Levels in Undergraduate Family Nursing Education - Personal Statement Example

of Reflection Essay on Placement East Barnet Health Centre 15th of November 2008 Reflective account using Rolfe et al model of Reflection: Nursing Essay Introduction I am a student nurse, and in my placement, there was an incident recently that is worth reflecting. In this assignment, I will record my reflections on that incident (Boyd and Fales, 1983, 99-117). This was about Mr. X, for ethical and confidentiality reasons, his identity will remain undisclosed. The patient is a 51- year- old gentleman who has oesophageal cancer, advanced to a degree such that he is unable to swallow. The oncologist has disclosed the diagnosis to the patient, and since then, he is in a state of denial and is very upset. He was admitted to the hospital for 6 weeks, and there, he had a PEG insertion. The whole process evolving around his terminal illness, his hospital course, his inability to swallow due to esophageal obstruction has been a big shock for his family. Consequently, they have difficulty coping with it. Descriptive level of reflection The incident that I am going to relate is in relation with Mr. X’s post-discharge course. After this long hospitalisation, he was discharged from the hospital late in the evening on Friday. They gave instructions to his wife about how to use the PEG tube to administer his medication and bolus feed. On Saturday morning, when Mrs. X was giving the medication, the PEG got blocked (Dougherty and Lister, (eds) 2008, 12-56). The district nurses were called for help. The district nurse took me to attend Mr. X. When we arrived at their home, Mrs. X was very nervous and apprehensive. She looked petrified. Mr. X was no exception; he was distressed as well. Both of them appeared very anxious. The district nurse, my mentor started talking to them, and what I observed was worth noting. The visible anxiety gradually calmed down. This was an effective communication, and this was essential in this scenario to pacify them. When I went back home that night and when things started settling down, I thought I would go over the whole incident and find out what was special about this incident, and how this incident can help me in any future incident in the professional practice (Ghaye and Lillyman, 2000, 53-87). This was a setting of home health care, and from the incident, it was clear that the incident had considerable acuity. I was a student nurse, and therefore, it was a learning experience for me. The major goal of nursing care in this situation, given Mr. Xs advanced cancer is palliation and restoration of maximum health function. I was entirely inexperienced, so I decided to observe what my mentor did in this situation (Ghaye, 2005, 7-37). Therefore, I was keen on observing Mr. and Mrs. Xs reactions, their anxiety, and how my mentor was handling this situation. Given his PEG tube, there is a high likelihood that it may get blocked, and perhaps, this got blocked due to the tablet that was given to him through the PEG tube. Given the fact that Mrs. X was new to this area, when it got blocked, it was quite natural for her to get anxious. Mr. Xs anxiety was a result of discomfort, fear, and the disease burden. However, my mentor handled it carefully and with professional expertise, when I was also anxious what would happen to Mr. X. My mentor demonstrated sound therapeutic communication skills, and he explained the situation to both of them, demonstrated what to do if it occurs again, assured them that she would be available for them whenever necessary, and as a result, I observed, they were both at their ease. From sheer anxiety, they demonstrated that they felt secure, confident, and valued (Nursing and Midwifery Council, 2008, 1-7). I understood that my mentor had developed great skills at personal level not only as a messenger, but also as a receiver. She listened to their concerns attentively, paid adequate attention and demonstrated value to their perspectives, and she possessed skills necessary to facilitate communication. Both Mr. and Mrs. X were in pain and distress, are newly bereaved due to his PEG tube and end-stage esophageal cancer, and my mentor could understand their difficulty in expressing their feelings, and she consistently encouraged and supported them (Bell, 1997, 227-229) to verbalise their concerns. The result was outstanding in the sense that they were relieved, demonstrated understanding, and appeared confident. I thought it would be a good opportunity for me to learn from this situation, since effective communication is a skill that needs to be developed (Hardman, Maguire, and Crowther, 1989, 235-237). I decided I would reflect more on this to learn the pros and cons of effective communication. Theory and knowledge building level of reflection While reflecting, I gradually came to understand, well-developed communication skills are therefore essential tools for nurses. It was a face-to-face situation, and perhaps there is no substitute for it. I witnessed how effective and appropriate communication helped to establish a therapeutic helping relationship and enabled my mentor to determine their care needs and how it promoted trust and confidence, and facilitated care appropriate for this situation. They were anxious and angry. This was highly probable since they both were facing very high levels of stress (Riley, 2000, 11-43). My mentor decided to defuse the situation to make it less tense. As far as I could recognise, she took the model of de-escalation. She was utilising control trilogy with stages such as calming, reaching, and controlling (Bell, 2000, 203-209). She kept calm, although I kept silent I was anxious within, and I would also accept that it was difficult for me to keep calm. Although it was a fact that both Mr. and Mrs. X were suffering, there is nothing that my mentor or me could do to that. We were not the cause of his suffering. While this thought perturbed me, I observed with surprise that my mentor, the district nurse was relentless endeavouring to calm both of them. Later when I reflected on why I was not able to calm myself down, I found that our ability to think can be affected by our emotional response to a situation, and in turn our emotional response can affect our behaviour (Jarvis, 1992, 174-181). In such a conflict situation, emotions can run high; therefore it is important that we try to remain calm so that we can think clearly and act appropriately. Most probably due to my inexperience, in different times during the initial phase of this encounter, sometimes I was wanting to move away, sometimes wishing I could have avoided this situation, and sometimes, was almost going to challenge them (Powell, 1989, 824-832). My mentor, however, was unperturbed, although she was showing nonverbal cues of her own irritation. However, she did never lose her composure, and she was intent and careful listening to them. I noted Mrs. X raised her voice several times, but my mentor, what I had discovered later, listened to the content and emotion of their issues. She was obviously basing her actions on theories of communication. She was not responding immediately, and this would have sent the message across that she was taking their complaints seriously. This gradually calmed down them, and with this opportunity, she having encouraged them to explain their grievances, had successfully built a communication bridge to move the conversation forward. She was now in the drivers seat and clarified the facts or key points made; ensuring that she knew exactly what the problem was or what was needed. She also demonstrated that she empathized with their feelings (Wilkinson, 1991, 677-688). I understood that the final stage had been reached, where she controlled the whole affair, and they were ready to listen. Adequate and sensitive communication between patient and provider often successfully resolves such problems. Most cases will benefit from sustained attempts to clarify the patient’s values and the likelihood of the various relevant outcomes and to improve communication with patients or their surrogates. For life-threatening illness like Mr. X, advanced clinical knowledge, critical thinking, clinical judgment, and communication skills can be used to address complex problems, such as, addressing the issue of blocked PEG tube, and these would help both of them to cope. The frequency, intensity, and duration of stressful situations contribute to the development of negative emotions and subsequent patterns of neurochemical discharge. By appraising situations more adequately and coping more appropriately, it is possible to anticipate and defuse some of these situations (Wright, 1989, 15-16). In his situation, such stressful situation may be frequent in future, since PEG tubes although maintain nutrition in cancer patients, are known frequently to block. These might be avoided with better communication and problem solving. Although this encounter had calmed them down for now, I must accept that there was no chance to address Mr. Xs denial (Rolfe, Freshwater, Jasper, 2001, 1-36). Denial is an ineffective coping, and thus he was avoiding and distancing himself from this problem. The intent of denial is to control the threat, but it may also endanger life. Models of illness frequently cite stress and maladaptation as precursors to disease. A general model of illness, based on Selye’s theory, suggests that any stressor elicits a state of disturbed physiologic equilibrium. If this state is prolonged or the response is excessive, it will increase the susceptibility of the person to illness. The communication must take care of this problem in Mr. X (Parle, Jones, and Maguire, 1996, 735-744). On reflection I had a new insight into the situation (John and Freshwater, 2005, 8-28). Communication is important part of management of any patient, and any patient suffering from any condition has a communication need. These must be addressed whenever there is an opportunity since they help patients coping better with their situations, thus leading to better healthcare quality ((Rolfe, Freshwater, Jasper, 2001, 35-44). The broader issues that arise are that an effective communication would elicit the patients problems and concerns, involve exchange of information, discussion of treatment options with them and allowing them to participate, and being supportive in an empathic manner. Action-oriented level of reflection Indicators of stress and the stress response include both subjective and objective measures. They are psychological, physiologic, or behavioral and reflect social behaviours and thought processes. Some of these reactions may be coping behaviors. Over time, each person tends to develop a characteristic pattern of behavior during stress that is a warning that the system is out of balance. This had been the case with Mr. and Mrs. X. Interventions with family members are based on strengthening coping skills through direct care, communication skills, and education. Healthy family communication has a strong influence on the quality of family life and can help the family to make appropriate choices, consider alternative strategies, or persevere through complex circumstances. Knowledge and experience are important attributes of a caring nurse who can communicate effectively to cater a better care. In this situation, if I would have been in the situation to handle things, I would offer a daily home visit to build their confidence and gradually help them adjust and cope with. I would have felt better if the initial tension would not have been there. This is possible through paying attention to the broader issues of communication (Johns, 2004, 1-23). Eliciting patients problems and concern and summarizing them is an effective way to make the patient believe that they have been heard. It could be enhanced further by inquiring about the social and psychological impacts of their illnesses. Anxiety often results from ignorance. This means in this patients care there must be some gap in communication or the family or the patient had been inadequately involved in decision making. The nurse must show empathy to show that she has a sense of how the patient is feeling with continuous feedbacks. With these approaches I feel, Mr. X, and his wife would not be panicked further if such things recur. If they are allowed opportunity to participate in their decision making, the communication becomes easier and problems less (Jasper, 2003, 1-31). Conclusion This was a unique opportunity to learn the importance and techniques of effective communication in nursing. On reflecting on this, I was able to learn what was not possible in the classroom, and I feel this experience will help me to implement this learning in practice in future, when there is a chance. Reference List Bell, JM., (1997). Levels in undergraduate family nursing education [Editorial]. Journal of Family Nursing, 3, 227-229. Bell, JM., (2000). Encouraging nurses and families to think interactionally: Revisiting the usefulness of the circular pattern diagram [Editorial]. Journal of Family Nursing, 6, 203-209. Boyd, E. and Fales, M. (1983). Reflective learning key to exploring from experience. Journal of Humanistic Psychology, 23. (2), 99-117. Dougherty, L. and Lister, S, (eds) (2008). The Royal Marsden Hospital Manual of Clinical Nursing Procedures. (7th ed). Chichester: Wiley-Blackwell 12-56 Ghaye, T. and Lillyman, S. (2000). Reflection: Principles and Practices for Health Care Professionals Oxford: Blackwell Publishing. 53-87 Ghaye, T. (2005). Reflective health care team. Oxford: Blackwell Publishing 7-37. Hardman, A., Maguire, P., and Crowther, D., (1989). The recognition of psychiatric morbidity on a medical oncology ward. Journal of Psychosomatic Research;33:235­7. Jarvis, P., (1992). Reflective practice and nursing. Nurse Education Today; 12: 174–81 Jasper M. (2003) Beginning Reflective Practice:: Foundations in Nursing and Health Care. Nelson Thornes,Cheltenham, UK. 1-31 Johns, C. (2004). Becoming a Reflective Practitioner. Oxford: Blackwell, 1-23 John, C. and Freshwater, D. (2005). Transforming Nursing through Reflective Practice. Oxford: Blackwell Science 8-28. Nursing and Midwifery Council, (2008), The Code: Standards of conduct, performance and ethics for nurses and midwives: London, NMC. 1-7. Parle, M., Jones, B., and Maguire, P., (1996). Maladaptive coping and affective disorders in cancer patients. Psychol Med;26:735­44. Powell, JH., (1989). The reflective practitioner in nursing. Journal of Advanced Nursing; 14: 824–32. Riley, J.B., (2000). Communication in nursing. St. Louis, MI: C.V. Mosby. 11-43. Rolfe, G., Freshwater, D., Jasper, M., (2001). Critical Reflection for Nursing and the Helping Professions: A Users Guide. Palgrave, Hampshire, UK, 1-36. Wilkinson, SM., (1991). Factors which influence how nurses communicate with cancer patients. Journal of Advanced Nursing; 16: 677–88. Wright, LM., (1989). When clients ask questions: Enriching the therapeutic conversation. The Family Therapy Networker, 13(6), 15-16. Read More