IntroductionThis assignment will reflect upon a critical incident within practice It will

IntroductionThis assignment will reflect upon a critical incident within practice. It will explore the principles of communication and consent but also dignity and respect surrounding the patient. This assignment will use a model of reflection to reflect upon the critical incident within this essay and will discuss the reasons for using that model. This assignment will use the pseudonym ‘Mrs Jones’ to refer to the patient. It will also not refer to the name of the health board, anything identifying staff and anything identifying other patients in our care at the time. This is according to the NMC confidentiality code written into the 2018 edition of the NMC code. This is so the identity of the patient is protected as they have a right for all of their information to be confidential. “As a nurse, midwife or nursing associate, you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately” (NMC 2018)What is reflection?Boud et al. (1985) describes reflection within the context of consciously looking and thinking about experiences, actions, emotions, feelings and responses then interpreting them in order to learn from them. Jasper (2003) describes a critical incident as a specific occurrence that happens to us that we can use as a focus for reflective activity. Utilising these for analysis using a structured framework enables us to build up a collection of evidence of our learning and development. The most common model of reflection is Gibbs’ model. Duffy (2007) critiqued this model and found that it was easy to use and was derived from education. The model focused on experience and learning from incident but found that the reflection can stop suddenly at any stage of framing action. Duffy also found that the model lacks a means of closure and is not focused specifically on practice. Gibbs’ model first starts by describing the event. For example, the location, who was there, what the scenario was and what happened. The second stage of the model is where reflection of feeling happened before the event, during the event and after the event. Stage three is the evaluation. This is where it is stated in the experience what went well but also what didn’t go quite as well. Stage four is the analysis. This is where reflection on what you and others did well, but also reflect on why something went wrong and what contributed to this. Stages five and six of Gibbs’ model is the conclusion of what has been learnt from the incident and then create an action plan as to if something similar happens again, what would be done? Another reflective model that could be used for the reflection is Borton’s development Framework (1970). This model is relatively simple as it has only three stages. Jasper (2003) endorses the use of this model by novice practitioners and students as this model allows novices to reflect in the “real world of practice” (Jasper 2003, p99), therefore allowing novices to be analytical of their developing practice. As described by JasperThis assignment will be using Gibbs’ model to reflect upon the critical incident. This is because it will explore the incident in more depth than using Borton’s Framework Model. It will help the reflection be explained in full detail with references to show where the information has come from. Describe the incidentThe critical incident I will be describing happened on the second day of my spoke placement. I will be describing how I took Mrs Jones’ blood pressure. I began by greeting Mrs Jones and asking how she was. I also told her my name and that I was a first year student nurse on my first placement. As Mrs Jones was a regular to the ward she wouldn’t know who I was so I found it best to introduce myself. I then asked Mrs Jones if I was able to take her observations. Mrs Jones agreed so I started my getting out the Adult Observation Chart and setting up the observation machine. Using the SOLER technique, I sat on a chair next to the patient so I was at their level. I made sure that I sat upright and was not slouched so if they had any hearing difficulties they would be able to hear me properly or see my lips to read them. I made sure to always make eye contact with the patient so they knew I was listening to everything they were saying but also understanding them as well. I received implied consent from Mrs Jones as she held out her arm to me when I asked “Can I take your blood pressure please Mrs Jones?” I showed Mrs Jones respect and kept her dignity by only rolling up her sleeve to expose their upper arm. I also offered to draw the curtains around Mrs Jones in case she wanted some privacy while she had her observations. Mrs Jones declined but I wanted to offer her all options to help keep her dignity. I took Mrs Jones bloody pressure as well as taking her heart rate, SPO2 levels, temperature and respirations and noted them onto the adult observation chart. Mrs Jones’ systolic blood pressure was raised which worried her. I reassured Mrs Jones that this was perfectly normal for her after I looked at the pattern of her BP observations. This relaxed Mrs Jones as she knew that it was nothing bad. Throughout taking Mrs Jones’ observations I talked to her casually but remained in a professional manner. This was so that Mrs Jones would remain calm and that none of her observations were affected. As Mrs Jones was one of the first patients I had taken clinical observations on, I felt nervous before taking them in case I did anything wrong. During the observations my confidence increased as I became more familiar with taking them and more confident using the equipment. I still felt unfamiliar with the observation chart so this made me feel a little panicked incase I put anything in the wrong place. After the incident I felt relieved that I had done well at taking observations. A lot of things went well during this incident. One thing for example was efficiently taking Mrs Jones observations while gaining her consent and communicating with her. I made sure to always check what I was doing was okay and that Mrs Jones was comfortable. After reflecting on my clinical practice, I have seen things that I have done well but also things that I could improve upon. The first thing I did well was communication. Throughout the whole process I made the patient calm by talking to her. We talked about what her observations showed. I reassured Mrs Jones by explaining the blood pressure was slightly elevated but all other observations were within normal parameters. I also talked to Mrs Jones about everyday life to make sure they felt well in themselves but also so I could do a social assessment. I was making sure that Mrs Jones didn’t have any issues at home or anything physically. If I found that Mrs Jones was perhaps struggling with the stairs at home I could put a social referral in. I could also do referrals to occupational therapy or physiotherapy if she was struggling with her mobility. The patient told me all about her condition and why she was on a certain drug to treat it. This gave me an insight to the patient which also helped me learn. Before my placement I researched the main parts of communication and found out about the SOLER theory. SOLER theory is an acronym for non-verbal communication (which stands for: “Sit squarely”; “Open posture”; “Lean towards the other”; “Eye contact; “Relax”) (Egan 1975). This theory gave me a basis of how I should communicate with my patient not only verbally but non verbally too. How I present myself to a patient is very important so if I present myself in the wrong way this would have a lasting negative impression on the patient. Another thing I did well was gaining consent from the patient. When I asked the patient if I was able to take their blood pressure, they held out their arm to me. This is known as implied consent. Collegea states that implied consent occurs through the actions or conduct of the patient rather than direct communication through words. For example, implied consent can be implied from patient’s nodding of the head, or by them showing up at the agreed upon time for surgery. I gained consent for every observation I did on the patient and mostly gained implied consent such as when the patient held out their arm or moved their hair to allow me to take their temperature with the tympanic thermometer. My priorities include always being respectful to patients as I have shown throughout my placement. From the moment I met them I made sure I called the patient ‘Mrs Jones’ as this is more respectful for them. I respected the patient by letting them have control. When asking if I could take their blood pressure, I let the patient choose which arm they would like me to do it in. This was the same for taking their temperature. I also did research before I started placement on how I can keep a patient’s dignity and respect. I found a checklist which showed me that giving the patient choice and control over their treatment was an example of keeping a patient’s dignity and respect. Another way I found was not using medical jargon. This confuses patients so I communicated with them in a way they would understand. From this incident, I have learnt how to effectively communicate with a patient while taking observations. It has also taught me how you need to change the way you interact with each patient. The way I communicated and acted with Mrs Jones was completely different to how I interacted with the next patient. This is because every individual is different and require different ways of interaction. I have also learnt how to act professional with the patient and learnt the boundaries between being friendly and being a professional. I have learnt that most patients give you implied consent when asking if you’re able to take their blood pressure. I found that they held out their arms to me when asked. Action PlanIf I was to be in this situation again I would be more confident. This reflection has shown me I am capable of doing the job and that I shouldn’t be so shy in clinical practice. I am familiar with the charts we are using so if I was to do it again I would take the observations and fill out the chart faster and more efficiently. This is because I am used to the format of the charts and will be able to operate the equipment too. ConclusionIn conclusion, this assignment has shown the main points of communication, consent and the keeping of dignity and respect of the patient. It has shown some models of reflection and sources to show which one is best to use. It has also shown reflection in practice ReferencesBoud et al – http://eprints.bournemouth.ac.uk/21394/3/Enhancing%2520skills%2520of%2520critical%2520reflection%2520for%2520BURO.docx.pdf Confidentiality – https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf Gibbs Model – https://www.brookes.ac.uk/students/upgrade/study-skills/reflective-writing-gibbs/ Duffy (2007) – Duffy, A. (2007) A Concept Analysis of Reflective Practice: Determining Its Value to Nurses. British Journal of Nursing, 16. (22): 1400-7. SOLER – Nurse Education in Practice, Volume 11, Issue 6, November 2011, Pages 395-398Implied Consent – https://www.colleaga.org/article/informed-consent-express-or-implied-consentChecklist – https://www.highspeedtraining.co.uk/hub/wp-content/uploads/2017/03/Human-Dignity-Respect.pdf

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