The Diamond Approach to Inner Realization - Personal Statement Example

Reflective Essay This paper encompasses a personal reflection of a patient portfolio for pain. It will examine in depth client profile looking at history taking and physical exam, diagnostic tests, diagnoses and appropriate management/ treatment. The basics of the assessment of pain are the same as the assessment of other medical complaints. Yet pain is the most common complaint that presents to the primary care practitioner; therefore, it is valuable to give some focused attention to the specifics of the methodology for assessing this problem. (Boas RA, Cousins MJ 1998) There are different expectations of reflection dependent upon your level of study. Goodman (19984) identifies three levels of reflection (level 1-3). At level 1 reflection is largely a descriptive account of what happened and the part the nurse played in this. Largely a descriptive account of what happened and the part the nurse played in this. There is a minimal exploration of health care professional's feelings but little beyond this. At level two students will be expected to identify their learning. And draw conclusions about patient care that are transferable to other situations. Students will need to demonstrate their own knowledge base by applying theory to practice and analysing theory in the light of practice. Finally third level reflection acknowledges wider ethical and political resources. This equates with Taylor (2000) issues of reflection: technical at level 1, practical at level 2 and emancipatory at level 3. This personal reflection of a client profile looking at history taking and physical exam, diagnostic tests, diagnoses and appropriate management/ treatment and referral will be interpreted using the Gibbs and Johns models. These methods will demonstrate evidence based on practice/ best practice and interprofessional/ collaborative working. Reflective Frameworks GIBBS MODEL (1988) Description Action Plan Feelings (If it arose again what would you do) (What were you thinking) Conclusion Evaluation (What else could you have done) (What was good and bad about the experience) Analysis (What sense can you make of the situation) JOHNS MODEL (1994) Cue Questions 1. Descriptions of the experience Phenomenon - describe the here and now experience Causal - what essential factors contributed to this experience Context- what are the significant background factors to this experience Clarifying- what are the key processes (for reflection) in this experience The models wsere applied to a patient experiencing pain. Given the framework of thee Gibbs and Johns models the following steps werew used when vdealing with the patient. A. Core questions to be answered as part of a pain assessment: What is the type or category of pain Is there a primary cause of the pain What additional factors are contributing to the pain Are treatments available for the primary cause of the pain Are treatments available for the additional factors which contribute to the pain Are there other medical or psychosocial conditions which should influence the choice of treatment B. The methodology of the pain assessment: History Past medical history Current medications Physical examination Special tests Psychological evaluation Differential diagnosis CORE QUESTIONS TO BE ANSWERED AS PART OF A PAIN ASSESSMENT A. What is the type or category of pain 8 1. Nociceptive Pain -- This is the typical pain that we have all experienced. It is the signal of tissue irritation, impending injury, or actual injury. Nociceptors in the affected area are activated and then transmit signals via the peripheral nerves and the spinal cord to the brain. Complex spinal reflexes (withdrawal) may be activated, followed by perception, cognitive and affective responses, and possibly voluntary action. The pain is typically perceived as related to the specific stimulus (hot, sharp, etc.) or with an aching or throbbing quality. Visceral pain is a subtype of nociceptive pain. It tends to be paroxysmal and poorly localized, as opposed to somatic pain which is more constant and well localized. Nociceptive pain is usually time limited--arthritis is a notable exception--and tends to respond well to treatment with opioids. 2. Neuropathic Pain -- Neuropathic pain is the result of a malfunction somewhere in the nervous system. The site of the nervous system injury or malfunction can be either in the peripheral or in the central nervous system. The pain is often triggered by an injury, but this injury may not clearly involve the nervous system, and the pain may persist for months or years beyond the apparent healing of any damaged tissues. In this setting, pain signals no longer represent ongoing or impending injury. The pain frequently has burning, lancinating, or electric shock qualities. Persistent allodynia--pain resulting from a nonpainful stimulus, such as light touch--is also a common characteristic of neuropathic pain. Neuropathic pain is frequently chronic, and tends to have a less robust response to treatment with opioids. (Patten 1977) Psychogenic Pain-- The use of this category should be reserved for those rare situations where it is clear that no somatic disorder is present. It is universal that psychological factors play a role in the perception and complaint of pain. These psychological factors may lead to an exaggerated or histrionic presentation of the pain problem, but even in these circumstances, it is rare that the psychological factors represent the exclusive etiology of the patient's pain. (Boas 1998) Mixed Category Pain-- In some conditions the pain appears to be caused by a complex mixture of nociceptive and neuropathic factors. An initial nervous system dysfunction or injury may trigger the neural release of inflammatory mediators and subsequent neurogenic inflammation. For example, migraine headaches probably represent a mixture of neuropathic and nociceptive pain. Myofascial pain is probably secondary to nociceptive input from the muscles, but the abnormal muscle activity may be the result of neuropathic conditions. Chronic pain, including chronic myofascial pain, may cause the development of ongoing representations of pain within the central nervous system which are independent of signals from the periphery. This is called the centralization or encephalization of pain. (. Bonica 1990) What additional factors are contributing to the pain For most of the last 300 years, our understanding of pain has been dominated by the Cartesian model. Viewed from this perspective, the human body is a complex machine which is separate and distinct from the mind and the process of perception. Therefore, physical pain is a function of the mechanics of the body. In the last 30 years, we have come to appreciate that pain is an experience rather than a bodily function. Experience is a function of the mind; therefore, the experience of pain cannot be separated from the patient's mental state, including their social-cultural background. We now know that environmental and mental factors can be so critical that they can actually trigger or abolish the experience of pain, independent of what is occurring in the body.38 We now understand some of the mechanisms of how the brain can influence the spinal processing of pain via descending inhibitory and facilitory neural pathways. Furthermore, suffering should not be considered synonymous with pain. The emotional impact and distress caused by pain differs from person to person. Different patients may report very different intensities of pain for similar injuries, but even when they report similar degrees of pain, they may have vastly different amounts of suffering. (Donohoe 1998) Other physical factors Other physical factors may also contribute to the experience of pain, including: sleep disturbance inactivity and poor muscle conditioning weight gain other injuries or illnesses In conclusion, using the Gibbs model or the Johns accessing the patient and their pain I was trying to achieve an answer to the source of the patient's pain. For the reasons listed above as protocol for diagnosing pain is why I prepared the client profile aws I did. This was to help me find the source of the pain so I could intervene e and find some relief for the patient. What was I trying to achieve I was trying to find the cause of the pain and if I could stop it. The consequences of my actions for: Myself were minimal be cause I followed protocol and seemed to provide the patient with relief by talking about the pain. The patient expressed their relief to me just knowing that the pain was being investigated. Although more time and tests will be necessary to find the source of the pain provide the patient with this mental comfort made this a positive experience for me. References Almaas, A. H. (1986). Essence: The diamond approach to inner realization.York Beach: Samuel Weiser Boas RA, Cousins MJ: Diagnostic Neural Blockade. In Cousins MJ, Bridenbaugh PO (eds): Neural Blockade in Clinical Anesthesia and Management of Pain, JB Lippincott, Philadelphia, 1998 Boucouvalas, M. (1988). An analysis and critique of the concept "self" in self-directed learning: toward a more robust construct for research and practice. In: M. Zukas (Ed.), Proceedings of the trans-Atlantic dialogue conference (pp. 56-61). Leeds, Engeland: University of Leeds. Calderhead, J. (1989). Reflective teaching and teacher education. Teaching and Teacher Education, 5, 43-51. Calderhead, J., & Robson, M. (1991). Images of teaching: Student teachers' early conceptions of classroom practice. Teaching & Teacher Education, 7(1), 1-8. Miller, G. A., Galanter, E., & Pribram, K. H. (1960). Plans and the structure of behaviour. New York: Holt, Rinehart & Winston. Ofman, D. (2000). Core qualities: A gateway to human resources. Schiedam: Scriptum. Peterson, C. & Seligman M. E. P. (2000). Values in action (VIA): Classification of strengths. Philadelphia: Values In Action Institute. (http://www.positivepsychology.org/taxonomy.htm) Piaget, J. (1977). Recherches sur l'abstraction rflechissante 1: L'abstraction des relations logico-aritmtiques [Research on the reflective abstraction 1: The abstraction of logical-mathematical relationships]. Paris: Presses Universitaires de France. Rogers, C. R. (1969). Freedom to learn. Columbus, Ohio: Merrill. Walsh, R. (1992). The search for synthesis: transpersonal psychology and the meeting of East and West: psychology and religion, personal and transpersonal. Journal of Humanistic Psychology, 32(1), 19-45. Watzlawick, P., Weakland, J. H., & Fisch, R. (1974). Change: principles of problem formation and problem resolution. New York/London: Norton. Read More