Nursing : An Example of a Clinical Incident
Nursing : An Example of a Clinical Incident
In this assignment the author shall first of all choose a clinical incident when they were involved in a health program during a clinical placement. The author shall give a clear rational for choosing this particular intervention and will write a brief summary of the background of they client or clients that were involved in the health program including the care setting.
The author will then choose a Model of health and give a rationale for choosing this model and discuss its application in relation to the chosen intervention and health need.
The author must then use a reflective framework to evaluate the health nursing intervention also giving a rationale for choosing this particular framework for the chosen intervention.
To complete this assignment the author has chosen to use an intervention that was carried out during their community placement. The reason that this intervention was chosen was because it is one which they enjoyed doing and one that sticks in their mind. The author also feels that this was a very valuable experience for them during their training and therefore feels it is an appropriate intervention to reflect on. The author also feels that this is one time that an intervention they carried out truly had an effect on more than one individual's health. I have chosen to complete this assignment in the terms of the first person, as it is a reflective piece of work.
The health visitor and I chose to complete a teaching session on weaning because we asked the parents at a previous mother and baby club what they felt they did not have enough knowledge about. After discussion it was agreed that they did not have enough knowledge about the weaning process in all aspects and so this is how we decided on the topic. We agreed amongst ourselves that the session would best be done in a group instead of individually as the mothers could share their own experiences with each other and offer each other some valuable advice. Group sessions also meant that less time would be consumed than carrying it out the session with each mother separately, and time is very valuable to health professionals. The reason that we decided to carry the intervention out with mother and baby club attendees was that they were very enthusiastic mothers who truly wanted their child to have the best start in life.
The area in which the health visitor's caseloads were based was a very deprived area in every sense of the word. The housing conditions of the area were extremely bad; most of them were damp and cold with insufficient heating for a family especially with a young infant. Job prospects for the families in the area were also very bad; most jobs were taken by people living in surrounding areas because people in the area had no or very little qualifications. This meant that many families were living of benefits and claims, and so they therefore found it hard to be able to afford a baby. Many of the parents did not have a partner to give them assistance financially or physically and this was not only mothers, there were many single parent families where the father was the single parent. There were also not very many nursery places for those mothers or fathers who could work and so there was also a lack of childcare.
The mothers who attended the mother and baby club did not fit into all of these categories but many of them fitted into at least one of them. They had come to mother and baby club because they were lonely having just a baby to look after and felt they'd meet new people this way and they wanted to give their child the best start in life that they possibly could.
Using a model of health promotion can be helpful because it encourages u to think theoretically, and come up with new strategies and ways of working. It can help you to prioritize and locate more or less desirable types of intervention.
When completing this health promotion session Tannahills model of health promotion was used. This model was used because both the health visitor and myself felt this model was easiest to comprehend and apply. This is also a health promotion model that was mentioned on numerous occasions during lectures and so this is the model that I felt I was most familiar with. There is also a lot of literature to support our choice of health promotion model and so we would be able to justify and support any decisions or choices we made together as a team or individually.
Tannahill(1985b) developed a model which identifies three distinct elements that make up the field of contemporary health promotion activity. The three are health prevention, health protection and health education the element of health education is then divided into three further headings which are primary health education, secondary health education and tertiary health education.
Tannahill (1996) defines health education as communication to enhance well being and prevent ill health through influencing knowledge and attitudes
Health prevention also known as illness prevention is defined as having an aim to prevent ill health (Ewles and Simmnett 1995)
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Tannahill(1985b) developed a model which identifies three distinct elements that make up the field of contemporary health promotion activity. The three are health prevention, health protection and health education the element of health education is then divided into three further headings which are primary health education, secondary health education and tertiary health education.
Tannahill (1996) defines health education as communication to enhance well being and prevent ill health through influencing knowledge and attitudes
Health prevention also known as illness prevention is defined as having an aim to prevent ill health (Ewles and Simmnett 1995)
Health Protection is defined by Tannahill (1985b) Safeguarding population health through legislative fiscal or social measures
I used Tannahills model of health promotion (1996) to carry out the health intervention however two spheres of his health promotion model over lapped although Tannahill does state that this can sometimes be the case. The two spheres that overlapped were health protection and health education. This occurred because we were focusing on improving the mothers social and life skills as well offering them education. This model was used applied the intervention because the session consisted of primary health education and health prevention. Health education was is the sphere we applied because the mothers were being educated on how to wean their child using healthy foods and the right methods that could be used to wean a child successfully. The mothers were also being educated on why weaning was important to give their child a healthy start in life. This meant that we were educating the mothers so that they could make an informed choice about their infant's health. When using health education I used primary and secondary health education. We were therefore giving the mothers appropriate information for them to make an informed choice on their child's life
Health prevention was utilized also because we were ensuring that the infants were not weaned before they were physically ready or too late. We were also preventing the children from developing any problems due to being given the wrong foods. In the session we were carrying out primary prevention as we were 'averting the onset of a disease or condition' (Pike,Forster1995)
Tannahil also states that the nurses health education role arises as part of the usual process of nurse-patient interaction: the nurse should read cues which indicate a patients readiness to learn and responds to these by seizing or creating the opportunity for teaching. Before doing this they will identify gaps in the clients knowledge and will sense how much information they want. My self and the health visitor did this by discussing with the mothers what knowledge they already had and what exactly they wanted to know.
The session was to be carried out in the health center in whichever room was possible to book for that day and time. It was decided that the health visitor was the best place to carryout the session because all the mothers knew where it was and so there would be no problems with the mothers getting lost. It also meant that the health visitor and myself would be close to base when we finished so that we could take on any other caseloads we needed to that afternoon on time.
To carry out the session the chairs in the room were arranged in a circle so that the health visitor, the mothers and myself were all part of the same group. We did this because if the chairs were laid out in rows side by side it would be too much like a classroom and we wanted to make this as informal as possible. We also ensured that the room was not going to be too hot or cold and also made sure that the room would be away from any noise pollution.
To ensure a health promotion session is carried out successfully the surrounding environment should be taken into account (Williams1996)
REFLECTION
When carrying out an intervention it is very important to reflect on that intervention once it has been completed. This is because reflective practice presents an opportunity for nurses to revisit existing practice and act as a catalyst for change. (Oberman 1990)
As the reflective thought process develops, not only the personal but also the institutional and social context and their various historical, political, social cultural and ethical influences can be explored.(corr 1987, Driscol 1994)
To complete this assignment I have chosen to use Johns model of Reflection (1995)
I decided after looking at many different models of reflection that Johns model would be the best one to use. I came to this decision because there was a lot of literature to support this model of reflection and it is also the model that was recommended during lectures. I also felt that johns model was the easiest to comprehend and apply to my work. Johns model is also the model with which I am most familiar and comfortable
Johns (1995) states that reflection makes caring visible, enabling it to be acknowledged, affirmed and valued.
Johns model (1995) consists of six structured points which are
) Phenomenon- Describing the experience
2) Aesthetics - What was I trying to achieve, why did I respond as I did, the
Consequences of my actions and how the client felt and how I know this
3) Personal- how did I feel during the situation and what factors influenced me
4) Ethics-how my actions matched my beliefs and what made me act in incongruent ways
5) Emperics-What knowledge did or should have informed me.
6) Reflexivity- how dos this experience connect with previous ones, could I handle the experience better in different situations, what consequences would be for alternative actions, how do I now feel about the experience, can I now support others and has this experience changed my way of knowing.
PHENONEMON
First of all the health visitor put her acetate sheets onto the overhead and defined what weaning actually is and then explained to the mothers why weaning is very important for babies. We decided acetate sheets were best as this meant that the parents could read the writing as they listen and it would give what the health visitor was saying more clarity. Once it had been explain what weaning is and why it is important I then talked about when a child would be ready for weaning and what the recommendations for weaning actually are. I supplied this information on an over head projector so that I would have some guidelines to do my section by. I got this information from my own research and what the health visitor had taught me.
It was also explained to the parents why it was important that babies were not weaned to late or too early in regards to the development of their digestive system.
After this part of the session it was explained to the mothers how their children should be weaned. First of all the health visitor talked about the foods that were best to wean your child with. The foods that she suggested were Non wheat cereals, fruit vegetable and potatoes ( DOH 1994). The health visitor explained how the foods were best to be prepared to suit the baby's level of weaning and age. She also explained to the parents that it is important not to add any salt or sugar or any spices to the babies food and that if they wanted it on their own food to cook it separately (DOH 1994 ). The health visitor then using the table laid out with foods we had obtained earlier demonstrated how the food should be prepared.. The health visitor also explained to the parents where the best places are to obtain the foods for weaning are. She was aware that the parents were on low income and so previously the health visitor and myself visited a few local supermarkets to see which were best to get the cheapest food. In the end we recommended that the best place to get fruit and vegetables from was the local market. We supplied the parents with a list of different places that would be ideal to get the food from, as it is not ideal to suggest one place. The health visitor also explained to the parents that although she had used a blender to puree the food, this could just as easily be done using a fork or potato masher. We still however supplied the parents with information about where a blender could be obtained if prepared.
After this we then showed the parents a video that basically summarized what we had told them. Although it was a very short video that only lasted for about fifteen or twenty minutes the health visitor and myself felt it would be very helpful. We then supplied the parents with some leaflets about weaning that we made our selves and some were from the department of health for future reference.
We then told the parents that we were open to any questions they would like to be answered and we would try to answer them as best we could. Only a few questions were asked and most of these were just clearing up confusion etc that had occurred during the session.
AESTHETICS
From completing this assignment I was trying to help the parents of infants to obtain all the knowledge possible to assist them in making an informed choice about weaning their child. In doing this I was aiming to supply them with information explaining to them why weaning a child correctly is important if you intend on giving them a healthy start to life. I was also hoping to improve my communication skills when carrying out the session with both parents and members of the health care team and to improve my teaching skills to prepare myself for qualifying and becoming a staff nurse. I responded as I did because I felt this was the best possible way for me to achieve these aims effectively. The consequences for my actions meant that I supplied the parents with valuable information that would help them to wean their child successfully. However the parents may have felt that because I was so young and had no experience in weaning that what I had told them was not valuable. They may have chosen to listen to what the health visitor had said but not to what I had said. There were also consequences for the health visitor as this session will have shown her whether her teaching skills were sufficient. This was because prior to the session she gave me a short but effective teaching session on weaning and my performance at the session would show to her whether what she taught me could be put into use. For me the consequences were that I had a chance to improve both my teaching and communication skills and would learn how to deal with any negative feedback given by the parents. After discussion at the end of the session we were made aware of how the parents felt throughout. The parents said that they felt that the information that was supplied was useful but at the start they felt they were being told things they already knew but became aware that we had intended to start at the basics of weaning. Many of them also stated they did not want to ask me any questions during my session because the felt that if I was not able to answer them I would get into trouble. The parents also stated that they didn't really want to ask questions because they thought they would be 'silly' and irrelevant.
PERSONAL
When completing the session I was extremely nervous because I had never done a teaching session before. Although during lectures and previous education I had presented work in a teaching form to my own peer group I had never done this in front of people outside my peer group. I felt that because I was only a student nurse that the parents would make the choice not to listen to me and felt the fact that I was so much younger than them that this may also have been daunting to them. The fact that the health visitor was present when I completing my part of the session was also very off putting at the start but she gave me lots of encouragement and this was a great help to me. At one stage there was also a lot of commotion going on outside the room, this caused a lot of noise and felt II had to shout over this. I have a soft voice and found it hard to project it over the commotion and so became quite embarrassed but the health visitor got rid of the commotion.
ETHICS
I believed that the section I knew most about was about when a baby should be weaned and the recommendations for this. This belief influenced me to decide that this should be the section of the intervention that I myself should be involved in. I also believed that if I were to talk for too long I would loose the audiences' attention, as I was not as knowledgeable as the health visitor was. There were some factors that made me act in incongruent ways. When the commotion started outside and I was unable to project my voice over the noise this caused me to become agitated. There were also situations when babies were crying and this caused a lot of disturbances and so an interval during my part of the session was necessary and although I felt this was appropriate this resulted in a momentarily loss of audience attention.
EMPERICS
There were many sources of knowledge that influenced my decision making, the biggest influence would probably have been the advice I received from and discussions I had with the health visitor I was working with. The fact that she had a lot of knowledge and experience in similar situations influenced me to take all the advice she gave me and to use this. Also from reading books about health education the knowledge I gained from these influenced me to use the teaching methods that I did. These books and the health visitors personal experience and knowledge also influenced us in deciding after a lot of discussion which room was appropriate for the session and why it was appropriate.
REFLEXIVITY AND CONCLUSION
My previous experience of talking amongst and teaching a group of people was very limited. However the experiences I had had were all people who were in my own peer group and were also people who I knew well and had worked alongside many times. This however was a completely new and different experience. However I feel that for this intervention I was more prepared than in my previous experiences and although it was different I had an insight into what was expected of me. I feel that my previous experiences did help to prepare me for this intervention and had I not had my previous experiences I may not have does as well as I did. I feel I could have dealt better with the situation but this would have taken more preparation time and this was not ideal and I do know I used all of my preparation time effectively. I also feel that things would have been better had I not got so annoyed and frustrated at the surrounding commotion, however the health visitor informed me later after the session that this would have had the same effect on her. There are alternative actions that we could have taken when completing this session such as for me only to observe the session and not take part. This however would mean I would have to face the consequences of not improving my communication skills or gaining an extra in sight into the importance and methods of weaning. This also would have meant that the health visitor would not have seen how the knowledge she supplied me with was put into practice and so would not have knowing if her teaching methods were effective. I feel this whole experience was extremely important and valuable to me because not only did I improve my communication and interpersonal skills but I also improved teaching skills and gained an insight into weaning and this will be very useful to me as a qualified staff nurse. I have learned from the completion of the assignment the importance of reflective practice in nursing and the benefits of carrying out reflective practice.
REFERENCES
Corr (1987) Becoming critical, Education, Knowledge and action research The Falmer Press, Sussex
Driscoll (1994) Senior Nurse Vol 13 No 7, Jan/Feb
DOH (1994) Weaning and The Weaning Diet DOH London
Evans D, Head MJ, Speller V (1994) Assuring Quality In Health Promotion
Ewles and Simmett(1995) Promoting Health A Practical Guide Scutari Press England
Johns.C (1995) The value of reflective practice in nursing Journal of clinical nursing 19954.23-30
(Osterman (1990) Reflective practice a new agenda for action. Education and urban society 22(2) 133-152
Pike.S, Forster.D(1995) Health Promotion for All Churchill livingsone Edinburgh
Williams(1996) Promoting Health :Back to Basics Scutari Press England