In this essay, I will be reflecting on my clinical practice during my placement from module one to three. I will discuss them in four different domains, which are Professional and Ethical practice, Care delivery, Care Management and Personal and Professio
CHINNY EJIOGU
Group 2 Feb 06
REFLECTIVE ESSAY
In this essay, I will be reflecting on my clinical practice during my placement from module one to three. I will discuss them in four different domains, which are Professional and Ethical practice, Care delivery, Care Management and Personal and Professional development. I will be defining reflection as well highlight my strength and weakness and relate theory to practice. I will finally give an over all conclusion of my experience in relation to reflective practice.
In accordance to NMC Code of Professional Conduct (2004) which states that you treat information about patients and clients as confidential and use it only for the purpose for which it was given and must guard against breaches of confidentiality by protecting information from an improper disclosure at all times. I have will use a fictitious name for the patients.
Reflection is not a new invention. Indeed, to nurse, midwife or health visitor you must constantly reflect upon your practice to remain safe and competent. (Jones 1999).
Reflection is all about challenging myself, what was I thinking and feeling? What was good and bad about the experience? What sense can I make of the situation? What else could I do if the situation rose again? (Gibbs 1988).
John (2004) defines reflection as being mindful of self, either within or after experience, as if a window through which the practitioner can view and focus self within the context of a particular experience, in order to confront, understand and move towards resolving contradiction between one's vision and actual practice.
PROFESSIONAL AND ETHICAL PRACTICE
Nurses Dictionary (2001) defines consent as voluntary agreement with an action proposed by another. Consent must be obtained before any treatment and care is given. The patients decision whether or not to agree to treatment must be based on informed choice information so that they can make up their mind. It is important that information is shared freely with patient in an accessible way and in an appropriate circumstance. (NMC 2004).
There is a new professionalism and culture of care emerging that seeks to 'work with' rather than 'do to' patients and clients. The practice of individual accountability within a robust framework of professional values and belief is the key. Hence the outcome of Code of Professional Conduct which applies to all practice interventions and includes: Respect the patient or client as individual; obtain consent before you give any treatment or care.
During my placement in day care ward, I observed ways in which doctors seek consent in an accessible and appropriate manner, before the procedure, the doctor gave informed choice and wait for feedback from the patient. Irene is 55 years old woman whose has come in for Hysteroscopy. When asking for consent, the doctor informed the Irene of all relevant and significant risks and benefit of the proposed procedure. In addition, the doctor also informed her about the type of anaesthesia to be used and why. Irene was given time to ask any question and if she agreed ...
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During my placement in day care ward, I observed ways in which doctors seek consent in an accessible and appropriate manner, before the procedure, the doctor gave informed choice and wait for feedback from the patient. Irene is 55 years old woman whose has come in for Hysteroscopy. When asking for consent, the doctor informed the Irene of all relevant and significant risks and benefit of the proposed procedure. In addition, the doctor also informed her about the type of anaesthesia to be used and why. Irene was given time to ask any question and if she agreed to go ahead with the procedure.
How I used consent, is that I was asked by the staff nurse to collect urine sample from Irene to check for urinalysis. I went to her and pulled the curtains to acknowledge privacy I informed Irene of what want to do and explained the reason of doing it. I asked her if she was in agreement for me to take the urine sample, to which she said yes. I explained this in a sensitive and understanding manner. With the help of a health advocate, patients whose linguistic capacity to understand is limited or non-existent they were be given all necessary information and allowed to ask questions in their own language in order that they have the opportunity to give informed consent.
In another situation, I was allocated to assist an 85 year old gentleman with his morning wash and general personal hygiene. I went to him and introduced myself to him and explained what I was to do to him. I asked if he was okay for me to do assist him with his wash, to which he declined and said he would not be requiring my help as he does not feel like having a wash that morning. I asked him why and he said that he feels weak. I reported this to my mentor, who went to him to check what was wrong. It was documented that he fell out of his bed during the night.
On reflecting back, I learnt about the importance of consenting patients before carrying out any procedure as this has a legal implication. (NMC 2004). I noticed that few member of the team observe this, as they normally assume that something as little as urine sample do not require patient's consent. The sense I can make out of this situation, is that I have a duty of care to my patients and clients, who are entitled to receive safe and competent care. (NMC 2004).
This experience made me question the way I behave in front of patients, the way I communicate with them and sometimes my feeling about things afterwards. If found in the same situation, I will always obtain patient consent at all times before any care is given.
CARE DELIVERY
In care delivery, nursing models is deployed; a systematic approach to assessment is put into practice. Assessment is the first part of nursing process and assists the nurse in identifying patients or clients strengths and weakness, and in the formulation of a care plan. Information obtained at assessment may be subjective or objective. These assessments are carried out when the patient or client first meets the nurse, and is then carried out continuously as care is evaluated. Information for assessment may come verbally from the patient or client, or it may come from the use of notes, questioning of the family and carers or using the nurse's senses. Assessment enables nurse to undertake a holistic assessment care plan of patient considering all of the patient's individual needs in order to identify his or her problems and needs can be actual or potential. (Roper et al 1996).
Mr Andy was 75 years old was who was referred to the diabetic clinic. In order to plan a care for Andy needed to be assessed for baseline or routine observation for the records. As a new patients I explained the procedure to him, that he needs to be weighed, height measured, urine sample tested, check his blood pressure and his eyesight checked. He agreed and I was able to document all these information accurately in his file. This information was then passed on to the doctor, who advised Mr Andy on his weight and the need for him to change his diet and lifestyle. Planning is the stage of process that the nurse in conjunction with the patient and the carers sets achievable goal and plans and how the can be achieved. Goals can be long or short term. (Roper et al 1996). At this stage I observed that the nurse specialist took up the planning of care, which was according to what the doctor indicated to Mr Andy. She had his blood sugar level assessed and informed Mr Andy of the medication prescribed by the doctor. Mr Andy was encouraged to participate in setting the goals and referred him to the dietician where some diet regimen were listed, he was able to inform the dietician of the diet he likes and the choice of reducing intake, or do without some. Mr Andy agreed to the goals by taking immediate control of his care and hopes that by the next appointment his health would have shown some improvement.
In another clinical experience, I was asked to assess Bobita 74 year old Asian woman who was admitted via the accident and emergency with falls and reduced mobility. Bobita speaks very little English and her grand daughter Aliyah is the interpreter. Aliyah was only 15 years old and very weary of me as I was a stranger to her. I was able to obtain information through Aliyah about her grandmother's activities of daily living and any changes that might have occurred due to her illness which will help in the assessment needs of Bobita. Care plan was then carried out as necessary and implemented appropriately. Following the assessment, she later referred to occupational therapist, physiotherapist and social worker.
Reflecting back, I noticed that the daily activity of living was not applied in the assessment in some of the clinics in the outpatient. But was always applied in the ward. Rather in the clinics assessment was focused on observation relevant to the clinic e.g. diabetic clinic.
If I have the opportunity to practice in clinic again I will ask the nurse in charge why the activity of daily living is not applied in the clinics.
CARE MANAGEMENT
Measures designed to ensure safety of self and other from environmental hazards in my clinical area is the universal precaution for infection control. As we are aware, that health care personal should practice universal precautions at all times.
While on clinical placement, I observed that universal precaution for infection control was effective. In each consulting room, the small sharps boxes were positioned (in places that are out of reach of children); this was for disposal of needles and syringes. Sharp boxes were disposed by not allowing it to be full and the clinical waste bags were disposed by incineration. Waste disposal policy in which the use of white bag for dirty linen and black bag for domestic waste was rigorously followed. Bed linen was changed after examination of each patient and put away in the white bag.
The practice of hand washing was essential before and after coming in contact with patients. I observed the doctor and nurse specialists wash their hands as well using the gloves and apron when in contact with body fluid or blood. When asked to collect a sample of urine from a patient, I washed my hands first, and then put my apron and gloves. After collecting the sample, I discarded my gloves and apron in the appropriate waste bag and washed my hands. Reflecting back, the whole team in the clinic followed the universal precaution infection control and I was able to put theory in practice.
In a different clinical area, I was asked to assist a 56year old patient into the shower and stay with her while she washed. I was concerned because this patient had brain metastases, giving her poor co-ordination. I was also worried that she would be embarrassed about having a shower while I was in the bathroom. The patient walked unaided to the bathroom and promptly undressed and stood in the shower. I adjusted the shower head and checked with her that the water was not too hot. When she finished I turned the water off and gave her two towels to dry herself with. I dried the floor to prevent slipping I positioned the chair directly in front of the patient for her to sit and put her pyjama bottom on.
The patients stood up to put her bottoms on and I suggested that she sit down. It was at this point that the patient tipped over her pyjama bottom and fell. In manual handling training I was taught that you should not try to prevent a patient from falling, at spot of the moment I tried to but was unsuccessful. Patient got up unaided and asked her if she was okay and she replied that she was okay. After settling the patient to her bed I reported it to my mentor and documented it in her notes. Observations was taken and recoded.
I believe that I could have prevented that patient's fall if I had led her to the chair and explained more clearly what I wanted to do. Next time I am asked to carry out the same or similar task I will use effective communication aimed at the needs and ability of the patient. I will not assume that patients understand what I am asking or suggesting them to do.
