The aim of this assignment is based on the reflective account as

The aim of this assignment is based on the reflective account as well as the episode of care I was included within the clinical placement. The patient’s name will be mentioned as Mr. A, this to maintain privacy and confidentiality in the procedure to nursing and midwifery council [NMC 2015 p.08]. Which state that the patient information should be regarded as the same way as confidentiality and must be exercised for only the purpose for which it was given, this is to make sure that they are informed about their care and that the information about them is shared carefully. This essay will provide attention to my feelings, my experiences and in ways, I had shown my relationship with someone that has dementia and who is moaning of severe pain. Management and leadership styles will be taking into consideration as well as political, moral and legal elements which will direct patient’s care. Prioritizing, organizing and provision of care will be looked at within the patient care and teamwork. Self-awareness will be used in the management foundation, this is by leadership and qualities which was intended for the patient. To give a high-quality standard of care, you must develop your own performance, be able to manage the ways you are reasoning as well as developing yourself and successfully involved in good rapport. I would be applying [Gibbs 1988] reflective cycle as a guide for this assignment. The reason for using Gibbs cycles is that Gibbs makes it clear and accurate by allowing for narrative, analysis as well as evaluation aimed for the experience by helping the reflective practitioners to create a sense of knowledge and sympathetic on their own practices. Gibbs make available with a useful framework of reflecting in theoretical and is usually after practice achievement, he does not provide the means to close the cycle, but to move the reflective practice in the form of acting [Jasper 2003] p85. Gibbs make available with a useful framework of reflecting in theoretical and is usually after practice achievement, he does not provide the means to close the cycle, but to move the reflective practice in the form of acting [Jasper 2013] p85. Gibbs consists of six steps which are [A] Description; this describes, where were you? what happens? when did it happen? In managing the patient’s case who was admitted into the clinical wards as well as in managing his postoperatively with right fractured necks of femurs and total knee replacement. [B] Feelings this described your thought, your self-awareness, what were you thinking at the period, what did these makes you feel, how did you feel when the event started. [C] Evaluation this described my experience around what was good about my experience and what was bad about the experience or did not go well. [D] Analysis this described what went well, what did I not do well and what the others do well. [E] conclusion this described what could have done differently.[F] Action plans at this stage if I encounter this problem again and to plan what I will do; would I act differently or do the same. [Jasper 2013]. self-awareness is the process of understanding one’s own beliefs, thoughts, motivation, biases and limitation and recognizing how they affect the care and services provided [Whetten and Cameron 2010]. Without being self-awareness, recognizing our personal and cultural beliefs and understanding interpersonal strengths and limitation, it will be impossible to create and maintain an effective relationship with our co-workers and among the patients. According to [Burnard 2002 p.30-31] defined self-awareness as ‘’a gradual and continual process of noticing and exploring aspects of the self whether behavioural, psychological or physical with the intention to develop personally as well as social perceptive to become more aware of ourselves as well as to developed a deeper knowledge of ourselves, by having a sharper as well as clearer picture of what is happening to others.’’ Maslow [1954] defined self-actualization as the maximum phase of needs by improving the capability to spread the performance of individual awareness, the success as well as competence. As a student nurse, it is essential that we must aware of our weakness and strength also conscious of any limitation or constraints. [Boros,2009 p.23] cited in [Oelofsen,2012 p.3] Defined reflective practice ‘’as the process involved in making sense of events, situations, or actions that occur in practice settings; reflection, this sense highlights a thoughtful, method of understanding your personal experience, in real time or retrospectively’’ [Bolton 2005 p.2] described reflective practice as a state of mind , an ongoing attitude to work and life and it enable the professional to learn from experience about themselves, their works, the way they relate to home and work.DESCRIPTION In my clinical ward placement, I was attached to MR. A who is 72 years old man and had been admitted a day earlier from care home with fracture right neck of the femur as well as a hip replacement as a result of a fall. The moment I reached the ward with my supervisor, the night nurse gave us the bedside handovers on the bay and told us that MR. A has dementia Alzheimer’s disease and diagnosed with acute pain. Alzheimer’s disease is a disease of the central nervous system that manifests as a cognitive disorder. [Gulanick, 2012 p.544]. That his blood pressure was low, and he has a high pulse rate. As I approached MR. A to assist him with his personal care, he said to me in an angry way that he is in serious pain, and at that occasion, my supervisor was given another patient personal care in the ward. I turn out to be conscious of the stress and the pain Mr. A was, also his wound was oozing. He was shouting and speaking angrily that he needs a stronger painkiller. I familiarise with Mr. A to take consent to make a good relationship as well as to start good nursing and patient’s rapport. According to the NMC [2015 p.07] stated that nurses must always balance the need to act in the best interests of people with the requirement to respect a person’s right to accept or refuse treatment and that properly informed consent should be sought and documented before carrying out any action, to make sure that their dignity is preserved and their needs are recognised. While I bent down to support Mr. A, he started to swear utterly and noisily at me, and I felt concerned that other staffs and patients would become aware of the noises and wonder what was going on, I was surprised as I have never been physically approached in that way before. I tried to reassure him that I will speak to my supervisor and that I will let him know the outcome, I told my supervisor that MR. A was very aggressive and complaining of pains and I informed my other colleagues and we keep the nurse in charge updated with the patient. My supervisor said he needs some strong painkillers as he is in serious pain, and we both checked Mr. A medication prescription and found that he is on oral morphine 10mg four hourly because of his age and has been documented that he has been given the remaining dosage two hours ago, my supervisor enlightened me that next time before I come to her, I should make sure that I have done Mr. A vital sign and encouraged him to drink a lot of fluids as well as his care plan check or patient notes and that Mr. A may possibly require an additional in dosage and his doctor was informed. FEELINGS Originally my impression at the time was that I was worried that my act has triggered him to feel frightened and wants to protect himself and that he might be in serious pain as well there is needed to give him stronger painkillers which must be our focus on. The international association for the study of pain [IASP]. cited in [Gulanick 2012 p.149] defined ‘’pain as unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage’’. Pain may arise from emotional, psychological, cultural, or spiritual distress. Pain can be difficult to explain because it is unique and as such should be treated differently and this can be challenging, especially in older patients in whom cognitive impairment and sensory-perceptual deficits are more common. [Gulanick 2012 p.144]. I felt guilty, but I stayed calm and tried to think of what I have done wrong. I felt ashamed however my supervisor encouraged me, and that Mr. A will possibly require a re-examination by his doctor to review his pain. I felt uncomfortable during the interaction as well as communicating among my colleagues, I then explained to MR. A that he will need to be re-evaluation through his doctor in order to boost or amend his drug and that his doctor had been informed and has been recorded. EVALUATION I had prepared with Mr. A personal care but been my first time to work with a patient that has dementia as well in pain, I need to learn many things and understand how pain can be controlled or managed as well as how to deal with the challenge’s behaviour. I felt self-confidence by providing privacy, dignity, choices as well as respect for Mr. A but also aware of my colleagues for I felt uncomfortable around communicating with them. [Verderer 1998] cited in, communication in nursing practice p65. defined ‘’communication as transaction and message creation consisting of physical space, cultural and social values as well as psychological conditions also he further explained that communication aid the accurate performance, consistent and by means of nurse easy work, by ensuring equal satisfaction for the patients as well as the health professional’s safety. While communicating with someone that has dementia, it is very important to avoid damaging their confidence, self-esteem and willingness to express themselves, [Miller, 2002 cited in Morris and Morris,2010]. According to [McDonald 2016] concluded that poor communication can lead to nervousness and unhappiness. I was involved in Mr. A care by monitoring Mr. A vital sign and recording his fluids balanced chart and urine output accurately. Mr. A was in an aggressive mood that morning, I had made sure that I familiarised myself to him and took his consent so that I can start a successful patient’s nursing relationship. My supervisor explained to me that when a patient in serious pain as well on patient control analgesia [PCA] or medication they need to be monitor closely because of the reaction of the drugs, such as vomiting and nausea, dehydration and constipation and also stated that vital signs must be monitor closely for changes and must immediately act to properly because observation take priority over other nursing intervention. After Mr. A medication had been reviewed by his doctor his morphine was increase to 20mg and 1000g of paracetamol was added to his drug every four hours to lessen the pain as well as minimize the risk of infection or any contradictions. What was worse was that I was sworn at and I was shocked until I get home. ANALYSIS Mr. A did not recollect what he had done towards me, this is as a result of his dementia, I understood that he had not purposely aimed to swear on me as this is as a result of aggressive behaviour due to his dementia and may be a way of safeguarding himself when he believed he had been threatened. The entire procedure takes place as I came into the ward that Mr. A told me that he is in pain and swear on me till this day has remained exciting and progress for me. Since the period of the incident, I have read further on how pain can be managed, in what way to communicate with somebody who has dementia as well in what way to manage challenging performance, I also understood that this must be expected in this type of patient once they are not in their recognized environment. Mr. A was provided with an option to increase his morphine to manage his pain although it has a benefit of lessening the pain, but it causes vomiting and nausea as this is as a result of the reaction, although antiemetics needed to be given to reduce the effect of vomiting and nausea as well as laxatives was prescribed for constipation. I contributed mostly in the monitoring and observing Mr. A blood pressure, respiratory rate, temperature and monitoring the fluids intake and the urine output and recording them accurately. according to what my supervisor said, she said that it is necessary to maintain good fluid balanced and recorded it accurately because it maintains a stable internal environment. I felt I had provided good health promotion in encouraging Mr. A to take on some of his own needs.CONCLUSION I now feel that I could have done a lot in this situation by remained with Mr. A then attempt to calm him down, but then again, I have not developed the experience of dealing with someone that has aggressive behaviour and I did not understand what to do as at the time, as this is my first assignment in clinical ward, what I could have done otherwise from the first moment that I went to Mr. A is that I should have looked at his care plan, his patient notes, check his medication chart, his personal hygiene needs care note and to check if it is really a good idea to work with dementia and aggressive person alone. We ran out of time to do the dressing of his wound and had to record it and hand this over. [According to the NMC,2015 p.11] stated that good record keeping is an integral part of nursing and midwifery council practice and is essential to provide safe and effective care and records must be accurately complete without any falsification. It demonstrates and communicates how decisions were made and it also enhances continuity of care within the multi-disciplinary teams. To minimize the likelihood of error, managing a patient’s care, there will be necessary for accurate documentation for the drugs coming in and out of the patient’s drug chart. I had made known to recognize that pains might not be completely objective but on other hands subjective and take into consideration the constituent of feeling as well as the individual experience [Braun et al 2003]. ACTION PLAN In the future, I will know how to prepare and well organize for someone with dementia as well as to being violent. I will continue to reflect on it and studied how acute pain will be managed, the significant, and the roles of nursing as well as how to look at the patient’s documentation. I would be more organized and takes more time to reassure and talk with the someone with dementia as well as making sure that I get their permission and avoid working alone by myself in a situation of an aggressive person. To improve pain management, assessment tools must be used especially in acute pain, such as verbal descriptor scale [VAD], this is quick and easy to use, it is valid and fits with the world health organization analgesic ladder and it is a preferred scale for older people, reliable and valid with cognitive patient impairment [Bird, 2005]. According to [Macintyre and Schug 2014 p.3] stated that treatment of acute pain is important not only for the humanitarian reasons but also because it may lead to better patient outcome both in the short and long term. I will do more research on the challenges of interprofessional working and its benefits and seek support from my colleagues when this situation arises again, and my experience will build on this in my future practice.In summary, the objective of this assignment was to write a reflective account of an episode of care. The six Gibbs reflective cycle was explored, the other professional roles were also discussed and the impact of pain on the patient was explored. While writing this assignment I have had the chance to learned from my mistakes because this has really opened my eyes as this will make me improve on how patient care and my own safety will be maintained in future. The Gibbs reflective cycle is appropriate for this assignment because it helps me to think and break it down in another way. It has made me see the situation in a different way and learn from it. The concepts of interprofessional working should be used within the health care services and health care professional in other to encourage different professionals to work together to achieve a good quality of care.

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