Critical Reflection - Report Example

Critical Reflection Introduction Reflection is considered the process of extensively and internally evaluating a specific incident or issue, one which prompts a deeper clarification based on varying and conceptual considerations (Jasper, 2003). Evaluations based on personal insights have also been established by Mann and colleagues (2009). Moreover, the significance of reflection in practice has been acknowledged by Boenik, et al., (2004) who indicate that reflective practice is one of the more acceptable processes in effective medical care. This essay shall now reflect upon evaluative thought processes in terms of my learning after my elective placement. A critical assessment of my communication skills will be carried out based on specific incidents. An evaluation of my experience in a small private clinic in Angola and in a stroke unit will be considered. The essay will also establish possible strategies in the specific areas in order to provide possible changes and improvements in the future practice. Body Before I started my placement in a small clinic in Angola, I knew that communication was going to be one of my main challenges because of the language barrier, with the local language being Portuguese and the medical terms being in predominantly English. Although I did not feel much trepidation going into the placement, I was aware that the language difficulty would likely be a challenge. I was aware that I needed to make adjustments in these communication skills in order for me to gain any sort of progress in my placement and future practice. For example, I knew I needed to learn more about how to translate the English medical terms into the Portuguese language in order to communicate effectively with patients and to ensure my therapeutic efficacy as a physiotherapist. Effective communication is a significant element in the delivery of health services. This perception has also been supported by Pountney (2007) who believes that effective communication is a form of medical therapy by itself. This is also emphasized by Herbert (2005) who pointed out that where the communication process is not ensured by the health provider, the patient’s response to the treatment or intervention would be poor. Based on these studies and points of discussion, I believe that it is important to consider my communication process during the placement in order to detect issues in communication and secure significant improvements in my future practice. One of the incidents during my placement is vivid in my memory. In one of my visits to the hospital tagging along with my clinical educator, I was able to observe and assist in caring for a patient who suffered from an ischemic stroke. Based on her symptoms, I was able to immediately observe which side of her brain was affected. I was however shocked to see, for the first time, a patient who had one side (right) of her face paralysed (mostly on lip and mouth area). It was an exciting experience for me and I learned a lot because my clinical educator was able to show me various techniques on how to manage the patient, including the stretching of the muscles around the affected area. She also allowed me to practice on the patient, making sure to gain first the patient’s consent for my actions. Notably, we also coordinated with the attending physician for our orders; we had to refer to his orders and to clear medical procedures with him, including the techniques the clinical educator was applying on the patient. Towards the end of the session, I was already impressed with the results and I observed that the patient was also able to say a few words after several tries. In this case, I observed the difference between the private and public sector treatment where, in the NHS due to time constraints, only 20 minutes could be allocated to the patients, and in the private clinic, close to 1 hour could be allocated to each patient. Due to the longer time spent, the doctors could carry out more tasks with the patient, as opposed to the patients in the NHS where only a limited amount of time could be allocated. Due to the longer time spent in the private clinics, the communication process with the patient was more effective and I could also make a more effective attempt to translate the medical terminology for the patient in order to help the patient understand what he needed to know. At times, the language barrier was very much difficult for me to handle because I feared possible errors in communication. I felt frustrated at times to encounter the translation gaps with the patient. I also felt disappointed with myself for not being more prepared in terms of crossing the language barrier with my patients. My greatest fear in the failure of communication was the fact that I might be mistranslating the medical terms to the patient. After the session however, I also felt that in the future I needed to improve my communication skills in order to be a better physiotherapist. I felt that I was able to learn from the experience, and to find out what I needed to improve in my future practice. It also made me aware of the remedies I could make in order to prevent any misunderstanding, mostly by consulting with the other bilingual health workers in order to help explain the medical terms to the patients. I also understood how important it was for me to look at the patient while she was talking in order to make the patient feel included in the decision-making process even if he did not completely understand what I was explaining to him. I also found out that despite the limitations in the verbal communication process, there were other ways for me to communicate with the patient, including non-verbal gestures. These were possible improvements in my communication skills which I sought to secure during the remaining days of my placement. After the initial evaluation, a second consultation was scheduled after 1 week in order to evaluate the patient’s condition. I also prepared for this second consultation and as part of my preparation, I learned to explain the medical terms into the local terms, especially the words I would need and use during the follow-up consultation. I learned how to make the communication process less technical and less complicated for the patient. During the follow-up check-up with the patient, I greeted the patient in her language and this made her immediately feel happy and valued as a patient. I was also able to evaluate the relationship of the patient and the family member (daughter). Primarily however, I was able to assess the efficacy of the improvements I made in my communication skills. It was clearly apparent that my efforts gained a favourable response from the patient. I was able to secure rapport with the patient due to the adjustments I have made in the communication process.. The improvement in my communication may be caused by various elements including the recognition of the gaps in my practice, the apprehension I observed from my patient who could not understand what I was trying to say to her, and my strong attempts to learn the language. All in all the follow-up was successful, especially from the feedback of the clinical educator who was pleased with my attempts in improving my communication skills. I was able to establish rapport with my patient at a shorter length of time, and I was able to ask the questions I needed to ask personally. I was able to talk to the patient personally, and make myself be understood better. This process helped me develop confidence in my ability to communicate with my patients, but mostly in my ability to adapt to any communication gaps I encountered. However, I believe that even as the session was a significant improvement from the first consult, it did not yet reach superlative status. For one, I felt that I was still using some wrong words while talking with the client in the Portuguese language. This element however can be improved with repetition and practice. In effect, I now understand that for future incidents, I would further practice my communication skills in order to prevent any miscommunication with my patient. This would give me the confidence I would need at the beginning of the session and would help me build immediate rapport with my patient. Learning during the placement was affected by my personal feelings and lack of experience. This was already expected at the beginning of the placement and this further exacerbated my feelings of apprehension during the placement. I feel that such feelings of trepidation were based on my lack of experience and my fear of committing a mistake. I also felt that I can hurdle through these feelings for as long as I maintained a professional demeanour and stayed alert at all times. The link between feelings and reflection has been discussed by Eva and Regehr (2005) who point out that feelings of trepidation are a necessary part of effective reflection. They further point out aspects of reflection and the personal elements of its conceptualization. They discuss how the personal elements can often impact on one’s actions and decisions in one’s profession (Eva and Regehr, 2005). Utilizing reflection under these personal emotional scenarios can impact on one’s career. It also secures ways by which one can evaluate the professional and personal experiences during the placement or actual practice. Before my placement, I knew that there were various fields of specialization I would get to witness and experience. One of these areas is the stroke unit. This was a unit where there were several patients who were in dire need of physiotherapy. I have not had a previous opportunity to work in a stroke unit, and so I was very much a newbie in the area. The interventions being carried out and ordered in the stroke unit were also new to me. All in all, my initial experience in this unit was very much new and challenging. During the few times I was scheduled to be at the stroke unit, I was very much apprehensive because I felt like every moment I went there was my first time. I still remembered the time when I cared for the ischemic patient and I still felt shocked every time I saw an actual manifestation of paralysis. These feelings came about because of my lack of experience and because I was overwhelmed by the patient’s condition. I however observed how my clinical educator handled the situation confidently by speaking to the patient with confidence and by listening to the patient intently. I also observed how important it was to be guided and assisted by the physicians in the delivery of patient care. They indicated the pertinent orders, and we carried out these orders based on their specifications. Based on my observation, I felt that I needed to develop more confidence and experience in order to gain her expertise. I also made a stronger effort towards discarding my feelings of apprehension in managing the patient. After each session, I made regular attempts to reflect on the situation, the gaps in my practice, and the gains I was able to achieve during my placement. While the placement continued, I was able to gain more confidence, especially as I was able to learn from my mistakes and I was able to regularly evaluate my progress through the placement. As discussed by Gustafsson and Fagerberg (2004), learning from one’s mistakes can help improve the professional practice. Throughout my placement, there were aspects of my practice I was not able to improve on. I believe this was because I was more concentrated on resolving issues with language barriers with my patients. In the future, I know I have to somehow also consider other elements of my practice which need improvement in order to have a more holistic career. I should also improve my ability to overcome my fears in the practice in order to improve my patient outcomes. Discussing these fears with my clinical educator and with other health professionals would help me eliminate my fear as they can give me tips on how to manage my fears. The experience and the strategies establish a way to improve reflection during non-communicative and fearful situations. Reflection can however be biased because of issues with memory and anxiety. It is therefore important to keep written accounts of the experience in order to ensure accurate accounts of experiences. With accurate accounts of the experience, a more effective management scheme can be implemented. Conclusion In general, this paper has evaluated my experiences during my placement, assessing aspects in relation to communication and apprehension in the practice. I believe that communication is crucial in physiotherapy because a strong link between the patient and the therapist has to be established before effective patient outcomes can be gained. Through reflection, it is possible to establish effective goals in the practice, aligning these goals towards the bigger goals of holistic and professional development. 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