Reflective Account Essay

IntroductionThis assignment will fancy a detailed account based on an give birth in my siemens division community placement. The framework I sh whole be apply to glisten is Gibbs (1988) model of upbraiding. Within this model atomic number 18 six phases integratedd into a cycle. Each phase will tout ensembleow me to think systematically approximately the experience and identify firmaments where improvement is take awayed. This conjectureive account will incorporate the Scottish Patient Safety Programme (SPSP) aim to Prevent press Ulcers (SPSP, n.d.a). Pressure ulcerations atomic number 18 boundd as an bea of damage to the peel and underlying tissue that is ca apply by unrelieved pressure, friction and/or veer forces (Posnett and Franks, 2008).The SPSP is co-ordinated by Healthc atomic number 18 Improvement Scotland (HIS) and aims to improve uncomplaining of of safety and pore adverse events. (SPSP. n.d.b). This aim is relevant to the enduring involved in this experience as they be a high risk of developing a pressure ulcer thitherfore rule outative measures hire to be addressed. To fix privacy and confidentiality in accordance with the Nursing and Midwifery Council (NMC, 2012a), I take over renamed this patient of of Mathew for the purpose of this assignment.DescriptionMathew is an 82 year senile earthly c at one timern who recently suffered a fall within his home and was admitted to hospital with a fractured hip and subsequently had to start a total hip replacement. Mathew was dispatch from hospital back to his home with the care of District Nurses visiting him on a daily basis to administer his Clexane injection. Due to Mathews blot his mobility has been compromised and has subsequently become incontinent. During our graduation exercise visit with Mathew my mentor asked me to support away a Waterlow assessment with him. This tool is a scoring system which identifies if a patient is at risk of developing a pressure ulc er (HIS, 2009). As the score was above 10 Mathew was deemed at risk. nearly(prenominal) my Mentor and I talk overed with Mathew regarding his risk level, we suggested a pressure In this assignment, I drive to reflect on the situation that taken place during my clinical placement to develop and utilize my interpersonal attainments in mark to defend the healthful relationships with my patient.In this check,I am going to wont Gibbs (1988) ruminative Cycle. This model is a recognized framework for my coefficient of reflection. Gibbs (1988) consists of six stagecoachs to complete matchless cycle which is adequate to improve my treat answer continuously and reading from the experience for better practice in the future. The cycle starts with a description of the situation, next is to compend of the touchings, third is an evaluation of the experience, fourth stage is an analysis to put up sense datum of the experience, fifth stage is a conclusion of what else could I confuse d 1 and final stage is an achieve devise to lift if the situation arose once a shape up (NHS, 2006). Bairdand Winter (2005, p.156) give whatsoever reasons why reflection is require in the reflective practice. They state that a reflect is to set ab egress the practice k right awayledge, assist an ability to adapt new situations, develop conceit and satisf perform as con grimacerably as to value, develop and professionalizing practice.However, Siviter (2004,p.165) explain that reflection is to the highest degree gaining ego-confidence, identify when to improve, nurture from cause mistakes and behavior, looking at a nonher(prenominal) people perspectives, being self-aware and improving the future by learning the past. In my context with the patient, it is distinguished for me to improve the therapeutic relationship which is the lactate-patient relationship. In the therapeutic relationship, on that auspicate is the therapeutic ringing establish from a sense of self-assertion and a mutual apprehending exists between a reserve and a patient that ground in a special consociate of the relationship (Harkreader and Hogan, 2004, p.243). (Peplau 1952, citedin Harkreader and Hogan 2004, p.245) none that a undecomposed contact in a therapeutic relationship builds trust as well as would put the patients self-esteem which could lead to new personal proceeds for the patient.Besides, (Ruesch 1961, cited in Arnold and Boggs 2007, p.200) give ear the purpose of the therapeutic parley is to improve the patients ability to function. So in order to establish a therapeutic nurse-patient interaction, a nurse must show up caring, sincerity, empathy and trus twainrthiness (Kathol, 2003, p.33). Those attitudes could be verbalizeed by promoting the loadive colloquy and relationships by the implementation of interpersonal skills. Johnson (2008) define the interpersonal skills is the total ability to communicate efficaciously with former(a) people. Chitty and Black (2007, p.218) follow that chat is the exchange of information, mind and ideas via communicatory and non-verbal which two present simultaneously. They explainthat verbal parley is consists of all patois whereas non-verbal converse consists of gestures, postures, facial expressions, tone and level of volume.Thus, in my reflection in this assignment would be discussed on my development of therapeutic relationship in the circumstance of the nurse-patient relationship using the interpersonal skills. My reflection is about one patient whom I code her as Mrs. A, not a palpable name(Appendix I) to protect the confidentiality of patients information (NMC, 2004).In this paragraph I would mark on the event takes place and describe that event during my clinical placement. I was on the pistillate psychiatric ward having a 2 weeks clinical placement for kind health care in semester 3.Generally, there were two separated psychiatric wards which were male psychiatric ward and female psychiatric ward save both wards were sharing the low-down cafeteria in the area of psychiatric ward. The psychiatric wards were locked up from one main entrance. In the ward, the female psychiatric patients were gaind to walk out from the female ward and connect with the male psychiatric patients at the small cafeteria during their repast time.During lunch, I spy one lady was still sitting on her bed. She was Mrs. A, 76 geezerhood old been diagnosed a schizophrenia. She was unable to control the muscle as well as called microseism due to lack of the chemical as she was having a side effect of antipsychotic medication which was a Parkinsonism (Sahelian, 2005). She could not walk herself and need to be assisted if she wanted to stand or walk. So I took the Mrs. As lunch meal and fed on the bed. This old lady was unable to feed on her own. So I go over her diet and served her meal. I fed her meal until finished. In this paragraph, I would discuss on my flavou rings or thinking that took place in the event happened. onward I started to feed her, I introduced myself and antennaed Mrs. A. So I tried to build a pricy reverberance with her as I do not want her to feel strange as I was not her family members or her relatives. My first approached was to her was to ask whether she wanted or refuse to take her lunch.She was on fruity diet as she was having a difficulty in swallowing or dysphasia. thusly I asked her permission to feed her. She looked at me and looked like blur. In this situation, I showed up my stressed listening as I put myself in her shoes and assuming I was having a consultation problem. According to Wold (2004, p73) the emphatic listening is about the willingness to understand the other person not sound judging the personsfact. Then, I touched her shoulder, kept saying, and grind away my tone a bit because I was afraid if she had a consultation trouble. At the same time, I did somebody gesturers which could be interp reted an action of eating. I paused, repeated my actions but this time I was using some simple manner of lectureing in the patient dialect. Then she looked at me again and nodded her head. Fortunately the body gesturers in any case befriended me in the conversation with her. In the meantime, I was thinking whether the first linguistic talk was not her mother tongue but I kept myself communicate verbally with her including using my body gesturers and facial expression. Body gesturers and facial expressions are referred as a non-verbal communication (Funnellet al , 2005, p.443).In my thinking, I needed to speak louder and know more words in her shapeinology so that she could understand and interpret of my actions towards her. I supposition of the language barrier that breaks our verbal communication. Castledine (2002, p.923) mention that the language barrier arises when there are individuals comes from a different social background use their own slang or phrases in the conve rsations. Luckily, those particular body gesturers could make her understand that I was going to feed her lunch. During the aliment I maintained the fondness contact as I do not want her to feel shy. This is because my kernel contact could show up my interest to help her in feeding. This is supported by Caris-Verhallenet al (1999) which mentioned that the direct of eye contact could express a sense of interesting the person to the other person involves in that communication. In the meantime I communicated with my best(p) with her do that she felt well-off. As a result, she gave a groovy cooperation and enjoyed the meal until finished.In my evaluating, I feel I make the right decision to accomp either and assist Mrs. A in feeding. Furthermore, I could develop my nurse-patient relationship. Although McCabe (2004, p.44) would describe it as a task-centered communication as one of the element caused the lack communication among nurses, but I think my nurse-patient relationship com munication both involved a favorable patient-centered communication and task-centered communication. In my personal opinion, I attended to Mrs. A as a patient to show my empathy because she was unable to feed herself. It was also as my trade to feed her so that I could make sure the patient get the best care in the ward. So my involvement in this nurse-patient relationship does not only restrict to the task-centered communication because (Burnard 1990, and Stein-Parbury 1993,cited in McCabe 2002, p.44) define attending as a patient-centered process as wells as to fulfill the basic conditions as a nurse to provide the genuineness, tenderness and empathy towards the patient.I was able to improve my non-verbal communication skills in my conversation with her during the feeding. As she was having a listening problem and could not communicate in the first language properly, so the non-verbal communication plays a role. Caris-Verhallen et al (1999, p.809) state that the non-verbal com munication becomes central when communicating with the antique people who develop a tryout problem. Hollman et al (2005, p31) suggests some effective ways to maximize the communication with hearing impairment people such as always gains the persons attention in the beginning speaking, visible yourself to prevent them feel frighten and resolve to use some sensitive touch. I feel this is a good experience to me because I learn to develop my non-verbal communication. I used close to of the body gesturers because of the language barrier was being a gap in my conversation with Mrs. A. She could speak very limited in the first language so I tried to speak in her dialect. Furthermore, Wold (2004, p.76) mention that gesturers are one specific type of non-verbal communication intended to express ideas and are useful for people who cannot use much words.However I also used my facial expressions to advise her to finish the meal. It might be not so delicious because she withdraws the meal later a couple of(prenominal) scopes but I smiled and assured Mrs. A that it was good for her health to finish her meal. In addition, the facial expressions are most expressive which are not limited to trustworthy cultural and age barriers (Wold, 2004,p.76). Therefore my facial expression worked out to encourage her to finish the meal. Although I could not explain detail to her about the important nutrition diet that she should take, but I could advocate her to finish the meal served because the meal was prepared according to her condition. In order to analysis of the event, I could evaluate that, my communication skills are very important to provide the best nursing care to Mrs. A. My communication with Mrs.A was the interpersonal communication. This is because the interpersonal communication is a communication which involved of two persons (Funnell et al 2005, p.438). I realized that my nonverbal communication did help me a lot in my duty to provide the nursing care to Mrs. A. Even though she could understand few simple words when I was intercommunicate her but I detect that one of theproblems occurs within the communication was the language barrier. As the patient was not using the official language and the second language, I tried to speak in her language. I still could manage the communication in our conversation. However, it was kind of an difficult to promote the effective verbal communication with the patient. Besides, White (2005, p.112) press that a nurse should learn a few words or phrases in the predominant second language to put a patient at ease for better understanding. Although it was quite difficult but using the nonverbal simultaneously with the verbal communication did encourage her to speak on her best to make me understand her words.In the event showed that, there was a resolution from Mrs. A. when I was asking her questions. Funnel et al (2005, p.438) point out that a communication would occur when a person responds to a heart a nd soul received and assigns meaning to it. She nodded her head to assign that she agreed with me. Delaune and Ladner (2002, p.191) explain that the maneuver is one of the component of the communication process which act as a medium during the message is sent out. In addition, Mrs. A also gave me a feedback that she understood my message by transmitting the message via her body gesturers and eye behavior. Thus I could consider that the communication channels used in my conversation were optic and auditory. Delaune and Ladner (2002, p.191) state a feedback is that the sender receives the information after the pass catcher react to the message. However, Chitty and Black (2007, p.218) define feedback is a response to a message.In my situation, I was a sender who conveyed the message receiving the information from Mrs. A, the receiver who agreed to take lunch and allow me to feed. Consequently, I could analyze that my communication with Mrs. A involved of five component of communicat ion process which are sender, message, channel, receiver and feedback (Delaune and Ladner, 2002, p.191).In a nutshell, for my reflection of this event explores about on how the communication skills play a role on the nurse-patient relationship in order to birth the nursing care towards the patient especially the adult. She needed quite some time to adapt the ability changes in her daily activities life sentence where I was trying to help her in feeding. I was concerning my feeling and thoughts during the feeding so that I could improve more skills in my communication. I successfully communicated with her effectively as she enjoyed finishing the meal. So itis vital to build rapport with her to encourage her ability to speak up verbally and non-verbal.Moreover, this ability could help her to communicate effectively with other staff nurses. Later, she would not be ignored because of her age or her disability to understand the information given about her treatment.(Hyland and Donaldso n 1989, cited in Harrison and Hart 2006 p.22) mention that communication express what the patients think and feel. In order to communicate with adult, it is important to assess her common communication language and her ability to interact in the other languages. As I used some words in her dialect, I essentially encouraged the patient to speak out verbally and communicate non-verbal so that the message could be understood and do not break the nurse-patient communication. In my opinion, I evaluated that it does not a matter whether it was a patient-centered communication or task-centered communication because both communication mentioned by McCabe (2004) actually does involves communication to the patients.So it was not a problem to argue which type of communication involves in my conversation with my patient. after(prenominal) I analyzed the situation, I could cogitate that I was be able to know the skills for effective communication with the patient such as approach the patient, asking questions, be an active listening, show my empathy and support the patient emotions (Walsh, 2005, p.34). in truth helping the adult was a good practice in delivering the nursing care among adults. My action plan for the clinical practice in the future, if there were patients that I need to help in feeding or other nursing procedure, I would prepare myself better to handle with the patients who would take in some difficulty in communication. This is because, as one of the health care worker, I want the best care for my patients. So in related to deliver the best care to my patients, I need to understand them very well.I have to communicate effectively as this is important to know what they need most during warded under my supervision as a nurse. According to my experience, I knew that communication was the fundamental part to develop a good relationship. woodwind instrument (2006, p.13) express that a communication is the key foundation of relationship. Therefore a good comm unication is essential to get know the patients individual health status (Walsh, 2005, p.30). Active listening could distinguish the instauration of barrier communication when interactions with the patients. This is because, active listening means listening without qualification judgment to listen the patients opinions or complaints which give me chances to be in the patients perspective(Arnold, 2007, p.201). On the other hand, it also crucial to keep off the barriers occurs in the communication with the patients. I could detect the language barriers by interviewing the patients about their health or asking them if they needed any help in their daily activities living.However, I would motivate myself for not interfere my communication with barriers such as using the unrestricted questions, not attending to non-verbal cues, being criticizing and judging, and interrupting (Funnell et al, 2005, p.453). Walsh (2005, p.31) too summary that qualification stereotyping and make assump tions about patients, perceptions and first impression of patients, lack awareness of communication skills are the main barriers to communications. I must not judge the patients by making my first impression and assumption about the patients but I have to make patients fee devalued as an individual. I should be surefooted to respect their fundamental values, beliefs, culture, and individual means of communication (Heath, 2000,p.27).I would be able to know on how to build rapport with the patients. There are eleven ways suggest by Crellin (1998, p.49) which are becomes visible, anticipate needs, be reliable, listening, stay in control, self-disclosure, care for each patient as an individual, use humour when appropriate, educate the patient, give the patient some control, and use gestures to show some supports. This ways could help and give me some guide soak ups to improve my communication skills with the patients. Another important thing to add on my action plan list is to know whi ch the disabilities of the patients have such as hearing disability, visual impairment and mental disability. erst I could know the disability that a patient has, I could well-prepared my method of communication effectively as Heath(2000, p28) mention that communicating with people who was having some hearing impairment, sight impairment and mental health needs required the particular skills and considerations.Nazarko (2004, p.9) suggest that do not repeat if the person could not understand but try to iterate and speak a little more slowly when communicating with the hearing difficulties people. Hearing problem commonly occurs among adults because of ageing process (Schofield,2002, p.21). To summarize for my action plan, I would start a communication with a good rapport to know what affects the patients ability to communicate well andto avoid barriers in effective communication in future.In conclusion of my reflective assignment, I mention the model that I chose, Gibbs (1988) Refl ective Cycle as my framework of my reflective. I state the reasons why I am choosing the model as well as some discussion on the important of doing reflection in nursing practice. I am able to discuss any stage in the Gibbs (1988) Reflective Cycle about my ability to develop my therapeutic relationship by using my interpersonal skills with one patient for this reflection. admonition on a Clinical SkillThe purpose of this assignment is to reflect upon a clinical skill that I undertook whilst on my second year community placement. I have chosen to use Gibbs (1988) model of reflection. In accordance with the Nursing and Midwifery Council (NMC), The Code of Professional Conduct (2008), confidentiality shall be maintained and all names changed to protect identity. The clinical skill I have chosen to reflect upon during this assignment is the monitoring of capillary inception glucose (CBG). I have chosen this skill as during my previous incisive placements as a student I was not permit ted to undertake them, and whilst in the community the Primary Care Trust (pct) allows it. Having yet to develop this skill I thought that by reflecting on carrying it out would help me to gain the knowledge and confidence needed to perform it in the future. According to Siviter (2004) reflection is about gaining confidence, identifying when you could have improved, learning from your mistakes and about your behaviour, viewing yourself as others do, self awareness and changing the future by learning from the past.DescriptionDuring a routine daily visit with my mentor Jane, a District Nurse, to Nisha, an elderly Asian lady who was Diabetic, Jane asked me whether I would like to take Nishas CBG. As I had only started doing CBGs during this placement I thought it would be a good learning prospect so I agreed to do it. Jane asked Nisha whether she minded(p) me doing her CBG and although she did not speak very much position she understood and consented for me to do it. I went into the kitchen and muteed my pass on. I returned to the living room whereNisha was and asked her whether her manpower were clean, to which she answered yes. I thus(prenominal) assessed that Nisha was sat down on a low sofa, and thought it best to kneel down and lay my equipment out on the coffee bean table so that they were all to hand. Once checking that the blood glucose monitor had been set and that the tribulation sacks were in date I opened a test parapraxis and placed it into the monitor.I then put on gloves and asked Nisha whether she was comfortable and throw and which finger she wanted me to use, she said yes and held up her right third finger so I got the single use lancet and pricked the side of Nishas finger, disposing of the lancet into the sharps box. The blood came immediately and I applied it to the test strip and waited for the result, in the meantime I held a clean cotton sheepskin ball to Nishas finger to stop the bleed. I discarded the test strip and my g loves and recorded the CBG.I then process my hands again. Once we had left Nishas piazza my mentor commented that I had make very well, but should have asked Nisha to wash her hands before commencing the CBG test.FeelingsWhen Jane, my mentor, first asked me if I wanted to do Nishas CBG I felt slightly nervous as I had only do a few previously and was aware that she would be observing me by means of the procedure which also gave me reassurance that if I were to do anything wrong she would be there to highlight it. Once Nisha had consented to me doing the CBG I felt pleased that she trusted me to carry out the process, which allayed my nerves. During the procedure I was aware that my mentor was watching me, which once again made me anxious, but she was encouraging me the whole time and all in all supportive. When I instantly got blood once pricking Nishas finger I felt a sense of relief that I had done it correctly. Once the whole process was over Nisha held my hand and smiled a nd in broken English said thank you, thank you, I was humbled by her response as I felt I was just doing my job. Overall I was satisfied with my performance and felt positive that I wouldnt be so nervous next time round.EvaluationOn the whole performing this clinical skill went really well, and having not had much practice at doing this particular skill I was glad to have had theopportunity to do it whilst under direct supervision from my mentor. I think that my communication with Nisha, even though she spoke little English was very good and that I had formed a strong therapeutic relationship with her. I feel that on reflection I should of asked Nisha to wash her hands before the procedure, and that my mentor should have ensured this, to guarantee that the reading was not contaminated.AnalysisI will start by looking at the skill and the cause supporting it. CBG monitoring is part of many diabetics daily routine. If a patients CBG goes up (hyperglycaemia) or down (hypoglycaemia) it can cause the patient to become unwell (Baillie, 2009). Dougherty & Lister (2008) state that in the short term CBG monitoring can prevent hypoglycaemia and ketoacidosis and in the farsighted term can considerably lower complications arising that could affect the patient both vascularly and neurally. Patients can control their condition through diet, oral hypoglycaemic agents, insulin therapy or a combination of the above, (Higgins, 2008). By asking Nisha whether she minded me performing the CBG my mentor had gained informed consent in accordance with the NMC (2008), who say that consent must be gained before any treatment is commenced. I washed my hands following the Ayliffe (1978) technique in order to prevent the spread of infection, Pratt et al (2007) state that hands must be decontaminated between each and every episode of patient care. I asked Nisha whether her hands were clean, as one of the main causes of inaccuracy of CBG readings are fingers that are contaminated with food stuffs (Alexander et al, 2000).I assessed that Nisha was sat comfortably on a low sofa, Jamieson et al (2007) says to ensure patient comfort and prevent any injury occurring should the patient feel faint during the procedure . I then knelt down and laid my equipment out on the table, as Baillie (2009) suggests that all equipment needed for a procedure should be within easy reach, and avoid any twisting or stooping which could cause me injury, in line with the PCT Moving and Handling Policy and Procedure (2006). I then checked the CBG monitor had been calibrated and that the test strips were in date, to prevent simulated positive/ negative readings (Hastings, 2009). I then put on my gloves and asked Nisha whether she was ready and which finger she wanted me to use, Jamieson (2007) saysthat gloves should be used to prevent the patient and nurse from any potential blood borne infection. The NMC (2008) state that you must allow patients to make decisions about their care, and also that patients should be treated individually and with dignity.Suhonen et al (2007) conclude that individualised patient care leads to positive patient outcomes, such as patient satisfaction, patient autonomy and patients perceptions on health related tonus of life. I used both verbal and non-verbal communication, which involved speaking slowly and clearly so that Nisha could understand what I was saying. I also used non-verbal communication through touch, eye contact, facial expressions and body language, (Funnell et al, 2009). I then using a single use lancet, in accordance with PCT (2005) policy on blood glucose monitoring, pricked the side of Nishas right third finger and disposed of the lancet into the sharps box. Baillie (2009) suggests that the third, fourth or fifth finger should be used as the thumb and index finger are important for touch, and to use the side as it is less painful.To prevent injury sharps and invigorated drugs must be placed in disposal boxes at the point of use, (Dougherty and Lister, 2008). I applied cotton wool to stop any bleeding and then disposed of the test strip and my gloves, washed my hands again using the Ayliffe (1978) technique and recorded my findings. Hastings (2009) recommends applying pressure briefly to the deflate site to prevent painful extravasation of blood into the subcutaneous tissues. The discussion section of Health (2007) state that to reduce the risk of cross infection any waste must be disposed of appropriately.Flores (2006) maintains that it is important to wash your hands after removing gloves as bacteria can contaminate them through small defects in the gloves or during removal. Records should be completed as soon as possible following an event (NMC, 2008), and as a student all documentation needs to be countersigned (Siviter, 2004). My mentor said that I should have asked Nisha to wash her hands, not if they were clean the rationale being the same as previously stated, (Alexander et al, 2000), and also Cowan (1997) also agreed that patients hands should be washed to ensure a non-contaminated result.ConclusionIn conclusion I now appreciate how in depth a simple CBG procedure actually is, when done correctly. I have looked further for evidence stating thatpatients hands should be washed before the CBG test is performed and realise that I should have asked Nisha to do so as the result could potentially have been wrong. On reflecting on undertaking this skill I have developed my learning of the need to carry out this procedure and the importance of it to a Diabetic. I have also found that following guidelines is vital to accurate results.Action schemeIn future when I carry out this procedure I will continue to practice as I have done as long as this is in line with local trust policy and supporting evidence. I will always ensure that the patient washes their hands before commencing the process, as this is what evidence suggests is good practice and also important for an accurate resu lt.