Gibbs Cycle of Reflection - Term Paper Example

Reflective Practice Introduction This is a reflective account of my placement as a specialist nurse in the Rehabilitation Unit. I will use Gibbs cycle of reflection in this account to critically review my practice with a patient, whom I was assigned care with. For confidentiality reasons, this patient’s identity will remain undisclosed, and throughout this assignment I will refer him to be Paul, which obviously is a pseudonym. It was also important to seek and secure client’s consent, since the information provided by him will be used in this assignment, and this would ensure primacy and autonomy of the client, and as a nurse this would fulfill the requirement of ethical practice. He was an Afro-Caribbean young male of 28, referred from the Early Intervention in Psychosis (EIP) unit. In short, the client was sent for rehabilitation due to his psychotic illness. The basic problems were issues with cultural diversity, difficulty with housing, and a poor history of engagement. It was my first assignment of this kind, and I thought before going ahead with the assessment and formulation of a care plan, it would be very justified to develop a therapeutic relationship with Paul. I was good in communicating, where smooth exchange of information is the necessity of development of such relationship. I knew that good communication also needs experience, and thus I was a little shaky as to whether I would be able to communicate with the patient through demonstration of good interpersonal skills (McKibbon and Walker, 1994). It is required by the professional standards to have these as the basis of development of a therapeutic relationship with a client. As a support worker, I had the opportunity to work with this client. I decided to take advantage of previous acquaintance to start the process of development of a therapeutic relationship as a student nurse. This was important since the core nursing skills are manifestations of ability to establish a rapport, willingness to listen, and dealing through an empathic approach. I could gain a fresh consent, but the previous acquaintance helped to just get it straightforward. Before going ahead, I decided to contact EIP Unit, and the care coordinator helped me to gain his consent and reportedly explained him what I was going to do with his information. It was necessary for me to know his case records, and since information from them may be used to provide baseline evidence that can be used for formulating his care plan and assessment strategy. Nurses have been blamed to stereotype clients based on personal beliefs, own lifestyles, and naivety. I was aware of this, and the basis problem remains the nurses’ lookout for illnesses (Hayward & Bright, 1997). I was determined to find out the positives in Paul which could help in a truly person-centred assessment and care plan in order to move the patient forward in order to enable him to sustain his independence in the community after he has been rehabilitated (Jones et al., 1984). Most of the clients prefer a private place for assessment (Braithwaite, 1989). However, time of assessment is also important. I decided to ensure Paul’s primacy by consulting and discussing with him where and when to conduct the assessment. He agreed for Tuesday afternoon after 2. I also made sure that it was done in a private place, and all notes were stored appropriately and nothing remained unattended. He agreed, and we met in place agreed, and I began the session with a cup of tea for us both. This helped to set the relaxed and calm tone of this session, so the appropriate information could be available that would help formulate a personalized care plan (Open University, 2007). My mentor supervised this assessment, and I used the Strengths Model assessment along with Social Functioning Scale, Becks Depression Inventory 2, KGV, and other psychiatric assessments (Barker, 2004). Strengths and positives of the client is assessed by the Strengths Model, and the protocol of the unit is to emphasise on this model. This becomes, I felt, more pertinent in such clients who have innumerable negatives in the history. I recorded this conversation in running records, and the team was required to be debriefed after the session regarding my findings. I was initially hesitant whether the team will criticise me about what I did not do well. However, to my relief, I was proved to be wrong, and the team was very encouraging. Moreover in this, I found an opportunity of professional development since when I revealed my skills and knowledge in practice, there was a scope for identification on my part about the areas that needed further development (Open University, 2008). I remembered from my academic learning that it was also important on my part to look at the other areas of assessment and care planning through a mnemonic, SMART, which dictated the care plan to be specific, measurable, achievable, realistic, and time limited. Moreover, the practice must be evidence-based where care must be imparted based on collected valid evidence from research, patient information, and clinician observation (Open University, 2007). Interpretation of the assessment was a difficult task, but this is an important standard to be maintained. As a student nurse, due mainly to lack of my experience, it would be difficult for me to interpret information collected through assessment. It appeared to me that from this session, the information collected may prove to be inadequate to interpret, and I decided to reflect on this to formulate my interpretation. Two things were very apparent though, since I was using the Strengths Model, the patient was really suffering from two important negative aspects, social exclusion and discrimination (Byrne, 1997). The client was suffering from social exclusion and feeling depressed about discrimination (Bates, 2004). The existing medication regimen was not after his heart. He has been diagnosed with schizophrenia, which in itself is a socially isolative disease. His support networks have collapsed. Social support appeared to be very important for him, and I felt that appropriate social support can alleviate his stress through care, love, value, esteem, motivation, and a sense of belonging (Burchardt et al., 1999). His social history was very traumatic, his parental divorce, no relationship with his father, currently strained relationship with his mother, may all contribute to his suffering. He was originally very sociable and is hungry for social relations, company, people, and friends. This lack of social support or network is very typical of such clients, since they virtually lack a social life due to their mental illness, which get further accentuated by lack of employment, income, and social support and prevalence of stigma (Cobb, 1976). This could also lead to discrimination which would further aggravate the problem. As time went on, I began to understand him, he was opening up, and I could sense development of a therapeutic relationship, so important in mental health practice, and I was happy that I could fulfill this criterion. Before developing a care plan, I was in constant touch with my mentor and the care coordinator. Despite presence of negative points, although little hesitant, I ultimately gathered courage to highlight his strengths. The client wanted his normal community life back (Lipponcott, Williams and Wilkins, 2008). I ascertained the specific needs of the patient and decided to contact a local support group. Health promotion would be important, and I contacted the gym for that. Moreover, for his cultural needs, the local ethnic cultural group was contacted (Department of Health, 1999). Conclusion In this assignment of reflection, I found that I have developed myself professionally, and I could realize in a better manner the importance of the NMC Standards of Practice (Driscoll and Teh, 2001). In my own opinion I maintained professional boundaries in developing the therapeutic relationship. I was aware and conscious of the fact that I did not stereotype the patient in any way, and I maintained the ethical responsibility as a nurse (Nursing and Midwifery Council, 2008). Regarding development of skills, I needed help, and my mentor and the other members of the team provided that, although I think I may be lacking in communication due to inexperience. Academic learning is very important for drawing evidence, and next time in such a client, I decided, I would prepare myself better. Some members of the MDT team expressed stereotype (Goffman, 1963), which I could not criticise or oppose, but my mentor compensated for that, since I observed that she was very vocal. I decided to be my patient’s advocate in my next assessment and care planning. In this assessment and care/personal plan development and process, I feel that I have achieved all the following NMC standards of proficiency (Nursing and Midwifery Council, 2008): 2.1 Engage in, develop and disengage from therapeutic relationships through the use of appropriate communication and interpersonal skills 2.2 Create and utilise opportunities to promote the health and wellbeing of patients, clients and groups 2.3 Undertake and document a comprehensive, systematic and accurate nursing assessment of the physical, psychological, social and spiritual needs of patients, clients and communities 2.4 Formulate and document a plan of nursing care, where possible, in partnership with patients, clients and their carers and family and friends, within a framework of informed consent 2.5 Based on the best available evidence, apply knowledge and an appropriate repertoire of skills indicative of safe and effective nursing practice 2.6 Provide a rationale for the nursing care delivered which takes account of social, cultural, spiritual, legal, political and economic influences Reference List Bates, P (2004) Social inclusion and mental health Oxford University Press Oxford Barker, P.J (2004) Assessment in Psychiatric and Mental Health Nursing. 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