Reflection in Nursing Essay

This assignment is a reflective account of events that arose for a nursing student during their send-off clinical placement in a community hospital. A brief definition of reflexion allow for be given, with emphasis placed on discourse. This reflection has been chosen to highlight the need for nurses to consent healthful communication skills, to provide holistic care for those diagnosed with dysphasia or speech personnel casualty and the scope of learning opportunities it has provided to improve practice in this area.All names in this text have been changed, to respect the confidentiality of the patient and new(prenominal) healthcare nonrecreationals (NMC 2002).Reflection, in this instance, is a substance of analysing past incidents to promote learning and improve safety, in the spoken communication of health care in practice. The Gibbs reflective cycle has been chosen as a framework for reflection (see appendix 1).Mr. comer was admitted to his local community hospital f or respite care. He has suffered multiple, acute strokes in the past, which has left over(p) him with severe disabilities. These include paralysis rendering him immobile, aphasia (speech loss) and dysphagia (swallowing difficulties). He relies on carers for all normal activities required for day by day living (Roper et al 1996) and is advised to have a pureed diet and thickened fluids.My mentor asked me to observe her feed Mr Comer. She had prepared my learning the week previously by providing literature on the subject of feeding ripened patients and discussion on safe practice for feeding patients with dysphagia.I was alarmed and unprepared for the physical passel of this patient, who was coughing noisily and laboriously and a thick, green stream of mucus was exuding from his mouth.I observed Mr. Comer being fed and noticed he was coughing more than normal during his meal, simply was informed that this was instead normal for him. I was asked to feed him the next day. When I uncovered Mr Comers meal he started to cough in the same manner that I had witnessed before, but this time he evaded all midsection contact. I was sapidity extremely anxious, but proceeded to load a spoon with his meal. His coughing increased in intensity accompanied by rapid eye blinking, turning his head away from me and throaty groans that I seat only describe as woed candid growling.I was terrified at this dismantle and called for assistance, thinking Mr. Comer was having some kind of seizure. I discovered very quickly from another health carer who knew Mr. Comer well, that he was protesting profusely about(predicate) the pureed dinner I was going to give him which he dislikes immensely. On the previous day, he had received an ordinary meal, mashed to a smooth consistency, which is what his carers provided for him at home.This experience left me feeling very uncomfortable and inadequate in my role. I tried to understand why he reacted so alarmingly by putting myself in hi s position. I felt anger and frustration, but more importantly the feeling of helplessness. Not being able to voice my dislike to the meal offered exacerbated the urgency of hunger or thirst.Although this experience was very frightening for me and frustrating for the patient, it has highlighted the need for me to improve my communication skills. NMC (2002) outlines that we moldiness not hit extra stress or discomfort to a patient by our actions and we must use our professional skills to identify patients preferences regarding careand the goals of the therapeutic relationship.Severtseen (1990) cited by Duxbury (2000) applies the term therapeutic communication as the dialogue between nurse and patient to achieve goals tailored exclusively to the patients needs. In this nerve dialogue is used by Mr. Comer in the form of body language and noise to proclaim his needs because of speech loss.Nelson-J wholenesss (1990) states that facial expressions are an intrinsic way to express emoti ons and eye contact is one way to show interest. The avoidance in eye contact displayed by Mr. Comer showed his distinct lose of interest. Compounding these factors was his facial paralysis, which made it especially difficult for me to ascertain the exact constitution of his feelings.The nurse must be the sender and more importantly the receiver of clear information. Patients with speech impairment or loss have a more difficult task sending the messages they want and are sometimes empty-handed in making themselves unders in additiond. (Arnold & Boggs 1995).It appeared to me that Mr. Comers cough was not only a physiological unsoundness caused by his condition, but a way for him to communicate, in this case, his displeasure. Critical analysis of this experience has pointed to the fact that I have inadequacies in my skills, to identify covert and overt clues provided by Mr. Comer to his needs. I had focussed too much on the presenting task to feed him, with my mind occupied on his safety due to the nature of his swallowing problems. I had not considered his other needs like his wishes or desires and I had not gathered generous personal information about him beforehand to know this (Davis & Fallowfield 1991).I had been unsure about what to say or do to alleviate Mr. Comers apparent anxieties and had adopted what Watson & Wilkinson (2001) describe as the blocking technique. By continuing my actions to carry on with the meal, I was cutting short the patients need to communicate a problem. I was influenced in this decision because I felt obliged to be seen to reduce his anxieties, knowing my actions would be judged by an audience of other care workers and patients on the ward. I did not respond efficiently to reduce his distress and this pressure led me to deal with the situation inadequately and for that I felt guilty (Nichols 1993).I should have allowed more time to understand what Mr. Comer was thinking and feeling by putting words to his vocal sounds and ac tions. I could have shown more empathy in the form of my own body language to promote alive(p) listening (Egan 2002) and not worried about other peoples views on my decisions and beliefs to act in a way I felt comfortable with and thought was best for my patient.Gould (1990) cited by Chauhan & Long (2000) have suggested that many of the non oral behaviours we use to reassure patients, such as close proximity, prolonged eye contact, clarification, validation, touch, a calm and soothing voice, the efficient use of questions, paraphrasing and reflecting thoughts and feelings and summarising are all sub skills with the totality of empathy.There is an abundance of information about communication, especially for nurses because it is considered by many as the core component to all nursing actions and interventions. Lack of effective communication is a problem that still exists because the learning process that leads to a skilled level of exponent may take years of experience to develo p (Watson and Wilkinson 2001).It has been quite difficult for me to admit my inadequacies in communication, but Rowe (1999) explains that a person must identify their weaknesses as an initiative for becoming self-aware. Only with acceptance of ones self, can a person begin to acknowledge another persons uniqueness and build upon this to provide holistic care.