Nursing Reflective Essay using Driscoll’s reflective cycle

| November 27, 2012



Introduction:

In this reflective account essay, I will be describing nursing skills that I undertook during my practice placement, using Driscoll’s (2000) reflective cycle, a recognised framework for reflection to demonstrate my ability to reflect on different nursing skill.   According to Driscoll’s (2000), there are three processes when reflecting on one’s practice. They are: What (what happened), so what (what were you feeling, what was good/bad about the experience and Now what (if it happens again what you would do differently). The application of Driscoll’s reflective cycle will enable me link theory to practice.

As outlined, in the Nursing and Midwifery Council (NMC, 2004), the practice of reflection will allow me to explore, through experience, area for development in providing the necessary quality of care (Taylor, 2006). Reflection is a significant part of attaining knowledge and understanding, to reflect on experiences which could be positive or negative allowing for self criticism (Bulman and Schutz, 2004).

My 1st skill will explores how communication can be enhanced for clients with communication impairments which I raised in one of the multidisciplinary team meeting (MDT). I will be  drawing from knowledge and experience gained from that meeting which involve social workers, speech & language therapist, adult nurse, mental health nurse and a carer experience. Names have been changed to maintain confidentiality (NMC, 2007)

1st skill:

I discover the level at which nurses and support worker communicate with service user are not up to standard simply because they have an impairment see Appendix 1

This now lead me to carry out a research on this issues which I discover that it has been estimated that there are 2.5 million people in the UK with communication impairment (Communications Forum, 2008).  It is estimated that 50% to 90% of people with intellectual disabilities have communication difficulties and about 60% of people with intellectual disabilities have some skills in symbolic communication using pictures, signs or symbols (Fraser & Kerr, 2003).

The World Health Organization’s classification of impairment, disability and handicap relating  to communication disorders are impairment which disruption the normal language-processing or speech production system e.g. difficulty with finding the right words or with reading sentences, reduced spelling ability and reduced ability to pronounce words clearly (World Health Organization, 2001).

Communication is ‘a process that involves a meaningful exchange between at least two people to convey facts, needs, opinions, thoughts, feelings and other information through both verbal and non-verbal means, including face to face exchanges and the written word’. (DH, 2003)

Communication is a two-way process, involving at least two people who alternate in sending and receiving messages (Ferris-Taylor, 2007).  When the message is received, it is interpreted and normally a response is given. In some people there may be a delay in response time as result of communication impairment. This was the problem encountered by Mr Kee whilst I felt frustrated sometimes as I felt nurses/support workers were not patient enough with him.

I propose both verbal and non verbal communication is important when dealing with Mr Kee as it is important to ensure the message put across is clear. There is a need to devise a strategy to communicate that would promote empowerment, building on existing strengths so as not to reinforce a sense of helplessness and power imbalance. Studies have showed that by using verbal and non verbal communication techniques appropriately can help us nurses/carers and families to communicate and enhance the communication experience for Mr Kee.  For example we should  create conducive environment,  listen carefully to what he is trying to say, observing his body language, using positive body language to convey warmth and reassurance, speaking slowly, using short and simple words,  give Mr Kee opportunities to talk in indirect ways and to express himself, I tried emphasis the need for us nurses/support worker to be creative, adaptable and skilful to avoid disempowering Mr Kee because of his communication impairment (Allan 2001, Feil & DeKlerk-Rubin 2002 and Alzheimer’s Association 2005). ‘One of the ways in which people with dementia are disempowered in communication is that of being continually outpaced, having others speak, move and act more quickly that they are able to understand or match’ (Killick and Allan, 2001, pp. 60–1)

The MDT experience has emphasised the importance of interprofessional working together as it encourages holistic care to be delivered.  The learning gained from this experience will impact my future practice in various areas which include communication and empathy. I am mindful of the challenges faced by Mr Kee and this has increased my knowledge in clinical practice where I have observed that mental illness can impair patient’s ability to communication, for example dementia, schizophrenia, depression and psychosis cause’s cognitive impairment which can interferes with a person’s ability to think clearly, to distinguish reality from fantasy, to manage emotions, make decisions, and relate to others, which often hinders the development of a therapeutic relationship. I have learnt a lot about The Mental Capacity Act, 2005 provides guidance as to what factors should be taken into consideration when making a decision in someone’s best interest.

As a qualified nurse my role would be to ensure decisions are made on behalf of the service user after much consultation with the service user as communication advocacy is universally considered a moral obligation in nursing practice as it is the crucial foundation of nursing (McDonald, 2007) Effective advocacy can transform the lives of people with learning disabilities enabling them to express their wishes and make real choices.

In Mental health nursing, empowerment usually means the intent to ensure that conditions are such that the individual can act as a self advocate (Webb, 2008)]

This experience has highlighted the difficulties that may be encountered in communicating and gaining valid consent which I will be aware of in future practice.

In conclusion steps towards better health care can be made by providing encouragement and support to improve communication between nurses/support workers and carers with communication disabilities [Godsell and Scarborough, 2006]. In order to battle any restriction for Mr Kee to access good health care and prevented anything against his wellbeing.

Introduction

In this reflective account essay, I will be describing nursing skills that I undertook during my practice placement, using Driscoll’s (2000) reflective cycle, a recognised framework for reflection to demonstrate my ability to reflect on different nursing skill.   According to Driscoll’s (2000), there are three processes when reflecting on one’s practice. They are: What (what happened), so what (what were you feeling, what was good/bad about the experience and Now what (if it happens again what you would do differently). The application of Driscoll’s reflective cycle will enable me link theory to practice.

This 2nd skill will define the concept of dignity and its important in relation to Mr  Moses, an elderly patient, has difficulty hearing, frail, require assistant to walk, his trouser and shoes wet with urine and the smell of faeces. Actions and support according to the Code of Professional Conduct (Nursing and Midwifery Council (NMC, 2008) as suggested to be used in rendering care to Mr Moses. Also, the Nursing actions that will promote and maintain Mr Moses dignity during his care will be described.

2nd Skill

The way Mr Moses was treated by the staff gave me concern see appendix 2

This now gave me an interest into this topic as to acquit myself before escalating the matter.

I was involved in the care for Mr Moses who has diagnosed with dementia. Dementia is a chronic lifelong condition that causes memory loss, communication problems, incontinence and neglect of personal hygiene (Prime, 1994 p, 301). Mr Moses neglect of his personal hygiene was profound due to his incontinence condition

Dignity  mean “Being treated like I was somebody” (Help the Aged, 2001).Relating dignity in the care Mr Moses, dignity will be define as care given to Mr Moses that will uphold, promote and not degrade his self respect despite his present situation (being wet with urine and smell of faeces), frail or his age (SCIE, 2006). Mr Moses despite his present circumstance should feel value before, during and after his care (Nursing Standard, 2007).

The concept of dignity has to do with privacy, respect, autonomy, identity and self worth thereby making life worth living for them (SCIE, 2006). However, each patient needs is unique, the level of these concept will varies on individual service user, such as the privacy that other service user need will be different from what Mr Moses require at the time of His care. When dignity is not present during his care, Mr Moses will feel devalued, lacking control, comfort and feel embarrass and ashamed (RCN, 2008).

Things that emerged in my observation for Mr Moses to be provided with care in a dignified way involves, delivery Mr Moses personal care in a way that maintain his dignity, having support from team members and an up to date training in delivering care, and supportive ward environment (NHS evidence, 2007). I did raise some issues with my mentor that was missing when attending to Mr Moses which includes: Respect, Privacy, Self-esteem (self-worth, identity and a sense of oneself) and Autonomy (SCIE, 2006).

Respect is a summary of courtesy, good communication and taking time (SCIE. 2006). It is the objective, unbiased consideration and regard for the right, values, beliefs and property of all people (Wikipedia, 2006).Mr Moses being  particularly vulnerable because he  solely dependent on staff to provide his personal care because of his age , frail and needing assistant to walk (Help the Aged, 2006)  should be treated as an individual. He should not be discriminated. Emphasised should be on Procedures during care should be explained to Mr Moses and his care should be person centre rather than task-oriented (Calnan et al, 2005).

The dignity of Mr Len must be respected and protected as a person who is born free, equal in dignity and has basic human right (Amnesty international, 1999).Health service will need to recognise the specific needs of older people in caring for them, demonstrating respect for Mr Len autonomy, privacy during Mr Len care and avoiding poor practice that will deify Mr Moses dignity, such as: allowing him to remain wet and soiled or scolding him  (Age Concern, 2008).

The NMC (2008) code of conduct state that the care of Mr Moses should be the nurse first concern, respecting Mr Moses dignity and treating him as an individual. Mr Moses will be approached in a dignified manner, he should be given choice to decide whether or where he want his care to be carried out, demonstrating appropriate communication, sensitivity and interpersonal skill during interaction. Dignity is defy when there is a negative interaction between staff and Mr Moses when freedom to make decision is taken from him (BMJ, 2001). Mr Moses appearance is essential to his self respect; Mr Moses will require support in changing his wet cloth. Mr Moses should not be neglected based on his appearance rather supported to maintain the standard he is used to (SCIE, 2006).

The NMC (2004), also instruct nurse to promote and protect the interest and dignity of service users irrespective of gender, age, race, ability sexuality, economic status, lifestyle, culture and religion or political beliefs. Mr Moses being an elderly man will not be problematic, because according to the code, care should be delivered, his culture preference , such as preferring a male staff to assist with his care .

Treating Mr Moses fairly without discrimination is part of the Code, Mr Moses should not be discriminated against because he smells of faeces and trouser wet with urine Quot  but should be respected while attending to his needs.

Privacy is closely related to respect (SCIE, 2006). Mr Moses care should be deliver in a private area, ensuring Mr Moses receive care in a dignified way that does not humiliate him: Discussion about Mr Moses condition should be discussed with him where others are unable to hear and curtain or doors are closed during Mr Moses care (Woolhead et al, 2004).

Not giving Mr Moses the privacy that he needs makes feel that he was treated as incontinent because he was wet of urine and smell of faeces( which was stated in Mr Moses case not at the end of that shift “incontinent of urine and faeces). Incontinence is not uncommon; it may be cause by various reasons. It affects all age group (Godfrey and Hogg, 2002).

Incontinent is defined to be an involuntary or inappropriate passing of urine or faeces thereby having impact on social functions or hygiene of client (DOH, 2000). There are various types of incontinent such as: stress incontinent (this can occur when coughing, or during physical activities), urge incontinent (overactive bladder), reflex incontinent (incontinent without warning) and mixed incontinent (both urge and stress incontinent) (Chris, 2007). Mr Moses may have be a victim of any of the above.

In conclusion my knowledge about the concept of dignity and its importance to health care and the benefit to service users increased. NMC has made dignity clearer to understand by including dignity among its codes. This easy has also clarified that dignity has different meaning to various people.

 

Introduction

In this reflective account essay, I will be describing nursing skills that I undertook during my practice placement, using Driscoll’s (2000) reflective cycle, a recognised framework for reflection to demonstrate my ability to reflect on different nursing skill.   According to Driscoll’s (2000), there are three processes when reflecting on one’s practice. They are: What (what happened), so what (what were you feeling, what was good/bad about the experience and Now what (if it happens again what you would do differently). The application of Driscoll’s reflective cycle will enable me link theory to practice.

This 3rd Skill will look at the assessment I did.

One week into my placement at the community I was told by my mentor that I will be carrying out an assessment for a new patient that was referred to our service. To prepare for this I started to read the assessment note of other patient and doing research on the best method to get information from the patient.

Barker (2004) defines mental health nursing assessment as ‘the decision making process, based upon the collection of relevant information, using a formal set of ethical criteria that contributes to an overall evaluation of a person and his circumstances’. Assessment is a continuous process which includes collecting information in a systematic way from a variety of sources.

Assessment can be describe as a two stage process of gathering information and drawing inferences from the available data and decisions made regarding a person’s need of care. (Norman and Ryrie, 2007).  The purpose of assessment include judging and understanding levels of need, planning programmes of care and observing progress over time, planning service provision and conducting research (Gamble and Brennan, 2006)

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Meaningful and accurate assessment is essential if a person’s needs are highly complex so as to streamline the service user care requirement (DOH 2004). Assessment of person’s strengths and needs in social functioning is a fundamental stage in developing planned care that is familiar to practitioners. Making an accurate assessment of social functioning provides valuable information about the range of activities that a person can undertake on his or her own as well as those activities where a person requires support (Godsell and Scarborough, 2006)

During our (Mentor and I) brainstorm to identify the main communication needs of the new service user based on the referral letter/note that I need to use the open question as this will give the patient the opportunity of expressing himself as supported by crouch and Meurier (2005). I observed differences in perception of needs between disciplines. This was beneficial to the group as it enabled us to achieve a holistic view of possible needs.

Reference

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Amnesty international (1999).Universal Declaration of Human Rights. Amnesty International UK, London.

Barker, P.J. (2004) Assessment in Psychiatric and Mental Health Nursing: In search of the whole person. 2nd edition. Cheltenham: Nelson Thornes.

British Journal of Community Nursing (2001). Maintaining the dignity and  autonomy of older people in the healthcare setting. Downloaded from bmj.com on 12 April 2011

doi:10.1136/bmj.322.7287.668 BMJ 2001;322;668-670 Kate Lothian and Ian Philp

Calnan, M, Woolhead, G, Dieppe, P. & Tadd, W. (2005) Views on dignity in providing health care for older people. Nursing Times, 101, 38-41.

Chris brooker, & Anne Waugh  (2007). foundation. In foundations of nursing practice. fundamentals of holistic care (p. 92). Philadelphia: mosby elsevier.

Communication Forum (2008)  www.communicationforum.org.uk accessed on the  15 April 2011 @ 16:03

Department of Health (2000). Good Practice IN Continence Services. DH, London

Department of Health (2003) Essence of Care: National patient-focused benchmarking for health care practitioners. London: DH.

Fraser, W & Kerr, M.  (2003). Seminars in psychiatry of learning disabilities. 2nd ed. London: The Royal College of Psychiatrists.

Ferris-Taylor, R. (2007) Communication. In: Gates, B. (Ed) Learning Disabilities: Toward Inclusion. 5th edition. Edinburgh: Churchill Livingstone.

Gamble C and Brennan, G. (2006) Assessments: a rationale for choosing and using. In:  Gamble, C and Brennan, G (Eds) Working with Serious Mental illness: A manual for clinical practice. 2nd Edition.  London: Elsevier Limited.

Godfrey H, Hogg A (2007).  Links between social isolation and incontinence. Continence –UK. 1(3): 51-8.

Godsell, M. and Scarborough, K. (2006) Improving communication for people with learning disabilities. Nursing Standard 20(30) 12 April : 58-65

Help The Aged.(2006). Measuring Dignity in Care for Older People. Picker Institute Europe.

MacDonald, H. (2007) Relational ethics and advocacy in nursing: literature review. Journal of Advanced Nursing 57(2): 119-126

Nursing and Midwifery Council (2004) Code of professional conduct: standard for conduct, performance and ethics. NMC, London.

Nursing and Midwifery Council (2007) Code of professional conduct: standards for conduct, performance and ethics.NMC London.

Nursing and Midwifery Council (2008) Code of professional conduct: standards for conduct, performance and ethics. NMC London.

NS401 Matiti M et al (2007). Promoting patient dignity in healthcare settings. Nursing  Standard. 21,45,46-52. Date of acceptance: June 15 2007.

NHS Evidence (2007). Caring for Dignity: A national report on dignity in care for older people while in hospital. Healthcare  Commission.

Nursing and Midwifery Council (2008). The NMC Code Of Professional Conduct: Standard of conduct, performance and ethics for nurses and midwives. NMC, London

Royal College of Nursing (2008). Defending Dignity: Opportunities and Challenges for Nursing. RCN, London.

Social Care Institute for Excellence (2006). Dignity in care. Great British.

Steven Richards, A. F. (2007). Working with THE MENTAL CAPACITY ACT 2005. Hampshire: Matrix Training Associates Ltd.

Webb, J. U. (2008) The application of ethical reasoning in mental health nursing. In: Dooher, J. (ed) Fundamental aspects of mental health nursing. London. Quay Books.

Woolhead, G, Calnan, M, Dieppe, P. & Tadd, W (2004) Dignity in older age- what do older people in the United Kingdom thinks? Age and Ageing, 33, 165-169.

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