Reflection on the Application of Healthcare Skills - Essay Example

?Table of Contents Table of Contents Reflection on the Application of Healthcare Skills 2 Introduction 2 Importance of Using the Gibb’s Reflective Model 2 Learning Objective One - Comprehensive History Taking Process 3 Learning Objective Two -Physical Examination Technique 4 Learning Objective Four -Problem Solving 5 Learning Objective Five- Communication Skills 10 Stage Two of Gibb’s Reflective Model 11 Stage Three of Gibb’s Reflective Model 12 Stage Four of Gibb’s Reflective Model 13 Conclusion 14 References 15 Aehlert, B. (2013) Paramedic practice today: above and beyond, Jones & Bartlett Learning, New York. 15 Blaber, A. (2012) Foundations for paramedic practice: a theoretical perspective, Open University Press, Maidenhead. 15 DiPrima, Jr., P. (2012) Paramedic survival guide, McGraw-Hill Medical, New York. 16 Fellowes, S. & Fellows, B. (2012) Paramedics: from street to emergency department case book, Open University Press, New York. 16 Wade, C. (2011) ‘Planning and writing an evidence-based critical reflection’, Journal of Paramedic Practice, vol. 3, no. 4, pp. 190 – 195. 17 Reflection on the Application of Healthcare Skills Introduction I will use the Gibbs Reflective Learning Cycle to reflect on my experiences and professional practice as a paramedic. This reflective theory is quite practical because it allows for a clear description of facts, and an assessment of the medical practitioner’s reactions to the patient(s) at the scene of an accident or other crisis. It also allows for a paramedic to be able to make sense of all that he or she experienced while expending medical care to traumatised people. This is particularly important because it allows the paramedic to reflect on if he would alter anything if he was confronted by another similar incident. In addition, paramedics are usually the first people to arrive at disturbing scenes that would be frightening and traumatising to people. They are required to keep their feelings in check and avoid panic even as they deal with injured people. The repression of feelings of shock and fear is not healthy, and it is important for paramedics to be able to express their true feelings about the situations they face on a daily basis without the fear of disapproval (Mamede, Schmidt and Penaforte, 2008). In keeping with the professional conduct principle of confidentiality which is stipulated in the Nursing and Midwifery Council (NMC), the real names of the patients I met will not be used in this essay (Nursing and midwifery Council (NMC) 2008). Importance of Using the Gibb’s Reflective Model The Gibb’s reflective model allows for a more meaningful reflective method by encouraging a more in-depth enquiry of past actions (Dougherty and Lister 2008). This will allow the paramedic to be able to make better decisions in future. It could be said any reflective practice in my area of specialty, which concerns paramedic work, has always been organised the debriefing process that is conducted after paramedics attend to patients in a serious accident (Duffy, 2009). The debriefing process can also be conducted among co-workers in the cab of the ambulance (Nursing and midwifery Council (NMC) 2008). The first principle that is addressed in the Gibb’s reflective model concerns the description of an event or incident (Blaber, 2012). One of my first experiences as a paramedic was in treating the casualties in a road accident. My crewmate who is an ambulance technician and I got an emergency call from the ambulance control office late one evening about a serious accident that had occurred at a city intersection. A man had been knocked down by speeding car. As the city intersection is not far from where we were, we were able to rush to the scene without having to encounter traffic jams. Learning Objective One - Comprehensive History Taking Process There was a growing crowd at the scene of the accident that appeared to be wary about moving the wounded victim even though various people were fanning him. As my colleague tried to convince the people in the crowd to give us some room to work on the unconscious man, I mentally made an assessment of the car that had hit the pedestrian. Its distraught occupant stared at me vacantly and appeared to be trying to say something even though he was not producing any sound. His car had a shattered windscreen, and a damaged bonnet. I donned one of the two pairs of gloves I was carrying, approached the driver and loudly asked if he was wounded while examining his hands and legs and torso. A few people from the crowd around the victim made their way back to the driver and began to reassure him that he was not to blame while also telling me that the victim appeared to be drunk and stumbled unexpectedly onto the highway. After ensuring that the driver did not have any serious injuries and was mainly experiencing mild shock, I joined my colleague who was kneeling next to the victim. The victim lay about four feet away from the car and appeared to be unconscious. He appeared to be a middle aged gentleman and was wearing a ‘medical alert bracelet’ that had his name, phone number, and indication that the victim was allergic to peanuts. The medical bracelet also indicated that the victim was allergic to poison ivy. There was no mobile phone or wallet in any of his pockets. The victim did not appear to be bleeding deeply from any part of his torso but had lacerations and swellings across his shoulders, abdomen, as well as a small swelling on his head. My colleague had already started trying to intubate the patient. Learning Objective Two -Physical Examination Technique After a short while, the patient regained consciousness and began to moan softly. My partner, who had already donned gloves, stopped trying to intubate the victim. As he identified himself as a paramedic, I donned a pair of gloves and asked the victim to indicate if he felt pain when I touched him. My colleague held the victim’s head with both of his hands to keep his neck in line as I started a head to toe examination. I first shined a light in the eyes of the victim and asked him to follow it without moving his head, which he did. His pupils were not dilated and he appeared to be able to move them in all directions. I then pressed both of the sides of his face with my hands. Even though I had suspected that the man was too drunk to speak or understand what I was trying to say, he shook his head to indicate that he understood what I was trying to do and felt no pain when I squeezed the sides of his face. Next, I pressed his neck from all sides, pressed his jaw, and then moved his shoulders, which, he said, was a bit painful. I then squeezed his hands all the way from his elbows and finally asked him to squeeze my fingers when I put them on his palm. This, he did quickly. I then repeated this examination using the other arm while remembering to take pulses from both arms. I then took both of his arms and crossed them to touch the opposite shoulders and asked the patient if he experienced any pain. He indicated that there was mild pain. I then palpated his abdomen in four different regions, and he stated that he was also experiencing some pain there. The victim had small swellings as well as grazes on his shoulders and abdomen which appeared to be soft tissue injuries. My colleague applied ice on the swollen parts and compressed them. My colleague also applied pressure to the victim’s legs and asked him to point his toes towards his head and away from it, as though pressing on a stone. I recorded my findings, the man’s name, which he volunteered, his pulse rate and other findings while my colleague tried to question him to find out if he remembered what had taken place. Even though the man stressed that he only felt some pain at the gashes at his elbows, shoulders, and abdomen, he did not appear to remember what had happened to him. He asserted twice that he had had some beer an hour before, however. Learning Objective Four -Problem Solving Decision-making is always encumbered by uncertainties for most paramedics (Levett?Jones, 2007). This is because, in most accident scenes, there may be a lot of confusion as well as missing information. Accident scenes also tend to be lacking in the treatment equipment that is usually found in hospital settings (Mamede, Schmidt, and Penaforte, 2008). Paramedic practice is also distinctively different from other accident scenarios because the medical processes used to treat wounded victims have to be made to fit in the uncontrolled setting. Paramedics can use different thinking strategies for determining the best treatment for a victim. When they make use of event-driven therapy, they will first treat the existing or visible symptoms based on acquired knowledge and then re-evaluate the victim’s reaction to the first set of treatments before making further decisions on the next set of treatments (Mann, Gordon, and MacLeod, 2009). When paramedics use their intuition, they make decisions without consciously thinking about their decisions because they have witnessed the presenting symptoms before and are well-accustomed with how to treat them. It is usually the experienced paramedics who use this method of thinking (Howatson-Jones, Standing, and Roberts, 2012). When paramedics use pattern recognition, they combine the outstanding features that are visible in order to come up with a diagnosis that also has a management plan (Wade, 2011). When paramedics use the exhaustive thinking strategy, they will accumulate facts in a random manner and then come up with a fitting diagnosis by sifting through the facts. In the use of the hypothetico-deductive strategic thinking method, paramedics will arrive at a conclusion that is based on preliminary findings, and even modify their ideas based on subsequent findings (Greaves, 2006). They can also make the decision to gradually exclude different possibilities in order to arrive at the best option. In the use of the algorithmic strategic thinking, paramedics will use a predetermined method of treatment which is founded on pre-established principles (Webb, 2011). In most cases, the more experienced paramedics use shortcuts to reach decisions because there are no rational decisions used, but rather the procedures remembered from memory. While using one’s dependence on memory and past experiences can cause a paramedic to unintentionally make mistakes; this is a process that minimizes the period used before taking action and can thus prevent more harm from happening to the victim. For instance, as my victim had remained unconscious and unresponsive to any stimuli for a short period before regaining consciousness, my colleague and I immobilized his spine without giving much conscious thought to doing this because it is something that we had done before. In my formal education as a paramedic student, I discovered that it is quite easy to learn the procedures used in responding to an emergency call. Moreover, it is harder to comprehend how such decisions are made. Most of the time paramedic students tend to lay more emphasis on simulation and not on the acquisition of critical thinking skills. This can prove to be unhelpful when one is exposed to the real life situation. The on-scene stage of responding to an emergency calls for a paramedic to make the clearest decisions. It is vital to be aware of this in order to minimize adversities at the scene of an accident. Even though our patient had some abrasions and lacerations across his chest, elbows, and abdomen, they did not appear to be deep. On questioning the patient when he regained consciousness, he stated that he felt some pain but emphasized that it was not excruciating. He also stated that he was not experiencing nausea, and, on checking him, he was not exhibiting sweatiness. This allowed my colleague and I to arrive at the decision that the mild chest pain that the patient was experiencing was from a musculoskeletal source and not a cardiac one. We arrived at this decision after decisively deliberating between two possibilities and making comparisons. Experienced paramedics tend to memorize the characteristics of different illnesses and physical disorders. It is also true that paramedics tend to use ideal representations of different diseases or fractures which are usually a result of the formal knowledge acquired and past experiences. My, in this case, spoke with a drunken stutter and had confirmed that he had had a lot of alcohol just an hour before. However, the fact that he had been unconscious for some time before he suddenly became conscious and even started speaking made me suspect that he might have suffered more injuries than were apparent. His stuttering could have been as a result of his drunkenness or a more serious problem like a concussion. He was not nauseous and only appeared to have a small swelling on the side of his head. However, due to previous experience, I chose to err on the side of caution and decided to treat him as a concussed victim. After immobilising the victim, my colleague and I phoned a nearby hospital to provide information on the condition of the patient we were about to bring. While my colleague kept a small ice pack on the head of the victim, I tried to make other examinations while speaking slowly to the man. In this case, my colleague and I assessed the situation through the use of previously acquired mental knowledge and past experience. To acquire the relevant information on the patient, my colleague and I depended on the medical bracelet that the victim was wearing as well as the conducting the physical examination to ensure that the patient did not have any internal wounds. With these facts, my colleague and I were able to compare the present case with anecdotal information, other cases or situations to which we had been called in the past, and the medical information acquired through formal instruction. This assessment allowed us to come up with information about the present scenario (DePlacido, 2010). I also compared the victim’s seeming confusion with other past cases in which I had witnessed similar symptoms. I had witnessed past incidences where accident victims appeared to only have minor wounds and actually stood up and walked away from accident scenes only to collapse later or experience increased pain when they returned to their homes. Paramedics do not only require problem thinking skills, but also have to have social perceptiveness in order to determine why people react as they do. It is known that many people have suffered concussions and remained conscious (Moon, 2004). However, such victims of concussions may report seeing things in black and white, seeing stars, or experiencing nausea and disorientation. Due to the fact that our victim, in this case, had consumed a lot of alcohol, I wondered if he was experiencing some of these symptoms but was not able to articulate it. If he was accustomed to being drunk, experiencing odd symptoms might not have been something shocking to him. I looked at one member of the crowd and motioned towards the spinal board and trolley which my colleague had dragged from the ambulance as he ran towards the victim and which was now just out of our reach. The spectator quickly retrieved it and we very slowly placed the victim on to the spinal board while using straps and head blocks to make sure that his spine remained immobile. At this time, a police car arrived and two officers came to the crowd while another went to the distraught driver. My colleague and I left the officers interrogating the crowd and transferred the trolley into the ambulance after answering a few questions from the law enforcement officials about the state of the patient. Even though I was aware that my colleague and I had done everything in our power to ensure that the victim would survive, I was still anxious about the patient. I find that I still remember that it was a warm night when this incident occurred and there were many graduation parties being held around the town as students from three universities were graduating. I returned to the hospital where the patient had been admitted and found out that he had actually experienced a mild concussion and was now recovering. Learning Objective Five- Communication Skills Any paramedic has to be a confident person who can take leadership even in a chaotic situation. There is also a great deal of responsibility entrusted to this job because the paramedic literarily makes decisions that will affect the lives of victims and casualties (Mann, Gordon and MacLeod, 2009). One has to have the capacity to act decisively in an unstructured setting that may constantly be changing. The paramedic also has to have the ability to remain calm and communicate effectively with panicking people (Gallagher and Hodge, 2012). When my colleague and I first arrived at the scene of the accident, there was a group of emotional people surrounding an unconscious man while a small group surrounded the driver of the vehicle that caused the accident. After removing my hat, I first questioned the driver, who was obviously terrified that he might have unintentionally caused the death of a stranger, in a calm manner and examined him for injuries. Having established that he was not at fault, I looked him directly in the eye and reassured him that everything would be alright before going to join my colleague who was crouched next to the victim and had began to intubate him after immobilizing his head. When the victim suddenly regained consciousness after a short while, my colleague and I identified ourselves and proceeded to inform him of all the procedures we were conducting before we carried them out. Before asking the victim for his name and other details, I moved to his eye level and removed my glasses so that he could see me more clearly. My colleague asked the bystanders to give him a little room so that he could breathe. However, the real reason for this was so that the victim could not see the shock on their faces. This man, in my estimation, had been incredibly lucky. When I first saw the dents in the car, I expected to be confronted by a worse scenario and prepared myself so as not to seem shocked to the victim. However, the victim did not appear to have any serious injuries on the outside. I suspected that he had suffered a concussion, though. The members of the public were loudly wondering how the man was still alive; and so might have caused him more anxiety. While it is vital for a paramedic to be able to reassure a victim, the non-verbal cues shown by the paramedic are of even greater importance (Gregory and Mursell, 2010). This is why my colleague and I maintained postures and facial expressions that were calm and unaffected and also spoke in soft tones so as not to convey any doubt about the ‘possibility of the patient recovering. Stage Two of Gibb’s Reflective Model The second aspect in Gibb’s reflective cycle has to do with feelings (DePlacido, 2010). When my colleague and I first arrived at the scene of the accident, many of the bystanders were quite emotional and excited. In addition, the driver of the car that caused the crash was distraught and appeared to be in shock. Upon reflection, I know that I did not take enough time to reassure the crowd while speaking for a lengthier period with the distressed driver. When I saw the dent in his car and the shattered windshield, I assumed the worst. I was quite calm when speaking with him, but did not remain with him for long after establishing that he was not wounded in any way. I guess that a part of me felt that he had the crowd to console him and that his victim was in more need of help. I was also rather brash with the crowd that had formed around the unconscious victim. In accident scenes, most paramedics have to get to the victims and administer treatment as soon as possible in order to prevent the conditions of the victims from worsening. Paramedics are also forced to present a calm face and respond helpfully with victims while also empathising with them. At some stage, during the analysis of the now conscious victim, I felt a bit irritated by the seeming unaffected stance adopted by the victim when questioned about his symptoms. It is as though he felt that we were bothering him and did not understand that he was alright. At one point, even after we had instructed him to remain completely still, he tried to remove the structure we had put on him to stabilise his head so that he could leave. Being a little frustrated and irritated, I resumed silence while my colleague slowly questioned the victim about any medical history he might have had. I was frustrated because I knew the victim would endanger his life again if he did not learn how to control his drinking habit. It also appeared that he did not seem to understand how close he had come to death. Moreover, other than reacting from such feelings, I chose to remain silent. Stage Three of Gibb’s Reflective Model The third phase in the Gibb’s reflective model has to do with evaluation (Gibbs, 1988). From this experience I have learned that it is important to carry out a comprehensive assessment of the accident scene once one arrives there in the capacity of a paramedic (DiPrima, 2012). This does not only mean assessing the patient’s wounds, or, if they are conscious, asking about pre-existing medical problems, but assessing the surroundings (Goldberg, Mccormick and Wood, 2006). Even before beginning treatment, the paramedic has to grapple with crowds and marshal them to support him or her. In this case, both my colleague and I had to ask the crowd members different questions about how the accident took place and also ask for them to give room so that we could treat the victim. Even though the crowd appeared to be meddling at times, it was instrumental in comforting the distraught driver who appeared to be fearing the possibility of being charged for a crime. At other times, an accident may have taken place at a bend. This means that even before commencing treatment, the paramedic has to make sure that the patient(s) and even cars are removed from the centre of the road (Fellowes and Fellows, 2012). This is particularly important if the accident took place at a bend where on-coming cars may be totally unable to see the cars in the middle of the road until they have came around the bend, in which case it is usually too late and additional accidents occur (Levett?Jones, 2007). This, however, can be a difficult thing to implement; particularly when the paramedics are responding to an accident that was caused intentionally and is therefore a crime scene (Howatson-Jones, Standing and Roberts, 2012). In such cases, the law enforcement officers usually require that cars and bodies, if any, be left where they lie (Webb, 2011). Paramedics also have to have crowd calming skills because they are often confronted by odd situations that may require them (Aehlert, 2013). It is also important for paramedics to remain calm in all situations; particularly when they are faced by situations in which all other people are extremely emotional. Stage Four of Gibb’s Reflective Model Analysis is the fourth stage in the Gibb’s reflective model (Gibbs, 1988). When a paramedic first arrives at the scene of an accident, he or she has to assess the situation and then decide on the best way to communicate with the victim or his or her relatives in order to get the best communication about what has taken place (Esterhuizen and Freshwater, 2008). In this case, we could only communicate with the members of the public who witnessed the accident. In such situations, if the bystanders are reacting in emotional ways, it may sometimes be necessary for the paramedic to get the victim away from them or request them to move back so that the patient, if conscious, may not develop a greater anxiety because of hearing what people are saying (Jasper 2003). Leadership characteristics, in such situations, will ensure that work is not repeated, situations are controlled, and the necessary resources are acquired and used for the benefit of saving the wounded (Wade, 2011). In addition, when serious incidents of a national scale such as terrorist attacks, occur, it is likely that there will be multiple emergency response teams that come to help with the salvaging efforts (Greaves, 2006). In such cases, it is vital for paramedics to use plain speech in when operating in different scenarios in order to reduce confusion among different organisations that are involved in salvaging efforts (Davis, 2004). When there are massive casualties and wounded people in such scenarios, it becomes important for the different medical agencies involved to determine the way they are going to divide the wounded people in the way that will allow all of them to be treated (Duffy, 2009). For instance, the medical agencies have to determine what will constitute ‘priority one’ cases which require immediate medical attention and which characteristics will constitute the secondary groups of cases who will not lapse into unconsciousness if there is delayed treatment. Conclusion Reflection is vital in the professional life of a paramedic because it allows for one to meditate on different medical practices that were conducted (Jones, 2004). It also helps paramedics to share together their views on different medical practices and compare notes on how to respond to the most challenging situations. Structured reflection also has the potential to improve the skills of paramedics and contributes to the increased execution of professional standards. References Aehlert, B. (2013) Paramedic practice today: above and beyond, Jones & Bartlett Learning, New York. Blaber, A. (2012) Foundations for paramedic practice: a theoretical perspective, Open University Press, Maidenhead. Davis, F. (2004) Models of the communication process, Brooklyn College/CUNY, New York. DePlacido, C. (2010) ‘Reflective practice in audiology’, Hearing Review, vol. 17, pp. 20- 25 DiPrima, Jr., P. (2012) Paramedic survival guide, McGraw-Hill Medical, New York. Dougherty, L. & Lister, S. (2008) The royal Marsden hospital manual of clinical nursing procedures: student edition, Wiley-Blackwell, Oxford. Duffy, A. (2009) ‘Guiding students through reflective practice ? the preceptors experiences. A qualitative descriptive study’, Nurse education in practice, vol. 9, pp. 166?175.  Esterhuizen, P. & Freshwater, D. 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