The model of reflection I will be using is Kolb’s Learning Cycle (1984) there are four stages to the cycle, One, Experience and throughout our lives we have ample occasions to learn from. Two, reflect we use this as an opening to think about what we have seen, learnt or undergone, reflection can be instinctive or must be learnt by reflection on every opportunity. Three, conceptualise here we begging to understand and decipher what we are reflecting upon and we start to make suggestions about the implications of what we have experienced. Fourthly the plan this is where we experiment with what we have implemented to see if this has criticised or assisted the hypotheses. We need to adapt our learning to gain every opportunity of knowledge and to help us we must pass through Kolb’s stages completely. As it states in his model by reflecting on our experiences, interpreting them and testing our interpretations. I will be using Kolb’s to reflect upon two events that have occurred while I have been on placement to reflect is the foundation of a good and proficient individual, this model of reflection will suit my style of writing and learning.I will be reflecting on an event in the operating theatre which could have changed a patient’s life but due to the surgeon’s experience and professionalism the outcome was positive. The operation was a laparoscopic assisted vaginal hysterectomy and bilateral splpingo oophorectomy the patient had consent to this, and the surgical safety checklist had been completed. I had been asked to scrub for this operation with a scrub nurse for the experience. A scrub nurse is defined as a nurse who has cleaned arms and hands, donned sterile gloves and, usually, a sterile gown, to assist an operating surgeon, primarily by-passing instruments TheFreeDictionary.com. (2019). The surgeon had a registrar with them and was teaching about the procedure and agreed to teach me too. They let the registrar assist them and she caught the bladder at this time the surgeon regained control over the procedure and asked if the senior nurse could find another Gynaecologist or Urologist that could work laparoscopic in the hospital. It was established that no other surgeon’s where available to support her, so she made the decision to open the abdomen and perform the procedure and repair the bladder. As the operation had changed, I asked if I could descrub so I would not be in the way and for safe practice also the senior nurse was scrubbing in to help the surgeon. As a student I have a duty of care to point out to my mentor that I am unable to perform the duties they have given me so not to endanger the patient, the team and myself (Eveleigh, 2018). Each professional has skills applicable to each phrase of care required whilst providing the best care possible and promoting the upmost safe environment for the individual (Ndoro, 2014). The procedure was carried out and both the hysterectomy and bladder repair were done, and the operation ended.This was the first hysterectomy I had seen and being scrubbed for this I was pleased to have the experience. Holly Veness (2019) stated that learning opportunities are ongoing upon qualification; however, as a registered nurse you will not get as many chances to embrace experiences that are available to you as a student. I was asked to perform the sign in from the safety checklist knowing the importance of this I felt nervous and my voice faltered at the beginning. The World Health Organisation (2009) implemented the safety checklist it comprises of the sign in this is before anaesthesia, time out this occurs before the knife has touched the skin and sign out happens as the operation is coming to an end and all the equipment used is counted in correctly. Gillespie and Marshall (2015) wrote that the checklist enhanced the quality of patient safety and established superior teamwork nevertheless the accordance of its use is varying. As the procedure progressed I was able to watch it on the screen and learn about the equipment which was used I felt exhilarated I was able to be there and be part of the team working which evolves the knowledge of healthcare by collaborating with other professionals (Massimi et al, 2017) as working together improves results for all involved and essentially the patient (Meyer, 2016). When the operating procedure changed the surgeon kept her head and brought a calming to the theatre reassuring the registrar and nurses. I knew that the patient would of been told of this possibility before in her consultations and consent for the operation was given and check before the procedure started consent must be gained voluntary and the patient must have all relevant information given and the patient must have capacity to understand and made decisions for it to be valid (National Health Service 2019). I tried hard to imagine how I would feel if this was me and I knew I would be angry not at anyone but that it was me it had happened too. The operation was laparoscopic, when the registrar had pierced the bladder the catheter bag inflated like a balloon due to the gasses in the abdomen giving her confirmation of the incident. Due to the bladder being damaged the patient will leave hospital with an indwelling catheter while the bladder heals, and it will be removed within the month. After the surgery had finished the surgeon got the team together and thanked us she said she would see the patient before leaving the hospital to inform her of the problems that occurred during surgery this is backed up by the Duty of Candour this regulation safeguards the patient or person acting on their behalf that the organisation and person giving treatment are open, honest and clear with the care and treatment they receive(Quality care commission 2017), NHS(2019) say having a clear purpose for engaging patients and the public, rather than doing so because it is seen as the right thing to do. This is agreed in section 14 of The Code (A,2018) which states we must Be open and candid with all service users about all aspects of care and treatment, including when any mistakes or harm have taken place. Due to the unforeseen circumstances an incident form would need to be completed too, this is to report accidental, unforeseen or unexpected occurrences that may lead to the patient being injured or when a patient has been injured whilst in the care of the NHS, NHS (2009). We do these for the patient’s safety and our learning experiences. To conclude through my experience in the operation it has become clear the importance of collaborative working to provide the best patient centred care and the understanding of patient safety and that it is there to benefit both the patient and healthcare worker. Experiences can have a positive and good outcome and by owning up to our mistakes and apologising for them as it is the individual who need to be at the centre of everything we do and working collaboratively can ensure they remain the focus. My second reflection surrounds learning disabilities, there are people with learning difficulties that manage to live independent lives bur may take additional time to acquire new skills. Cares may be need for activities of daily living for some whilst others may have multiple disabilities NHS (2018). Our patient was able to live independently in sheltered accommodation where cares checked daily to see if he was managing. When we arrived at his flat, we gained access and obtained consent for treatment which was to be wound care on both legs and complete the assessments in the community nursing notes. As Healthcare professionals we have to gain consent before any procedure and the guidance for consent to treatment must not be forced on the patient because we want him to have treatment but he must be able to understand in a language he can interpret and retain so he knows what treatment he will receive and the good it will do him and his health Dartford and Gravesham NHS Trust(2019). I introduced myself as a student nurse and asked if he agreed to me performing his treatment as I am competent at the procedures, that I was performing as working with in the Code (B,2018) I strive to update and keep abreast of my skills and knowledge I will need for successful and safe practice. Explaining what I would be doing on our visit I kept repeating myself to see if he understood as when we communicate with people who have learning disabilities, we adapt our body language, how we use words and the tone of our voice as talking and listening isn’t all what communication is about Mencap (2019). As I dress his wound I try and encourage him to eat healthy to help heal the wound alongside the treatment he is receiving. Being one of the largely essential medical issue nutrition is overlooked in chronic wounds as a major problem when they are being managed (Molnar, Underdown and Clark, 2014). The assessment required today was the skin inspection, the trust we work for uses the Waterlow score ( see appendix 1) for this it is a pressure ulcer risk assessment/prevention tool and is reviewed monthly or if any variations in circumstances with the patient’s health to establish if the patient requires any treatment or pressure relieving equipment (Judy-waterlow.co.uk, 2007). He allowed me to assess his skin and it was all intact I recapped the importance of good nutrition and to keep moving to help his skin keep intact. I recorded what I had done in the patient’s community notes as I did this, I followed SMART, Specific and clear measurable achievable and realistic related to the assessment of need and the overall concerns time related (Dchs.nhs.uk, 2019).Having met and talked to the patient I agree with the paper People with Learning Disabilities in England (2015) in which it says, “People with learning disabilities have more difficulty than others identifying ordinary health problems and getting treatment for them”. He told me he did not mix much with others preferring his own company he did like to see the carers daily but felt like people were looking at him if he went out, I tried to reassure him this would not always be the case. In Emma’s story she identifies that living with learning difficulties she lives with the bereavement of what life might have held for her (Intellectualdisability.info, 2019). Especially when I am nursing people with or without any disabilities, I must always be aware of how I converse with people and what impression my own opinions and ideas has on them. If they have difficulty in communicating themselves, I must be able to distinguish this and react successfully (Nmc.org.uk, 2019). In conclusion I believe to become a good nurse you have to Make Every Contact Count (MECC) this inspires all health care professionals to use every visit we have to make constructive improvements for future visits and beyond, whilst we are treating and interacting with our patient (Health Education England, 2019). People with learning difficulties can with beneficial encouragement live a healthier and improved longer life, just because they have learning difficulties, they do not need to have poorer health (Assets.publishing.service.gov.uk, 2017).