Reflection On Nursing Care

Demonstrates the impact of reflection on future practice through critical thinking and synthesis of ideas .

Evidence of the identification of personal values and beliefs on caring as a nurse.

Clear linkages of the creative representation in the reflection on values and beliefs .

An engaging and clear creative representation of person-centredness within your practice and an application of the Synthesised Model of the Communication of Caring in Nursing Participation in online forum discussion .

Relevance to practice ( /20)

 

Analysis of how ordinary nursing practice that may be perceived as extraordinary.

 

Evidence of how the creative representation will enable your future practice to be authentic to your values and belief .

 

Nursing is considered as a fusion of science and art wherein the theoretical framework is formed by caring. Caring and nursing are based on a relational understanding, connection and unity between the patient and the nurse. The art of caring in nursing is based on the metaphysical and empirical knowledge that forms the science of nursing (Robinson 2014). The personal values and beliefs on caring as a nurse include human dignity, justice, privacy and human relationship. These values and belief form the spiritual and humanistic approach to the art of caring in the nursing profession (Boyd 2013). Justified intentional care, competence and compassion forms the core of caring and nurses are expected to develop these qualities while being in their profession (Robinson 2014). This assignment is a critical reflection of the personal values and beliefs on caring as a nurse of a situation that was based on a geriatric care ward for a patient with dementia, following Borton’s developmental framework.

I am a registered nurse working in the medical ward of a multispecialty hospital and this reflection is about an incident where I perceived an ordinary practice of nursing as extraordinary. This reflective incident is about a 70 years old patient named Harry suffering from dementia and started at 7:30 am when my shift starts. It is common for the elderly to develop diseases like dementia and Alzheimer’s disease with the increase in life expectancy (Fong et al. 2015). Dementia is a condition where the mental ability gets declined and interferes with the activities of daily life like communicating, thinking and memory. This patient was aged and was suffering from a long time without much improvement in his condition and I was involved in his nursing care. From this situation, I was providing the essentials of nursing care for an elderly patient with dementia as the process was challenging and it is quite difficult to manage the patients without having an appropriate understanding of the disease process (Peters, Villeneuve and Belleville 2014). I made active participation in the caring process by providing a safe environment for the patient and it was very much important to treat them with respect and maintain their dignity (Baborie et al. 2012). Person centered care was adopted for providing care to the patient as it is beneficial for the patients of dementia since they are considered as individuals rather than focusing on their disabilities and illness. It helps to treat the patients with respect and dignity (Brooker and Latham 2015). Harry was happy on my arrival and when I approached him for a bath, he became forgetful and confused and it is necessary for the nurses to supervise the patients of dementia during the process. Although the process went smooth, it got derailed at the end when he was asked to leave the bath as he started shouting with swearing and personal insults as he did not want to get out. From the incident, I developed mixed feelings as I believed that a previously happy patient turned agitated and distressed due to my actions and this evoked a feeling of guilt that made me upset. Although I was aware that mood swings are a part of dementia, however, considering his condition of ill health made me sad. However, I was happy that I eased the situation and was able to calm him down. This entire situation was ordinary from the perspectives of a registered nurse as they are used to the aggression of the patients of dementia, however, my perception and learning from the incident made it extraordinary for me. When Harry was informed about the changes in his behavior after he was pacified and how I handled the situation, he perceived the situation as extraordinary as well. Although it was my duty to handle such situations with care and kindness, he was surprised how someone can be kind when the patient is going rough and abusive. This was the perception of Harry of my patient centered care for his dementia and he perceived my ordinary nursing care as extraordinary. The outcome of this perception was beneficial for the treatment as he co-operated with me in his other care processes.

During my process of pacifying Harry, I had a number of things going on in my mind. I was trying to apply the knowledge and theory of nursing care to get over this embarrassing situation created by Harry during his bath. His reactions were based on the thought that he will be allowed to do whatever he wish without any restriction and my actions were based on the scientific and ethical grounds of nursing care. On stopping him, he outburst with anger and this somewhat frightened and shocked me. However, the reaction was handled with care and I was there with him to calm him down as it was my professional and ethical obligation not to abandon the patient during the process of nursing care (van der Steen et al. 2013). According to the person-centered nursing framework, I was expected to provide holistic care and engagement to the patient and this was the reason I could not leave the patient on his time of discomfort. I was aware of the knowledge of the nursing care for the patient with dementia and in such cases of patient anger, the most effective way to handle the situation is redirection of the topic in a firm and calm manner (Borson et al. 2013). This will ensure patient safety and reduce his confusion of expression of thoughts and following instructions. However, distracting his attention towards some other direction with the help of playful activities could have served the purpose effectively and made the situation better (Baborie et al. 2012). From the situation, I understood that even trivial events could bring about sudden changes in the mood of the patient with dementia that can even lead to aggression that has to be handled with appropriate patience and care, without leaving the patient.

The broader issue that needs to be considered in this incident to make it successful is based on the critical analysis of why and where it went wrong that caused Harry to get angry Patients with dementia needs to be communicated in a way that makes them comfortable, based on the principles of person centered care of nursing (Borson et al. 2013). During his bathing process, if I communicated with Harry with small talks to distract him, the embarrassment could have been avoided (Catic et al. 2014). The consequence of this action could have made him feel ease with the situation and he could have avoided the verbal aggression (van der Steen et al. 2013). From this incident, I learned this skill which I will implement in my future cases of nursing care for the patients with dementia. I also realized that the curricula of the nursing schools should expand to include the courses on gerontology and geriatrics for providing specialized training for preparing the future nurses to provide optimal care to the patients with dementia and avoid such embarrassing situation to confuse and aggravate the patients.

By reflecting on this incident, I have identified the gaps that I had in my knowledge regarding the nursing care of the patients with dementia that I bridged as the treatment progressed. Using Borton’s developmental framework through action and reflection enabled me to develop the knowledge that is required in the practice of nursing (Rolfe, Freshwater and Jasper 2001). Action and reflection as the core values enabled me as a nurse to work with the patients suffering from mental health and support their families by enabling mutual learning and co-production of the knowledge (Rolfe, Freshwater and Jasper 2001). In this reflection, I used the framework of my theoretical knowledge and practical experiences to get over the problematic situation and established a dynamic theory of nursing practice.

Baborie, A., Griffiths, T.D., Jaros, E., Momeni, P., McKeith, I.G., Burn, D.J., Keir, G., Larner, A.J., Mann, D.M. and Perry, R., 2012. Frontotemporal dementia in elderly individuals. Archives of neurology, 69(8), pp.1052-1060.

Borson, S., Frank, L., Bayley, P.J., Boustani, M., Dean, M., Lin, P.J., McCarten, J.R., Morris, J.C., Salmon, D.P., Schmitt, F.A. and Stefanacci, R.G., 2013. Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimer’s & Dementia, 9(2), pp.151-159.

Boyd, M.D., 2013. The Art of Nursing: Preserving History.

Brooker, D. and Latham, I., 2015. Person-Centred Dementia Care: Making Services Better with the VIPS Framework. Jessica Kingsley Publishers.

Catic, A.G., Mattison, M.L., Bakaev, I., Morgan, M., Monti, S.M. and Lipsitz, L., 2014. ECHO-AGE: An innovative model of geriatric care for long-term care residents with dementia and behavioral issues. Journal of the American Medical Directors Association, 15(12), pp.938-942.

Fong, T.G., Davis, D., Growdon, M.E., Albuquerque, A. and Inouye, S.K., 2015. The interface between delirium and dementia in elderly adults. The Lancet Neurology, 14(8), pp.823-832.

Peters, F., Villeneuve, S. and Belleville, S., 2014. Predicting progression to dementia in elderly subjects with mild cognitive impairment using both cognitive and neuroimaging predictors. Journal of Alzheimer’s Disease,38(2), pp.307-318.

Robinson, S.G., 2014. True presence: Practicing the art of nursing.Nursing2015, 44(4), pp.44-45.

Rolfe, G., Freshwater, D. and Jasper, M., 2001. Critical reflection for nursing and the helping professions: A user’s guide. Basingstoke: Palgrave.

van der Steen, J.T., Radbruch, L., Hertogh, C.M., de Boer, M.E., Hughes, J.C., Larkin, P., Francke, A.L., Jünger, S., Gove, D., Firth, P. and Koopmans, R.T., 2013. White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliative medicine, p.0269216313493685.