Reflective practice has been recognised by health care professionals as an essential tool to link theory to practice, which can help us learn from our experiences (Jasper 2003a). During my first placement I experienced an incident that a struggled to deal with because I did not understand the condition that the patient had. By using a reflective model I am going to revisit this incident with the intention of learning from it to improve my future practice. There are many reflective models that I could have used, such as John’s Model of Structured Reflection, but the reason that I decided not to was because John’s (2004) reflects on uncovering the knowledge behind the incident and the actions of others present, which I felt was not suited to my chosen incident. The reflective model that I have chosen to use is Gibb’s Reflective Cycle (1988), as I feel that this is a simple model, which is well structured and easy to use at this early stage in my course. Gibbs (1988) will help me to explore the experience further, using a staged framework as guidance.
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Description – what happened?
I was assisting an elderly patient that had Parkinson’s disease, with her drink. It was my second shift and I had not had much contact with the patients on the ward, but I felt confident enough to assist this patient as I have previous experience of care. I was holding the cup for the patient whilst she was sucking the fluid through a straw, but she was struggling as she wasn’t sucking hard enough. She became distressed, and said that I was stopping the fluid from coming out of the straw and being evil towards her; even trying to kill her! I was shocked by her accusations but thought that there must be a logical explanation, so I stayed with her, reassuring and assisting the best I could, as I didn’t want her to see that I was distressed. I then left the ward and immediately went to seek advice from my mentor.
Feeling – what were you thinking and feeling?
Initially, at the time my feelings were for the patient, as I was concerned that my actions had caused her to feel threatened, but I didn’t understand why. I felt embarrassed by her comments, and doubted myself, as this was a simple task so how could I get it wrong? I began to feel tearful, but then quickly reminded myself that there must be a reasonable explanation.
Evaluation – what was good and bad about the experience?
I felt happy and confident to assist the patient. I referred to the Nursing & Midwifery Council (NMC) code in my head and recalled that I should gain consent before offering to assist them NMC (2008), which she agreed. The patient appeared quite and I thought it would be nice for her to have some interaction, and to also feel at ease with a student nurse caring for them.
The downside was that the patient felt that I was being nasty to them. It also made me doubt myself and the care that I was providing. I was also in a bay area, so other patients would have heard their comments. Would they then look at me differently, and not trust me to care for them too?
Analysis – what sense can you make of the situation?
The patient had no recollection of what she had said to me and since the incident she has made these comments to other staff, which has put me at ease and made me realise that I had done nothing wrong. My mentor explained that a patient with Parkinson’s can often behave like this as they develop dementia, which Noble (2007) also confirms. Since the incident I have read about Parkinson’s and am now aware that the patients expressionless face Netdoctor (2008), also made her comments appear more confusing and aggressive.
Conclusion – what else could you have done?
I could have asked my mentor before assisting the patient what the disease was like, so that I was prepared. I did ponder about calling over another member of staff, which may have helped me to understand that the patient had a condition that was making her act this way, but I didn’t want to appear incapable of doing my job.
Action Plan – what would you do if this situation arose again?
I am now more prepared for any future patients with this disease as I have researched it. I will take the time to talk to them, to make sure they are at ease with me, before providing any care. If they appear distressed I would get another member of staff to help me to reassure them.
From my reflection it is clear to me that learning through reflective practice and being able to identify, and understand, my skills and abilities in both theory and practice are crucial for me to be able to act as a professional practitioner (Jasper 2003b). It is also important that I look at, and be honest about, the strengths and weaknesses that I have. So that I am able to identify these I have produced two Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis’, one for theory (Appendix A), and one for practice (Appendix B). I am now going to explore these further, identifying the main areas that I feel are important to me, and my future development.
My SWOT analysis for theory identifies my strengths, as a whole, as being very organised with my preparation for the work I have to undertake, with strong determination and motivation to succeed. (Appendix C) is a reflection that I wrote after completing my 1st week in university and demonstrates these qualities towards the course. It was important for me to realise that enrolling on a professional university course would mean that I became an independent learner, who must have strong organisational skills in order to succeed (Burns & Sinfield 2008a). I believe that from my preparation this is a very strong strength that I have developed.
The weaknesses that I have identified in my SWOT analysis for theory, that I feel will affect my grades in the future if they are not improved are referencing, revision technique and exceeding the word limit on assignments. I feel that these are weaknesses because they are new to me and as a mature student I have been outside of academic study for some time. (Appendix D) for example, is my feedback from my 1st assignment and shows how I have been penalised one grade point for exceeding the word limit. I will need to look at these weaknesses more closely and plan to improve them overtime, as Burns & Sinfield (2008b) have commented, it takes time and practice to be a good student; we are not just born that way.
My SWOT analysis for practice shows my strengths as wanting to help people, being determined to succeed, my willingness to learn and valuing people. These are all good qualities of a being a successful and professional nurse (NMC 2008). I have always had a caring nature and I am very determined to succeed and be successful in what I choose to do. (Appendix E) is a reflective journal that I wrote after my second week in placement and clearly highlights my strengths in practice. I feel that during my time as a student nurse I will build on these strengths even more.
I have identified my weaknesses in practice, from my SWOT analysis, as communicating with difficult patients, showing emotion and aseptic technique. (Appendix F) demonstrates how I found it difficult to communicate with a patient because I did not understand her condition. It was also difficult for me not to take her behaviour to heart and show emotion at the time, it is clear that this is an area I need to build on for the future. I also need to practice my aseptic technique as I feel very unsure of the whole process, but need to be able to get it right as it will protect me and the patient from contamination (Dougherty & Lister 2008).
According to Bulman & Schutz (2008), nursing requires effective preparation so that we can care competently, with knowledge and professional skills being developed over a professional lifetime. One way this can be achieved is through what Schon (1987) refers to as technical rationality, where professionals are problem solvers that select technical means best suited to particular purposes. Problems are solved by applying theory and technique. However, Bulman & Schutz (2008) argue that this is failure to educate and for us to learn from practice and develop thinking skills. I would agree with them, as I learn best from practical experience, and build on it to improve my skills. With this is mind, I am now going to focus on my weaknesses, in both theory and practice, and state how, when and why I plan to improve on these.
Referencing – This is very new to me and when writing my 1st assignment I found that it took up much of my time, as I struggled with it.
Revision Technique – According to Cottrell (2008a), reading through notes over and over is a pitfall with revision. This is the strategy that I would normally use.
Exceeding the word limit on assignments – I must take more care with this as on my 1st assignment I was penalised for it.
How I Plan to Improve
Referencing – To practice writing out references from different sources.
Revision Technique – I have decided to use the advice of Cottrell (2008a) and produce index cards that ask me questions relevant to my chosen subject. I will also produce a timetable in order to manage my time.
Exceeding the word limit on assignments – I will count the words manually and make sure that I do not use the whole +10% again so that I am in danger of being penalised.
When I Plan to Improve
Referencing – When I receive my feedback from my 1st assignment I will use the comments on my referencing to guide me.
Revision Technique – I will start preparing my index cards immediately and plan my timetable to start after submission of this assignment.
Exceeding the word limit on assignments – This is the next assignment that I will hand in so I will make sure that I adhere to the word limit.
Why I Plan to Improve
Referencing – Referencing plays an essential part within my writing Gimenez (2007), so correct use and structure of references will improve my grades.
Revision Technique – Improving my revision technique will mean that I am more relaxed before an exam, and will help me to achieve better grades (Cottrell 2008a).
Exceeding the word limit on assignments – Adhering to the word limit as Cottrell (2008b) suggests, will improve my grades in future assignments.
Communicating with difficult patients – On my 1st placement I experienced a patient that had communication difficulties which I found difficult to deal with.
Showing emotion – I am a very sensitive person and feel anxious that I will get upset in front of a difficult patient, or a patients family at an inappropriate time, e.g. patient death.
Aseptic technique – In practice I need to get this procedure right, but I do not feel 100% confident with it at present as I have not had much practice with it.
How I Plan to Improve
Communicating with difficult patients – I will observe as much as possible my mentor, and other nurses communication skills.
Showing emotion – I will use reflective models to make sense of what has happened, and also discuss it with my mentor.
Aseptic technique – I have asked my mentor if I can practice this procedure as much as possible.
When I Plan to Improve
Communicating with difficult patients – Each time I am on placement I will plan to improve my skills in communication.
Showing emotion – I will start to use reflective models in my practice now so that I have experience of using them ready for when an emotional situation happens.
Aseptic technique – During the rest of my time in my 1st placement I plan to practice this so that I am comfortable with it by the end of my 1st semester.
Why I Plan to Improve
Communicating with difficult patients – As a student nurse, and in line with the NMC (2008), I should make the effort to meet patients communication needs to provide the best care that I can.
Showing emotion – I want to appear professional to patients and their family, however I do agree with Scott (2008), that sometimes we should not be afraid to show emotion as a nurse, as long as we maintain our professional image at the same time.
Aseptic technique – The correct use of aseptic technique will protect myself and the patient from healthcare associated infections (Hart 2007). It will also prevent infections from being spread around the rest of the ward, which could harm other patients.
I have clearly demonstrated that by using a reflective model as a guide I have been able to break down, make sense of, and learn from my experience during my 1st placement. So that I could identify my strengths and weaknesses in both theory and practice easily, I found that the use of a SWOT analysis provided a good framework to follow. I have then built on this by producing a development plan that focuses on my weaknesses and how, when and why I plan to improve on them. I will now begin to work on these, the main reason being of course, that I am determined to be a competent, professional nurse in the future.
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