Reflection on theory and knowledge in nursing

reprimand on theory and association in nursingThe aim of this situate k immediatelyn is look at a searing incident that occurred in utilise and relates this to the theory and k directledge regarding colloquy and interpersonal skills, so as to present an arrangement of my views on the art and science of reflection and the issues surrounding m give awayment recitation that is to say, what skills were and were non put ond at the time of the incident. Confidentiality will be maintained as required by the nurse tocology Council encrypt (NMC, 2008). There is a discussion appraising the concept of reflection twain generally, and in my leave-takingicular argona of institutionalise of urgent c atomic number 18. Reflection is take apart of musing answer and is a skill that is developed. It stern be seen as a way of adjusting to life as a qualified health tutorship original and enhancing the development of a professional identity (Atwal Jones, 2009).Reflection is def ined as a serve up of reviewing an experience which involves description, analysis and evaluation to kick upstairs cultivation in apply (Rolfe et al 2001).This is supported by (Fleming, 2006), who draw it as a take form for of reasoned thought. It en fitteds the practitioner to criti identifyy survey self and their approach to practice. reflective practice is advocated in health sustainment as a learning process that encourages self-evaluation with subsequent professional development externalisening (Zuzelo, 2009). thoughtful practice has been identified as one of the key shipway in which we can learn from our experiences. Reflective practice can ungenerous taking our experiences as an initial point for our learning and developing practice (Jasper, 2003). Many literatures ache been written in the past that suggest the go for of meditative assignments and journaling as dents to mitigate reflection and thinking skills in health anxiety (Chapman et al, 2008). Refle ctive journals are an ideal way to be actively entangled in learning (Millinkovic Field, 2005) and can be implemented to allow practitioners to place down events and document their thoughts and actions on daily points, and how this whitethorn affect their future practice (Williams Wessel, 2004). exampleSIn order to provide a simulation for methods, practices and processes for stimulateing friendship from practice there are several models of reflection avail satisfactory. All can religious service to direct individual reflection. Some may be curiously useful for superficial problem solving, and other better when a deeper reflective process is required. Reflective models however are not meant to be employ as a rigid set of questions to be answered but to interpret some structure and encourage making a record of the activity.Johns (2004) reflects on uncovering the knowledge behind the incident and the actions of others present. It is a favourable cock for thinking, explor ing ideas, clarifying opinions and supports learning.Kolbs Learning Cycle (1984) is a cycle that reflects a process individuals, groups and organisations attend to and understands their experiences and subsequently, modifies their behaviour.Schn (1987), however, identifies two types of reflection that can be apply in healthcare, Reflection-in-action and Reflection-on-action. Reflection-in-action can likewise be described as thinking whilst doing. Reflection-on-action involves revisiting experiences and further analysing them to improve skills and enhance to future practice. Atkins and Murphys model of reflection (1994) stupefy this idea one step further and suggest that for reflection to make a real difference to practice we follow this with a committal 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 an experiential learning cycle, and added trigger questions that can be utilise to complete the cycle.Gibbs (1988) reflective cycle is fairly straightforward and encourages a swooning description of the situation, analysis of feelings, 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 have chosen to use is Gibbs Reflective Cycle (1988) as a framework, because it thinkes on incompatible aspects of an experience and allows the bookman to revisit the event to the fully. Gibbs (1988) will servicing me to explore the experience further, using a staged framework as guidance ad I feel that this is a simple model, which is thoroughly 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. to begin with the critica l incident is examined it is important to look at what a critical incident is and why it 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 sucks cannot increase or develop their knowledge to its full potential unless they examine their own practice.Context of incidentIn the scenario the long-sufferings lift will be given as Xst. The consequences of my actions for the client will be explained and how they might have been ameliorate, including what I learned from the experience. My feelings ab issue the clinical skills apply 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 ke ep professional development and learning. Description flatten Xst is 55 year sexagenarian woman who has a 10 year old daughter. She suffers from psychiatric problems, miss of motivation and has difficulties in maintaining her personal hygiene and the cleanliness of her flatbed. She was one of my mentors clients to whom I had been appoint to coordinate and oversee her care. noetic health Nurses owe their perseverings a province of care and are expected to offer a high model of care based on current best practise, (NMC 2008). Miss Xst had been dictate Risperidone Consta 37.5mg periodic, which is a moderate music. Risperidone belongs to a group of medicines called antipsychotic, which are usually used to help treat people with schizophrenia and similar condition such as psychosis. Although her condition 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 pole clinic and she miss three consecutive appointments. My mentor decided after the third non-attendance to repeal the issue in the handover confrontation 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 hear from her and a further home visit was carried come in to arrange for her next depot clinic appointment. I called a meeting of the multi-disciplinary group (MDT) who agreed that there would be a problem if the next injections were missed. The mixer worker who was part of the team verbalize that she will arrange for a community support worker to help clean Miss Xsts flat on a weekly basis (Adams 2008).We waited for slightly an hour for Miss Xst to attend the clinic for her depot injection but she failed to attend. I then certified the Community Psychiatry Nurse (CPN) that Miss Xst had expressed negative feelings almost her medication and t hought she did not need them she had claimed she was already feeling well and therefore wanted the medications to be discontinued. At a subsequent meeting with the affected role role, she agreed a joint visit with the CPN and myself to re-assess her condition and consider if it was unavoidable to refer her case to the consultant (Barker, 2003).I was given the opportunity to put up out the initial assessment, which showed that her behaviour was actually unpredictable and very forgetful. Her inability to take her medication and to manage her personal hygiene clearly demonstrate that she was not well. The assessment tool I used was the Mental distinguish Examination which helps determine the level of her insight into her unsoundness and indeed I give out that she was in denial (Barker, 2004).I talked to Miss Xst about her non-concordance with her medication, but she persisted in saying 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 ready on her next outpatient appointment, with the option of reviewing or reducing her medication. I distressed the importance of her communicating any side effects or reservations she may have about the medication to doctor. She push throughed to understand this and following 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 identify and minimise risk to patient. The principle of sympathy (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 optional extra to be fitted in if circumstances allow N MC (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 do unshakable 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 uncomfortable about giving feedback to the whole team. I was worried about making mistakes during my handover that could lead to inappropriate care hold outence given to Miss Xst or could cause her readmission to hospital. As a scholarly person nurse I felt I lacked the necessary experience to be passing information to a group of qualified stave 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 increase my confidence.EvaluationWhat was commodity abo ut the experience was that I was able to dribble out the initial assessment and identify what caused Miss Xst tribulation to obey with the treatment regime. From my assessment I documented the 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. doubting 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 considerably 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 essential 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 provide enough time to freely act 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 middlebreaker (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 course session a small amount of the vast literature available, the student was able to analyse the incident, and look at how badly this situation was handled. I pull in 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 effective 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 emotion 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 best 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 t o 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 kindle in what I was saying and they asked questions.The patient had no recollection of what she had s forethought 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 nothing wrong. My mentor explained that a patient with Parkinsons can often behave like this as they develop dementia, which terrific (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 come out of the closet more confusing and aggressive.ConclusionIn conclusion, I have learnt that through effective communication, any problem can be solved disregar ding 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 fare 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 reverence 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 NEEDSSo 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 men tal health problems before providing care to themTo read my patients notes.On- goingTo ensure a good rapport exist between my patient and I, in order to build up a therapeutic relationship with them and to gain their trust.I will have regular 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-going decisionI 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 requ ires 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 technological rationality, where professionals are problem solvers that select technical means best desirable 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). Psychiatric and mental health nursing The craft of caring Arnold, capital of the United KingdomBeauchamp, T. and Childress, J. (2001) Principles of Biomedical Ethics, (5th Edition) Oxford University Press.Bolton, G. (2001) Reflective answer. Writing and Professional Development. Paul Chapman Publishing Limited, London.Bulman, C. Schutz, S. (2008 ) An opening to Reflection. In Bulman, C. Schutz, S. (ed.) Reflective Practice in Nursing, 4th edition. Oxford, Blackwell Publishing Ltd, pp 6 8Burns, T. Sinfield, S. (2008a) How to organise yourself for independent study. In Essential Study Skills The exonerate Guide to Success at University. 2nd edition. London, Sage Publications Ltd, p 64.Burns, T. Sinfield, S. (2008b) handout to University. In Essential Study Skills The Complete Guide to Success at University. 2nd edition. London, Sage Publications Ltd, p 16.Dougherty, L. and Lister, S. (2004) Royal Marsden of clinical nursing procedures. sixth edition. London Blackwell publishers.Gamble, C and Brennan, G (2005) Working with serious mental illness a manual for clinical practice. Oxford Bailliere Tindall.Kenworthy et al (2003)Marrelli, T. M (2004) The Nurse Managers excerption Guide Practical Answer to Everyday Problems, United States of America ElsevierNursing and Midwifery Council (2004) cypher of Professional Conduct NM C London.Nursing and Midwifery Council (2008) The Code Standards of conduct, Performance and Ethics for Nurses and Midwives. London Nursing and Midwifery Council.Nursing and Midwifery Council (2009) Record keeping Guidance for nurses and midwives. London Nursing and Midwifery Council.Rolfe, G., Freshwater, D. Jasper, M (2001) Critical Reflection for Nursing and the Helping professor a Users Guide. Palgrave Macmillan, London.Roger, B. Ellis, chase Gates, Neil Kenworthy. (2003) Interpersonal Communication in Nursing Theory and Practice, 2nd edn. Churchill Livingstone, London, UK. Schon, D.A. (1983) The Reflective Practitioner. Basic books. Harper Collins, San FranciscoSchon, D. (1987) Preparing Professionals for the Demands of Practice. Educating the Reflective Practitioner. San Francisco, Jossey Bass, pp3 21.Thomas, B. Hardy, S. and Cutting, P. (1997) Mental health Nursing Principles and Practice London MosbyTurley, J.P.( 2000) toward and integrated view of health informatics. I nformation Technology in Nursing 12 (13).