Reflecting On Ones Practice Nursing Essay

Reflecting On Ones exercising Nursing EssayStriving to become better at what one does entails reflecting on some(prenominal) the positive things that one has achieved and the drifts committed in the emergence of performing ones duties and responsibilities. Reflective practice focuses on the instruction that has evolved and correcting what has been through with(p) wrong. This essay assesses my master, clinical development through an analytical contemplation factor from a persevering seen in the Emergency Care Centre (ECC), as trip of the holistic health assessment staff. The assessment mannikin utilize in the consultation will be examined, together with theoretical and tell undercoater practice, and how this has helped developed my approach, linking decision- devising and best practice outcomes.Following Gibbs (1988) model of reflection, I shall establish the integration between theory and practice. This model identified six stages complex in musing practice where a t each stage the I would ask my self-importance a number of questions leading to the final stage of an follow through plan. It begins with selecting a critical possibility to reflect upon followed by keen observe and describing of the incident, thusly analyzing my experience. This is followed by interpreting the experience and exploring alternatives leading up to an run plan. This is is a cyclical process which en subjects continual retrospective reflection.II. Reflective formReflective practice has been a key underpinning of qualified nurses since the United land Central Council for Nursing, Midwifery and Health Visiting (UKCC) (1992) required them to keep a original portfolio. As professionals, we are accountable for our on difference attainment and self development, providing the best care to our perseverings. To ensure this, we command to focus on our actions and skills to be able to meet the demands of uncomplainings, colleagues and professional bodies. In order to be reflective practitioners, we need to be reflective thinkers. Reflective thinking is thinking that is sensible of its own assumptions and implications as well as being conscious of the reasons and evidence that support the conclusion (Lipman, 2003, p.26). John Dewey defined reflective thinking as an active, persistent and careful consideration of any belief or suppose form of fellowship in the light of the grounds that support it and the come on conclusion to which it tends (cited in Martin, 1995, p.167). Reflective thinking leads one to be to a greater extent self-aware so he lot develop new fellowship about professional practice.Reflective practice has been recognised to be an main(prenominal) withall for professional development. Rowls and Swick (2000) agree and observed that practitioners who regularly reflected enabled them to develop their skills and the flair they deal with patients. Schunk and Zimmerman (1998) describe how a self- reflective practice allows us to monitor, estimate and adjust our performance during learning. Adjusting strategies based on assessment on our learning helps to achieve the goal of learning and identifying the activities well suited to our situations (Schunk Zimmerman, 1998). However, practitioners often found the process quite time consuming and there was a great fear of becoming introspective or being critical of oneself alike such(prenominal) in practice. It is likely that one can be too engrossed in his reflection that he gets to neglect the delivery of a great work performance.Schons theory outlines two different types of reflection that buy the farm at different time phases reflection on action (Schon 1983) and reflection in action (Schon 1983). denunciation in action is often referred to the colloquial phrase as thinking on your feet a term used to being able to assess ourselves within a situation, making suspend swops and still keeping a steady flow in the process. Reflection on action is when re flection occurs after the event. This is where the practitioner makes a hand and conscious attempt to act and reflect upon a situation and how it should be handled in the future (Loughran 1996). This means while performing a professional task, and one keeps thinking if what he is doing is right, he is doing reflection-on-action. After the task, he gets to rate what he has done right or wrong, and at that point, he is act in reflection-in-action. I am aware that I practice both kinds in my profession.However ,Fry, Ketteridge and Marshall (2003) seem to take a equilibrise view and define reflection to be an integration of existing fellowship and new knowledge. This implies that as a reflective practitioner, I should always esteem if my current knowledge is still applicable, and in updating myself, should be able to incorporate my new learning with what I already know.My Own PracticeI have been an Emergency Nurse Practitioner for the past 6 eld. My task was mostly seeing patient s in the emergency setting with chela injuries. I took this course to gain merely knowledge and revise what call for to be improved in what I previously learnt during my 15 years as a nurse.Basically, I assess patients with localized paradoxs (i.e, sprained ankles, lacerations, painful joints, venial head injuries etc.). I found it very daunting having to deal with the mortal as a whole again and investigate multiple systems (respiratory, cardiac, muscular, etc). Having tended to(p) tutorials regarding the assessment of these systems using the inspection, palpation, percussion and auscultation (IPPA) methods, I was eager to practice what I have learned and felt ready to assess a patient.Reflecting on Ones PracticeIn the tradition of Gibbs (1988) reflective practice, the first step is concentrating on one particular example from my own work experience. One incident that is worth reflecting on was my encounter with a patient with go away-sided toilet table pain. I readyly th ought that the patient was suffering from cardiac white meat pain, barely upon further inquiry, I found out that the patient actually had a recent actors assistant infection which was do by by a GP with antibiotics. The chest infection was resolved, but the patient was left with residuum chest pain. It turns out that it was mild pleuritic chest pain after all.In this incident, I ab initio felt confident in my diagnosis of cardiac chest pain due to my years of experience as an emergency nurse. such(prenominal) vast experience exposed me to a variety of symptoms and its diagnosed illnesses. My confidence similarly came from having attended lavish tutorials regarding the assessment of symptoms manifested by different body systems. Upon teaching the patients notes, the symptom of left-sided chest pain immediately do me conclude that it was cardiac chest pain. I know that merely reading the patients notes is not enough in coming up with conclusive diagnosis. The clinical payg rade may include the basic inspection, palpation (feeling with the hands), percussion (tapping with the fingers), and auscultation (listening) (IPPA) (The Free Dictionary, 2013) contain 65, which is a simple well-validated tool for the assessment of severity in community acquired pneumonia (CAP) is some other essential evaluative method in checking the presence of a deucedly respiratory disease. The Ohio State University College of Medicine (2012) shares its guideline in the use of this approach. CURB is short for checking the patients confusion, gunstock urea northward, respiratory rate, and systolic product line rack. If the patient seems to be delirious or confused, then he is given a score of 1 on the confusion item. If his blood urea nitrogen value is greater or equal to 20 mg/dL, then it overly garners a score of 1. A respiratory rate that is more or equal to 30 breaths/minute is also credited for 1 point. The same is true for the systolic blood mechanical press if it is less than 90 mm Hg or a diastolic blood pressure less than or equal to 60. If the patient is 65 years disused and above, then it also gains 1 point. Computing all the points, if the patients score is 0 or 1, then he can safely be treated as an outpatient. However, a score of 2 may indicate that he needs closer supervision when receiving outpatient treatment, or he may be recommended for inpatient observation admission. Most of the time if the collated score of the patient is 3, 4 or 5, then this usually means the patient needs to be confined to inpatient treatment (Ohio State University College of Medicine, 2013). Clinical judgment of the professional is necessary for a decision to be do for the patient. (Karmakar Wilsher, 2010).Still other evaluative method in examining the patient is the Pulmonary Embolism rule-out Criteria (PERC) (Hugli et al., 2011). The staring(a)going(a) process it entails determines if there is a potentially life-threatening cause of chest pain whic h may include pulmonary embolus, acute coronary syndrome, aortal dissection or tension penumothorax (King et al., 2012, para.3). If the patients chest pain becomes worse when he is use deep inspiration and recumbency, then it is likely that it is due to a pleuritic cause.With Gibbs reflection model, so far, the first three steps of identifying a critical incident, sight and describing of the incident have already been done. Now comes analyzing my experience. Triage notes stated a 57 year old female who was suffering from left sided chest pain. Observations were blood pressure 184/78, pulse 74, respiratory rate 16, saturations on O2 98%. I had decided to take this patient and perform an assessment on her.The immediate thoughts were of cardiac chest pain as it was stated to be left sided in nature. Since starting the health assessment module the cardiac patient was the system I was least confident in, in the assessment process. I was anxious before seeing the patient. I had conclu ded that she was suffering from a cardiac chest pain, and imagined her to be requiring some form of intervention from the cardiac team. However, when meeting the patient and gaining further medical history it was clear that she was in fact a stable patient with a different kick from my first impression.She had recently been treated for a chest infection by her GP, she had undergone a course of anitbiotics, amoxicillin 500mg for 1 week, after which she had felt a great deal better, but over the following week had been left with a residual left sided chest pain which was worse on deep inspiration. She had initially had an expectorating cough, which had now resolved to an occasional dry cough. After a thorough assessment including IPPA, baseline observations, chest x ray, bloods including D Dimer, full blood count, UEs, cardiac enzymes, and a Wells score to rule out PE, the patient was diagnosed with pleuritic chest pain or pleurisy by the Doctor. (see appendix 1)Initially, I was unc omfortable evaluating the patients condition because it was my first patient with a cardiac problem.Throughout the assessment process I felt queasy with the knowledge that I had initially made a judgement about the patient without even meeting her. It made me revise my approach to patients as a whole and not burst forth to conclusions before all avenues had been investigated. I was humble enough to accept my mistake when it was confirmed that it was a mild pleuritic chest pain, garnering from the education from further examination and history taking. I felt the need to read up on cardiac chest pain and push myself into seeing patients with that particular problem so that I can overcome my apprehensions.Next in Gibbs model is the interpretation of my experience. The interpretation of the patients condition from the initial triage notes made me aware of myself making a judgement before setting eyes on the patient. This refer me and made me question my actions. I understood that I w as nervous and uneasy at the thought of assessing a patient unaccompanied, and with hindsight put too much pressure on myself regarding responsibility and duty of care. I recognised the need for me to understand that I was gaining knowledge and skills as part of the degree module that I was completing, this didnt require me to diagnose the clinical conditions of the patients, but facilitated in the learning process of assessment skills and putting into place ideas of diagnosis / differential diagnosis. It also made me reflect on my thought processes regarding making snap judgements without gaining further information.The last stage in Gibbs model entails creating an action plan. The experience I have just analyzed made me realize that the current knowledge and experience I currently have are not enough. I need to learn to be more open in my evaluation of the patients symptoms, and hold my judgment until I have completed the necessary information derived from both examination tests a nd consulting the medical history of the patient. The fast rate of change in the medical field necessitates health practitioners like me to constantly modify myself of current trends and the latest methodologies in nursing care. I should also actuate myself all the time that the patients welfare comes way before my own ego in terms of priority.ConclusionThrough reflective evaluation I was able to adjust the way I assessed patients with chest pain. I relaxed well more and let myself enjoy the assessment process. I was able to unite the new skills I had learnt and put in place a methodical process of evaluating differential diagnosis. I understood that the official diagnosis was going to be made by the Doctors mentoring my practice which considerably lessened the pressure I put on myself.Through this reflective process it became spare that good and bad working practice can be monitored and evaluated. Mistakes can be avoided and good working practice can be upheld. Although the fe elings initially were disheartening, support from colleagues and my own learning outcomes have helped me progress and develop my skills of assessment. As Atkins and Murphy (2003) suggest that reflection should be made in multiplication of uncomfortable feelings and thoughts surrounding a situation.