I will be reflecting on my clinical practice to will improve my

I will be reflecting on my clinical practice to will improve my professional practice for the foreseeable future and because it will help me learn from my mistakes and improve my patient care (Nixon, 2013). It is apparent that reflection in practice is a fundamental part of health care practice and should be used by all healthcare professionals as a requirement (Nikon, 2013). There are many definitions for reflection, though I have chosen one: a process of reviewing an experience of practice in order to describe, analyse, evaluate and inform learning in practice (Reid, 1993). It is important to consider that true reflection is an honest process and should contain purposes such as personal self-awareness and professional development (Blaber, 2008). By the end of my reflection, I am hoping to progress my clinical development, but also aim to maintain positive mental health by encouraging analysis of practice (Blaber, 2008). I will reflect on my clinical practice by identifying what I have practiced correctly and/ or incorrectly and how a professional would practice a similar task for self-improvement. Additionally, I will identify what I have learnt or lack of through clinical practice by discussing the skills of: communication, teamwork and patient handling.What- Bariatrics patient My clinical practice entailed a bariatric patient that required a transportation from her bariatric bed in her home to a specialised ambulance. In total, this job needed 5 people. I was aware that this patient weighed over 260kg, but not her exact weight. There was basic equipment being used; which were large slide sheets and one bariatric board in preparation to transport the patient to the bariatric vehicle. Throughout this task, I opted the role of one of the main communicators to ensure everyone was aware what they were doing at the same time, for example, to lift and transport the patient as a team. I also volunteered for this role due to possessing a lack of confidence because I felt nervous to handle the patient at first. For one of the lead communicators, I positioned myself at the front of the bariatric bed for all the crew to clearly see and hear me for quality team work. My reaction was shock and nervousness as I approached the home because it was my first bariatrics patient encounter, though I feel more confident presently with the use of reflecting upon practice.So What, what nowThroughout this task, verbal communication was the chief skill used from the team involved to be able to appropriately handle the patient safely and with absolute care. It was important that everyone knew what was going on what was occurring around themselves, thus why I was a communicator of the group. However, there was an inkling of self-doubt and fear of getting the task wrong because my team had more experience in the matter than I. The patients husband was present during the whole task, which is when the question of safeguarding should be raised. Although, safeguarding did not have to come into action as the environment and surrounding people were identified as safe by myself and the team. It was important to be polite and considerate towards the patient as I was are she may have felt belittled compared to other patients. This embarrassment can perhaps be as a result of her obesity and due to the involvement of five handlers as this is rather uncommon in most circumstances. Although, it is important to consider the appropriate number of handlers, thus, was well thought-out (Smith, 2011). To continue, it is important to act professionally while ensuring (negative) personal judgements, prejudices and beliefs do not compromise the care of the patient (Webb, 2011). I think this theory is important and although I acted professionally, the weight of the bariatrics patient shocked me. To improve on this skill, I should be more aware of the various people that make up the UK’s population in order not to feel anxious through another bariatrics encounter; because of this, I was avoiding most handling because I merely did not know how to deal with such a large lady. Compassion can be identified as understanding another’s needs (Smith and Field, 2011). Even though I projected the outmost respect and dignity towards the patient, I could not help feeling uncomfortable by her obesity and how she was unable to stand for herself. To improve this, I feel I could research into obesity to understand others’ health problems and gain a more well-rounded view.The HCPC (2016) expresses the importance of trust and honesty. For example, I was honest of my skills, experience and role as a student paramedic to the patient and in return I feel I gained her trust. The general analysis for dignity can be identified as a universal value and that caring should be viewed as an ultimate value in order to guide’s one’s actions (Morrison and Burnard, 1991, 1997). In relation to the care of the patient, I ensured dignity and respect was one of my main focuses. For example, to ensure she was covered up if necessary and that she was stable on the bariatric bed as there was little privacy within the neighbourhood. Dignity and privacy is important for basic human rights and respect towards the patient (Smith, B, 2011). Dignity can include not patronising the patient and making them the centre of care being received. For privacy, Smith, B (2011) emphasizes the importance of appropriate clothing. This should include blankets to respect the patient’s privacy and modestly. I believe I followed this suggestion automatically because it was cold outside when transporting her to the vehicle. Safeguarding was an issue I needed to carefully consider through my whole clinical placement to protect vulnerable people, according to the North east ambulance service (2018). I considered safeguarding through the transportation of the bariatrics patient but could confirm that I did not need to take safeguarding action because I did not feel there was any concern within the environment or between her husband, who was present. However, if need be, I know to assure them and to remain calm in high stress situations. (neas, 2018). In addition to handling the patient: according to Smith, J (2011) handling for bariatrics, we should consider sliding the patient towards the edge of their bed in opposite direction of the transport bed to accommodate abdominal pannus, we should also consider asking them to attempt to move themselves. With help from Smith’ guide, I have correctly carried out this manoeuvre with my team, which can approve pre-hospital care and transport for a bariatric patient. Although, I did rely more on my team for the handling of the bariatrics patient because of my nervousness; this is where I would mostly communicate to the team and guide them with handling the patient when I was in a better position to view. Smith, J (2011) also recommends using repositioning sheets and slide sheets in order to reposition the patient correctly on the bed. I can confirm that this suggestive handling technique was carried out as it was the only equipment used by our team. According to the Royal college of nursing (1997), there is a growing number of overweight people and so handlers should trust the equipment used while also being trained to use them. As a reflection to myself, I believe part of my anxiousness towards this task could have been related to fear of using the equipment incorrectly, this problem can now be solved in the future.Smith, J (2011) also encourages patient safety and care. For example, she discusses the importance of planning the manoeuvre and not acting without planning. Smith highlights the importance of discussing the task between the team, while ensuring the patient is comfortable and at ease. Myself and the team discussed various ways of handling the patient with everyone’s input involved. The most communication was delivered by the PTS team as they held more experience than I. However, we could all make a conclusive decision as to what wold be most effective and appropriate in a short duration. This is where communication and team work became most effective through the task. I can further improve this skill by involving myself more and not feeling as pressured by a team with far more experience than me. I have more experience and skills for a bariatrics patient for foreseeable handlings. According to the HSE (2018) on handling, employers should: follow appropriate systems of work, co-operate with their employer and take reasonable care to ensure their actions do not put themselves or others at risk. I believe I correctly followed this guide because I did not put anyone (or myself) at any risk, whilst ensuring the effectiveness of team around me. Furthermore, team work can intertwine with the skill of communication as I believe it is ineffective without clear and verbally projective communication. I ensured my communication was projective, clear and concise for everyone to be thoroughly aware of what was occurring. For example, we had to work as a strong team to be able to move the patient from her bed to the transport bed via speaking to each other and guiding each other. I feel as though my communication has improved, specifically towards a bariatric patient as this was my first bariatric transport encounter. I now know how to effectively communicate to them compared to various other patients. An example of different communication for a bariatrics can entail of precise communication in a small duration; this is because the person needs transport, so a reassuring conversation is sufficing to then act and handle.Finally, it is understandable that a risk assessment is most important for myself, the crew and the patient; the environment should be assessed and attempted to lower risks (HSE, 2018). However, I can confess that I did not carry out a thorough risk assessment of the environment (her home). I should have indeed carried out a moving and handling assessment, to include the consideration of the person’s needs and ability, task, load and finally environment. A safety assessment was unable to be carried out as we had to proceed to task of bariatric transportation due to the practice had already begun. Simple generic assessments were not personally carried out by myself, such as where the fire exits are in the home and whether there was the appropriate and correct equipment involved as I relied on the pervious team to have the correct equipment prepared for use. This is certainly a simple skill that I should have been aware of and can develop and rectify in the future. To continue, an individual assessment was neither carried out, i.e. I was unware whether the bariatric patient was deaf, unable to verbally communicate independently, or even move independently. This is a disadvantage as I arrived on scene completely oblivious as to what was expected. To improve this in the future, I should request the patient’s current situation and history before arriving on scene by asking my team (HSE, 2018).ConclusionTo conclude, there are skills that I can progress in the future for paramedic practice. However, I have considerable and appropriate skills for which I correctly used throughout my clinical practice. I particularly believe my teamwork and communication skills were effective and of quality through my clinical experience, which is proven with evidence from guidelines and voices of health care professionals. For the future, I can further improve incorrect, or lack of, skills through clinical practice by producing a reflective diary during my clinical experience (Webb, 2011), this can help me to identify what I do correctly or incorrectly and ensure my skills and knowledge are up to date to practise safely. I feel I have demonstrated the ability to practice within legal, ethical and professional frameworks. All-in-all, I am satisfied with the standard of skills I currently possess and how I was able to use them during my clinical experience. However, there is still substantial skills I can further improve for the foreseeable future with some experience for a bariatrics patient encounter.References:• Blaber, A. (2008). Foundations for paramedic practice: a theoretical perspective. Mc Graw Hill.• Reid, B. (1993). ‘But we’re doing it already’ exploring a response to the concept of reflective practice in order to improve its facilitation. Nurse Education today, 13(4), 305-309.• Galloway, J. (2018). Dignity, values, attitudes, and person-centred care. [online] Esht.nhs.uk. Available at: https://www.esht.nhs.uk/wp-content/uploads/2017/08/Dignity-values-attitudes-and-person-centred-care.pdf [Accessed 17 Dec. 2018].• HCPC. (2016). Standards of conduct, performance and ethics |. [online] hcpc-uk.org. Available at: https://www.hcpc-uk.org/standards/standards-of-conduct-performance-and-ethics/ [Accessed 17 Dec. 2018].• HSE. (2018). Moving and handling in health and social care: What you need to do. [online] Available at: http://www.hse.gov.uk/healthservices/moving-handling-do.htm [Accessed 17 Dec. 2018].• Morrison, P and Burnard, P. (1991, 1997). Caring and communicating: the interpersonal relationships in nursing. 2nd ed. Macmillan press ltd.• Neasnhs (2018). Safeguarding Patients – North East Ambulance Service – NHS Foundation Trust. [online] Available at: https://www.neas.nhs.uk/patient-info/safeguarding-patients.aspx [Accessed 18 Dec. 2018].• Nikon, V. (2013). Professional practice in paramedic, emergency and urgent care. 1st ed. John Wiley & sons, ltd.• Patientsafety (2018). Teamwork and communication | Patient Safety Resource Centre – The Health Foundation. [online] Available at: https://patientsafety.health.org.uk/area-of-care/safety-management/teamwork-and-communication [Accessed 12 Dec. 2018].• Royal college of nursing. (1997) the guide to the handling of patients. 4th ed. National back pain association.• Royal College of Nursing. (2015). Communication. [online] Available at: http://rcnhca.org.uk/top-page-001/ [Accessed 21 Dec. 2018]. • Smith, J. (2011). The Guide To The Handing of People: A Systems Approach. 6th ed. BackCare.• Smith, B. (2011). Nursing & health: Compassion, Caring and Communication- survival guide. Pearson education ltd.• Smith, B and Field, L. (2011). Nursing care: An essential guide for nurses and healthcare workers in primary and secondary care. 2nd ed. Pearson education ltd.• Webb, L. (2011). Nursing: communication skills in practice. Oxford university press.

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