Reflecting On Ones Practice Nursing Essay

Reflecting On Ones Practice Nursing Essay Striving to become better at what one does entails reflecting on both the positive things that one has achieved and the mistakes committed in the process of performing ones duties and responsibilities. Reflective practice focuses on the learning that has evolved and correcting what has been done wrong. This essay assesses my professional, clinical development through an analytical reflection from a patient seen in the Emergency Care Centre (ECC), as part of the holistic health assessment module. The assessment model used in the consultation will be examined, together with theoretical and evidence based practice, and how this has helped developed my approach, linking decision-making and best practice outcomes. Following Gibbs (1988) model of reflection, I shall establish the integration between theory and practice. This model identified six stages involved in reflective practice where at each stage the I would ask myself a number of questions leading to the final stage of an action plan. It begins with selecting a critical incident to reflect upon followed by keen observing and describing of the incident, then analyzing my experience. This is followed by interpreting the experience and exploring alternatives leading up to an action plan. This is is a cyclical process which enables continual retrospective reflection. II. Reflective Practice Reflective practice has been a key underpinning of qualified nurses since the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) (1992) required them to keep a professional portfolio. As professionals, we are accountable for our ongoing learning and self development, providing the best care to our patients. To ensure this, we need to focus on our actions and skills to be able to meet the demands of patients, colleagues and professional bodies. In order to be reflective practitioners, we need to be reflective thinkers. Reflective thinking is thinking that is aware 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 supposed form of knowledge in the light of the grounds that support it and the further conclusion to which it tends (cited in Martin, 1995, p.167) . Reflective thinking leads one to be more self-aware so he can develop new knowledge about professional practice. Reflective practice has been recognised to be an important tool for professional development. Rowls and Swick (2000) agree and observed that practitioners who regularly reflected enabled them to develop their skills and the way they deal with patients. Schunk and Zimmerman (1998) describe how a self- reflective practice allows us to monitor, evaluate 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 greater fear of becoming introspective or being critical of oneself too much 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 occur at different time phases: reflection on action (Schon 1983) and reflection in action (Schon 1983). Reflection 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 appropriate changes and still keeping a steady flow in the process. Reflection on action is when reflection occurs after the event. This is where the practitioner makes a deliberate 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 evaluate what he has done right or wrong, and at that point, he is engaging 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 balanced view and define reflection to be an integration of existing knowledge and new knowledge. This implies that as a reflective practitioner, I should always evaluate 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 Practice I have been an Emergency Nurse Practitioner for the past 6 years. My task was mostly seeing patients in the emergency setting with minor injuries. I took this course to gain further knowledge and revise what needs to be improved in what I previously learnt during my 15 years as a nurse. Basically, I assess patients with localized problems (i.e, sprained ankles, lacerations, painful joints, minor head injuries etc.). I found it very daunting having to deal with the person as a whole again and investigate multiple systems (respiratory, cardiac, muscular, etc). Having attended 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 Practice In 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 left-sided chest pain. I immediately thought that the patient was suffering from cardiac chest pain, but upon further examination, I found out that the patient actually had a recent chest infection which was treated by a GP with antibiotics. The chest infection was resolved, but the patient was left with residual chest pain. It turns out that it was mild pleuritic chest pain after all. In this incident, I initially felt confident in my diagnosis of cardiac chest pain due to my years of experience as an emergency nurse. Such vast experience exposed me to a variety of symptoms and its diagnosed illnesses. My confidence also came from having attended enough tutorials regarding the assessment of symptoms manifested by different body systems. Upon reading the patients notes, the symptom of left-sided chest pain immediately made 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 evaluation may include the basic inspection, palpation (feeling with the hands), percussion (tapping with the fingers), and auscultation (listening) (IPPA) (The Free Dictionary, 2013); CURB 65, which is a simple well-validated tool for the assessment of severity in community acquired pneumonia (CAP) is another essential evaluative method in checking the presence of a deadly respiratory diseas e. 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, blood urea nitrogen, respiratory rate, and systolic blood pressure. 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 also 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 pressure 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 old 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 made for the patient. (Karmakar Wilsher, 2010). Still another evaluative method in examining the patient is the Pulmonary Embolism rule-out Criteria (PERC) (Hugli et al., 2011). The thorough process it entails determines if there is a potentially life-threatening cause of chest pain which may include pulmonary embolus, acute coronary syndrome, aortic dissection or tension penumothorax (King et al., 2012, para.3). If the patients chest pain becomes worse when he is applied 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, observing 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 concluded 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 complaint 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 much 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 uncomfortable evaluating the patients condition because it was my first patient with a cardiac problem.Throughout the assessment process I felt uneasy 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 jump 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 information 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 concerned me and made me question my actions. I understood that I was 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 and consulting the medical history of the patient. The fast rate of change in the medical field necessitates health practitioners like me to constantly update myself of current trends and the latest methodologies in nursing care. I should also remind myself all the time that the patients welfare comes way before my own ego in terms of priority. Conclusion Through reflective evaluation I was able to adjust the way I assessed patients with chest pain. I relaxed considerably more and let myself enjoy the assessment process. I was able to consolidate 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 evident that good and bad working practice can be monitored and evaluated. Mistakes can be avoided and good working practice can be upheld. Although the feelings 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 times of uncomfortable feelings and thoughts surrounding a situation.

Cultural Background Paper Essay

UNESCO (United Nations Educational, Scientific and Cultural Organization – 2002) defined Culture â€Å"as the set of distinctive spiritual, material, intellectual and emotional features of society †¦. it encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs. † With migrant ethnic groups, they become so far removed from their homeland that their traditions have considerably been altered, are gone, or simply forgotten. It was mostly after World War I, in the 1500s to the 1800s in the Great Migration when most African immigrants were taken against their will to the New World. They were brought in as slaves and their hard work was responsible for the prosperity of the New World. Similarity of African and American Culture. America is a melting pot, where all cultures meet and blend. America is multi-racial because of the continuous influx of foreign migration to American shores. The culturally-diverse population of America makes it a pluralistic society. The Wikipedia (11 Jan 2002) describes Africa as â€Å"one continent with many worlds. † Various ethnic, social and tribal groups make up Africa. Africa is more of a multi-ethnic culture. Contrasts between African and American culture. The difference between Africa and America is on certain significant cultural aspects. African society is male-dominant, where women submit to patriarchal authority. America is more liberal and espouses gender equality. Societal relationship in Africa is familial, very family-oriented even in business. America is individualistic. Food and eating in Africa is a ritual, in America food and eating is a basic need. Behavior, values and norms are often clannish or often dictated by the ethnic group or the clan. America has always been independent. Africa has many languages, America speaks only English. Having been born in America, I have totally embraced the culture that is predominantly American. However, this is not denying my roots and my rich African heritage. On the contrary, I feel that there is something great that people like me can contribute to the mainstream culture. The support system of families, the sharing of trials and triumphs of Africans are cultural strengths that I would rather have than the individualistic ways of America. The equal treatment and opportunities to both sexes of America, to me however is more acceptable than the male-dominant practices in Africa. The similarities in my cultural background and that of the dominant American culture made it easy to integrate to a society that is made up of culturally diverse people. I did not feel isolated or left out because of my color or creed. The similarities and differences of the both cultures had a positive effect on my life. I am shown the strengths and the weakness of each one. The primarily independent-thinking American culture is necessary to make choices and standing by it. It is a trait that I believe in and which I try to be all the time. Food and Eating as rituals and basic needs at the same time are to me necessary for us to enjoy and sustain life. I do not wish to rush all the time and so I take every moment to find meaning in my every action. I believe that my own cultural background has to a certain extent contributed to the mix in the dominant American culture. When the early Africans banded to demand equal rights from a society that was once discriminatory of their race, it showed the world and history what unity can do to push for reforms. That movement has indeed gone a long way. There is respect for cultural diversity and equal opportunities now. In a culturally diverse society such as America, culture exchange flourished. With people of African descent like me in mainstream society, other people became aware of Africa. They got introduced to the sights and sounds, literature, its people, traditions, ways, and everything else. Pretty soon famous African Americans are into government service, entertainment, the academe, the media, and business. I believe that to be the greatest contribution to of the African culture to dominant American culture. I learned of my cultural roots through a conscientious effort on my part. I knew I look different, I knew I belong to a defined group, I knew we had different ways of doing things, practically we have our own culture. I asked my parents about us, about our culture. Our family is one that takes pride on who we are. It became a pleasant, welcomed, and enlightening revelation. I read books about Africa, searched the web for more information and watched movies about Africa. It was a moment of discovery. I connected to our cultural past. I have not let up until today. I still visit sites of Africa and learn more of my forefathers’ homeland. Having lived in America all these years, I know I have developed an entirely new culture that is neither African nor America. It might yet be a blend of both cultures. I may look and sound African, think and act American and I am African American. I have in me the clannish African and the independent American. The influences on me to develop a new culture are varied. Interaction with those people who belong to other dominant cultures, opportunities to experience these other cultures first hand, unconsciously picking up the best in each one and living it are possibly the first ones that come to mind. The world is getting smaller by the day. With the advent of modern means of travel and communications getting in touch is relatively easy. Cultures meet and merge every second, every day. Sources: http://en. wikipedia. org/wiki/American_culture#Relationship_to_other_countries. 2Fcultures http://en. wikipedia. org/wiki/Culture_of_Africa

Charles Dickens: A Christmas Carol Essay

INTRODUCTION A Christmas Carol (1843) is one of the most recognizable stories in English literature. With its numerous literary, stage, television, radio, and cinematic adaptations, the tale has become a holiday classic, and the character Ebenezer Scrooge has become a cultural icon. First published in 1843, the novella garnered immediate critical and commercial attention and is credited with reviving interest in charitable endeavors, the possible perils of economic success, and festive traditions of the Christmas season. It is the first work in Dickens’s series of Christmas stories known collectively as the Christmas Books, as well as the most popular and enduring. Plot and Major Characters Set in the 1840s on Christmas Eve, A Christmas Carol chronicles the personal transformation of the protagonist, Ebenezer Scrooge, the proprietor of a London counting house. A wealthy, elderly man, Scrooge is considered miserly and misanthropic: he has no wife or children; he throws out two men collecting for charity; he bullies and underpays his loyal clerk, Bob Cratchit; and he dismisses the Christmas dinner invitation of his kind nephew, Fred. Moreover, Scrooge is a strong supporter of the Poor Law of 1834, which allowed the poor to be interned in workhouses. As he prepares for bed on Christmas Eve in his solitary, dark chambers, Scrooge is visited by the ghost of his former partner, Jacob Marley. In life Marley was very similar in attitude and temperament to Scrooge: remote, cruel, and parsimonious. In death he has learned the value of compassion and warns Scrooge to reform his ways before it is too late. Marley announces that Scrooge will be visited by three more specters: the Spirits of Christmas Past, Present, and Yet to Come. The Ghost of Christmas Past takes Scrooge back to his unhappy childhood, revealing that the young boy’s experiences with poverty and abandonment inspired a desire to succeed and gain material advantage. Unfortunately, Scrooge’s burgeoning ambition and greed destroyed his relationship with his fiancà ©e and his friends. The Ghost of Christmas Present is represented by a hearty, genial man who reminds Scrooge of the joy of human companionship, which he has rejected in favor of his misanthropic existence. Finally, the Ghost of Christmas Yet to Come appears in a dark robe and shrouded in mystery. Silently, the ghost reveals the ambivalent reaction to news of Scrooge’s own death. Scrooge realizes that he will die alone and without love, and that he has the power and money to help those around him—especially Bob Cratchit’s ailing son, Tiny Tim. Scrooge begs the ghost for another chance and wakes in his bed on Christmas morning, resolved to changing his life by being generous and loving to his family, employees, and the poor. Major Themes A Christmas Carol has been deemed a biting piece of social commentary by some. Critics have underscored the scathing criticism of 1840s London, an economically and socially stratified city that Dickens believed imprisoned its poor and oppressed its lower classes. The prevailing socio-economic theory of that time held that anyone who was in debt should be put in a poorhouse. In his story, Dickens contended that the reformation of such a materialistic, shallow society can be achieved gradually through the spiritual transformation of each individual. The story is well regarded for its expression of a fundamental faith in humanity and its unflagging censure of social injustice, which was inspired by Dickens’s troubled background and his visit to the Cornish tin mines where he observed young children laboring under appalling conditions. As Scrooge transforms from a cruel, embittered miser to a kindly philanthropist, Dickens advocates a more forgiving, generous society that values spiritual growth, not material wealth. Other major thematic concerns in A Christmas Carol include the role of memory, the importance of family, and the soul-deadening effect of greed on the human spirit. Critical Reception Upon its initial publication, A Christmas Carol was greeted with mixed reviews. Some commentators derided the tale as too sentimental and laden with exaggeration; other critics maintained that A Christmas Carol lacked the complexity of Dickens’s later work. Yet the novella remains a Christmas favorite. Commentators praise Dickens’s evocative portrayal of 1840s London and his passionate exploration of social and political issues. Dickens’s fervent belief in social justice as depicted through A Christmas Carol is credited with inspiring an outpouring of charitable endeavors during his time and a revival of Christmas spirit and traditional celebrations. Critics have also explored the fairy-tale and gothic elements in A Christmas Carol, and many praise Dickens’s use of wry humor in the story. The relevance and power of Scrooge’s transformation from forlorn old niggard to benignant philanthropist is regarded as the key to the novella’s unflagging popular appeal. Several scholars have debated the nature of Scrooge’s conversion, which is known as â€Å"the Scrooge problem.† Some critics, including Edmund Wilson, conclude that the transformation is a temporary one; others have maintained that it is total and irrevocable. Scrooge’s metanoia has also been placed within its historical and literary context, and critics have related it to the religious revival then fervent in nineteenth-century England. A few full-length studies of the novella have traced the impact of the story on English and American culture and have discussed the copious imitations, adaptations, and modernized versions of the tale.

Christianity, And World View Of The World - 1568 Words

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In this essay I will discuss the pre Christian world and how i ts ethos differed from Christian ones. I will also discuss the characteristics of monotheism, as well as the special characteristics of Christianity, and finally the differences between major Christian movements such as Catholics and protestants, liberals and fundamentalists shall be explored. Monotheism and Christianity Christianity is a monotheistic religion and as such it shares a few characteristics with other monotheistic religions. The one true god is the creator and theShow MoreRelatedThe World Views Of Islam And Christianity1115 Words   |  5 PagesIslam and Christianity This term we have covered a reasonable amount of materials based on the different types of religions in the world. There are many religions that have strong views and principles, and in order to understand them we must have an open mind and a true understanding of their beliefs. 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