Evidence to Demonstrate Practice Learning - Term Paper Example

Based on what I have seen and experienced so far, nurses don’t have much time to reflect on their work since they are either too busy doing their tasks or too tired to think some more about work. They would rather watch TV or read non-health-related magazines. Thus, it took a moment and some certain research for me to begin and to actually appreciate doing a reflection. I now know the importance of this activity and, using Gibb’s Reflective Cycle and the guide questions written by Jasper (2003, pp. 77-80), here are my thoughts on my first practice placement.   Description       What exactly happened during my first practice placement?       My supervisor, Leanne, had told me to help out at the orthopaedics ward of the hospital I had been assigned to. One of my main tasks was to hand out the trays of meals and help out the patients as much I could since some of them were in braces.       I got along fine with most of the patients. But one patient stood out among the rest. He was a boy, about 17, who had been involved in a car crash. I learned later on that his whole family had died and he had been the sole survivor.       Even during my first day on duty, I already noticed that the boy was still in a heavy mental shock and denial. He didn’t pay attention to anything around him. He hardly touched the food that I would deliver to him. I tried talking to him about everyday things like the weather but he would not respond. If I asked him something like “Do you need help with anything?” or “Is there anything I can do for you?”, often he would just look at me with dead eyes. Once he glared at me when my tongue slipped and I mentioned something about his hair being “nice and silky, probably something you got from your parents.”  Feelings and Thoughts       What was I thinking the whole time? How did I feel before and after the event? What did other people’s actions and words made me think?       My heart had gone to him the moment I heard about his predicament. I wanted to say something comforting to him. However, I knew that saying something direct about his predicament was taboo. If something so indirect as inheriting his hair from his parents would make him glare, I knew that something deeper would probably make him lash out.       I felt frustrated. I wanted to help him. I kept thinking “what can I say to ease his pain?” But I didn’t know what to do. Also after he glared at me, I began to feel uncomfortable whenever I would be with him so I began to talk less. In the end my frustration doubled because I really didn’t do anything even if I wanted to do something.       Because I was feeling flustered, I also opted not to ask for some advice the other nurses in that area. In a way I was also feeling shy because the other nurses seemed to be doing just fine and I thought that all I really needed was more experience. I also thought that I didn’t want to bother them because they were already swamped with work and I didn’t want to burden them with my insecurities as a newbie.       On the other hand I also wanted to prove that I could find a way, on my own, to help this one patient. Somehow I also felt that it was a challenge for me since I could interact with my other patients, so why not him as well? Maybe this was just my stubborn pride egging me on to do everything my own way. Besides I had studied a lot so I should be able to come up with a solution to my dilemma.  Evaluation       What was good and what was bad about the experience?       What was bad was the frustration I felt at my helplessness and my stubbornness. Also I kept asking myself, was I the right person to console him? Would the doctor or some more senior nurse be more appropriate to approach this boy? Were they already doing something and I just missed the times when they would help the boy?       However, looking at some silver lining behind that dark cloud of frustration and headache, I realized how much I still needed to know about the ‘real’ world of nursing and just what my weaknesses were. From that point on I knew which aspects to improve on to be a better nurse in the future, foremost was my communication skills. I needed to improve and find ways to better approach and talk with my patients, and with my colleagues  Analysis       What was the sense of the whole practice? What went well and what turned out badly? What did others do well? What went wrong or did not turn out the way I thought it should? Did I contribute something to the event?       I tried so hard to think of something that I passed up on the chance to seek help from other, more senior nurses. I might have done better if I had talked with some other nurses. Then again, my communication skills even with fellow nurses faltered. I let my frustration overcome me so started becoming uncomfortable with my patient. And my body language might have sent so many wrong messages to my patient, in the end.       Yes, I had read how body language is important to strengthen trust between nurse and patient (Bayne, Nicolson and Horton,1998, p.42) and how eye contact helps to reassure patients that the nurse is paying attention to them (Burnard, 1992, p.89-90). But remembering what I’ve read and putting them into practice are two very different things. Also, how could I practice Burnard’s “S.O.L.E.R.” (Sit squarely, Open position, Lean forward, Eye contact and Relax) if my patient was unresponsive or if my patient’s body language became somewhat hostile? How could I relax when I kept thinking of what to do next?  Conclusion       What else could I have done?       I could have tried harder and found the right words to console my patient.       I could have also talked with the other nurses and doctors to find out how to better handle the situation. My inner debate on whether I was the proper person to talk with my patient could have been answered right away. Talking with someone else could have prompted someone else with better skills to lend a hand and help the boy.       In some way I must have made the boy more miserable by being awkward and hesitant. If I had straight out asked him if he wanted to share his thoughts with me, would he and I have made some progress not just with his physical but towards his mental recovery as well? Maybe.  Action Plan       If I go through this type of activity again, what would I do?       Because I know that I will surely come across a case the same as or similar to what I had gone through, I will aim to be more competent when I experience it again. This initial reflection has already prompted me to learn further so that I will be better equipped to handle the next situation. I will read books about Bereavement and Counselling.       I will also ask advice from the more senior nurses in my area on how to better handle the situation and get tips from them on how to better communicate with patients. I must also always remember that learning and asking advice and evolving is a life-long process that never stops because the nursing profession demands that we always keep up with the latest findings or research or conditions going on around us (Glanz, Lewis, & Rimer, 1997, p. 253)  Final Thoughts       This reflection has made me realize just how much more I need to learn. As Kinlaw (1995, p. 67) wrote, this “internalization process” has also motivated me to improve my performance. It has become my first step to “realize desirable and effective actions” or, to put it in a more poetic way, it has started my road towards transforming myself (John, 2002, p. 8; Palmer, Burns, and Bulman, 2002, p.1).       Nurses should learn to become proactive because of all the “new and different challenges” we come across in our profession today. This is why I must develop a critical mind and continue to reflect on my job. Both of these actions will force me to continuously ask questions and try to find out how to enhance my work, specifically, and my profession in general (Bowden, 2003, pp. 28-31; Schon, 1991).       Nurses who value critical thinking and reflection will never take things at face value. Rather, they take on a broader perspective, taking into account not just the immediate situation, but the comprehensive care of and how to better serve the patients under their charge. I believe that nurses like this will become truly competent workers who are “more self-directed and goal-oriented”. They are proactive because they believe that they can inspire and affect the people, events, and conditions around them (Zea, Reisin, Beil, & Caplan (1997) in Miller and Mason, 2001, p. 36). I am to transform myself to become this type of nurse.       Mezirow (1990) wrote that transformative learning involves “becoming more reflective and critical, being more open to the perspectives of others, and being less defensive and more accepting of new ideas.” I must also develop what Mezirow says as the second domain of learning, the communicative domain whereby one gains practical knowledge to handle events or conditions. With continuous exposure to the constantly changing and rich environment of the nursing profession, I know that I will continue to “expand and deepen the scope and depth of [my] knowledge” And with hope, practice, and patience, this transformation might give me the benefits enjoyed by empowered people—a more meaningful and enjoyable life and work.        References Bayne, R. Nicolson, P. Horton, I. (1998). Counselling and communication skills for medical and health practioners.Leicester: BPS books. pp.42, 241  Bowden, S.D. (2003). Enhancing Your Professional Nursing Practice Through Critical Reflection. Abu Dhabi Nurse, www.abudhabicme.com/main/doc/nurs01c28_31.pdf, accessed on December 15, 2008, pp. 28-31   Burnard, P. (1992). Counselling: a guide to practice in nursing.Oxford: Butterworth-heinemann.  Glanz, K., Lewis, F.M., & Riner, B.K. 1997. Health Behavior and Health Education: Theory, Research, and Practice. 2nd edition. San Francisco: Jossey-Bass, Inc.  Jasper, M. 2003. Beginning Reflective Practice: Foundations in Nursing and Health Care. Cheltenham: Nelson Thornes.  John, C. 2002. Guided Reflection, Advancing Practice. Osney Mead: Blackwell.  Kinlaw, D. 1995. The Practice of empowerment. Hampshire: Gower.  Mezirow, Jack, 1990. Fostering critical reflection in adulthood: a guide to transformative and emancipatory learning. San Francisco : Jossey-Bass.  Miller, R. & Mason, S. 2001. Using group therapy to enhance treatment compliance in first episode schizophrenia. Social work with Group, 24(1): 37-56.  Morison, M., Moffatt, C., Franks, P.J., 2006. Leg Ulcers: A Problem-Based Learning Approach. Oxford: Elsevier Health Sciences.  Palmer, A., Burns, S., & Bulman, C. 2002. Reflective practice in Nursing, The Growth of the Professional Practitioner. Osney Mead: Blackwell Scientific.  Schon, D. 1991. The Reflective Practitioner. Avebury: Aldershot. Read More