REFLECTIVE WRITING INTRODUCTION Reflection is a tool that ios commonly used as part of student nurse education and in clinical practice.It can help to demonstrate everyday learning and is also useful for processing thoughtsafter a critical incident.It is often supported by the use of different models.A new model of reflection is Gibbs (1988) Model.It includes following steps: Describe the event Identify your feelings Evaluate the experience Analyse the experience Draw conclusions Draw up an action plan(Justine Barksby,N. A Whysall,2015) A clinical incident has been explained below using Gibbs (1988)Model DESCRIPTION The incident I will be reflecting on occurred while I was placed in a rest home in an aged care facility.It was an afternoon shift,second day into my placement. The day was going as per normal,nothing unusual out of ordinary.I was alone in the nurses station, documenting the wound care plan and evaluation form after performing a wound dressing of another resident.Some other residents were sitting near to the nurses station.The RN who was supervising me was in her break.I saw a 81 year old female who was diagnosed as Gastro oesophageal reflux disease ,walking towards me holding her stomach, reflecting discomfort from her face(Kenneth M Prkachin 2009).She was not able to elaborate her pain with me at first.Possibly, she was a bit hesitate to open, as I was an unfamiliar face for her.But it takes a few seconds to convey her feeling of pain to me. I was patiently waiting for what she is going to tell and I can read from her face that she is bit anxious(Snaith,R,Baugh,S.,Clayden,A.,Husain,A.,&Sipple, M.1982).She notified ”I had a burning sensation in my abdomen and chest”.She requested for the pain medication .I replied her that I am nursing student and the RN is not here and I will call the nurse for giving you the medication.(NZNO,Guidelines for nurses on the administration of Medicines,2012,content 9.6).At that time,I saw one of the caregiver is coming out of a resident‘s room.I assigned that caregiver to call the RN who is in break.I did not feel comfortable living her alone.When that resident feels me helpless,she became anxious and agitated.I make her sit in a chair and offered a cup of coffee and biscuits.Soon she became calm and settled .Meanwhile,I checked her vital signs and performed pain assessment PQRST(Horald Breivik,PC Borchgrevink,SM Allen,LA Rosseland,L Romundstad,EK Breivik Hals,G,2008) to rule out the provacating factor ,quality ,radiating, severity and timing. She mentioned that it is not a radiating to shoulders and arms,it is only a heartburn and scored 7/10 in pain scale.I auscultated her bowel sounds as she stated that she did not open her bowel for 3 days.She had decreased bowel sounds(Ferguson CM, 1990).I checked her bowel chart to confirm it. In between the RN came and administered Tab Buscopan 10 mg PRN for her colicky pain. FEELINGS Prior to the incident occuring ,I was so relaxed and confident in care of residents as I have done wound evaluation and wound dressing for another resident.Also I felt that I have full capability to dress the wound that results in healing and prevent complications.At the time of the incident,I felt helpless because I was not able to help her fully.This is due to the fact that as a student I cannot administer any medication to any of the resident without RN’s supervision(Kerry Reid-Searl,Brenda Happell,Karena J Burke,Cadeyrn J Gaskin,2003).In addition,I was so disappointed after realizing that although I do have the medical background,I could not able to manage this incident independently.Although, I recognizing and respecting the legal issues behind this situation(Scope of Practice for Student Nurses,March 2017 .Also I became nervous seeing her agitated as I could see she was in severe pain and also I was not aware of the time frame it will take RN to arrive onsite.However,I am so satisfied that I did some assessment before RN arrives,it greatly helped the RN to do plan of action.At the same time,there were other residents sitting near to the nurses station.From my observations what I could gather was a mixed reactions from them.Some residents exhibited nervousness and slight of scaredness ,while others were thoughtful ,some were engaging in their activities what they were doing before and there were some residents with no major reaction that could be picked up on. EVALUATION I would say through the whole situation,it was fairly easy for me to get the resident to open up about her pain, in order for me to assess the severeity of pain and to evaluate her bowel movements and manage the problems..It also realize me that even in unpredictable situation ,I could able to stay calm , think critically and take decision.The feeling of helplessness was a negative about this situation.Actually I was in a position where I needed RN’s supervision to give her PRN medication.Seeing the resident in so much pain and making her wait for RN made her more aggressive and anxious.It make her the feeling of mistrust and hatred towards me.In addition,me being able to take charge of the whole situation even when everything was not in favour ,would be what went well.I think that in this situation,while being in student placement restrained me from fully using my capabilities.Moreover,the caregiver helped me to call the RN ,otherwise I have to leave the resident with pain alone to call her into the situation. ANALYSIS Using my knowledge and previous experience,the resident develops Gastro oesophageal reflux disease as she was an ex smoker .According to an article Smoking and gastro oesophageal reflux disease (Pandolfino JE,et al.Eur J Gastroenterol Hepatol,2000),explains that smoking reduces lower oesophageal sphincter pressure and predisposes to stain – induced reflux.Smoking prolongs acid clearance by decreasing salivation.According to Scandinavian Journal of Gastrology (P J B oekema ,M Samsom ,GP Van Berge Henegouwen ,AJPM Smout,1999),states that coffee intake promotes gastro oesophageal reflux .According to European journal of gastroenterology and hepatology(Rolf Carlsson,John Dent,Richard Watts,Stuart Rilev,Raian Sheikh,Jan Hatlebakk, Kjell Huag,A Dalvag, O Junghard,I Wiklund 1998)describes the efficacy of Tab Omeprazole and reflux symptoms.The resident is on regular Tab Omeprazole 40mg for the reflux.According to Journal of Medical Hypotheses and Ideas,2015,Tab Omeprazole has an adverse effect of constipation. So this reflux disease, constipation and Tab Omeprazole are related with eachother.According to a research article(Sanna,L Stuart,A L,Berk. M et.al.2013),there is an association with anxiety and GORD related symptoms. Here,the resident had a history of anxiety. CONCLUSION I learnt the relation between smoking and GORD symptoms.Also I attained the knowledge regarding why constipation is common in residents who takes Tab Omeprazole.Now I am confident to manage an agitated resident who has pain,instead of becoming nervous . ACTION PLAN I should develop critical thinking ability to correlate the clinical picture with the book picture.If I am aware of the resident’s condition in detail ,I could have deal this situation more effectively than this.Also,I will offer some yoghurt,milk or some cool drinks,instead of cup of coffee and fried food items.I will educate the resident not to go for sleep soon after the meals as it cause regurgitation.I will educate the caregivers to monitor fluid intake and bowel movements of the residents and to maintain bowel chart daily.Also instruct the caregivers to offer kiwi fruits and prunes to prevent constipation.Psycological support will be given to the resident.