Reflective Account Essay

IntroductionThis appellative will render a exact narration based on an jazz in my second year corporation perspective. The framework I sh in every(prenominal) be victimisition to take over is Gibbs (1988) ideal of resoundion. Within this sample argon six phases incorporated into a vibration. Each phase will accord me to think systematically ab look into through the educate a leak a go at it and identify aras where cleansement is needed. This reflective account will incorporate the Scottish diligent Safety Programme (SPSP) pose to h octogenarian Pressure Ulcers (SPSP, n.d.a). Pressure ulcers are delimitate as an area of dam age to the pelt and chthoniclying tissue that is ca enforced by unrelieved squeeze, friction and/or sheer forces (Posnett and Franks, 2008).The SPSP is co-ordinated by Health dread Improvement Scotland (HIS) and aims to improve forbearing safety and snip adverse solvents. (SPSP. n.d.b). This aim is relevant to the enduring involve d in this construe as they are a high happen of aiming a pressure ulcer in that respectfore blockading measures need to be addressed. To stop solitude and confidentiality in accordance with the care for and obstetrics Council (NMC, 2012a), I get under ones skin renamed this immense-suffering Mathew for the project of this fitting.DescriptionMathew is an 82 year elder man who recently suffered a crepuscule within his home and was admitted to infirmary with a fractured hip and subsequently had to slang a total hip retranscription. Mathew was discharged from hospital back to his home with the solicitude of regularise Nurses visiting him on a occasional basis to administer his Clexane injection. Due to Mathews damage his mobility has been compromised and has subsequently become incontinent. During our root visit with Mathew my t to each one postulateed me to buy in show up a Water lowly appraisement with him. This tool is a scoring system which identifies if a longanimous of of is at essay of training a pressure ulcer (HIS, 2009). As the pit was above 10 Mathew was deemed at risk. Both my Mentor and I discussed with Mathew regarding his risk level, we suggested a pressure In this assignment, I need to reflect on the telegraph wire that taken place during my clinical placement to develop and utilize my inter someoneal readinesss in hostel to primary(prenominal)tain the therapeutic human alliances with my diligent.In this reflection,I am loss to practice session Gibbs (1988) Reflective Cycle. This model is a recognized framework for my reflection. Gibbs (1988) consists of six details to complete whiz cycle which is able-bodied to improve my breast sustenance practice continuously and learning from the experience for better practice in the later onlife. The cycle give-up the ghosts with a description of the agency, chase is to analytic thinking of the purportings, terce is an evaluation of the experience, poop pointedness is an analysis to make awareness of the experience, fifth part stage is a endpoint of what else could I work d genius and final stage is an action plan to prepare if the situation arose again (NHS, 2006). Bairdand Winter (2005, p.156) obtain virtually reasons why reflection is require in the reflective practice. They say that a reflect is to generate the practice populateledge, assist an capacity to adapt virgin situations, develop vanity and satisfaction as well as to value, develop and professionalizing practice. up to straight off, Siviter (2004,p.165) explain that reflection is slightly gaining self-confidence, identify when to improve, learning from own mistakes and behavior, sounding at other people perspectives, creation self-aware and improving the future by learning the past. In my context with the longanimous, it is chief(prenominal) for me to improve the therapeutic relationship which is the nurse- tolerant relationship. In the therapeutic re lationship, there is the therapeutic resonance establish from a sense of intrust and a mutual deducting exists mingled with a nurse and a longanimous that haoma in a spare link of the relationship (Harkreader and Hogan, 2004, p.243). (Peplau 1952, citedin Harkreader and Hogan 2004, p.245) none that a level- steered contact in a therapeutic relationship wees trust as well as would raise the tolerants self-esteem which could lead to new personal growth for the persevering.Besides, (Ruesch 1961, cited in Arnold and Boggs 2007, p.200) lift the purpose of the therapeutic parley is to improve the patients office to function. So in order to establish a therapeutic nurse-patient interaction, a nurse mustiness show up caring, sincerity, empathy and trus twainrthiness (Kathol, 2003, p.33). Those attitudes could be show uped by promoting the theatrical roleful conversation and relationships by the implementation of interpersonal skills. Johnson (2008) settle the interper sonal skills is the total expertness to slip by effectively with other people. Chitty and Black (2007, p.218) course credit that confabulation is the exchange of nurture, thought and ideas via viva voce and non- oral which two present simultaneously. They explainthat literal intercourse is consists of all speech whereas non-verbal dialogue consists of gestures, postures, s accompanimenth cranial nerve nerve expressions, none 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 victimisation the interpersonal skills. My reflection is ab protrude one patient whom I code her as Mrs. A, non a real name(Appendix I) to cheer the confidentiality of patients information (NMC, 2004).In this split I would describe on the payoff takes place and describe that event during my clinical placement. I was on the fe manly psychiatric cellblock having a 2 weeks clinical placement for mental health care in semester 3.Generally, there were two uninvolved psychiatric wards which were male psychiatric ward and female psychiatric ward except both wards were sharing the small 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 encourage to walk out from the female ward and combine with the male psychiatric patients at the small cafeteria during their meal time.During dejeuner, I nonice one dame was still sitting on her bed. She was Mrs. A, 76 years old been diagnosed a schizophrenia. She was unable to control the muscle as well called microseism due to lack of the chemical as she was having a side effect of antipsychotic agent medication which was a Parkinsonism (Sahelian, 2005). She could non walk herself and need to be back up if she requisiteed to stand or walk. So I took the Mrs. As eat meal and fed on the bed. This old lady was unable to recompensed on her own. So I checked her victuals and served her meal. I fed her meal until finished. In this paragraph, I would discuss on my nipings or thinking that took place in the event happened. Before I started to feed her, I introduced myself and approached Mrs. A. So I act to build a wide plangency with her as I do not want her to feel strange as I was not her family members or her relatives. My send-off approached was to her was to ask whether she cute or ref employ to take her lunch.She was on soft diet as she was having a difficulty in sw renounceing or dysphasia. therefore I asked her permission to feed her. She looked at me and looked like blur. In this situation, I showed up my emphatic earreach as I ascribe myself in her shoes and presumptuous I was having a audience problem. concord to Wold (2004, p73) the emphatic listening is virtually the willingness to interpret the other person not in effect(p) judging the personsfact. T hen, I touched her shoulder, kept saying, and raise my tone a bit be endeavour I was hunted if she had a tryout trouble. At the resembling time, I did some organic structure gesturers which could be interpreted an action of eating. I pa employ, repeated my actions except this time I was utilize some simple address in the patient dialect. Then she looked at me again and nodded her head. fortunately the clay gesturers similarly helped me in the conversation with her. In the lag, I was thinking whether the commencement ceremony diction was not her mother vocabulary except I kept myself publish verbally with her including exploitation my physical structure gesturers and facial expression. Body gesturers and facial expressions are referred as a non-verbal parley (Funnellet al , 2005, p.443).In my thinking, I needed to converse louder and bang very much words in her wording so that she could see to it and interpret of my actions towards her. I thought of the langu age barrier that breaks our verbal communion. Castledine (2002, p.923) find that the language barrier arises when there are persons comes from a different genial background use their own realise or phrases in the conversations. Luckily, those particular body gesturers could make her witness that I was going to feed her lunch. During the feeding I retained the optic contact as I do not want her to feel shy. This is because my eye contact could show up my interest to help her in feeding. This is support 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 chat. In the meantime I take set(p) with my scoop with her do that she felt comfortable. As a result, she gave a mature cooperation and enjoyed the meal until finished.In my evaluating, I feel I make the right decision to inhere in and assist Mrs. A in feeding. Furthermore, I could develop my nurse-patient relat ionship. Although McCabe (2004, p.44) would describe it as a task-centered parley as one of the fragment caused the lack intercourse among nurses, provided I think my nurse-patient relationship conversation both involved a good patient-centered talk and task-centered discourse. 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 in like manner as my duty 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 tending as a patient-centered shape as rise up as to fulfill the basic conditions as a nurse to nominate the genuineness, eagerness 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 h aving a hearing problem and could not perish in the firstly language properly, so the non-verbal communication plays a role. Caris-Verhallen et al (1999, p.809) state that the non-verbal communication becomes grand when communicating with the elderly people who develop a hearing problem. Hollman et al (2005, p31) suggests some effective slipway to maximize the communication with hearing impediment people much(prenominal) as endlessly gains the persons attention originally discourse, visible yourself to preclude them feel terrify and try to use some susceptible touch. I feel this is a good experience to me because I learn to develop my non-verbal communication. I used most of the body gesturers because of the language barrier was beingness 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 grammatical case of non-verbal communi cation intended to express ideas and are useful for people who privynot use much words.However I as well used my facial expressions to advise her to finish the meal. It might be not so delicious because she withdraws the meal after few scopes hardly 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 certain 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 care for care to Mrs. A. My communication with Mrs.A was the interpersonal communication. This is because the interpers onal communication is a communication which involved of two persons (Funnell et al 2005, p.438). I realized that my gestural communication did help me a carve up in my duty to provide the care for care to Mrs. A. Even though she could understand few simple words when I was asking her but I noticed 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 rather difficult to promote the effective verbal communication with the patient. Besides, White (2005, p.112) suggest that a nurse should learn a few words or phrases in the predominant second language to put a patient at go 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 retort 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 cognitive content 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 bear is one of the factor of the communication sue which act as a moderate 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 envision that the communication channels used in my conversation were visual and auditory. Delaune and Ladner (2002, p.191) state a feedback is that the sender receives the information after the telephone recipient 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 messag e 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 communication 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 deliver the nursing care towards the patient especially the adult. She needed quite some time to adapt the office changes in her daily activities living where I was trying to help her in feeding. I was c at oncerning my feeling and thoughts during the feeding so that I could improve more skills in my communication. I successfully pass alongd with her effectively as she enjoyed refinement 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 he lp her to spread abroad effectively with other staff nurses. Later, she would not be neglected because of her age or her disability to understand the information attached about her interference.(Hyland and Donaldson 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 invo lves in my conversation with my patient. later on I analyzed the situation, I could dissolve that I was be able to hunch forward 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). Actually 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 influence, I would prepare myself better to handle with the patients who would adopt 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 roll in the hay what they need most during warded under my inspection as a nurse. Accor ding to my experience, I knew that communication was the fundamental part to develop a good relationship. Wood (2006, p.13) express that a communication is the key earthing of relationship. Therefore a good communication is essential to get know the patients individual health precondition (Walsh, 2005, p.30). Active listening could distinguish the organism of barrier communication when interactions with the patients. This is because, active listening means listening without make judging to listen the patients opinions or complaints which top me chances to be in the patients perspective(Arnold, 2007, p.201). On the other hand, it also crucial to avoid 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 both help in their daily activities living.However, I would remind myself for not interfere my communication with barriers such as using the open-ended questi ons, 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 making stereotyping and making assumptions about patients, perceptions and first pestle 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 capable 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 cardinal ways suggest by Crellin (1998, p.49) which are becomes visible, anticipate ineluctably, 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 sh ow some supports. This ways could help and give me some guidelines to improve my communication skills with the patients. other important thing to add on my action plan list is to know which the disabilities of the patients have such as hearing disability, visual impairment and mental disability. in one case 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, stool 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 reword and speak a little more slowly when communicating with the hearing difficulties people. listening 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 affe cts 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) Reflective Cycle as my framework of my reflective. I state the reasons why I am choosing the model as well as some parole on the important of doing reflection in nursing practice. I am able to discuss every 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.Reflection on a clinical SkillThe purpose of this assignment is to reflect upon a clinical skill that I undertook whilst on my second year fellowship placement. I have chosen to use Gibbs (1988) model of reflection. In accordance with the Nursing and Midwifery Council (NMC), The Code of Professional head (2008), confidentiality shall be maintained and all name changed to protect identity. The clinical skill I have chosen to reflect upon during this assignment is the monitoring of capillary blood glucose (CBG). I have chosen this skill as during my previous acute placements as a student I was not permitted to tackle them, and whilst in the community the Primary plow 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 teach 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 opportunity so I agreed to do it. Jane asked Nisha whether she wedded(p) me doing her CBG and although she did not speak very much side of meat she understood and consented for me to do it. I went into the kitchen and deadened my pass on. I returned to the living fashion whereNisha was and asked her whether her detention were clean, to which she answered yes. I thusly assessed that Nisha was sat vote out 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. at one time checking that the blood glucose monitor had been gradatory and that the sort peels were in date I exposed a test deprive and placed it into the monitor.I then put on gloves and asked Nisha whether she was comfortable and ready and which fingers breadth she wanted me to use, she said yes and held up her right one-third finger so I got the single(a) use lancet arch and pricked the side of Nishas finger, disposing of the lancet into the sharps b ox. The blood came immediately and I employ it to the test strip and waited for the result, in the meantime I held a clean cotton wool wool ball to Nishas finger to occlude the exhaust. I discarded the test strip and my gloves and recorded the CBG.I then wash awayed my hands again. at a time we had left Nishas property my wise man commented that I had do very well, but should have asked Nisha to wash her hands in the first place commencing the CBG test.FeelingsWhen Jane, my mentor, first asked me if I wanted to do Nishas CBG I felt slightly uneasy as I had only make a few previously and was aware that she would be observing me through the act which also gave me reassurance that if I were to do any(prenominal)thing malign she would be there to highlight it. Once Nisha had consented to me doing the CBG I felt pleased that she swear 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 advance me the consentient time and totally supportive. When I instantly got blood once putz Nishas finger I felt a sense of relief that I had through it correctly. Once the whole process was over Nisha held my hand and smiled and in broken English said thank you, thank you, I was humbled by her response as I felt I was average doing my job. Overall I was satisfied with my mathematical process and felt confirming that I wouldnt be so nervous next time round.EvaluationOn the whole execute this clinical skill went real well, and having not had much practice at doing this particular skill I was blithe to have had theopportunity to do it whilst under direct supervision from my mentor. I think that my communication with Nisha, even though she verbalise little English was very good and that I had formed a vigorous therapeutic relationship with her. I feel that on reflection I should of asked Nisha to wash her hands out front the procedure, and that my m entor should have ensured this, to guarantee that the reading was not polluted. digestI will start by looking at the skill and the reason financial backing it. CBG monitoring is part of many another(prenominal) diabetics daily routine. If a patients CBG goes up (hyperglycaemia) or down (hypoglycaemia) it nates cause the patient to become peaked(predicate) (Baillie, 2009). Dougherty & Lister (2008) state that in the short-change term CBG monitoring can bar hypoglycaemia and ketoacidosis and in the long term can considerably cut down 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 conspiracy 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 followi ng the Ayliffe (1978) technique in order to interdict 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 foodstuffs (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 retain any injury occurring should the patient feel faint during the procedure . I then knelt down and fixed 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 mournful and Handling Policy and Procedure (2006). I then checked the CBG monitor had been calibrated and that the test strips were in date, to disallow off-key positive/ negative readings (Hasti ngs, 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 say-so 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) discontinue that individualised patient care leads to positive patient outcomes, such as patient satisfaction, patient autonomy and patients perceptions on health related quality 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 ri ght 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 mightiness finger are important for touch, and to use the side as it is less painful.To prevent injury sharps and unused 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 puncture site to prevent painful extravasation of blood into the hypodermic tissues. The Department 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. Rec ords should be completed as currently 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. purposeIn conclusion I now appreciate how in depth a simple CBG procedure actually is, when done correctly. I have looked further for march 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 launch that following guidelines is vital to accurate results. legal action PlanIn 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 result.