到未能在精神层面上与安德鲁建立联系是因为我是基督徒，而他是穆斯林。 将来，通过学习文化技能，我会避免这种情况，这将使我能够照顾来自不同文化背景的人。 为了提高这种能力，我打算与更多的人打交道，并扩大与各学科专业人士的合作伙伴关系（Deane＆Fain，2016; Arnold＆Boggs，2019）。 我也希望与患者进行更透明的对话，以便对他们的观点，价值观和愿望有更深入的了解。
Reflection Two
This reflection will be focusing on my assertiveness as a nurse with reference to a clinical scenario during my clinical placement. I will use Rolfe's reflection model in the reflection. In accordance with the Nursing and Midwifery Council professional code of conduct (NMC, 2015), I will preserve confidentiality while also protecting the privacy of those with whom I associated by not using their real names.
译文：反思二
这种思考将集中于我作为临床实习期间的临床情况时作为护士的自信。 我将在反射中使用Rolfe的反射模型。 根据护理和助产理事会的专业行为准则（NMC，2015），我将保留保密性，同时还通过不使用其真实姓名来保护与之相关的人的隐私。 医疗report代写
What
Communication in hospital environments can mean the difference between life and death (Riley, 2015). I have had personal experience with cases where a message was considered rude, inconsistent, or hostile. These experiences have reinforced the decision to strengthen my assertiveness in order to improve my communication skills.
Achieving this would enable me to excel in multidisciplinary settings. According to Blasini et al. (2018), I can have a positive effect on my patients by enhancing my communication skills because effective communication promotes patient-practitioner connection.
Douglas (not his real name) was a 67-year-old man who reported to the emergency room at 10 p.m. complaining of nausea and loss of feeling on the right side of his body during my clinical placement. Since I was the only nurse in the ED department, I performed a thorough examination of the patient.
译文：什么
在医院环境中进行交流可能意味着生与死之间的差异（Riley，2015年）。 我曾在一些消息被认为是粗鲁，前后不一致或敌对的情况下有亲身经历。 这些经验加强了决定，以增强我的自信心，以提高我的沟通能力。
实现这一点将使我能够在多学科环境中脱颖而出。 根据Blasini等人的说法。 （2018），我可以通过提高沟通技巧对患者产生积极影响，因为有效的沟通可以促进患者与医生之间的联系。
道格拉斯（不是他的真名）是一位67岁的男子，他在晚上10点向急诊室报告。 在我就诊期间，他抱怨身体右侧出现恶心和感觉减退。 由于我是ED部门唯一的护士，因此我对患者进行了彻底检查。
I discovered that his blood pressure was 170/100 and that he had recurrent hypertension.
Regrettably, the patient died 17 hours after admission, triggering an investigation into the health professionals' actions during the patient's treatment. It emerged that the patient died due to stroke, which could have been prevented if his blood pressure was controlled.
Despite the fact that I remember telling the physician about Douglas's recurrent hypertension and high blood pressure, he argued that I did not pass this information during the inquiry.
Reflecting closely, I think I did not give adequate details about the condition of the patient, which I blame on my lack of assertiveness. Furthermore, the physician claimed that I did not show any sense of urgency in my documentation, so he did not see a need to re-evaluate the patient till the following day.
My lack of assertiveness hampered my capacity to point out indispensable concerns with urgency (Ibrahim, 2011), which resulted in poor health outcomes and my failure as a caseworker (Omura et al., 2018).
译文：我发现他的血压为170/100，并且他反复出现高血压。
令人遗憾的是，患者入院后17小时死亡，引发了对医疗专业人员在患者治疗期间的行为的调查。结果表明，该患者死于中风，如果控制血压，本来可以避免的。 尽管我记得曾向医生介绍过道格拉斯反复出现的高血压和高血压的事实，但他辩称在询问期间我没有传递这些信息。 仔细考虑一下，我认为我没有提供有关患者状况的足够详细信息，我将此归咎于我缺乏自信。此外，医生声称我的文件没有任何紧迫感，因此直到第二天他才需要重新评估患者。 我缺乏自信，阻碍了我指出紧急情况必不可少的能力（易卜拉欣，2011年），这导致健康状况不佳以及我作为个案工作者的失败（Omura等人，2018年）。
Assertiveness is described as a person's ability to convey oneself without becoming offensive or degrading the person receiving the information or message (McCabe & Timmins, 2013). However, previous studies have demonstrated that most student nurses fail to learn assertiveness skills (Omura et al., 2019). Simultaneously,
it has been shown that teaching assertiveness to student nurses increases their morale significantly (Pfaff et al., 2014a; Pfaff et al., 2014b). As a result, it's possible to argue that factors like self-esteem, trust, experience, and mentor relationships influence student nurses' assertiveness.
There is also a negative attitude and conduct among nurses with low self-esteem, and optimistic attitudes and behaviour among nurses with high levels of self-esteem (Kanade, 2018). When student nurses are recognised and supported by the hospital, they have a successful clinical experience (Reeve et al., 2013). In light of these results,
my biggest challenge was that I was reluctant to assert urgency on particular clinical problems for fear of being branded a sensationalist. Consequently, my communication was insufficient, resulting in adverse medical consequences. Despite these challenges, the clinical placement gave me a chance to learn, develop my skills, take action, and question poor practice.
自信被描述为一个人表达自己的能力而不会变得反感或使接收该信息或消息的人降级（McCabe＆Timmins，2013）。但是，先前的研究表明，大多数学生护士无法学习自信技巧（Omura等人，2019）。同时地，
研究表明，对学生护士的自信教学可以显着提高他们的士气（Pfaff等，2014a； Pfaff等，2014b）。结果，有可能争论诸如自尊，信任，经验和导师关系之类的因素会影响学生护士的自信。
自尊心低的护士也有消极的态度和行为，自尊心高的护士也有乐观的态度和行为（Kanade，2018）。当学生护士得到医院的认可和支持时，他们将获得成功的临床经验（Reeve等，2013）。根据这些结果，
我面临的最大挑战是，由于害怕被贴上耸人听闻的标签，我不愿对特定的临床问题提出紧急要求。因此，我的沟通不充分，造成了不良的医疗后果。尽管面临这些挑战，但临床实习给了我一个学习，发展我的技能，采取行动并质疑不良实践的机会。
student nurses' conduct throughout placement may largely be influenced by bureaucratic inequalities between them and registered nurses (Omura et al., 2017), which hamper assertive communication and jeopardise patient safety. One possible theory is that lower-level workers are fearful of questioning or standing up to supervisors about patient safety threats (Schwappach & Gehring, 2014; Tarrant et al., 2017).
Therefore, the relevance of assertiveness has been reinforced, with Alingh et al., (2019) noting that it reduces interpersonal tension, encourages teamwork, and improves nursing efficiency.
To that end, methods to encourage assertiveness have been developed, including the Describe, express, specify, consequences (DESC) and Rathus Assertiveness Scale (RAS). DESC allows people to thoroughly and critically explain the situation, share their opinions on the scenario, and identify the required action and its likely ramifications.
Consequently, it is possible to argue that DESC should support nursing students in coping confidently and procedurally with challenging circumstances to guarantee patient safety (Harini, 2017). On the other hand, RAS is a method that can be used to evaluate an individual's assertiveness level and behavioural improvements as a result of assertiveness training.
Undoubtedly, this can help students track their progress while training in assertion (Williams & Stout, 1985).
As they are connected with improved assertiveness in patient care, affirmative training programs are essential. They can specifically help students manage fear and tension by learning ways to advocate for what is right without conflicting with others (Eslami et al., 2016; Di Simone et al., 2018). Besides, the programs contribute to the creation of efficient social communication between students (Ünal, 2012).
学生护士在整个安置过程中的行为可能在很大程度上受到他们与注册护士之间官僚主义不平等的影响（Omura et al。，2017），这阻碍了自信的沟通并危及患者的安全。一种可能的理论是，低级工人担心对患者安全威胁提出质疑或向主管提出质疑（Schwappach＆Gehring，2014; Tarrant et al。，2017）。
因此，自信的相关性得到了加强，Alingh等人（2019）指出，它降低了人际关系紧张感，鼓励了团队合作并提高了护理效率。
为此，已经开发出鼓励自信的方法，包括描述，表达，说明，后果（DESC）和拉胡斯自信量表（RAS）。 DESC使人们可以对问题进行彻底和批判性的解释，就方案提出自己的意见，并确定所需的措施及其可能产生的后果。
因此，有可能提出DESC应该支持护理专业学生在充满挑战的情况下自信而有步骤地应对，以确保患者的安全（Harini，2017）。另一方面，RAS是一种方法，可用于评估个人的自信心水平和因自信心训练而导致的行为改善。
毫无疑问，这可以帮助学生在断言训练中追踪自己的学习进度（Williams＆Stout，1985）。
由于他们与改善患者护理中的自信心有关，因此积极培训计划必不可少。他们可以通过学习在不与他人冲突的情况下倡导正确的事情来帮助学生管理恐惧和紧张情绪（Eslami等人，2016; Di Simone等人，2018）。此外，该计划有助于在学生之间建立有效的社交交流（Ünal，2012）。
To this end, I agree that I need to engage in a training program in affirmation to develop my assertiveness skills. These programs and resources, such as DESC and Rathus, will increase my level of affirmation and also help me to take advantage of evidence-based practice. Taking part in assertiveness education would give me.
the knowledge and skill to handle difficult circumstances such as those where I have to negotiate with influential people if I think they are mistaken. Especially, skill sets intended to strengthen self - efficacy and confidence would allow me to discuss concerns without becoming judgmental while still advocating for my own and others' rights.
In conclusion, I intend to use the Rathus assertiveness schedule to evaluate my development while undergoing assertiveness training. By tracking my progress, I will be able to recognise places that I need to adjust or develop to become a more assertive nurse. I believe that taking control of my education would hasten the training process.
Additionally, in order to improve my assertiveness, I intend to gain more realistic experience by participating in a variety of clinical scenarios, especially those involving high-risk patients they tend to involve multidisciplinary teams that can teach me a lot.
So What 医疗report代写
Assertiveness is described as a person's ability to convey oneself without becoming offensive or degrading the person receiving the information or message (McCabe & Timmins, 2013). However, previous studies have demonstrated that most student nurses fail to learn assertiveness skills (Omura et al., 2019). Simultaneously,
it has been shown that teaching assertiveness to student nurses increases their morale significantly (Pfaff et al., 2014a; Pfaff et al., 2014b). As a result, it's possible to argue that factors like self-esteem, trust, experience, and mentor relationships influence student nurses' assertiveness.
There is also a negative attitude and conduct among nurses with low self-esteem, and optimistic attitudes and behaviour among nurses with high levels of self-esteem (Kanade, 2018). When student nurses are recognised and supported by the hospital, they have a successful clinical experience (Reeve et al., 2013). In light of these results,
my biggest challenge was that I was reluctant to assert urgency on particular clinical problems for fear of being branded a sensationalist. Consequently, my communication was insufficient, resulting in adverse medical consequences. Despite these challenges, the clinical placement gave me a chance to learn, develop my skills, take action, and question poor practice.
译文：所以呢
自信被描述为一个人表达自己的能力而不会变得反感或使接收该信息或消息的人降级（McCabe＆Timmins，2013）。但是，先前的研究表明，大多数学生护士无法学习自信技巧（Omura等人，2019）。同时地，
研究表明，对学生护士的自信教学可以显着提高他们的士气（Pfaff等，2014a； Pfaff等，2014b）。结果，有可能争论诸如自尊，信任，经验和导师关系之类的因素会影响学生护士的自信。
自尊心低的护士也有消极的态度和行为，自尊心高的护士也有乐观的态度和行为（Kanade，2018）。当学生护士得到医院的认可和支持时，他们将获得成功的临床经验（Reeve等，2013）。根据这些结果，
我面临的最大挑战是，由于害怕被贴上耸人听闻的标签，我不愿对特定的临床问题提出紧急要求。因此，我的沟通不充分，造成了不良的医疗后果。尽管面临这些挑战，但临床实习给了我一个学习，发展我的技能，采取行动并质疑不良实践的机会。
According to some scholars,
student nurses' conduct throughout placement may largely be influenced by bureaucratic inequalities between them and registered nurses (Omura et al., 2017), which hamper assertive communication and jeopardise patient safety. One possible theory is that lower-level workers are fearful of questioning or standing up to supervisors about patient safety threats (Schwappach & Gehring, 2014; Tarrant et al., 2017).
Therefore, the relevance of assertiveness has been reinforced, with Alingh et al., (2019) noting that it reduces interpersonal tension, encourages teamwork, and improves nursing efficiency.
To that end, methods to encourage assertiveness have been developed, including the Describe, express, specify, consequences (DESC) and Rathus Assertiveness Scale (RAS). DESC allows people to thoroughly and critically explain the situation, share their opinions on the scenario, and identify the required action and its likely ramifications.
Consequently, it is possible to argue that DESC should support nursing students in coping confidently and procedurally with challenging circumstances to guarantee patient safety (Harini, 2017). On the other hand, RAS is a method that can be used to evaluate an individual's assertiveness level and behavioural improvements as a result of assertiveness training.
Undoubtedly, this can help students track their progress while training in assertion (Williams & Stout, 1985).
As they are connected with improved assertiveness in patient care, affirmative training programs are essential. They can specifically help students manage fear and tension by learning ways to advocate for what is right without conflicting with others (Eslami et al., 2016; Di Simone et al., 2018). Besides, the programs contribute to the creation of efficient social communication between students (Ünal, 2012).
译文：根据一些学者的说法，
学生护士在整个安置过程中的行为可能在很大程度上受到他们与注册护士之间官僚主义不平等的影响（Omura et al。，2017），这阻碍了自信的沟通并危及患者的安全。一种可能的理论是，低级工人担心对患者安全威胁提出质疑或向主管提出质疑（Schwappach＆Gehring，2014; Tarrant et al。，2017）。
因此，自信的相关性得到了加强，Alingh等人（2019）指出，它降低了人际关系紧张感，鼓励了团队合作并提高了护理效率。
为此，已经开发出鼓励自信的方法，包括描述，表达，说明，后果（DESC）和拉胡斯自信量表（RAS）。 DESC使人们可以对问题进行彻底和批判性的解释，就方案提出自己的意见，并确定所需的措施及其可能产生的后果。
因此，有可能提出DESC应该支持护理专业学生在充满挑战的情况下自信而有步骤地应对，以确保患者的安全（Harini，2017）。另一方面，RAS是一种方法，可用于评估个人的自信心水平和因自信心训练而导致的行为改善。
毫无疑问，这可以帮助学生在断言训练中追踪自己的学习进度（Williams＆Stout，1985）。
由于他们与改善患者护理中的自信心有关，因此积极培训计划必不可少。他们可以通过学习在不与他人冲突的情况下倡导正确的事情来帮助学生管理恐惧和紧张情绪（Eslami等人，2016; Di Simone等人，2018）。此外，该计划有助于在学生之间建立有效的社交交流（Ünal，2012）。
Now What 医疗report代写
To this end, I agree that I need to engage in a training program in affirmation to develop my assertiveness skills. These programs and resources, such as DESC and Rathus, will increase my level of affirmation and also help me to take advantage of evidence-based practice. Taking part in assertiveness education would give me.
the knowledge and skill to handle difficult circumstances such as those where I have to negotiate with influential people if I think they are mistaken. Especially, skill sets intended to strengthen self - efficacy and confidence would allow me to discuss concerns without becoming judgmental while still advocating for my own and others' rights.
In conclusion, I intend to use the Rathus assertiveness schedule to evaluate my development while undergoing assertiveness training. By tracking my progress, I will be able to recognise places that I need to adjust or develop to become a more assertive nurse. I believe that taking control of my education would hasten the training process.
Additionally, in order to improve my assertiveness, I intend to gain more realistic experience by participating in a variety of clinical scenarios, especially those involving high-risk patients they tend to involve multidisciplinary teams that can teach me a lot.
译文：怎么办
为此，我同意我需要参加一个培训计划，以肯定自己的自信技能。这些程序和资源（例如DESC和Rathus）将提高我的肯定水平，也有助于我利用循证实践。参加自信教育会给我。 处理困难情况的知识和技能，例如在我认为错误的情况下我必须与有影响力的人进行谈判的情况。特别是，旨在增强自我效能和自信的技能将使我能够在不提倡判断的情况下讨论问题，同时仍然主张自己和他人的权利。 总之，我打算在接受自信训练时，使用Rathus自信表来评估我的发展。通过跟踪我的进度，我将能够识别出需要调整或发展以变得更加自信的护士的位置。我相信控制自己的教育会加快培训过程。 另外，为了提高我的自信，我打算通过参加各种临床案例来获得更现实的经验，尤其是那些涉及高风险患者的案例，他们倾向于涉及可以为我提供很多知识的多学科团队。
In conclusion, I have learned a lot from this reflective exercise. Principally, I have mastered that I can perform effectively in multidisciplinary settings. Another lesson is that no amount of nursing education can prepare one for every clinical scenario. Heath is dynamic, and patients have unique needs based on their conditions. The best way to prepare for unexpected situations is to engage in more practice and learn from past mistakes.
总之，我从这种反思性练习中学到了很多东西。 原则上，我已经掌握了可以在多学科环境中有效执行的能力。 另一个教训是，没有足够的护理教育可以针对每种临床情况进行准备。 卫生是动态的，患者根据自己的病情有独特的需求。 应对意外情况的最佳方法是多做一些练习，并从过去的错误中吸取教训。
医学代写
护理学代写
Alingh, C. W., van Wijngaarden, J. D., van de Voorde, K., Paauwe, J., & Huijsman, R. (2019). Speaking up about patient safety concerns: the influence of safety management approaches and climate on nurses' willingness to speak up. BMJ quality & safety, 28(1), 39-48.
Arnold, E. C., & Boggs, K. U. (2019). Interpersonal relationships e-book: professional communication skills for nurses. Elsevier Health Sciences.
Blasini, M., Peiris, N., Wright, T., & Colloca, L. (2018). The role of patient-practitioner relationships in placebo and nocebo phenomena. International review of neurobiology, 139, 211-231.
Bøen, H., Dalgard, O. S., & Bjertness, E. (2012). The importance of social support in the associations between psychological distress and somatic health problems and socio-economic factors among older adults living at home: a cross-sectional study. BMC geriatrics, 12(1), 1-12.
Cabaniss, D. L., Wainberg, M. L., & Oquendo, M. A. (2015). Evidence-Based Psychosocial Interventions: Novel Challenges For Training And Implementation. Depression and anxiety, 32(11), 802–804. https://doi.org/10.1002/da.22437
Incorporating Peplau's theory of interpersonal relations to promote holistic communication between older adults and nursing students. Journal of Holistic Nursing, 34(1), 35-41.
Di Simone, E., Giannetta, N., Auddino, F., Cicotto, A., Grilli, D., & Di Muzio, M. (2018). Medication errors in the emergency department: knowledge, attitude, behaviour, and training needs of nurses. Indian Journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 22(5), 346.
Epstein, R. M., Fiscella, K., Lesser, C. S., & Stange, K. C. (2010). Why the nation needs a policy push on patient-centred health care. Health Affairs, 29(8), 1489-1495.
Eslami, A. A., Rabiei, L., Afzali, S. M., Hamidizadeh, S., & Masoudi, R. (2016). The effectiveness of assertiveness training on the levels of stress, anxiety, and depression of high school students. Iranian Red Crescent Medical Journal, 18(1).
Grossman, C. H., Brooker, J., Michael, N., & Kissane, D. (2018). Death anxiety interventions in patients with advanced cancer: A systematic review. Palliative Medicine, 32(1), 172-184.
and assertiveness in nursing-myth or mandate. TNNMC Journal of Nursing Education and Administration, 5(2), 24-27.
Ibrahim, S. A. E. A. (2011). Factors affecting assertiveness among student nurses. Nurse education today, 31(4), 356-360.
Kanade, A. (2018).The effect of assertiveness training program on nurses. The department of Psychiatric & Mental Health Nursing, 15(2), 19-23. Doi:10.4103/2231-1505.255708
Kane, H. L., Halpern, M. T., Squiers, L. B., Treiman, K. A., & McCormack, L. A. (2014). Implementing and evaluating shared decision making in oncology practice. CA: a cancer journal for clinicians, 64(6), 377-388.
Levesque, J. F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International Journal for Equity in health, 12(1), 1-9.
Spirituality in medical education: global reality?. Journal of religion and health, 51(1), 3-19.
McCabe, C., & Timmins, F. (2013). Communication skills for nursing practice. Macmillan International Higher Education.
Nelumbu, L. N. (2015). Implementation of reflective practice program for registered nurses. International Journal of Advanced Nursing Studies, 4(2), 115.
Nursing and Midwifery Council (2015). The code: professional Standards Practise and Behaviour for Nurses and Midwives. London. NMC.
Omura, M., Levett‐Jones, T., & Stone, T. E. (2019). Design and evaluation of an assertiveness communication training program for nursing students. Journal of clinical nursing, 28(9-10), 1990-1998.
Omura, M., Maguire, J., Levett-Jones, T., & Stone, T. E. (2017). The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. International Journal of nursing studies, 76, 120-128.
Exploring Japanese nurses' perceptions of the relevance and use of assertive communication in healthcare: A qualitative study informed by the Theory of Planned Behaviour. Nurse education today, 67, 100-107.
Pfaff, K. A., Baxter, P. E., Jack, S. M., & Ploeg, J. (2014a). Exploring new graduate nurse confidence in interprofessional collaboration: A mixed-methods study. International Journal of nursing studies, 51(8), 1142-1152.
Pfaff, K., Baxter, P., Jack, S., & Ploeg, J. (2014b). An integrative review of the factors influencing new graduate nurse engagement in interprofessional collaboration. Journal of advanced nursing, 70(1), 4-20.
Puchalski, C. M., Blatt, B., Kogan, M., & Butler, A. (2014). Spirituality and health: the development of a field. Academic Medicine, 89(1), 10-16.
Reeve, K. L., Shumaker, C. J., Yearwood, E. L., Crowell, N. A., & Riley, J. B. (2013). Perceived stress and social support in undergraduate nursing students' educational experiences. Nurse education today, 33(4), 419-424
Riley, J. B. (2015). Communication in nursing. Elsevier Health Sciences.
Critical reflection in nursing and the helping professions: a user's guide. Basingstoke: Palgrave Macmillan.
Schwappach, D. L., & Gehring, K. (2014). Trade-offs between voice and silence: a qualitative exploration of oncology staff's decisions to speak up about safety concerns. BMC health services research, 14(1), 1-10.
Seppala, E., Rossomando, T., & Doty, J. R. (2013). Social connection and compassion: Important predictors of health and well-being. Social Research: An International Quarterly, 80(2), 411-430.
Tarrant, C., Leslie, M., Bion, J., & Dixon-Woods, M. (2017). A qualitative study of speaking out about patient safety concerns in intensive care units. Social Science & Medicine, 193, 8-15.
S., & Martin, J. (2015). 'You only have one chance to get it right: A qualitative study of relatives' experiences of caring at home for a family member with terminal cancer. Palliative medicine, 29(6), 496-507.
Ünal, S. (2012). Evaluating the effect of self-awareness and communication techniques on nurses' assertiveness and self-esteem. Contemporary Nurse, 43(1), 90-98.
Visser, C., Hadley, G., & Wee, B. (2015). Reality of evidence-based practice in palliative care. Cancer biology & medicine, 12(3), 193.
Williams, J. M., & Stout, J. K. (1985). The effect of high and low assertiveness on locus of control and health problems. The Journal of Psychology, 119(2), 169–173. https://doi.org/10.1080/00223980.1985.10542884
T. A., Matulonis, U. A., Block, S. D., & Prigerson, H. G. (2010). Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health. Journal of Clinical Oncology, 28(29), 4457.
Wynne, L. (2013). Spiritual care at the end of life. Nursing Standard (through 2013), 28(2), 41.
Conclusion
In conclusion, I have learned a lot from this reflective exercise. Principally, I have mastered that I can perform effectively in multidisciplinary settings. Another lesson is that no amount of nursing education can prepare one for every clinical scenario. Heath is dynamic, and patients have unique needs based on their conditions. The best way to prepare for unexpected situations is to engage in more practice and learn from past mistakes.
译文：结论
总之，我从这种反思性练习中学到了很多东西。 原则上，我已经掌握了可以在多学科环境中有效执行的能力。 另一个教训是，没有足够的护理教育可以针对每种临床情况进行准备。 卫生是动态的，患者根据自己的病情有独特的需求。 应对意外情况的最佳方法是多做一些练习，并从过去的错误中吸取教训。
医学代写
护理学代写
References
Alingh, C. W., van Wijngaarden, J. D., van de Voorde, K., Paauwe, J., & Huijsman, R. (2019). Speaking up about patient safety concerns: the influence of safety management approaches and climate on nurses' willingness to speak up. BMJ quality & safety, 28(1), 39-48.
Arnold, E. C., & Boggs, K. U. (2019). Interpersonal relationships e-book: professional communication skills for nurses. Elsevier Health Sciences.
Blasini, M., Peiris, N., Wright, T., & Colloca, L. (2018). The role of patient-practitioner relationships in placebo and nocebo phenomena. International review of neurobiology, 139, 211-231.
Bøen, H., Dalgard, O. S., & Bjertness, E. (2012). The importance of social support in the associations between psychological distress and somatic health problems and socio-economic factors among older adults living at home: a cross-sectional study. BMC geriatrics, 12(1), 1-12.
Cabaniss, D. L., Wainberg, M. L., & Oquendo, M. A. (2015). Evidence-Based Psychosocial Interventions: Novel Challenges For Training And Implementation. Depression and anxiety, 32(11), 802–804. https://doi.org/10.1002/da.22437
Deane, W. H., & Fain, J. A. (2016).
Incorporating Peplau's theory of interpersonal relations to promote holistic communication between older adults and nursing students. Journal of Holistic Nursing, 34(1), 35-41.
Di Simone, E., Giannetta, N., Auddino, F., Cicotto, A., Grilli, D., & Di Muzio, M. (2018). Medication errors in the emergency department: knowledge, attitude, behaviour, and training needs of nurses. Indian Journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 22(5), 346.
Epstein, R. M., Fiscella, K., Lesser, C. S., & Stange, K. C. (2010). Why the nation needs a policy push on patient-centred health care. Health Affairs, 29(8), 1489-1495.
Eslami, A. A., Rabiei, L., Afzali, S. M., Hamidizadeh, S., & Masoudi, R. (2016). The effectiveness of assertiveness training on the levels of stress, anxiety, and depression of high school students. Iranian Red Crescent Medical Journal, 18(1).
Grossman, C. H., Brooker, J., Michael, N., & Kissane, D. (2018). Death anxiety interventions in patients with advanced cancer: A systematic review. Palliative Medicine, 32(1), 172-184.
Harini, S. (2017). Autonomy, accountability,
and assertiveness in nursing-myth or mandate. TNNMC Journal of Nursing Education and Administration, 5(2), 24-27.
Ibrahim, S. A. E. A. (2011). Factors affecting assertiveness among student nurses. Nurse education today, 31(4), 356-360.
Kanade, A. (2018).The effect of assertiveness training program on nurses. The department of Psychiatric & Mental Health Nursing, 15(2), 19-23. Doi:10.4103/2231-1505.255708
Kane, H. L., Halpern, M. T., Squiers, L. B., Treiman, K. A., & McCormack, L. A. (2014). Implementing and evaluating shared decision making in oncology practice. CA: a cancer journal for clinicians, 64(6), 377-388.
Levesque, J. F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International Journal for Equity in health, 12(1), 1-9.
Lucchetti, G., Lucchetti, A. L. G., & Puchalski, C. M. (2012).
Spirituality in medical education: global reality?. Journal of religion and health, 51(1), 3-19.
McCabe, C., & Timmins, F. (2013). Communication skills for nursing practice. Macmillan International Higher Education.
Nelumbu, L. N. (2015). Implementation of reflective practice program for registered nurses. International Journal of Advanced Nursing Studies, 4(2), 115.
Nursing and Midwifery Council (2015). The code: professional Standards Practise and Behaviour for Nurses and Midwives. London. NMC.
Omura, M., Levett‐Jones, T., & Stone, T. E. (2019). Design and evaluation of an assertiveness communication training program for nursing students. Journal of clinical nursing, 28(9-10), 1990-1998.
Omura, M., Maguire, J., Levett-Jones, T., & Stone, T. E. (2017). The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. International Journal of nursing studies, 76, 120-128.
Omura, M., Stone, T. E., Maguire, J., & Levett-Jones, T. (2018).
Exploring Japanese nurses' perceptions of the relevance and use of assertive communication in healthcare: A qualitative study informed by the Theory of Planned Behaviour. Nurse education today, 67, 100-107.
Pfaff, K. A., Baxter, P. E., Jack, S. M., & Ploeg, J. (2014a). Exploring new graduate nurse confidence in interprofessional collaboration: A mixed-methods study. International Journal of nursing studies, 51(8), 1142-1152.
Pfaff, K., Baxter, P., Jack, S., & Ploeg, J. (2014b). An integrative review of the factors influencing new graduate nurse engagement in interprofessional collaboration. Journal of advanced nursing, 70(1), 4-20.
Puchalski, C. M., Blatt, B., Kogan, M., & Butler, A. (2014). Spirituality and health: the development of a field. Academic Medicine, 89(1), 10-16.
Reeve, K. L., Shumaker, C. J., Yearwood, E. L., Crowell, N. A., & Riley, J. B. (2013). Perceived stress and social support in undergraduate nursing students' educational experiences. Nurse education today, 33(4), 419-424
Riley, J. B. (2015). Communication in nursing. Elsevier Health Sciences.
Rolfe, G., Freshwater, D. and Jasper, M. (2001).
Critical reflection in nursing and the helping professions: a user's guide. Basingstoke: Palgrave Macmillan.
Schwappach, D. L., & Gehring, K. (2014). Trade-offs between voice and silence: a qualitative exploration of oncology staff's decisions to speak up about safety concerns. BMC health services research, 14(1), 1-10.
Seppala, E., Rossomando, T., & Doty, J. R. (2013). Social connection and compassion: Important predictors of health and well-being. Social Research: An International Quarterly, 80(2), 411-430.
Tarrant, C., Leslie, M., Bion, J., & Dixon-Woods, M. (2017). A qualitative study of speaking out about patient safety concerns in intensive care units. Social Science & Medicine, 193, 8-15.
Totman, J., Pistrang, N., Smith, S., Hennessey,
S., & Martin, J. (2015). 'You only have one chance to get it right: A qualitative study of relatives' experiences of caring at home for a family member with terminal cancer. Palliative medicine, 29(6), 496-507.
Ünal, S. (2012). Evaluating the effect of self-awareness and communication techniques on nurses' assertiveness and self-esteem. Contemporary Nurse, 43(1), 90-98.
Visser, C., Hadley, G., & Wee, B. (2015). Reality of evidence-based practice in palliative care. Cancer biology & medicine, 12(3), 193.
Williams, J. M., & Stout, J. K. (1985). The effect of high and low assertiveness on locus of control and health problems. The Journal of Psychology, 119(2), 169–173. https://doi.org/10.1080/00223980.1985.10542884
Wright, A. A., Keating, N. L., Balboni,
T. A., Matulonis, U. A., Block, S. D., & Prigerson, H. G. (2010). Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health. Journal of Clinical Oncology, 28(29), 4457.
Wynne, L. (2013). Spiritual care at the end of life. Nursing Standard (through 2013), 28(2), 41.
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