Writing Proficiency course free essay sample

The aim of this essay is to reflect on an incident, which took place in a hospital setting during the first month of my Foundation Degree Assistant Practitioner course. It will explore the importance of communication amongst the health care professionals and how a good nursing documentation is an integral part of nursing. It will also demonstrate how reflection enabled me to make sense of and learn from this experience, as well as identify any further learning developments needed to improve my practice and achieve the level of competency needed for when I qualify as an assistant practitioner. While discussing the knowledge underpinning practice, evidence based literature will be reviewed to support my discussion and for the purpose of reflection the essay will be written in the first person. Spouse, J, et al (2008). Jonhs, C (2009) defined reflection as learning through our every day experiences, towards realising one’s vision of desirable practice as a lived reality. He also added that it is a critical and a flexible process of self inquiry and transformation of being and becoming the practitioner you desire to be. However, Ghaye, T et al. (2000) stated that for the health care professionals to develop a more reflective posture, they must fully embrace both the principles and the practices of reflection. It is about becoming more aware of how we learn and how this affects what we think, feel and do. There are different models for reflection; some are more complex and detailed than others. To help me with my reflection, I have chosen Gibbs (1988) reflective cycle as a guide: The names of the patient, staff members and health care setting will be changed to protect their identity, and to abide by the Nurses and Midwifery Council code of conduct (NMC 2008). Description: Following my two week holiday, I returned to work on an early shift, which started with a handover. It was carried out in a private room to preserve the patient’s confidentiality, as the NHS is committed to the delivery of a first class confidential service. This means ensuring that all patients’ information is processed fairly, lawfully and transparently as possible according to the Department of health (2003). A copy of a handover sheet that contains: the patient’s name, age, consultant’s name, resuscitation statues, reason for admission, past medical history, and plans for discharge was given to all staff members. The nurse, in charge from the previous night, then gave an update of any changes that occurred during her shift and handed over any plans or procedures that needed to be carried out on the day. After the handover, the nurse in charge, who I am going to name Helen, allocated duties to each member of staff. I was given a bay with four female patients to look after and I was responsible for assisting them with their personal care, taking and recording their observation and assisting them with any other needs they may have had. Mrs. Smith was an 88 year old lady who was admitted with a urine tract infection and dehydration. She was bed bound, needed all care and normally lives in a nursing home. It was the first time I had met Mrs Smith, so I introduced myself, asked her how she was feeling and if she wanted to have a bed bath. She was very pleasant and stated that she would appreciate my assistance. After washing my hands, thoroughly, in line with the infection control policy (Buckinghamshire trust 2010), I assembled all the necessary equipments needed for this task and closed the curtains securely to ensure Mrs. Smith’s dignity and privacy in accordance with the NMC (2010). I started washing Mrs Smith, making sure I was talking her through what I was doing step by step; I got to the point where I needed to change the bed linen and Mrs Smith was very cooperative, turning to her side to facilitate the move. I was very close to her brushing her hair, when suddenly she punched me very hard to the right side of my head. Feelings: I was so shocked by Mrs Smith’s action. I stepped back and asked her why she hit me when I was helping her. I went out of the bay and called Helen and told her what had happened. She stated that Mrs Smith was known to have mood changes and be aggressive due to her dementia, which explained why she behaved that way. Mrs Smith suffered from Fronto-Temporal dementia, which is caused by damage to parts of the brain that help control emotional responses and behaviour. Therefore, many of the initial symptoms involve changes in emotion, personality and behaviour. NHS choices (2010). In a way, I felt better that it was nothing personal against me, however I felt angry that I was not warned by Helen, or other staff members that Mrs Smith can be aggressive. When I checked the handover sheet, dementia was written in the Colum for the medical history for Mrs Smith, but checking the  previous entries in medical notes it only stated:†patient confused at times†. According to Alzheimer’s society (2011), it is important that all staffs are aware of the person’s dementia while in hospital. Any additional information that carers and family can give is valuable as it will help staff to see and respond to the person as an individual. The nurse in charge should explain to other members of staff how the person’s dementia can affect their behaviour and communication. Evaluation: After finishing my duties in my bay, I checked Mrs Smith nursing assessment which stated that she is prone to behaviour change and can be aggressive. I went for my lunch break and started reflecting on what had happened. My first reaction was to blame the incident on the lack of communication and a poor handover from the previous shift. Johns, c (2000) suggests that the verbal handover might be considered the most significant form of communication. To reinforce their value within our every day practice, written notes need to be actively utilised when handover of care takes place. By using reflection, I realised that I was to blame just as much for not referring to Mrs Smith’s medical notes and nursing assessment prior to caring for her, and that both communication and a good documentation complement each other. Crawford, P et al (2006) stated that communication in any form: non-verbal, verbal or written is a powerful action that can change people’s lives for better or worse. Whatever our clinical focus, very different results can emerge from process of caring for others depending on how we communicate. Analysis: Trying to make sense of what happened, as Gibbs, G (1988) encourages the reflector to do, I realised that this situation has been a wakeup call for me. Having been a health care assistant for a long time, prior to starting the assistant practitioner course, I was arrogant in thinking my long years experience would allow me to deal with any situation. It has also made think of the importance of paying attention during the handover and reading the patient notes and nursing assessment, even if I already know the patient. According to Taylor, H (2005), a nurse may conduct assessments on both new and existing patients. She added that even when a nurse has been caring for the patient for some time, they will need to obtain information from other  nurses and healthcare workers, because no nurse works 24/7. The effective communication of information is therefore vital if nurses are to be fully informed about their patient and able to make a reliable assessment. Conclusion: Although I felt bad about the situation, the fact remains that this incident and the circumstances surrounding it have since been a learning situation. The good and bad aspect of it remains in the memory. I had since learned that communication and a good documentation are vital in nursing as they are a reflection of the standard of the practitioner’s professional practice. NMC (2004) believe that a good documentation is a mark of the skilled and safe practitioner, whilst careless or incomplete documentation often highlights wider problems with the individual’s practice. Action plan: Following the incident, I discussed what had happened with my mentor and explained that I had identified my mistake and I would like to improve my practice. She set an action plan for me, within my placement, to enable me to be more involved in patients’ nursing assessments and medical notes. Since practice makes perfect, I have been involved in completing and updating the nursing assessment for the new and existing patients with my mentor and associate mentor every time I have a chance to. I also researched communication and documentation in various websites and journals which made me more aware of the implication of inaccurate documentation, and the importance of communicating effectively with my colleagues to ensure the best care for my patients. So now I make sure that any nursing entry I make in the patients’ notes are clearly written, accurately dated, timed and signed and countersigned by the nurse in charge. Conclusion: This essay highlights the importance of reflection as a strategy for learning from previous experiences. In using Gibbs, G (1988) module of reflection I was able to identify my weaknesses in practice, follow an action plan and achieve the required level of competency to ensure a better practice in the future. It has also taught me that I can turn a negative experience into a positive one. My awareness concerning communication and documentation has been enhanced using reflection, furthermore I realised that reflection is an  important tool in practice which I intend to use throughout my career in nursing.