Reflection on theory and knowledge in nursing

Reflection on theory and friendship in nursingThe aim of this report is look at a critical incident that occurred in implement and relates this to the theory and familiarity regarding communication and interpersonal skills, so as to demonstrate an understanding of my views on the graphics and science of materialization and the rationalises surrounding thoughtful practice that is to say, what skills were and were not used at the time of the incident. Confidentiality leave behind be maintained as required by the nursing Midwifery Council Code (NMC, 2008). There is a discussion appraising the concept of reflection both generally, and in my particular area of practice of imperative maintenance. Reflection is part of reflective practice and is a skill that is developed. It roll in the hay be seen as a way of adjusting to life as a qualified wellnesscare professional and enhancing the development of a professional identity (Atwal Jones, 2009).Reflection is defined as a opera tion of reviewing an experience which involves description, analytic thought and evaluation to upgrade learning in practice (Rolfe et al 2001).This is halted by (Fleming, 2006), who described it as a process of reasoned thought. It enables the practitioner to critically assess ego and their approach to practice.Reflective practice is advocated in healthcare as a learning process that encourages self-evaluation with subsequent professional development architectural planning (Zuzelo, 2009). Reflective practice has been identified as one of the mark ways in which we can learn from our experiences. Reflective practice can mean taking our experiences as an initial point for our learning and developing practice (Jasper, 2003). Many literatures pee-pee been written in the past that suggest the use of reflective assignments and journaling as tools to alter reflection and thinking skills in healthcare (Chapman et al, 2008). Reflective journals are an ideal way to be actively twisti ng in learning (Millinkovic Field, 2005) and can be utilize to allow practitioners to record subjects and document their thoughts and actions on daily dapples, and how this may affect their early practice (Williams Wessel, 2004).MODELSIn order to provide a framework for methods, practices and processes for mental synthesis knowledge from practice there are several types of reflection available. All can facilitate to direct individual reflection. Some may be in particular useful for superficial problem solving, and other better when a deeper reflective process is required. Reflective models however are not meant to be used as a rigid set of questions to be answered and to give some structure and encourage making a record of the activity.Johns (2004) reflects on unc all overing the knowledge behind the incident and the actions of others present. It is a just tool for thinking, exploring ideas, clarifying opinions and supports learning.Kolbs Learning Cycle (1984) is a cycle that reflects a process individuals, teams and organisations attend to and understands their experiences and subsequently, modifies their behaviour.Schn (1987), however, identifies dickens types of reflection that can be applied in healthcare, Reflection-in-action and Reflection-on-action. Reflection-in-action can also be described as thinking whilst doing. Reflection-on-action involves revisiting experiences and further analysing them to improve skills and enhance to prospective practice. Atkins and Murphys model of reflection (1994) government issue this idea one step further and suggest that for reflection to make a real difference to practice we add up this with a commitment to action as a result.Terry Bortons (1970) 3 stem questionsWhat?,So What?andNow What?were developed by John Driscoll in 1994, 2000 and 2007. Driscoll matched the 3 questions to the stages of anexperiential learning cycle, and added trigger questions that can be used to complete the cycle.Gibbs (1988) r eflective cycle is fairly straightforward and encourages a clear description of the situation, analysis of sprightlinesss, evaluation of the experience, analysis to make sense of the experience, conclusion where other options are considered and reflection upon experience to examine what you would do if the situation arose again.CHOSEN MODELThe reflective model that I run through chosen to use is Gibbs Reflective Cycle (1988) as a framework, be take a leak it instructiones on different aspects of an experience and allows the learner to revisit the event fully. Gibbs (1988) will help me to explore the experience further, using a staged framework as guidance ad I feel that this is a truthful model, which is well structured and easy to use at this early stage in my course.By contemplating it thus, I am able to appreciate it and guided to where future development work is required.Before the critical incident is examined it is important to look at what a critical incident is and why i t is important to nursing practice. Girot (1997), cited in Maslin-Prothero, (1997) states that critical incidents are a means of exploring a certain situation in practice and recognising what has been learned from the situation. Benner (1984, cited by Kacperek, 1997) argues that nurses cannot increase or develop their knowledge to its full potential unless they examine their own practice.Context of incidentIn the scenario the patients name will be given as Xst. The consequences of my actions for the client will be explained and how they might have been improved, including what I learned from the experience. My feelings about the clinical skills used to manage the clients care will be established and my new understanding of the situation especially in relation to evidence based practice will be considered. I will finally reflect on what actions I will take in order to ensure my continued professional development and learning. DescriptionMiss Xst is 55 year old woman who has a 10 year old daughter. She suffers from psychiatric problems, lack of motivation and has difficulties in maintaining her personal hygiene and the cleanliness of her flat. She was one of my mentors clients to whom I had been assigned to coordinate and oversee her care. psychological health Nurses owe their patients a duty of care and are expected to offer a high standard of care based on current crush practise, (NMC 2008). Miss Xst had been prescribed Risperidone Consta 37.5mg fortnightly, which is a moderate medication. Risperidone belongs to a group of medicines called antipsychotic, which are usually used to help treat people with schizophrenia and similar trail such as psychosis. Although her teach is acute, it is not extreme and the reason for this medication is to help Miss Xst to stabilise her thought so she is able to support herself in the community (Healey, 2006). Miss Xst did not like attending depot clinic and she missed three consecutive appointments. My mentor decided after the third non-attendance to raise the issue in the handover undertakeing where it was decided to see Miss Xst in the morning but when we arrived she was not there. We left a note for her to call the office. We did not mind from her and a further home visit was carried out to arrange for her next depot clinic appointment. I called a meeting of the multi-disciplinary team (MDT) who agreed that there would be a problem if the next injections were missed. The social worker who was part of the team said that she will arrange for a community support worker to help clean Miss Xsts flat on a weekly basis (Adams 2008).We waited for about an hour for Miss Xst to attend the clinic for her depot injection but she failed to attend. I then informed the Community Psychiatry Nurse (CPN) that Miss Xst had expressed negative feelings about her medication and thought she did not need them she had claimed she was al scany feeling well and therefore wanted the medications to be discontinued. At a sub sequent meeting with the patient, she agreed a joint visit with the CPN and myself to re-assess her condition and consider if it was necessity to refer her case to the consultant (Barker, 2003).I was given the opportunity to carry out the initial assessment, which showed that her behaviour was very unpredictable and very for come outful. Her inability to take her medication and to manage her personal hygiene clearly demonstrated that she was not well. The assessment tool I used was the Mental State Examination which helps fructify the level of her insight into her illness and indeed I effectuate out that she was in denial (Barker, 2004).I talked to Miss Xst about her non-concordance with her medication, but she persisted in reflection she was well. I reminded her that continuous use of the medication would benefit her mental health and protect her against relapse. We agreed that she could discuss this with the doctor on her next outpatient appointment, with the option of reviewi ng or reducing her medication. I stressed the importance of her communicating any side effects or reservations she may have about the medication to doctor. She appeared to understand this and following(a) the discussion, she finally complied with her depot injection.Even though the NMC (2008) maintains that nurses have a responsibility to empower patient in their care and to trace and minimise risk to patient. The ruler of beneficence (to do well) must be balanced against no maleficence (doing no harm) (Beauchamp and Childress, 2001). All these transactions were recorded in Miss Xsts care plan file and in computer. Good record keeping is an integral part of nursing and midwifery practice, and is essential to the provision of safe and effective care. It is not an ex gratia extra to be fitted in if circumstances allow NMC (2009). The consequences of my actions for the patient and her daughter were that she attended to her daughters needs and to her personal hygiene, and made even fortnightly visits to the clinic. Her mental condition was improved, she was allowed to continue on her moderate medication and she did not have to be readmitted in the hospital.FeelingDuring the handover, I was nervous as I felt awkward about giving feedback to the whole team. I was worried about making mistakes during my handover that could lead to inappropriate care being given to Miss Xst or could cause her readmission to hospital. As a student nurse I felt I lacked the necessary experience to be passing information to a group of drug-addicted lag members. However, I dealt with the situation with outward calm and in a professional manner. I was very pleased that my mentor was available during the handover to offer me support and this increased my confidence.EvaluationWhat was good about the experience was that I was able to carry out the initial assessment and identify what caused Miss Xst failure to keep abreast with the treatment regime. From my assessment I documented th e outcome and related what had happened to the MDT with minimal assistance. Accurate documentation of patients care and treatment should communicate to other members of the team in order to provide continuity of care (NMC, 2008). The experience has improved my communication skills immensely, I felt supported throughout the handover by my mentor who was constantly involved when I missed out any information. Thomas et al, (1997) explains that supervision is an important development tool for all learners. The team were very supportive throughout the process as they took my information without doubt.What was not good about the experience was the fact that my mentor had not informed me that I was going to handover the information as a result I had not mentally prepared myself for it. I also felt that I needed more time to observe other professionals in the team carrying out their handovers before I attempted to carry out mine. During the original MDT meeting, I felt that we did not provi de enough time to freely interact with Miss Xst to identify other psychosocial needs that could impact on her health. However, in any event, she was unable to fully engage because of her mental state. Turley (2000) suggests that nursing staff should include their interaction with the patient when recording assessment details, which can be used to provide evidence for future planning and delivery of care. Dougherty and Lister (2004) have suggested that healthcare professionals should use listening as part of assessing patient problems, needs and resources. AnalysisThe literature regarding communication and interpersonal skills is vast and extensive. Upon reading a microscopic amount of the vast literature available, the student was able to analyse the incident, and look at how badly this situation was handled. I realised communication is the main key in the nursing profession as suggested by Long (1999) who states that interpersonal skills are a form of tool that is necessary for ef fective communication. 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 perception at the time, it is clear that this is an area I need to build on for the future. 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 outgo 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.Through effective communication I was able to convince Miss Xst of the need to take her medication. I was able to pass on the information to the MDT for continuity of care. Roger et al (2003) concluded that communication is an on-going process but can be a difficult process when dealing with mental health problems. During the handover I was pleased that the MDT members were supportive and interested in what I was formulation and they asked questions.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 nobody wrong. My mentor explained that a patient with Parkinsons can often behave like this as they develop dementia, which Noble (2007) also confirms. Since the incident I have read about Parkinsons and am now aware that the patients expressionless face Netdoctor (2008), also made her comments appear more confusing and aggressive.ConclusionIn conclusion, I have learnt that through effective communication, any problem can be solved regardless of the environment, circumstances or its complexity. Therefore, nurses must ensure they are effective communicators. I have identified the weaknesses that should be turned to strengths. I am now working on strengthening my assertiveness , confidence and communication skills. Participating in the care of Miss Xst, I have realised that a good background information and feedback about mental health problems before providing care to a clients can assist in accurate diagnosis and progress monitoring. A good relationship between client and staff nurse is therapeutic and help in building trust. This can be achieved by a free communication that allows the client to express their feelings and concern without the fear of intimidation. From the experience, I feel the knowledge I have acquired will aid me in future while in practice should such situation arise again.ACTION PLAN FOR MY LEARNING call forSo 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. 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.Learning NeedPlanned action to meet this learning needTarget time to meet the learning need.To improve my knowledge about patients illnesses and the risks of relapse associated with not takingMedication.Read books about different illnesses and causes of relapseEnd of third yearTo identify and have good background information and feedback about patients mental health problems before providing care to themTo read my patients notes.On- goingTo ensure a good ringing exist between my patient and I, in order to build up a therapeutic relationship with them and to gain their trust.I will have regu lar meeting with my clientOn-goingEffective communication with the patients and other members of the multidisciplinary teamA locating time to talk to patients and their relatives participating in the ward round.On-going skills to develop throughout the training.Being preparedTalking with senior members of staffOn-goingCONCLUSIONI 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 placement. At the time of the incident I felt very inadequateIt 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. 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.REFERENCESAdams, L. (2008). Mental Health Nurses can Play a Role in Physical Health. Mental Health Today. October 2008 pp27Barker, P. (2004). Assessment in Psychiatric and Mental Health Nursing. Cheltenham, Nelson ThornesBarker, P. Ed (2003). 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