A Reflective Account of a Teaching Session about Changing a Stoma - Essay Example

?Introduction As a nursing I usually have to teach patients several do-it-yourself practices and guide them to ensure that they perform suchprocedures well. The success of transfer of such knowledge from me to them depends to a large extent on my teaching and the patient’s efforts. It is thus important that on my part, I analyse my approach in teaching to determine its effectiveness, strengths, weaknesses and what I should do to make it better. The best approach to examine my approach to teaching is definitely through the use of Gibb’s reflective cycle as it will enable me to reflect a great deal in using one situation and analyse everything that occurred in it, relating my actions to each result that occurred. Through Gibb’s Reflective Cycle, I will analyse a case in which I taught a patient how to change a stoma. I will first describe the context of the teaching- how I acted and how the patient reacted. According to Jasper (2003) this should be followed by analysing ones feelings in the situation and emotions at the event. One then follows this up with an evaluation of the experience, determining which aspects turned out to be positive and which ones were not, and what failed to go according to plan. After this one needs to critically analyse the occurrence, establishing a conclusion on the entire experience and ultimately come up with an action plan to follow in case of a similar experience in the future. By the time I am through with this, the teaching experience will be analysed in entirety and the next patient I teach how to change a stoma will have a better experience. The context of the teaching This is the first step of Gibb’s Reflective cycle, where I will analyse what actually happened as I taught the patient how to change the stoma. To begin with, the patient had undergone a surgery to due to a severe case of diverticulitis and was just about to be discharged. I visited her ward as was required of me and undertook to explain to her how from that moment henceforth she would be changing the stoma. The patient was clearly in anxious emotional state due to the surgery she had just undergone, although it had been very successful. As Winston et al (1987) so ably puts it, the pre-operative and post-operative emotional states of surgery patients is characterised by anxiety, misgivings, depression and irritability. Spielberger (1973) had earlier on suggested that patients usually develop anxiety to surgery as an emotional reaction towards situations that physically threatening, while Furst (1978) demonstrated that patients under surgery usually reported fear, apprehension, worry and uncertainty. All this serve to explain the emotional status of my patient as at the time I was teaching her. I realise that even before I had started, she was in a state that would make it difficult to absorb what I was saying. I first explained briefly to the patient the procedure she had just gone through- the surgery, and a little about diverticulitis and stomas since I assumed she already had been informed. I told her that diverticulitis was a condition arising from inflamed pouches on her large intestines known as diverticula, and also informed her that it was not a rare condition since about 10% of Americans above the age of 40 have diverticula and of these, ten out of twenty five develop diverticulitis (Borgadus, 2006). On the stoma, I told her that it was a surgical bypass of her colon system which had been affected by the diverticulitis and now failed to function properly. I informed her that the colostomy meant that she had to have a bag for receiving fecal matter a single time (Stoma and Stomata, 2009). I could see that she was embarrassed by her condition and the life that she would lead from that henceforth. I then took the patient through the steps of changing a stoma. I used knowledge of the Honey and Mumford teaching and learning style to determine which kind of learner she was. The Honey and Mumford teaching and learning style identifies four distinct preferences of learning styles, classifying them as activists, theorists, pragmatists and reflectors. Activists learn by being involved in the activity being taught, theorists prefer understanding the reasoning and basis behind the teaching, pragmatists need you to show them how applicable the information you are giving them is to real life, and lastly reflectors learn by observing and thinking the concepts out (Honey and Mumford, 1982). I realised that she preferred that the procedure be demonstrated first and then she tries to do what she has just been shown-an activist- which was in fact the best scenario since she would have to perform the procedures herself later. The teaching involved first letting them know all the equipment needed, how to inspect peristomal skin, risks to peristomal infection and using the measuring card. I reviewed the frequency of emptying the pouch, night collection, emptying the appliance, remove the old appliance, observing the appearance of the stoma in terms of colour and texture, application of skin prep, application of skin barrier, and finally roll closure with the colostomy pouch (Clinical Manual / Nursing Practice Manual, 2009). I then actually demonstrated the procedure and let the patient repeat it. I ensured that she did correctly before concluding the session. Emotional status at the time of teaching In line with the second step of Gibb’s Reflective Cycle, the next step is to analyse my emotional status at the time I was teaching the patient. I realise that the anxiety and stress exuding from the patient had an impact on me. She found her condition embarrassing and seemed like she could not picture herself going through life always changing a stoma. I sympathised with her greatly and somehow showed my feelings by constantly reassuring her that all was going to be fine. At the time of the teaching, I realised that her emotional status was going to affect her memory of the steps. Erk (2003) suggests that the emotional state of a person at the time of learning affects their memory and that the stronger the emotional state the bigger the impact it will have on memory. Richards (2000) says that regulation of emotions is crucial in cognitive skills or memory, while Jefferies et al (2008) demonstrated that there is a relationship between emotions and attention using induction of calm, happy, sad, and anxious moods to study the effects of these on attention. It was not difficult for me to realise that she was trying to concentrate but her experience would not let her, and that I lost her attention on several occasions. This feeling of futility of my work and efforts were discouraging to me, and though I tried my best to explain and demonstrate the procedure I had a deep feeling within me that it was going to fail. Evaluation of the teaching session The session came just as the patient was to be discharged, and she seemed to be in a hurry to get home and relax. Her emotional state and my internal reaction played a big part in the outcome of the teaching session. I conducted the session as professionally as possible and took care of all the steps as I was supposed to. One positive from the session is that I covered the entire procedure for changing a stoma even though the patient was not very keen on listening. I was also able to determine her best form of learning according to Honey’s and Mumford’s template of teaching and learning, which went a long way in helping the efficiency of the learning. Through involving her in each step and letting her repeat the procedures after me, she was at the very least able to follow. The main setbacks that I can identify from the teaching session include the emotional status of the patient. As shown earlier, one’s emotional status has a very important effect on their cognitive abilities. Stress, anxiety, apprehension, bad moods, boredom and other such emotions limit the capacity of binding memories in the brain. The patient was in a bad state psychologically, affecting her attention and concentration and thus limiting the impact of the teaching. Although she demonstrated that she could perform the procedures at that time albeit with difficulty, I felt that she would have problems recalling it later. A lot of work has been done by researchers to demonstrate the impact of the emotional status of nurses and its impact on the health industry. According to Burke (2000) nurses who are undergoing stress develop habits such as poor eating and drug abuse, leading to personal health deterioration and in extension dips in the quality of patient care. These may affects the ability of nurses to perform their tasks in terms of decision making, concentration, motivation, apathy, and anxiety may stem in, which all threaten the safety of patients (Wong et al, 2001). It can also result in absenteeism and burn out, decreasing group cohesion and as a result lowering efficiency in the health care industry. It has been estimated that employ stress and burn out results in losses of up to $300 in the US alone (Jones et al, 2003). Stress problems add to labour cost in a health industry that is already characterised by insufficient numbers of nurses, also leading to reduced quality of care to patients (Aiken et al, 2002). My emotional status and reaction to hers was also not very helpful. Although there is no problem with showing empathy, the patient should see a nurse as calm and recollected. Sympathising too much has the effect of scaring her further. On top of that, the realisation that may be most of my efforts in teaching her would be futile had an impact on my delivery, as I resorted to do just the minimum necessary Step by step analysis of the teaching session The first thing I did in the teaching session was to give a brief background to the patient about her condition, covering diverticulitis and stoma and giving her some brief statistics. I figure that this was important in at least calming her nerves, although I should have started with first reassuring her and then giving her the statistics on the disease in order to calm her. I then proceeded to explain the procedure of changing and taking care of a stoma by word of mouth. This was followed by first showing her all the equipment that would be used, and then performing the procedure. I allowed for questions at any one time during my demonstration and then let the patient perform it herself. This was the correct way to approach the teaching, but I failed to harmonise it with her feelings. I should have given her time between the procedures to recollect, and continually ask her status. Conclusion The teaching session covered all that was needed in the procedures involved in changing a stoma. It however was inhibited by the emotional status of the patient; she was still anxious and scared from the surgery and was also embarrassed about having to live with and keep changing a stoma. Her attention and concentration was as a result hampered and I had to repeat several of the steps in order for her to get them. I figure that although she seemed to grasp the steps, it would be difficult for her to remember them and she would have to need further help. My reaction to the patient’s emotional state might have worsened her since I was not strong enough to keep her calm. After noticing that most of my work was going down the drain, I resorted to just doing the minimum required of me. The overall result was that the teaching session was not as effective and productive as it should be. Action Plan From all the reflections above and the conclusion that the teaching session was not very successful, I intend to make some changes to my approach to teaching. The first thing I will do in a future event is reassure the patient that the condition is nothing to be embarrassed about, and that the surgery has been successful meaning she should not worry about it anymore. I will then explain the procedures, demonstrate and let the patient perform it but all the time checking her emotions and reassuring her appropriately. In case the patient is unable to take control of her emotional state, I will endeavour not to be discouraged and undertake the teaching in the best moods possible. It may rub off on her and reassure her. The ultimate goal will be to make the patient take as much from the learning experience as possible. References Aiken, HL et al., 2002, Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction, JAMA, vol. 288, no. 16. Bogardus, ST 2006, What do we know about diverticular disease? A brief overview. Journal of Clinical Gastroenterology, vol. 40, no. S108–S111. 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