The purpose of this essay is to adopt Rolfe, Freshwater and Jasper (2001) model of reflection in reflecting upon my experience in practice placement while caring for a patient with a long term condition. This model will help to identify the learning needs and how it may be achieved. To maintain confidentiality in this essay with respect to the NMC code of conduct, I will be keeping the patient’s information anonymous, thus will be referred to as Elizabeth.
Reflection is an important element of learning (Arbel, 2009). John and Freshwater (2005) defined reflection as assessing previous experience to develop tacit and intuitive knowledge.
Rolfe et al (2001) model of reflection
propose a framework that uses Borton’s (1970) developmental model. Pryce (2002) explains that, this model is a simplistic cycle that is based upon three sample questions to reflect on a situation: What? So what? Now what? Hence, it is vital that student nurses reflect regularly so as to improve their practice, knowledge, skills and behaviour to care for their patients to the best of their ability. Ultimately, Botten (2012) stresses the importance of reflection for student nurses, as it enriches their clinical learning, enabling them to learn more about themselves and the way they practice.
I met Elizabeth during my previous practice placement at the surgical ward, she is 70 years old and was diagnosed with severe chronic bronchitis approximately 8 years ago. She was admitted to the ward due to acute exacerbation of chronic obstructive pulmonary disease (COPD). According to Kauffman (2014), bronchitis is the Inflammation of the bronchi associated with partial obstruction of the bronchi by secretions or constriction. Chronic bronchitis is also included under the umbrella of COPD (Jindal & Vijayan, 2011). In regards to NICE (2010), about 3 million people have COPD in the UK, 900,000 have diagnosed COPD and an estimated 2 million people have COPD which remains undiagnosed. Also, according to department of health (2010) COPD mainly affect people aged over 45 with a history of smoking.
Elizabeth stated that she was experiencing progressive dyspnea and increased cough. McCann (2007) stated, with chronic bronchitis, increased accessory use of muscles may be chronic and is preceded by a productive cough, sputum production and shortness of breath. At the time of assessment during admission, Elizabeth reported that she has been unable to care for herself and has difficulty managing her daily activities as she lives alone. Elizabeth’s personal hygiene appeared to have deteriorated and she was only able to speak in short sentences.
Elizabeth’s personal hygiene was deteriorating as a result of her inability to self-care. According to Field & Smith (2008), hygiene is fundamental for all people. The nurses used Roper et al (2001) and Orem (1991) nursing models in meeting Elizabeth hygiene needs. In addition to Field & Smith (2008), it is stated that, this nursing models helps patients to achieve the activities associated with their daily life independently. Following the care plan, the nurse assessed Elizabeth’s hygiene needs, taking into consideration any deficit that may affect her ability to care for herself. The nurse made sure that appropriate personal hygiene care including washing, oral care, hair care, mouth care and nail care was provided and this was discussed with Elizabeth in order to ensure her needs are fully met by protecting her right to privacy and personal choice. DOH (2003), states that personal hygiene is the physical act of cleansing the body to ensure that the skin, hair and nails are maintained in optimum condition. Dingwall (2010) also suggested that assisting patient in meeting their hygiene needs as well as helping them can develop a nurse-patient relationship and allow a skilled practitioner to assess how the patient is improving mentally and physically.
Due to the exacerbations, she had problems eating and swallowing, hence, simple routine nutritional screening was performed using a validated nutritional screening tool such as Malnutrition universal screening tool (MUST). According to Rice (2006) nutritional support is a vital part of nursing care because many patients with COPD are malnourished. This nutrition screening was carried out so that changes in her weight can be identified immediately and dietary changes can be started to improve her nutritional status as soon as possible. Specific dietary advice and support as well as general advice for meal planning were reinforced. Nazarko (2002) emphasised that, nutritional status is crucial to patient’s state of health. Referral to dietician and speech and language therapists was made to optimise her nutritional status, and assess and treat her swallowing difficulties. According Evans (2012), swallowing difficulties can make patient’s eating and drinking difficult and can often result in patients losing weight if no adequate support is given. Hence, Adjustment of food flavour, texture, density and temperature was made to help minimize dysphasia. Any liquid given such as water or ensure was thickened as they are difficult for the tongue to control and can easily splash into the trachea (Weetch, 2001).
Due to concerns regarding Elizabeth inability to carry out daily activities safely without risk of falls or accidents, which may result detrimental effect upon her health and quality of life, referral to the following members of multi-disciplinary team was made for further assessment to assist with her daily activities of living that may enable her to continue to live within her home safely. These members of multi-disciplinary team included; social services, physiotherapist, occupational therapist, social workers and age concern. According to Karen & Aidin (2011), Dyspnea causes many patients with COPD to withdraw from day-to-day activities and hobbies. Referral to rehabilitation services was considered to improve her breathing, oxygenation and endurance (NICE, 2006). Home care aide services were considered to assist Elizabeth with her activities of daily living care. Rice (2006) suggested, in planning care, it will be crucial to determine what activities of daily living the patient can perform.
In becoming an efficient nurse, there are some areas of improvement that needs to be considered for future practice such as; understanding more about activities of daily living for COPD patients, having more knowledge on assessment discharge, how they are done, package of care for COPD patients. These learning needs will be achieved through working closely within the multi-disciplinary team. According to Nehring & Lashley (2010), working within multi-disciplinary will give the student opportunity to enhance their professional skills and knowledge of patient’s care. Also, reading more about COPD exacerbation will enable the student to recognise a patient having exacerbation if it re-occurs in future practice, knowing how to manage their condition effectively, hence, providing high quality care.
COPD is a debilitating illness which causes patient’s emotional, social, psychological and physical distress due to the impact on daily living. This reflective essay has helped the student acknowledge the importance of reflection within practice as it allows professionals to convey thoughts of how they can improve on their practice to enhance effective delivery of care.
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