Reflective Case Study

The concept of reflection as a learning tool in workplace education can enable the student to problem solve in practice. By exploring the individuals own unique situations and past experience they can, in order to learn, consider past thoughts and memories to achieve a desired outcome. (Rolfe, 1998). Taylor (2000) suggests that, to reflect on action from an event, we must   remember our thoughts and memories.  Then we must use the ability of contemplation, meditation and consideration, which will enable us to make sense of them in order to modify our behaviour, should we encounter a similar experience in the future.  

Introduction

The following reflective account aims to explore specific complications and difficulties encountered after obtaining a history and performing a physical examination on a young patient that presented to the Accident and Emergency (A&E) Department.  The incident that I have chosen to look at took place whilst on a placement in the Minor Injuries Unit based in an A & E Department following a theoretical module on Patient Assessment.  Confidentiality has been preserved throughout in accordance with the Health Professions Council (HPC) Code of Professional Conduct (HPC, 2002).  

To achieve and understand the use of reflection in a structured manner, the Gibbs (1988) Reflective Cycle will be utilised.  Bulman and Schutz (2004) believe that reflection is a dynamic progression, and using a cyclical framework is of an advantage in providing structured guidance through a learning experience.  

Description

I was told by one of the Doctors in the A&E department, there was a young boy in one of the cubicles that had fallen over and bumped his chin on the seat of a chair as he fell. The Doctor thought that this would be of interest to me, as the child would need some sort of intervention i.e. a steristrip, glue or suture. When I found the little boy, Jamie, he was 6 year old and sitting quietly on his mother’s knee. He looked frightened and his eyes were red as if he had been crying. I introduced myself as an experienced paramedic, but on placement to gain some extra experience in a controlled setting, with the aim to become an Emergency Care Practioner (ECP). I sought permission from Jamie’s mum to obtain a history and examination Epstein et al (2003) state that by gaining a concise, methodical history will guide you to a diagnosis in 80% of cases.

Jamie’s presenting problem was that he had fallen against a wooden chair, sustaining a cut under his chin approximately 2 cm in length that had now stopped bleeding. He had his accident at school during lunchtime and the teacher had immediately contacted mum, who was at work, and she had brought Jamie straight into the A&E department. Apart from the odd cough and cold the child was normally fit and well and had used Calpol to good effect to relieve those symptoms. Jamie lived at home with both Mum and Dad and had an older sister, who attended the same school. He was not known to have any drug allergies. His initial observations were, respirations 20 per minute, pulse 104 per minute, temperature 37degrees centigrade. Blood pressure not taken. He assured me that although the wound felt painful he was coping very well and did not want anything for the pain.

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Piaget’s (1993) theory of cognitive development in children aged two to seven is linked to 4 stages, and that they may have trouble in distinguishing real from unreal. In this they lack the ability to generalise about things or to make deductions. Meaning that the child may not realise the need to complain formally about their pain in order to get relief from it. However, this is contested by Castiglia (1992) who suggests that there are 8 stages of these hypotheses and by the age of six, the child can relate to the pain resulting in the perception and response ...

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