Reflection as a Concept - Essay Example

Reflection Introduction Reflective practice is a concept that learning is developed from experiences. It sprouted from the work of Dewey (1938) whoseobservations were that individuals are able to learn by their actions and then understanding the consequences and recognising the effects of such actions (Jasper, 2006). Hence, reflection revolves around the idea that if we consider our experiences and evaluate our learning, we can truly develop our knowledge and understanding, thereby paving the way towards improvement and refinement of our future actions. Moreover, Schön (1991) identified reflection as a process of knowledge that can be described in two forms: reflection in action and reflection on action. Reflection in action is being able to think what we are doing while we are doing it. It is the ability to think while on your feet and being able to apply previous experiences to new situations. On the other hand, reflection on action is considered after a situation has occurred. In this way, Schön (1983 as cited in Jones, 1995) explicated that it allows the practitioner to review, describe, analyse and evaluate the situation to improve on potential new circumstances. Additionally, Kolb (1984) (cited in Jasper, 2003) developed a theory of experiential learning, which consisted of four different stages and must be followed in sequence for successful learning to take place. In so doing, it would further enhance understanding of the experience. In a similar vein, Johns (1995) suggests that reflective practice also facilitates the nurse to gain knowledge to attain more effective and rewarding work. Consequently, there are a number of frameworks which provide useful guidance in reflection like Gibbs (1988) and Johns (2004). However, for the purpose of this reflective assignment, I have chosen to use Gibbs Reflective Cycle (Gibbs, 1988) for the reason that it provides a structured and simplistic cycle and the fact that is often used in several literatures. The Gibbs Reflective Cycle (1998) is comprised of six key sections: (1) the description of the event that you are reflecting on, (2) then goes on to ask what was I thinking and feeling at the time, (3) followed by an evaluation, where you consider what was good and what was bad about the experience, (4) then the analysis, which is being able to make sense of the incident, (5) the next part is the conclusion, where this is about what you could have done differently, and (6) the last stage of which is the action plan, where the main gist is letting you ponder on the actions that you will do if the same situation will be encountered in the future. The figure below is the so-called Gibbs Reflective Cycle with its key concepts. Fig. 1. Williams (2008). ‘Gibbs Reflective Cycle’. Thus, the aim of this assignment is to utilize the Gibbs Reflective Cycle (Gibbs, 1988) and to apply it to a critical incident that I had encountered from practice placement as a first year student. Furthermore, the critical incident shall focus on practice outcome D1, which “contributes to providing safe nursing care sensitive to meeting the needs of the patient/clients”. Nonetheless, in order to maintain confidentiality of the patient, in line with the Nursing and Midwifery Council’s (NMC) Code of Conduct (2008), confidentiality will be protected and all identifying factors will be changed and obscured. In addition, relevant and reputable references shall be the basis for the discussion and analysis herein, thereby ensuring a scholarly approach of the details in this reflective paper. Description of what happened The incident that I have chosen to reflect on occurred whilst on placement in a medical ward in a hospital. At the beginning of the shift, my mentor discussed the tasks that could be carried out and suggested that I could have my own patients, under supervision, which included Mr. Edwards as he was a new transfer. The patient, Mr. Edwards, was transferred to the ward because of the complications from a left-sided weakness and dysphasia due to a cerebral vascular accident (CVA). He was immobile and so he had to be hoisted. As observed, Mr. Edwards was able to feed himself without assistance but was unable to communicate effectively. One morning, Mr Edwards became agitated and his distress was seemingly escalating. In this manner, I was able to witness the other staff members who told him to keep quiet. Nevertheless, instead of calming Mr. Edwards, the action of the staff had seemingly increased his distress, thus leaving the situation unresolved. During lunch time, I gave Mr Edwards his meal and ensured everything was within his reach, including his cutlery and the table. In so doing, I left him in order to pursue and carry on with helping others on the ward. Unfortunately, minutes after leaving Mr. Edwards, I heard him shouting and found him throwing his food and plates across the room. Initially, Mr. Edwards was so distressed that he could not even articulate his problem, and just continued to grab and throw things across the room. With this, I decided to approach him in order to remove the table away. Unfortunately, Mr. Edwards continued to shout and was unwilling to communicate with anybody during those instances. As the staffs were trying to settle him down, the curtains were pulled around him in order to give him privacy and to safeguard the other patients as well. Thereafter, Mr. Edwards was regularly monitored. When Mr. Edwards had calmed down, I was able to use the communication cards to find out the problem. By doing this I used simple yes and no questions and allowing time for him to answer (McCabe, 2006). Thoughts and feelings During those moments, I was really overwhelmed with threat and was concerned with the safety of Mr. Edward and other patients in the ward. In this way, I also felt the responsibility and accountability to ensure the safety of everybody in the area. Moreover, I undeniably felt distressed due to the fact that the patient was being aggressive towards me. I also felt embarrassed as if I were in the spot light while others were watching the scene. I felt so vulnerable and at risk. Nonetheless, I just did not want to make matters worse. [Key thoughts: 1. Concerned with the safety of the patients in general 2. Felt the responsibility to ensure safety 3. Recognised the accountability to enforce necessary safety precautions 4. Thinking what actions to carry out in order not to make things worse Key feelings 5. Overwhelmed with threat 6. Distressed due to the behaviour of the patient 7. Embarrassed because of the fact that people are looking at me 8. Felt so vulnerable] Evaluation Good I recognised the fact that the patient did not want to communicate because he was very distressed at that time, thus being able to later address the patient’s need to have “space" Although I was unable to calm him down at first, I still managed to reassure him and gave him space by drawing the curtains. I was able to make the area safe by removing the table so the patient could not cause harm to any body. I took control of a difficult situation Bad The patient was very distressed and upset and I could not even discern what his real problem was. At first, I felt helpless and in danger. My first attempts to calm the patient did not work and the situation seemed to be getting worse. I was very anxious. I did not have enough experience in handling that kind of situation. I lacked confidence during that time. Analysis The event that I encountered can be broken down into two essential concepts: safety and communication. Hence, the analysis shall deal with the aforesaid significant areas to exemplify the focus of this reflective essay, that is, practice outcome D1 (contributes to providing safe nursing care sensitive to meeting the needs of the patient/clients) Safety The situation I encountered and the intervention that I had to do in order to warrant Mr. Edwards’ and other patients’ safety must be the top priority and consideration of the nurses during that particular instance. Certainly, ensuring patients’ safety at all situation is of paramount concern to all nurses. In this regard, the literature supports the action that I have taken as with the National Patient Safety Agency (NPSA, 2004, as cited in Tingle, 2004) guidance booklet that illustrates vital steps to promote the safety of patients. Tingle (2004) cited NPSA’s seven steps that exemplify utmost consideration of patient care environment safety, which are as follows: 1. building a safety culture; 2. leading and supporting staff; 3. integrating risk management activity 4. promoting reporting; 5. involvement and communication with patients and the public 6. learning and sharing safety lessons; and 7. implementing solutions to prevent harm (Tingle, 2004, in British Journal of Nursing, 13 (13): 758) Indeed, the intervention that I did was duly in line with the precautionary measures needed to ensure the safety of the patients. What I did was to move, or bring, Mr. Edwards to a side-room to ensure that other patients will not be threatened and harmed with the ongoing situation. Fortunately, Mr. Edwards calmed down and eventually I was able to identify the cause of his distress that led to his aggression. In this manner, a solution was properly implemented, which, in turn, prevented the possibility of harm to other persons in the ward. Also, by transferring the patient to the side-room, not only did it provide safety, but was also able to respect boundaries and promote privacy, which would enable to establish a therapeutic nurse-patient relationship (Videbeck, 2006). Communication As regarded earlier, communication is an important aspect in the said encounter with the patient. Perceptibly, the patient had a difficulty in expressing what he really needed at that moment. Moreover, the patient’s distress can be associated with, or related to, his underlying disease condition, which is CVA or stroke. According to Welch (2008), stroke survivors would most likely experience stress on a variety of levels during hospitalization. He further added that “the impact of stroke reaches beyond the patient’s physical and psychological being, as it also involves his or her social existence and lifestyle” (Welch, 2008: 335). Therefore, Mr. Edwards’ special needs must be carefully assessed, evaluated, and effectively responded. Trying to approach Mr. Edwards in the midst of his aggression was definitely the most challenging part of the event. We really do not know what was wrong with Mr. Edwards, thereby making us difficult to respond to his exact needs. Indeed, “communication is more difficult when a person has difficulty expressing their choices and struggles to understand information” (Regnard et al., 2003: 173). At first, it was really hard for us to approach the patient, thereby leading us to become almost hopeless. This feeling is supported by the literature as Regnard and associates (2003) further shared that “it is possible that distress is perceived as a symptom that is too vague and therapeutically frustrating” (Regnard, et al., 2003:175)”. Nevertheless, the said circumstance did not stop us from approaching and finding every way to calm him. Hence, the action that we had taken in trying to communicate with Mr. Edwards despite his destructive behaviour was essential lead to let the patient know that we (the staff and I) were there to help him. Furthermore, Mr. Edwards’s aggression would suggest that he was feeling some degree of discomfort during those times. As such, Feldt and Warne (1998) and Hunt (2001) both listed aggression as one feature to identify pain and distress. According to Regnard and associates (2003), it is vital to fully understand what the patients are trying to communicate as manifested by their behaviour. Therefore, nurses must understand the so-called patient’s language of distress” (Regnard et al., 2003). Regnard et al. (2003) set the four core knowledge in identifying a patient’s distress, which correspond to the knowledge identified by Liaschenko and Fisher (1999) and by Hunt (2001), and are quoted as follows: 1. Documentation of the signs and behaviours in both content and distressed situations and the context in which they occur. This enables carers to make explicit the observations they already make intuitively, and to have confidence in their observations. 2. Use of a screening decision checklist. This enables an initial decision to be made on the general cause of the distress. 3. Use of specific decision checklists or protocols for specific causes of distress that have been suggested by the screening checklist, such as fear or pain. These are used to narrow down general categories of distress to one, or a few, possible causes which then suggest a specific treatment. 4. Testing of the treatment and reassessment of the distress (Regnard et al., 2003: 175-176) Conclusion The incident provided me with a new clinical experience. My aim was to calm the patient and ensuring his safety and others as well as protecting myself. The incident caused me to feel apprehensive, awkward and nervous. If I had not dealt with the patient (Mr. Edwards), I would have lost such valuable learning experience. I realised that the event was a challenge to face and fulfil despite the difficult situation. The following are the set of my conclusive remarks pertaining to the event: I was concerned about my own ability to deal with the situation. I realized that caring for someone after a stroke requires multiple skills I was able to communicate to Mr Edwards after he calmed down. I was concerned if it were appropriate for me as a first year student to carry out with dealing with the patient. I was able to discern that Mr. Edwards was only trying to communicate with others but was getting agitated as no one was listening. Through effective communication strategy, that is, by using communication cards, I was able to identify what the problem was. With this, the patient said that the ward was too noisy and he did not like it. By listening to the patient, I was able to identify his specific at that particular moment. According to the literature, patients often simply need someone to listen to them, someone who will allow them to express freely the emotions they are experiencing (Welch, 2008: 336). I was able to move the patient to a side room in order to protect other patients. By doing this, I was able to respond to the need of the patient to have “space”. Eventually, I resolved the situation. Although the experience was very frightening for me and frustrating for the patient, it highlighted the need for me to improve my communication skills. I gained the patient’s trust, which is definitely necessary in order to foster a therapeutic nurse-patient relationship. The said incident provided me with a new learning experience and insight. Additionally, my mentor gave me positive feedback and supported me all the way. Action plan Reflecting back has allowed me to consider how I would respond to a similar situation. Definitely, I would be more prepared and confident to face such a circumstance in the future. This is because increased preparedness and confidence can eventually lead to better provision of care (Regnard et al., 2003). Moreover, I also have to increase my awareness of my own feelings. In this way, I would be able to reflect on my personal views about a certain situation, thereby leading to a genuine understanding of my self as an individual. According to Vidibeck (2006), by being aware of one’s self, the client will be able to perceive the as a genuine person showing genuine interest (Videbeck, 2006). In so doing, “trust is developed and allows the client to see the nurse as a real person with perhaps similar problems and by then, the client may choose to reveal more information to the nurse” (Videbeck, 2006: 88). Also, I must develop my communication skills so that I can communicate well with my patients. This is especially important because “it is not just patients that have communication problems; professional carers have a problem understanding their communication” (Regnard et al., 2003). As such, the following are essential steps the actions, or action plan, that I must undertake for future encounters with the same situation, in reference to the cited literatures in this essay: Careful observation of the patient’s behaviour. In this manner, I can fully know what is going on with the patient. Further assessment of the situation. This is to conscientiously determine the elements of the situation as well as to identify the needs of the patient. Establish a good communication with the patient. Foster a trusting environment. For a patient to honestly and thoroughly communicate their needs, trust must be established (Videbeck, 2006). Allow the patient to verbalize their feelings. Listen carefully to what the patient is saying. Identify the patient’s needs. Specifically, the most important concern of the client at the moment, which is regarded as “client-centred goal” (Videbeck, 2006). Respond and implement nursing care interventions based on the client’s needs. Follow one’s institution or hospital policy on risk management and safety precaution. This would ensure that the hospital’s protocols are well implemented. Follow-up as necessary. In this way, the condition of the patient is monitored and evaluated, thereby determining the effectiveness of the intervention or management that was implemented to address to the needs of the patient. Conclusion As a result of this reflective essay, I was able to look at the event that I encountered in a more meaningful manner. It also paved the way for me to understand the depth of the situation, thereby enabling me to dissect the essential elements that revolved around the event. In that way, I was able to know how everything went through and positively, I believe that I did a good start in handling such kind of situation. Truthfully, I gained valuable experience and learning insight through a purposeful reflection of the said circumstance. Hence, I am looking forward for a better and more confident me whenever I encounter the same situation again in the future, as my meaningful journey through nursing continues. Bibliography Faulkner, A. (1996) Nursing: the Reflective Approach to Adult Nursing Practice. 2nd edition. London: Chapman and Hall. Feldt, K. S., and Warne, M. A. (1998) ‘Examining pain in aggressive cognitively impaired older adults’. J Gerontol Nurs, 24(11): 14–22. Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford. Hunt, A. (2001) ‘Towards an understanding of pain in the child with severe neurological impairment’. Development of a behaviour rating scale for assessing pain. PhD thesis. Manchester: University of Manchester. Jasper, M. (2003) Beginning Reflective Practice – Foundations in Nursing and Health Care. Cheltenham: Nelson Thornes Ltd. Jasper, M. (2006) Professional development, reflection and decision-making. London: Blackwell Publishing. John, C. (2004) Becoming a Reflective Practitioner. Oxford: Blackwell Publishing. Johns, C. (1995) ‘Framing learning through reflection within Carper’s fundamental ways of knowing in nursing’. Journal of Advanced Nursing, 22: 226-234. McCabe C. and Timmins F. (2006) Communication Skills for Nursing Practice. Basingstoke, Hampshire: Palgrave MacMillan. Regnard, C., Mathews, D., Gibson, L., and Clarke, C. (2003) ‘Difficulties in identifying distress and its causes in people with severe communication problems’. International Journal of Palliative Nursing, 9 (4): 173-176. Schön, D. (1991) The Reflective Practitioner. 2nd edition. San Francisco: Josey Bass. Tingle, J. (2004) ‘Nurses must know the steps to ensure safety of patients’. British Journal of Nursing, 13 (13): 758. Videbeck, S. L. (2006) Psychiatric Mental Health Nursing. 3rd edition. London: Lippincott, Williams & Wilkins. Walker, J., Payne, S., Smith, P., and Jarrett, N. (2004) Psychology for Nurses and the Caring Professions. 2nd edition. Berkshire: Open University Press. Welch, R. (2008) ‘Considering the psychological effects of stroke’. British Journal of Healthcare Assistants, 2 (7): 335-338. Williams, K. (2008) ‘Gibbs Reflective Cycle’ [Online image]. Available at: http://www.brookes.ac.uk/services/upgrade/a-z/reflective_gibbs.html (Accessed: 8 May 2009). Read More