Analysis of the Six Reflective Accounts - Essay Example

REFLECTIVE REPORTS Introduction My is Hissa Mohammed, a in the department of diagnostic radiography. This is my 4th year and final year for this degree. For the academic year of 2013-14, I have taken up professional practice 4 and clinical practice 4 modules. My learning, progress, growth, opinions, and accomplishments that I have attained in this year through my clinical placement are represented through this e-portfolio. The e-portfolio focuses on six of the eight available reflective accounts. These six are selected to contain the primary Knowledge and Skills Framework (KSF) cores. The six reflective accounts are: • Quality • Personal and people development • Service enhancement • Equality and diversity • Health safety and security • Communication Apart from the reflective accounts given above, there are two diagnostic radiography specific dimension reflective accounts which will be covered. These are: • Collection of Information and analysis • Assessment and treatment planning This E-portfolio also includes personal development plan, personal statement, and curriculum vitae for more information. Since Gibbs (1998) module of reflection is the most frequent reflective module in the health care reflective; it will be utilised in this E-portfolio. Communication I started by clinical experiences with very little regard for importance of communication in successful radiography. Through the course however, I started reading about some of the areas needed to ensure successful radiography, of which communication came out as very crucial. Since that time, I learnt to improve my communication skills through several means. In most of the cases however, my learning in communication happened on the job. This means that different work situations presented different ways in which I had to approach communication. For example there was one time when a 46-year-old female was transported in her bed to the Minor Injury Unit at Western General Hospital in Edinburgh, as the physician requested a lumbar spine X-ray for her after she fell down the stairs. The radiographer and I had difficulty communicating with the patient because she has aphasia, which is defined as a loss of language function and which is a result of injury to the language centres in the brain (Ehrlich and Coakes 2013). Before I started positioning the patient for the lumbar spine X-ray procedure, I asked the nurse who accompanied her about the way that she communicated with the patient. The nurse revealed that the patient was able to read and write and so she wrote what she wanted to say to the patient on a piece of paper and gave it to her so she could read it. Based on this, I brought a piece of paper with me and wrote down what would happen during the procedure as well as some instructions for the patient. I then gave her the piece of paper so she could read what I wrote. The patient read what I gave her and she wrote that she understood what I was trying to tell her and she felt more comfortable after having received this written explanation. As a result of this communication, we successfully carried out the examination. Alder and Carlton (2010) and Watkins (2001) note that good communication and compassionate care also have a great impact on the practitioner. In radiography, good communication with the patient helps him/her understand what the radiographer is expecting from him/her during the procedure, which will affect the patient’s actions and mood and will boost his/her ability to cooperate with the radiographer’s instructions. This will ease the procedure, save time and reduce the need to repeat the procedure due to non-cooperation during the examination, thus saving the patient from exposure to additional radiation (Alder and Carlton 2010; Watkins 2001). Even though from the feedback of the patient, I had achieved the goal of communicating to her, I later realized that apart from the written communication, there were other ways I could effectively communicate with her, including the incorporation of gestures and facial expressions that transferred the message of hope and assurance to her. This experience also gave me a realization on the need for me to learn sign language for future need. For NHS radiographers, or any other doctor, compassionate patient care and strong communication are extremely important for their daily activities. Considering the importance of this communication, and in order to be efficient, I will definitely try to learn sign language, which will help me communicate with patients who face speaking difficulties. For this reason, I learnt the importance of communication between the patient and the radiographer, which can result in a successful procedure, a good quality result and a good quality of patient care (Ehrlich and Coakes 2013). In future, I will keep on practicing adequate communication to improve patient care and improve the dignity and confidentiality of patient. More importantly, I shall ensure that communication will become more focused on the patient rather than focused on me so that I will be able to render client-centred care. Personal and People Development There have been a number of experiences that I have gained, which have helped in my personal and people development. Generally, I gained personal and people development through the need to interact with people; both patients and workers as a means of getting my work done. Constantly, I realised that my interaction with people was going to be difficult if I presented myself to them as a well developed person than they were or they were seen as well developed people than I was. Consequently, I was forced to be concerned not just about my own development or the development of others but to be concerned about both. There are specific examples that outline the way and manner in which I was able to achieve personal and people development. For instance, one day during my placement in the Minor Injuries Unit, the unit became so busy with patient requests that the workload also increased. Because of the increased workload I became very stressed, which affected my ability to efficiently attend to the work. I became physically tired and I experienced muscle tension; shortness of breath and a rapid heartbeat, which were all caused by stress (Michie 2002). I talked to the radiographer who was supervising me and she told me that she also experienced this problem when she first began working as a radiographer. She advised me to read some books to learn some strategies for managing work-related stress, which could help me improve the efficiency of my work in the future. In the immediate term however, my supervising radiographer advised me to take a short break to lower my stress level and to read some strategies that could help me organise my work so that I could reduce the work-related stress I was experiencing. Immediately, I was presented with the opportunity of learning about how to attain the best outcomes with workflow. This is because I came to realise that in order to function effectively, I needed to have a very good balance with my stress level and workload. Without such self adjustment, if I recorded total breakdown, the vacuum and effect that would be created on other people will be more than if I was present and helped in the best way my abilities could limit me to. Through further reading as the supervisor suggested, I realised that Radiographers experience negative impacts when high amounts of stress are present within the individuals working in the same profession (Astin et al. 2005). The stress is not only the result of the amount of work; it is also the result of the urgency with which work must be completed (Wainwright and Calnan 2002). The professional effectiveness of an individual is reduced when he/she suffers from stress. Once this happens, it does not only disrupts his/her personal relationships but also causes psychological distress, decreases job satisfaction, increases suicidal ideation, and also decreases his/her skills as a professional. Stress can therefore be said to be a critical factor in personal and people development as it must be controlled to make a person effective and function, as well as useful in supporting others. The decision making skills of a stressed individual are reduced along with his/her ability to form relationships or engage in effective communication with his/her patients. Through my clinical experience and personal learning, I came to realise a number of ways in which I could manage stress to become a well developed person and much useful to developing other people. Two of these means are: 1- The control of self-esteem as an effective step in the process (Murray 2004). I realised that I was happy and content within the work place once I had the ability to control my level of self-esteem. This allowed me to be engaged with the patients and co-workers in a manner that was acceptable by them and by me. 2- The management of time can be helpful to reduce the level of work-related stress by enabling the person to carry out a plan to achieve the goal in the most effective way (Halan 2005). With this known, I trained myself to implement stress management strategies along with increasing my knowledge regarding this important aspect of professional work, which is stress. For future, I plan to manage my stress level in the same way in order to reduce the negative effects that may occur. Health, Safety and Security My clinical experience exposed me to the understanding that health, safety and security are highly related terms and requirements, one of which could not be achieved in the absence of the other. This realisation was manifested through personal experiences I had whiles practicing. For example, during my placement in the Minor Injury Unit at Western General Hospital, I was once performing a portable chest X-ray in the ward with a radiographer. The patient was a 36-year-old male who had been admitted to hospital one week before and was suffering from Methicillin-Resistant Staphylococcus Aureus (MRSA). He also had a fever, a cough and difficulty breathing. The physician asked for a chest X-ray to assess whether the patient had pneumonia caused by MRSA (Rubinstein et al. 2008). After taking his AP sitting chest X-ray, the radiographer and I realised that the patient had right middle lobe pneumonia. This was clear from the right mid-zone shadow and the effacement of the heart border (Lacey et al. 2008). A radiologist asked us to do a chest lateral view to confirm the diagnosis, so we took the lateral radiography of the chest as the radiologist asked us. According to NHS (2014), pneumonia is a swelling of the tissue in the lung, which is usually caused by infection. The signs and symptoms of pneumonia are chest pain, fever, difficulty breathing and a rapid heartbeat (NHS 2014). From the experience I acquired from my superiors with whom we attended to the patient, I came to realise that MRSA can spread by contact route of transmission. Because of this, it was important to be holistic with the treatment by looking at all three factors of health, safety and security. The health was to focus on the patient, whiles ensuring that he gained improvement in the pneumonia situation. As we did this, we were to ensure that we gathered our own safety of not being contaminated. At the same time, we had to put the whole premises and all people around in save security of possible spread by contact. As a result, we ensured that the patient was kept in an isolation room to prevent transmission of the infectious agents. There is a guideline for controlling the spread of MRSA infection in the hospital. This guideline includes protocols, such as washing hands before and after contact with a patient; wearing gloves before having contact with an MRSA patient; disposing of those gloves immediately after engaging in that contact; wearing a mask and googles to protect the nose, eye and mouth; wearing a gown to prevent contamination of clothes; and handling the patient care equipment and instruments in an appropriate way (Siegel 2007). This reflective account helped me improve my understanding of MRSA and how to ensure health, safety and security at the same time. This knowledge gained will help me to prevent the spread of this infection if I have to take an X-ray for an MRSA patient in the future. Moreover, further experience in interpreting pneumonia X-ray images will help me more easily recognise this disease so as to avoid a misdiagnosis in the future. Service Improvement During my placement at Queen Margaret Hospital, one day I was performing a chest X-ray with a radiographer for a patient with tuberculosis (TB) who came to the department in her bed. I noticed that the nurse who accompanied her had inadequate knowledge about infection control, as she did not wear a mask or gloves which are important for preventing the transmission of TB as it can spread through the air (CDC 2014). Immediately, I sought the opportunity to improve service delivery not only to the patient but to the nurse as well. As I had gained through previous studies, tuberculosis is a bacterial infection that can spread through the air if the TB patient coughs or sneezes (NHS 2014). According to the NICE Guideline (2011), radiographers have to wear appropriate personal protective equipment to minimise the risk of transmission of TB during contact with a TB patient. I therefore offered my service to the nurse by indicating to her that the appropriate types of personal protective equipment that should be worn by the radiographer during contact with a TB patient are a filtering face piece (FFP3) mask. Such mask can provide a high level of filtering and fits the wearer’s face (HSE 2009). I also made her aware that gloves and an apron are equally important and needed (NICE Guideline 2011). After sharing this knowledge with the nurse, she confessed that such safety practices have not been in place and that there have been past instances of infection of nurses with TB. Being a superior, she made it part of the code of conduct of her department for such guidelines to be in place by all nurses. With the knowledge I gained from my course and personal learning therefore, I was able to effect a service wide improvement in the way we all had to be concerned about out safety at work. This reflective report improves my service usefulness on my knowledge of TB and the steps that are needed to prevent the spread of TB. Consequently, in future, I will be enforcing some of these basic guidelines in my department to minimise the risk of transmission and also to prevent and control the spread of TB infection. I will however not relent on this but will continue to read more about infectious diseases to improve my knowledge about the ways to prevent the spread of these infections and the methods that help control that spread. Quality As a result of my clinical experiences, I have come to realise that quality is a continuous improvement process and that at every point in time, I must be in a position to improve upon what I have already done to attain quality. This assertion is made due to one of my personal experiences. I was placed in the Fluoroscopy Unit at Western General Hospital for a week with one radiographer, one radiographer assistant and one radiologist who performed some fluoroscopy procedures, such as a water soluble enema, a barium swallow and a nephrostomy. On my first day, I realised that I didn’t know what I was supposed to do as a radiographer student in this situation. Especially with a multidisciplinary team, and I was not sure how I could be an effective person on this team. Multidisciplinary teams are defined as a functioning unit comprised of healthcare professionals from varying disciplines and specialties who coordinate their activities to provide services to patients (Bruner et al. 2001; Ducains and Golin 1979). In the midst of my frustration, I was advised by one of the members on the team that I could still be effective on the team and improve the quality of my practice is I shared a common goal with them and relied on each other to achieve our aims (Barrett et al. 2014). In a clinical imaging multidisciplinary team, the leadership sets the framework under which the team prospers (Barrett et al. 2014). Lo and behold, I did not become of no importance to the team as I understood that my responsibility was not to be working in isolation but in connection with the larger team. This is because from time to time, my level of contribution to the teamwork in delivering all the elements of clinical imaging services became improved. As noted by Barrett et al. (2014), such clinical imaging services are very important and this is especially true when implementing examination requests, insuring radiation protection, engaging in image acquisition, reporting on the results and engaging in management and service improvement (Barrett et al. 2014). In conclusion, I now understand that a successful reporting team is a multidisciplinary group that must learn how to effectively work together because the requests for imaging examinations are requests for expert clinical opinions from the clinical imaging team (Barrett et al. 2014). Also, I have learned that quality is a continuous process that is best achieved when one is supported by others to deliver in high standard. In the future, I will consider undergoing appropriate training and engaging in continuing professional development to be more effective as part of a multidisciplinary team. Equality and Diversity My clinical experience has made me come to realise that the best way to work with people and to work for people is to accept that you are the same and equal with them. This is regardless of any diversities and differences you may have with them. This is because once the people you are working with and those you are working for will have the realisation that you respect their differences and appreciate them, they are able to easily open up to you and accept you as part of them. This experience on equality and diversity was gained as chest and abdomen X-rays were to be carried out on a 93-year-old female in the Minor Injury Unit X-ray room at Western Hospital. The patient came to the X-ray room in the trolley bed as she had slight difficulties in movement due to her age. Because of this we decided to do a mobile chest X-ray for her. The radiographer and I explained to the patient what we were doing in order to insure that we obtained a good quality chest X-ray image. We told her that we would raise the head end of the bed in order to position her so that we could get a sitting chest X-ray and then we would put a hard board behind her back, which would be in place for less than one minute. After hearing our explanation, she accepted what we were going to do, but when we started to raise the head end of the bed, she started to shout at us and asked us to return her to a lying position. We did not take offence at her behaviour at all, as we understood her peculiar psychological needs due to her age. We did not also prove to be the professional who knew the right thing to be done, for which she had to listen to us by force. Rather, we tried to explain to her that the sitting position was important if we were going to be able to get a good quality image that would show us what was happening with her. This notwithstanding, she refused to be placed into a sitting position, so we decided to get the X-ray image while she was in a supine position. We started to put a cassette behind her back after we explained the procedure to her and she accepted our explanation. But just as we were to place the cassette she refused to allow us to put the cassette behind her. We tried to explain to her again about what we wanted to do and we showed a compassionate attitude to allow her to feel comfortable and secure, but she totally refused to our requests and she became uncooperative. We asked the charge nurse about the patient’s situation and the nurse said that the patient’s daughter was with her. We talked to the daughter and explained what happened. The patient’s daughter and I went into the X-ray room to talk to her mother and we showed a compassionate attitude toward her while explaining the procedure to her. After that, the patient’s level of cooperation improved as she felt more comfortable while her daughter was with her and knowing that we would not do anything unless she approved and she began to understand that we were there to help her. She displayed her level of comfort by smiling and speaking politely during the rest of the procedure. The procedure went smoothly due to the professional and thorough healthcare service we provided by respecting her position and not forcing her to do something she did not believe in from the beginning. I utilised a strong communication process, which helped her understand the entire situation. In the future, gathering more information regarding patient aggressiveness and staff assaults could help me improve the way in which I can manage these types of situations. Doing so could also increase my self-esteem since I would be able to carry out my professional duties more effectively. According to the Nursing and Midwifery Council Code of Conduct (2008), “The care of patients must be the first concern of the medical staff. This helps the patients believe that they are the first priority and they become much more comfortable with the healthcare services. Professionals have to make sure they convey their message clearly and be entirely involved with the process. The circumstances must not be used as a reason to neglect the patient and all individuals should be treated in an equal manner. Compassionate care is one of the most essential aspects which bring forward the actual professional capabilities of the medical staff”. The NHS also helps local communities when they decide to improve their services. The equality objectives and activities must be carried out effectively in order to make sure that the healthcare professionals’ equality performance is at its peak. A review of the activities is also carried out to make sure the process is done well. After exploring the equality and diversity theory, I realized that I demonstrated a good performance of equality with the patient as she got an accessed to the service and he got the right to involved in his treatment with respect and dignity. Diagnostic - Assessment and Treatment Planning My clinical experience has helped me to come to realise the importance of planning to assessment and treatment. This realisation was deepened when a 56-year-old female patient presented to the Accident and Emergency X-ray Department at Cross House Hospital after she fell from a wheelchair onto her knees. She experienced severe pain in her left lower leg after the fall. The patient was unable to move her left lower leg easily or to straighten her knee. For this reason, we had to perform the X-rays by placing the patient in modified positions in order to accommodate her status. The radiographer and I tried to take an AP view of the patient’s left lower leg but her leg was rotated internally. As a result, we tried to place some support items, such as sponges and a sand bag, to make the patient’s leg as straight as possible. After the AP view was taken, the radiographer and I interpreted the image in order to assess the patient’s condition and to decide whether or not the patient had any abnormalities. The image showed that the patient’s patella was inferiorly displaced with possible avulsion of the posterior distal aspect of the tibia and an oblique fracture in the tibia’s distal shaft. Rather than approaching the whole process in a haphazard manner, we used a well planned diagnostic approach as the radiographer asked me to do a horizontal beam lateral to check the fluid level. I proceeded to do so. I didn’t move the patient’s leg, but changed the position of the X-ray tube and put the cassette parallel to the horizontal beam. After taking the images, the radiographer and I checked the fluid level and found that it was normal. Therefore, the images were red dotted and the patient was sent back to the unit to enable her to receive proper treatment. From this case, I learnt that I am able to successfully read a patient’s condition from the X-ray request form and I am also able to ask the patient some questions related to the condition so I can decide what types of modifications need to be done to fit the patient’s status. I also learnt that I have to improve my image interpretation skills, which will be helpful for me in initially diagnosing a fracture rather than rushing to take actions that will not beneficial in the long run. According to Hardy et al. (2009), the potential role for image interpretation within radiographic practice is well recognised. Over the last two decades, the use of radiographer abnormality detection schemes (RADS), such as red dot and latterly commenting, has become widespread (Hardy et al. 2009). However, the contribution that radiographers make to the formal reporting provision within NHS trusts has increased and a recent survey identified that radiographers are now employed to report trauma radiographs in almost 60% of hospital sites (Hardy et al. 2009). In my future work in Qatar as radiographer, I can utilize my current knowledge regarding image interpretation and in discuss it with employers in order to improve the health care services. Diagnostic - Information Collection and Analysis After a successful planning procedure, information collection and analysis is also useful in giving out appropriate diagnosis. A patient came to the X-ray Department at Western General Hospital in Edinburgh with a request for a cervical spine X-ray. The patient had a history of a persistence cough for three weeks. For this reason, his clinical history did not meet the justification criteria because a cough is not an indication for a cervical spine X-ray (Gelderen 2004). I asked the senior radiographer about that and she asked me to do a chest PA view instead, rejecting the request for a cervical spine X-ray. My ability to collect information from the patient’s past was very useful in coming out with the right decision on what needed to be done for the patient. To insure radiation safety and to manage risk, radiology departments use the Ionising Radiation (Medical Exposure) Regulations 2006 (IR (ME) R 2012), which ensure that exposure to ionising radiation arising from work activities is kept “as low as reasonably practicable. These guidelines provide basic measures to protect the health of individuals against being exposed to the dangers of ionising radiation as a result of medical procedures. The regulations are used as a guideline by the people responsible for administering ionising radiation to patients in order to protect people who are undergoing medical procedures that entail being exposed to radiation. The Ionising Radiation Regulations 1999 apply whenever ionising radiation is used in the workplace (Department of Health 2011). Regulation 8 indicates that all necessary steps must be taken to restrict the exposure to ionising radiation to a level that is as low as reasonably practicable (ALARAB). This can be maintained by justification, which in recent years has increasingly come to the forefront of the minds of legislators. Knowing this, I have come to know the place of sufficient medical data as this is relevant to the type of medical exposure requested in order to enable the operator who is authorising the procedure, or the practitioner who is administering it, to decide whether or not there is sufficient benefit to be gained from the radiation treatment. In the future, I will practice justification in my work place adequately, and effective communication and resources will be used in regard to the unusual requests in order to determine whether the examinations are justified. Conclusion and Action Plan From the reflection report presented above, it can generally be concluded that the theories learnt in the various courses have been adequately applied in practice whiles undertaking my clinical experiment. This is because for each of the major themes and KSF cores, there are examples of specific decision based practices in which there were theoretical application of concepts. These successes notwithstanding, there are specific goals that ought to be achieved in the future. For example, it is still important that I expand and improve my knowledge in basic pathology in radiography so that I can have a deeper understanding of the diseases and health situations that the patients bring to the hospital. I am hopeful that having a deeper understanding of the actual causes of the problems for which patients come of seek radiography services will make it possible for me to give the right communication, quality, service enhancement, health safety and security, personal and people development, collection of information and analysis, and assessment and treatment planning. The action plan towards achieving this goal is based the expansion of my personal tuition programme. This means that whiles in professional practice and even doing higher studies, I am going to have time for expanding my knowledge base by reading wide range of books on the pathology of radiology. I have selected this form of self tuition so that it will enable me to balance my professional work with my personal time, which has lately been very compact. There are also plans to undertake weekend group studies to learn from other people. Read More