Reflecting on the Care of a Patient with Triple Positive Breast Cancer

 The Crisis of Cancer: Reflecting on the care of a patient with Triple Positive Breast Cancer

Contents:

1.  Introduction………………………………………………………………….Pg.3.
2.  Discussion on reflective practice & its importance to me as a medical radiations student………………………………………………………………………..Pg.4 & 5
3.  Discussion on the characteristics of the health professional, within relevant scope of practice, governance and practice frameworks………………  Pg.6 & 7
4.  Reflections on Michelle’s cancer journey and how this will impact me as a medical radiations professional………………………………………        Pg. 8Description……………………………………………………………    Pg. 8
5. Feelings………………………………………………………………     Pg.
6. Evaluation………………………………………………………………  Pg.
7. Analysis………………………………………………………………..    Pg.
8. Conclusion…………………………………………………………….. ..Pg.
9. Action Plan……………………………………………………………….Pg.
10. Conclusion……………………………………………………………………Pg.
11. References……………………………………………………………………Pg.

1. Introduction:

Many situations arise in an individual’s lifetime, however, the real irony in dealing with those situations is how we react and respond to it. Cancer is one of the few experiences which tend to cause reflection of undesirable medical information given to patients and families.

The mortality rate of cancer is high along with the diagnosis; however, it is ideally based on radiation practitioner’s management of communication, diagnosis, prognosis, the occurrence of unwanted symptoms, repeated clinical trials and medical errors that prolongs a patient life from cancer. (Morgans, A. K. & Schapira, L 2015).  This was apparent within Michelle Sullivan. Her treatment of cancer survival journey consisted of physical, mental and emotional turmoil. The cancer treatment gave her psychological impact and left her with vulnerability. Human minds are prospered to acknowledge all sort of intellectual information or guidance provided to them however the intake of reacting to a cancer situation provokes anticipation that life is ending

Within this reflective journal piece, a critical reflection is used to highlight the patient-communication that had occurred within Michelle’s story. It reviews how practitioners develop thinking, organizing, managing relations with their patients; Critical reflection provokes practitioners to examine assumptions and expose the potential limitations, rather than showcasing the unexplainable thoughts and actions, and instead develop mindfulness towards various situations to interpret new ways of thinking. (Cunliffe, A.L. 2016.)

Additionally, this journal outlines the significance and invaluable learning experiences that can be formed in writing a reflective journal, with the overall aim of signifying that all healthcare professionals should be focused to implement correct communication and professional behavior towards a patient’s cancer journey and consistently provide the best patient care

2. Discussion on reflective practice & its importance to me as a medical radiations student

Reflective practice involves the use of previous experience and contextual awareness to reflect on, challenging experiences, knowledge, and findings integrated within clinical practice, the prerequisite of reflection is to inhibit the practical skills and processes used to assist practitioners to refine improvements and thought process from performed actions. In the medical fields, practitioners are provided with an advantage to reflect on repetitive critical incidents to establish the ability to build a generalized theory about their own behavior and actions in those situations (Malthouse, R., Barensten, R.J & Watts, M. (2014) By reflecting on these experiences, reflective practice initiates mindfulness on procedures and behaviors carried out to provide higher levels of patient care and satisfaction.

In 1910, John Dewey an American Philosopher was initially cited as the founding figure of reflective practice, he claimed it is the act of thinking of a “subject in the mind and being considerate to initiate a focused thought process’ about a situation. Dewey’s work redefined reflected practice through the use of exploring experiences, reflections, and interactions. His work claimed the ideal use of thoughts and feelings to signify the consequences prior to examining all achievable considerations to resolve situations. (Hebert, C.2015). During the 1980’s Donald Schon followed Dewey’s negotiable work to articulate that reflective practice initiated from the knowing inherent actions of a skilled practitioner who legitimizes the knowledge encapsulated within a practice. Schon (1983) described the reflective practice as the origin of knowing in action. Knowing in action refers to strategizing spontaneous knowledge to aid the practitioner’s attention to uncertain or uncontrollable situations. Schon (1983) stated that a verified medical practitioner experiences multiple challenges throughout small types of cases, in which ‘he is able to “practice” his practice’. Schon (1983) stated a responsible practitioner is someone who “learns what to look out for and how to respond to what he finds, which states ones significant ability to observe and evaluate from different clinical practice within their career. Various practitioners tend to underestimate the act of knowing in action generalizing their work in repetitive and routine form within a clinical practice. Therefore, the practitioner tends to disregard the level of mindfulness, consideration and patient care as they become “inattentive to phenomena that do not fit the categories of his knowing in action”. Furthermore, patients face affliction and moreover practitioners face consequences of narrowness and rigidity (Schon D.A., 1983, 61).

Philosopher Donald Schon formulated the concept known as ‘reflection-in-action’ and ‘reflection-on-action’ to provide a framework which stimulated learning. The concept of reflective practice continuum enabled an essential conduit upon reflection to become a better critical reflector (Thomas, F.SC. 2012) Reflection in action refers to knowing in action; which Schon (1983) stated reflection of incident whilst it occurred rather than the aftermath of thinking how you should have reflected to resolve the situation. Schon (1983, p.68) stated when an individual “reflects- in action, they become a researcher in practical context” who don’t generalize ideas on “categories or established theory and technique but construct a new theoretical case in the unique expression” (Schon, D. 1983). Furthermore, practitioners are often challenged with   ‘situations, of uncertainty, instability, uniqueness, and value conflict” and this, as a result, must react ‘spontaneously’ (Schon, D. 1983, pp.49-51) Therefore knowledge in action does not imply from a ‘rational thought process or ‘prior intellectual operation’ (1983, p.51) Schon stated that unexpected incidents call for element of surprise as there is known inherence in the actions of a medical practitioner. The practitioners tend to handle “given” situations efficiently rather than reflecting on the process of how the problem occurred in the first instance. The main aspect of this process is to exhibit an impact on decision making, achievements, and conclusions taken on incidents. Schon assumed that knowing in action enables better skillful performance and it allows practitioners to “usually know more than they can say” (Schon., 1983, p.8)

Contrastingly, reflection-on-action refers to the analysis of practice in order to discover knowledge used and associate feelings within a particular situation.  Reflection on action refers to “what we have done in order to discover how our knowing inaction contributes to better “evaluation of an “unexpected outcomes’ (Schon, D.1983). This concept introduces the importance of becoming a skillful critical reflector promoting the autonomous development of self-reflected professionals in the clinical settings and reflecting on their actions and behaviors carried out to eliminate any diagnostic errors. Furthermore, Schon’s notable work defined reflective practice as ‘being more involved with the practice of critical thinking signifying the moment the practitioner is unable to shield his experiments from the implemented changes within the environment.  Although, in practical context, situations tend to change rapidly whereas the act of experimenting is a risk’ (Schon, D 1983, 144). Practitioners tend to contemplate after the situation has occurred to best avoid the norms of a negative outcome. Additionally, Schon stated that reflecting in action formulates a positive unexpected outcome and reflection should be based upon present time.

In my opinion, reflective practice is the fundamental component of progressing career development and essential requirement for all healthcare professionals to retain registration. Reflective practice enables health professionals to optimize their work practice and enhance interpersonal relationships through the self-reflecting. Additionally, the concept enables you to make good use of opportunities and acquire verbal skills, knowledge and learn from experiences. Furthermore, reflection identifies learning from both strengths and weaknesses to refine the quality of performance at work. Reflection impacts us to focus on the “how” of a situation rather than “what” for personal growth.

Conclusively, reflective practice portrays an essential role in the lives of all medical professionals it enables us to reflect on the concepts learned, behavioral changes and improvement and has the ability to restrain one’s actions and emotions which can directly impact our patients. 

3. Discussion on the characteristics of the health professionals; within the relevant scope of practice, governance & practice frameworks.

Codes of ethics are signified as an ethical aspect of the professional medical organization. The Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) acknowledge its duty and obligations to establish and encourage good exemplary professional standards of practice, conduct, and performance. Each member of ASMIRT in the profession has the responsibility to obey these standards. (ASMIRT, 2017) The term “code of ethics” governs the decision making towards maintaining higher standards of ethical values, principles, and ideals of an organization whereas the code of conduct governs the actions involved in support of health practitioners to deliver effective regulated health services within a framework. (ASMIRT, 2017). Practitioners have the role to care for patients as their first priority safely and effectively. The management of high levels of professional proficiency and conduct is essential to provide good care towards patients (MRPBA, 2014). Both codes of ethics and conduct are made to project optimal behavior towards the standard of practice and prevent poor professional conduct. These codes regulate conditions of license for the general safety of reassuring good relationships with colleagues and other medical professionals to strengthen patient relationships and provide best optimal care. Practitioners should have the ability to be self-reflective, responsible, mindful, trustworthy and compassionate to manage minimal risk and management of the good practice. (MRPBA, 2014)

There are numerous organizations and practices within Australia that summaries the required standards and codes. The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is the principal organization to promote national standards relating to the optimal patient care, clinical education and training as well as certify practices (Australian Radiation Protection and Nuclear Safety Agency 2017). In partnership with Nuclear Safety Committee and Radiation Health committee ARPANSA implements national standards and risk assessments based on evidence given by international organizations such as the International Atomic Energy (IAEA) and United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) (Australian Radiation Protection and Nuclear Safety Agency 2017). ARPANSA is the leading Australian Government agency which protects the well-being of people from environmental and damaging effects of ionization and non-ionizing radiation. These codes, guidelines, and fundaments enable practitioners to better understand the required standards to protect colleagues, patients, and the public from ionization radiation. The Australian Health Practitioner Regulation Agency (AHPRA) supports national boards to generate national schemes. AHPRA uses codes and information provided by ARPANSA and implement practice for all medical radiation practitioners (ARPANSA, 2017). AHPRA works in collaboration with 14 other National boards to implement National Registration and Accreditation Scheme, under the law which helps to provide protection to the public. (AHPRA, 2017). In the Medical radiations field, the “ Medical Radiation Board of Australia are responsible for registering practitioners and students, setting the standards the practitioners must regulatory follow and manage reports on health and conduct and implement qualities on the performance of practitioners. (MRPBA, 2015)

The code of conduct for medical radiations practitioners outlined by the Medical Radiations Practice Board of Australia (2014) states to assist and support practitioners to deliver suitable effective services with an ethical framework to highlight elements of good practice and professional behavior amongst patient-colleague relationships. Within Section 1.2 of the code “Professional values and qualities”, states that “Practitioners must have their own beliefs and values, there are certain professional values on which practitioners are expected to prioritize their patients and safely conduct practice regardless of setting to provide best “duty of care for patients …and to practice safely and effectively “(Medical Radiation Practice Board of Australia, 2014). Furthermore, the code states that practitioners need to assure patients that “they are ethical and trustworthy” displaying qualities of “Integrity, truthfulness, dependability, and compassion”. Therefore, patients can trust practitioners in believe of displaying competency and not taking advantage of their situation. Section 1.2 tends to summaries that practitioners need to display significant professionalism being self-aware and reflecting regularly “ to keep their skills and knowledge up to date, refine and develop their clinical judgment” ( Medical Radiations Practice Board of Australia 2014). By this practitioners ensure the use of good practice is centered within cultural awareness, mindfulness and pursuing effective communication with the patients to provide quality of care in treatment.

Additionally, a great practice is immensely focused on patient satisfaction. It enables practitioners to build high standard relationships with patients on a personal conduct.  Within code 3.3, MRPBA states that patients need to be well supported and encouraged with enough information about their health in assisting patient needs for better decision making towards their healthcare (MRPBA, 2014). Furthermore, medical practitioner considers many ethical elements solely based on consent, privacy, and confidentiality. Therefore, a medical practitioner engages with various numbers of patients facing multiple unexpected situations.  Due to the code 3.3, MRPBA states communication is essential in providing effective patient care and treatment, as it justifies all aspects of personal and professional conduct which result in a positive patient-practitioner  experience  (MRPBA, 2015) (MRPBA,2014)

4. Reflections on Michelle’s cancer journey and how this is going to impact me as a radiation professional:

..”We are not just your workplace”- Michelle Sullivan, 2018 Breast Cancer survivor

In my ‘Introduction to Medical Radiations’ lecture on the 17th April 2018, at the RMIT Bundoora Campus, I was introduced to Michelle Sullivan, a 53- year -old women who defeated Triple Positive Breast Cancer and also Ductal Carcinoma in Situ (DCIS) in 2016, which were both restricted to the area near the breast. On reciting her story, it became evident that dealing with the usual physical and psychological disadvantage that came with knowing having cancer was an additional disadvantage caused by the lack of understanding, communication,  and empathy provided by several medical practitioners.

4.1 Description:

In November 2015, on her 50th birthday, Michelle received a letter from the Breast-screen Australia notifying her that she was entitled to a free mammogram. “Things didn’t work out the way I had planned” (Michelle 2018). Breast cancer is the most common and second largest form of death causing cancer. In addition, the statistics state that 1 in 8 women are diagnosed with breast cancer by the age of 85 in Australia. (Cancer Council, 2018). The cancer council strategizes the risk of saving many women from breast cancer by the use of giving free mammograms by the age of 50 which was beneficial for Michelle and her family members for surviving it at an early stage. Therefore, in two weeks following her mammogram Michelle was called in for a ‘follow-up’ mammogram. During this appointment, Michelle was asked to complete tests after tests. After the second mammogram and an ultrasound, Michelle was informed what they had discovered her about the results which required her to do the biopsy on the same day. Just before Christmas Michelle was diagnosed with DCIS (Ductal carcinoma in situ), a neoplastic procreation restricted to the mammary ductal-lobular system and characterized by increased epithelial procreation which tends to progress to a non- invasive breast carcinoma (Newman, L.A & Bensenhaver, J.M. 2015). During the process of removing abnormal cells, two small tumors were found. Michelle was informed that these tumors were positive for Estrogen and progesterone, and had an over excess production of the receptor HER2 which was a non- metastatic cancer referred to as Triple Positive Breast cancer (Bapitiste 2015). (Cao, M.D., Lamichhane, S., Lundgren, S. et al. BMC Cancer (2014) 14: 941)

Michelle had various types of treatments which consisted of chemotherapy, intravenous Herceptin, and radiation therapy. Michelle’s treatment initiated at the John Fawkner’s Hospital (Coburg), where her experiences with medical practitioner were well. Michelle described the doctor to be very mindful and “reassuring and talked me through each step” (Michelle 2018). He was considerate about having support with her, was calm and explained every action performed on her. However, whilst performing the blood pool test (to evaluate the heart health) which consisted of 3-4 times in the 12- month period, Michelle wasn’t informed. On ‘measuring day’ (to define the treatment field) for Radiation therapy treatment, Michelle was held in an awkward and vulnerable position for an extended time, by 6 medical professionals arguing where to begin. She laid naked from the waist up, on a cold table, with her arms raised above her head, a position where it was the “ worst time to be disrespectful” ( Michelle 2018) Michelle listened to the medical practitioner conversing medically and she felt ignored and unaware about the things happening around her.

On her first day at Peter Maccallum Cancer Centre and prior to her treatment the receptionist handed Michelle her schedule and said if she had any questions. While finishing her Radiation therapy session, Michelle felt anxious and told the receptionist she needed to change the dates for one of the schedules, to which her response was rude “you’ve got a fit in with the schedule. I don’t think I will lend you that”. During her first day of Radiation Therapy treatment Michelle had brought her partner for support, and no one asked her partner to join Michelle for further support. After two sessions of Radiation therapy, Michelle asked if her partner could join, to which the response was ‘of course, just let me know which date’.  During her treatment sessions, a new face had joined the team at Peter MacCallum Cancer center, Michelle described her as reassuring “She was explaining everything as she did it to me” (Michelle 2018) and very empathetic. She would touch Michelle to declare and detail every action. In contrast, to the medical practitioners at Peter MacCallum who were focused on measurements, numbers and didn’t treat her as a human being. Michelle had had 30 sessions and during the involvement of her treatment, a long discussion would occur on positioning her breasts in a certain way. Michelle felt anxious, confused, and fearful and was frustrated that none of the practitioners communicated with her about her procedures as she stated: ‘No one’s talking to me… I have got very little information and not sure what’s going on”.

After one year of having multiple treatments and seeing practitioners/oncologists, Michelle was cancer free which gave her “a new insight into the life and not ignore the things that I need to get done”. Michelle’s quality of life was enhanced through this experience. However, from her treatment and scans she suffered numerous side effects from a range of severe burns from radiotherapy, nerve damage in fingers, fatigue, nausea, hair loss, nail color changes. Whilst Michelle was describing these symptoms I felt merciful, had immense respect and sadness as she valiantly handled this situation. Furthermore, Michelle was left feeling frustrated, dissatisfied, vulnerable, and angry by the lack of communication, no emotional support and least amount of professionalism was shown by the medical practitioners who treated her within her cancer journey. These side effects affected her daily lifestyle routine and having no emotional support tormented her physically and psychologically. Additionally, Michelle received was less informed about her procedures which provoked anxiety that would help her gets through cancer in gratitude.

 4.2 Feelings

The main emotion recalling from Michelle’s experience I felt disheartened and distressed. In reference to her events from her diagnosis to her treatment, there was a significant lack of understanding, professionalism, and support from various medical practitioners. Her partner and she were left in confusion as to what was occurring in their lives. This made me feel unpleasant that professionals were so busy being “professional” they gave up on humanity and relied on calculations to cure a patient. Michelle described being “so frightened that one of the machines was broken and it was going to fall on me”. I feel disheartened that such things can occur in this profession to a point where a patient feels ignored, frustrated and anxious when receiving a cure for her treatment due to lack of emotional support, communication and reassurance. Michelle mentioned ‘measuring day’ as to be one of the worst experience’s which had an impact on me. While listening to her recall her story I was feeling appalled by the discomfort of staying in vulnerable positions made me feel very pitiful and upset. Despite  5-6 practitioners being present in the room she was being touched without her consent , they had somewhat forgotten she was present in that moment and that the fact “ no one’s talking to me” states she  was treated as if she was speech deficit and was just an object. From her initial point of diagnosis to her treatment Michelle felt vulnerable and scared due to the intensity of treatment given “Severe burns. I thought it would feel like sunburnt but it was very painful”.  I felt furious due to the lack of respect and support shown by the receptionist at Peter Mccallum. Michelle had the right to ask any form of information as being a cancer patient it is already an overload of information you have to remind yourself. Displaying signs of disrespectful behavior towards a person states how inconsiderate and unprofessional that receptionist was. Showcasing genuine care and kindness has never cost anyone anything. Hence, many patients don’t receive the genuine care which in consequence affects their loved ones as well.

As a medical radiation practitioner, I would treat and respect everyone the way I wanted to be treated, with understanding and genuinely being kind. Furthermore, throughout her treatment, Michelle was treated disrespectfully and vulnerable. It is our responsibility to act sensibly towards everyone’s state of mind and emotions. However, in contrast to the doctor who performed the bone scan and the practitioner from one of radiation therapy who comforted Michelle states that there are compassionate people out there who are mindful about how reasonably they behave in their jobs. I felt relieved for Michelle as she found that lady to be comforting her in that vulnerable moment “little things that don’t mean anything to you mean the world to us” (Michelle, 2018). I felt grateful that humanity existing in some practitioners as they didn’t think too much about what they had to do but how they had to do things. Both practitioners made me feel less disheartened that this profession has propelled to think about the emotional aspect a patient suffers from. From recalling Michelle’s story the way the lady took her time to explain every detail to the last by communicating where she was touching Michelle gave me a sense of reassurance that Michelle’s suffering was cured with genuine compassion and significance at last. As a future practitioner I feel motivated and encouraged and I have learned that your support completes a patient’s life and that by being mindful and authentic towards your patient you can do your job efficiently. During her diagnosis to treatment, Michelle was left feeling highly anxious, uninformed, confused and insignificant towards the way oncologists and Radiation therapy team was conducting her scans and treatment.” I was lying there and no one was telling me what was going on”.  My overall feeling from this experience is frustration as having gone through surgery for my ACL ligament I realize the importance of communication and support you need to cope with. I can easily relate to how lack of information can cause stress which would mentally destroy the mindset due to anxiety and vulnerability. As a practitioner, I would conduct equality amongst my patients by showcasing emotional support whilst treating them fairly.

4.3 Evaluation:

The code of conduct outlines the expectations of how a medical professional should conduct themselves. Section 1.2 signifies that “Practitioners…. Will display qualities such as integrity, truthfulness, dependability and compassion” (Medical Radiations Practice Board of Australia 2014). The numerous practitioners that treated Michelle’s cancer journey expressed numerous occasions to ignore the section of this code. By ignoring the patient, not informing her or her family members about the actions taken for healthcare unless asked, and by being abrupt with her instead of communicating with understanding with her, the code was not followed. Michelle was not shown the qualities of dependability and compassion. However, the few practitioners that took the time to explain their actions in detail in her treatment, and reassured her of her safety did show all the qualities stated in the code of conduct, resulting in a positive experience, enabling Michelle and her partner to cope better emotionally . By handling Michelle in a professional manner and consistently reassuring her, helped eliminate further distress and anxiety on behalf of Michelle and her partner, preventing any further detriments and proving the impact professional behavior can have on patient experiences.

The disastrous situation created by the receptionist restricted Michelle and her partner’s ability to cope at an emotional state. As mentioned earlier, studies conducted by Baumeister and his team (2001) stated that if a patient is treated poorly, the psychological detriments are likely to increase equivalent to as people process and obtain more knowledge regarding negative events compared to positive events. After surviving Breast Cancer, it is evident that both patients and family suffer from psychological stress, due to poor treatment provided by the practitioner (Dizon, 2013). The impact of unfortunate behavior which Michelle received did not follow the code of conduct, and therefore resulted in disadvantaging Michelle’s emotional recovery from cancer and increased her partner’s compassion fatigue, but it also resulted in psychological and psychosocial damage (Carr & Steel 2013). Whilst Michelle was reciting her journey it was evident that her cancer journey had negative and positive experiences which changed her opinion on life. As known, Michelle’s practitioners expressed the lack of communication and empathy to enable Michelle and her partner’s emotional state to handle information. She stated, “I had radiation treatment  …it left the skin under my right breast incredibly sensitive… it was particularly painful and difficult…it wasn’t something I knew could happen to me” . This expresses how deeply vulnerability affected her psychologically and emotional well-being. The code of conduct under MRPBA section 1.2 states that practitioner needs to be dependable compassionate and have high integrity (MRPBA, 2015).  Her treatment lacked all of these characteristics and lacked duty of care of gaining Michelle’s trust. In contrast, the practitioners who conducted these characteristics explained all procedures as Michelle stated, “She was telling me what she was doing and where she was at and why she was doing it…simple things such as reassurance tends to make the patient experience a little happier “  Contrastingly, the scans taken at John Faulkner, Michelle recited on having a good experience stating “ the guy was so lovely and so calm, reassuring and talking through each step and he told me how long the particular scans were going to take”. This form of treatment stood out for Michelle as it followed the level of detail and uphold many codes and standards such as code 3.3 effective communication. It states that verbal and non-verbal communication enables the practitioner to be mindful about the situation the patient is going through and tends to highlight the ethical and supportive practice for the patient (MRPBA, 2015).  From this experience, I entitled the significance of understanding the emotional aspect as well as the communication aspect portrays a vital part in our patients lives it signifies the mindfulness and authenticity as a professional can impact  your patient in positivity. 

4.4 Analysis:

In reciting of her journey, Michelle made it evident that it was both professional and unprofessional behaviors which impacted her experiences with triple positive breast cancer.  The key components of Patient care relationships are built up on integration, decision making, communication, and collaboration. (Nicoloro-Santabarbara, J., Rosenthal, L., Auerbach, M. V., Kocis, C., Busso, C., & Lobel, M. (2017). In the code of conduct, section 2.3 ‘Shared decision- making’ signifies that making decisions based on healthcare is the ultimate responsibility between practitioner and patient who may wish to involve their family. (Medical Radiations Practice Board of Australia, 2014). Cancer triggers psychological difficulties in responding to the treatment many patients receive. These factors can trigger depression, anxiety, pain and fatigue affecting the quality of life. In the advance stages of cancer patients tend to hold onto the emotional sphere that it becomes difficult for patients and their family to handle a situation. Communication portrays as a strengthening factor for patient car and families as it strengthens them to have hope and motivation to fight the disease. (Glińska, J., Adamska, E., Lewandowska, M., & Kobos, J. (2012)) Furthermore, section 3.9 ‘Relatives, carers and partners’ states that good practice involve being considerate to carers. In relation to Michelle’s cancer journey it was evident that she wasn’t provided the opportunity to have her partner as a support in the treatments. It was assumed she is not family therefore there was no information provided in terms of how the appointment went. This added emotional distress on Michelle and her partner having to deal with things on her own as they were not able to fully support each other in regards to the treatment provided. In section 3.3 ‘Effective Communication’ the code states that practitioners should listen and ask the patients about the views on their healthcare. In relation to Michelle, practioners didn’t follow this code as Michelle stated during her treatment “six people there all were having a chat about we do this and that. Use the picket fence to keep my breasts in order. No one’s talking to me. No one’s explaining anything to me”.  (Michelle, 2018) This states that Michelle lay in a vulnerable position while practitioners were lacking reassurance and failed to engage with her during her treatment. The failed to “stay in the moment with the patient” (Michelle, 2018). Furthermore, in order to implement effective communication it is vital that as practitioners we tend to align positivity in  our goals, behaviors and being consistent with treatment processes carried out  which results in efficient patient care and experiences.

6. References:

1. Ann L. Cunliffe  Journal of Management Education Vol 40, Issue 6, pp. 747 – 768 First Published October 24, 2016 https://doi-org.ezproxy.lib.rmit.edu.au/10.1177/1052562916674465 Retrieved from: “http://journals.sagepub.com.ezproxy.lib.rmit.edu.au/doi/pdf/10.1177/1052562916674465”
2. Australian Health Practioner Regulation Agency (2017) National Boards: Available at: https://www.ahpra.gov.au/

3. Australian Health Practitioner Regulation Agency (2014). Guidelines for Mandatory Notifications. Retrieved from : file://rmit.internal/USRHome/shr/7/S3377187/Downloads/AHPRA—Guidelines-for-mandatory-notifications%20(4).PDF

4. Australian Radiation Protection and Nuclear Safety Agency. (2017). International Best Practice/Trusted International Standards. Retrieved from: https://www.arpansa.gov.au/regulation-and-licensing/regulation/international-best-practice

5. Australian Society of Medical Imaging and Radiation Therapy (2017). Code of Ethics: Available at : https://www.asmirt.org/media/124/124.pdf

6. Australian Radiation Protection and Nuclear Safety Agency. (2016). Radiation Protection in Planned Exposure. Retrieved from : https://www.arpansa.gov.au/sites/g/files/net3086/f/legacy/pubs/rps/dr_plannedexpv2.pdf

7. Australian Radiation Protection and Nuclear Safety Agency (2014, 2016, 2017). Radiation Protection Series. Retrieved from : https://www.arpansa.gov.au/regulation-and-licensing/regulatory-publications/radiation-protection-series

8. Australian Radiation Protection and Nuclear Safety Agency (2014). Fundamentals. Retrieved from : https://www.arpansa.gov.au/regulation-and-licensing/regulatory-publications/radiation-protection-series/fundamentals

9. Baptiste, K.A. (2015). Dig In Your Heels: The Glamorous (and Not So Glamorous) Life of a Young Breast Cancer Survivor. USA: Antiste Publishing.
10. Baumeister, R. F., Bratslavsky, E., Finkenauer, C., & Vohs, K. D. (2001) Bad is Stronger than Good. Review of General Psychology, 5(4), 323-370. doi: 10.1037//1089-2680.5.4.323 4)
11. Cancer Council (2018) Breast Cancer. Available at : https://www.cancer.org.au/about-cancer/types-of-cancer/breast-cancer/
12. Cao, Maria D., Lamichhane, Santosh, Lundgren, Steinar, Bofin, Anna, Fj?sne, Hans, Giske?deg?rd, Guro F., & Bathen, Tone F. (2014). Metabolic characterization of triple negative breast cancer. BMC Cancer, 14(1). Retrieved from : https://bmccancer.biomedcentral.com/track/pdf/10.1186/1471-2407-14-941
13. Carr, B.I. & Steel, J. (eds) (2013). Psychological Aspects of Cancer. Pennsylvania, US: Springer. Retrieved from : https://books.google.com.au/books?id=2jIeG78-s_MC&printsec=frontcover&dq=psychological+and+psychosocial+effect+cancer&hl=en&sa=X&ved=0ahUKEwjc0N2h94DUAhVFppQKHdqmDvIQ6AEIJTAA#v=onepage&q=psychological%20and%20psychosocial%20effect%20cancer&f=false
14. Dizon, D. S. (2013). Reflections on Patient Perspectives and Survivorship from the 2013 Breast Cancer Symposium. Haymarket Media, Retrieved from http://www.cancertherapyadvisor.com/from-the-advisory-board/reflections-on-patient-perspectives-and-survivorship-from-the-2013-breast-cancer-symposium/article/312606/
15. Farrell S C, Thomas (2012) Reflection on Reflective Practice. Revisiting Dewey and Schon. Available online at: https://onlinelibrary.wiley.com/doi/full/10.1002/tesj.10
16. Glińska, J., Adamska, E., Lewandowska, M., & Kobos, J. (2012). Evaluation of the psychological state of patients with advanced cancer and the impact of support on their emotional condition. Współczesna Onkologia,6, 563-568. doi:10.5114/wo.2012.32491. Retrieved from : https://www.ncbi.nlm.nih.gov/pubmed/23788945
17. Hebert, C. (2015). Knowing and/or experiencing: a critical examination of the reflective models of John Dewey and Donald Schön, Reflective Practice, 16:3, 361-371, DOI: 10.1080/14623943.2015.1023281 Retrieved from : https://www-tandfonline-com.ezproxy.lib.rmit.edu.au/doi/pdf/10.1080/14623943.2015.1023281?needAccess=true
18. Medical Radiations Practice Board of Australia. (2014). Code of Conduct for medical radiation practitioners. Australian Health Practitioner Regulation Agency. Retrieved from https://www.ahpra.gov.au/
19. Medical Radiations Practice Board of Australia. (2015). Using radiation in Australia. Retrieved from http://www.medicalradiationpracticeboard.gov.au/Registration/Using-radiation-in-Australia.aspx
20. Malthouse, R., Roffey-Barentsen, J., & Watts, M. (2014). Reflectivity, reflexivity and situated reflective practice. Professional Development in Education, 40(4) , 597–609. https://doi.org/10.1080/19415257.2014.907195 . Retrieved from : https://www-tandfonline-com.ezproxy.lib.rmit.edu.au/doi/abs/10.1080/19415257.2014.907195
21. Morgans, A. K., & Schapira, L. (2015). Confronting Therapeutic Failure: A Conversation Guide. The Oncologist,20(8), 946-951. doi:10.1634/theoncologist.2015-0050. Retrieved from : http://theoncologist.alphamedpress.org/content/20/8/946
22. Mueller, C. A., Tetzlaff, B., Theile, G., Fleischmann, N., Cavazzini, C., Geister, C., . . . Hummers-Pradier, E. (2014). Interprofessional collaboration and communication in nursing homes: A qualitative exploration of problems in medical care for nursing home residents – study protocol. Journal of Advanced Nursing, 71(2), 451-457. doi:10.1111/jan.12545. Retrieved from : https://onlinelibrary-wiley-com.ezproxy.lib.rmit.edu.au/doi/pdf/10.1111/jan.12545
23. Newman, L. A., & Bensenhaver, J. M. (2015). Ductal carcinoma in situ and microinvasive/borderline breast cancer. Springer New York. DOI: 10.1007/978-1-4939-2035-8. Retrieved from : https://link.springer.com/book/10.1007%2F978-1-4939-2035-8
24. Nicoloro-Santabarbara, J., Rosenthal, L., Auerbach, M. V., Kocis, C., Busso, C., & Lobel, M. (2017). Patient-provider communication, maternal anxiety, and self-care in pregnancy. Social Science & Medicine, 190, 133-140. Doi :10.1016/j.socscimed.2017.08.011 Retrieved from : https://www-sciencedirect-com.ezproxy.lib.rmit.edu.au/science/article/pii/S0277953617304835?via%3Dihub
25. Schon A, Donald (1983) The Reflective Practioner
26. Schön, D. A. (1987). Educating the Reflective Practitioner. San Francisco, CA: Jossey-Bass. Pg. 26.
27. Sicora, A. (2017). Reflective Practice, Risk and Mistakes in Social Work. Journal of Social Work Practice, 31(4), 491-502. doi:10.1080/02650533.2017.1394823.  Retrieved from : https://www-tandfonline-com.ezproxy.lib.rmit.edu.au/doi/full/10.1080/02650533.2017.1394823?scroll=top&needAccess=true