Reflection Of Clinical Experiences: A Placement Report

Reflection

Write a a report on Reflection of your clinical experiences.

Clinical placement is very important for an undergraduate nursing students because it enables them to get a clear link between the clinical practice and theories. In this case, the nursing students are required to get exposed to various clinical experiences to facilitate the understanding of the facts learned from the class settings (Levett-Jones et al., 2015). Therefore, part of clinical training takes place in the hospital whereby the student is placed under the supervision of qualified health care professionals, who in most cases are registered nurses. This placement experience enables students to get exposed to real life clinical experiences which is relevant for their future work. This is a placement reflection report based on the Gibbs reflection cycle (Husebø et al., 2015). This placement was conducted at St. Mary’s Mission hospital between February to April 2018. I was working under the supervision of Mr.Kiray, a registered nurse. This gave me an opportunity to practice the concepts taught in the classroom and develop clinical reasoning, on the basis of the challenges faced in the health care.

The event

During my second year clinical placement at St. Mary hospital, I met a number of patients who had different health needs. This made me develop a personality whereby I could adapt my professional training skills to meet and interact with patients suffering from all forms of illnesses and attend to them to my level best (Stunden et al., 2015). Of most importance, was the need to communicate effectively with each patient so as to understand their individual needs. During this placement, I was placed at the female ward, whereby I was to be in charge of one lady who was six years old, named patient Y. This was one of the youngest patients in that ward, and that I had ever encountered in my practice. She was suffering from uterine cancer and on most occasions, she would be in the company of her mother. I interacted with this patient Y for a period of two months while giving her as good care as possible. Considering that she was the youngest patient in the whole female wards, and that her condition was quite serious, I was compelled to give her a closer attention than the rest, because she was attending multiple rounds of radiology and chemotherapy.

In most cases, every time, she was in the company of her mother and whenever I needed to ask something, I was required to involve her mother. There was one major challenge with the mother because she was an Italian and therefore could only speak and understand little English. My major duties were to carry daily assessments of patient Y, and make a report which my supervisor would assess, make any necessary corrections and give to the doctor for necessary action concerning this patient. On most occasions, I spent a lot of time, trying to explain things to the mother, and trying to grasp some information related to patient Y from her. Under normal circumstances, when there is a patient who is a minor and is under the care of the guardian, or the parent (s), it is advisable that most questions are directed to the care takers (Levett-Jones et al., 2018). In this case, the patient was too young to comprehend some of the questions, and on most cases she was asleep, while the mother could not understand or speak fluent English (Nordenström & Thyen, 2014).

The event

While there is need for involving the patients in their own care, this kind of situation requires the guardian who accompanied the patient to be involved in patient assessment. Therefore, I decided to assess the patient Y physically and since I could not ask any questions to patient Y either, I filled the patient assessment on her progress after radiology and chemotherapy sessions based on observable features, and not the provided information. As I was taking this information, the Y’s mother kept looking at me and then at the registered nurse who was my supervisor. Such looks by the mother were indicative of possible guidance and reassurance. At this point, I felt quite uncomfortable and began looking at my supervisor for possible help. Then, I called the supervisor to a different nurses’ room in this ward and asked him to take over the assessment process. When he took over the process, I noted that his approach of assessment was quite different from mine. In this case, he made the patient Y wake up so that she could also participate in this process. Additionally, the registered nurse would also ask the questions in a slow yet a loud voice (Riess & Kraft-Todd, 2014). I noted that the patient Y’s mother could understand and answer the assessment questions concerning her daughter well. The patient also took part in the assessment although she was partial because she looked weak and sleepy. The process continued smoothly to the end, although I was feeling quite uncomfortable because I did not know how the mother was feeling about my competence (Hyde, 2015).

Feelings

At the beginning, I felt that this situation was quite normal, and that I did my best to help patient Y. However, considering the nursing standards in performing patient assessment, I found out that this is not the correct thing that I did. Thus, I can vividly remember that I had a mixture of feelings like confusion and surprise. My confusion came in because, I recalled that our lecturers had always emphasized on the need for effective communication for proper health care. It is important that patients or their guardians are involved in the patients care so as to make informed decisions (Browne et al., 2015). However, it would have been kind enough if I tried to phrase my clinical assessment question using simpler language or phrases that Y’s mother could understand. May be this would bring more understanding and the assessment would include some other information that could not be physically assessed.

Feelings

Considering the fact that when the registered nurse took over the assessment everything proceeded on well, I felt that I had let myself and my supervisor down, through failing to use various communication strategies to get information about patient Y. Additionally, I felt that I had failed my patient down because I had been unable to communicate well with her mother, when Y was asleep (Shitu et al., 2015). During the assessment, I also noted that the registered nurse was always looking at patient Y and her mother constantly, to ensure that he understood both the verbal and non-verbal communication (Dooley et al., 2015). To facilitate more understanding to Y’s mother, the registered nurse also used body language like gestures and nodding of the head, as well as facial expressions (Riess & Kraft-Todd, 2014). This facilitated the understanding of the questions he was asking the mother. The body language also enabled the mother to understand the significance of the assessment and hence respond appropriately. I was also amazed to find the registered nurse also used charts as visual aid, so that the patient Y’s mother could understand better. This made sure that, in case the patient or her mother did not understand what the registered nurse was saying, they could observe visually on the visual aids.  

Evaluation

This incident was quite challenging for me, and I really regret for not acknowledging this fact early enough. Based on this placement experience at this hospital, I have learned better skills in handling young patients, especially the minors. Since the young patients cannot speak for themselves in most cases, it is advisable that the nurses talk to the parents and or guardians to these young patients. This is because when children are suffering from some serious health conditions like cancer, the parent and or guardians are the ones who are mostly worried and helping them around. This means that these care givers are the ones who accompany such patients in most treatment cases, and thus have sufficient information about their wellbeing. Therefore, the parent or guardians of these children help them to manage the symptoms, until these young people become of age where they can take over the responsibilities.

Concerning the people with language difficulties such as the mother to patient Y who was not a fluent English speaker, speaking loudly, and use of body language can aid in communication. This ensures that during patient assessment, the correct patient information is collected and recorded, and that either the patients or, the patients and their families are involved in their care. In this occurrence during my placement, I also realized the importance of teamwork which enabled the registered nurse to take over the assessment process swiftly. This led to an efficient process, whereby proper information was captured and good health care offered. I am glad that when I called the registered nurse to a separate room to explain to him about this challenging task, he responded positively, without drawing the attention of patient Y and her mother, which would have brought some related controversies. Teamwork provides efficiency in patient care and facilitates the ease of decision making.

Evaluation

Analysis

This placement has given me a great experience concerning the improvement of communication skills, and the importance of teamwork (Materne et al., 2017). Of great importance was being able to communicate well when there are communication difficult like language barrier, as in the case of mother to patient Y. In the next encounters with patients such as those of such tender ages, I have learned the need for being keen to details such as the non-English speakers. In order to get used to this experience. I will need to get more exposure with patients suffering from such problems and with similar characteristics as patients Y in the next placement sessions. I hope that in future, I will be involved in the care of patients of other nationalities like French, Arabs and many more, who are non-English speakers. The experience with patient Y and her mother also helped me to learn from my supervisor on how clinical assessment questions are framed. Here, the language tone used as well as the merging of the questions to the body language was clearly explored. Based on the nursing and Midwifery Council code of professional act (2004), a nurse should identify and lower the risks that could harm the patients (Kangasniemi et al., 2015). In this case, this code can be applied because, making assessment without being keen enough can result in possible errors during treatment.

Conclusion

The presence of a minor patient and her mother brought a notion concerning the communication skills involving talking to two people at the same time without losing information flow. In this case, although the patient is presented as being young, they can also give information concerning, their health status. This was observed when my supervisor took over the assessment and first, he woke patient Y up, so that she to could participate in her assessment alongside her mother. Later, when, the patient was being discharged after one month, she and her mother came and thanked me for the care and concern that I had demonstrated to them during their hospital stay. Additionally, by looking back at this situation, I feel that I was supposed to act sooner, when I realized that I had problems in understanding the patient Y’s mother, while at the same time Y was already asleep, instead of beginning to write assessment notes through mere observations. After a brief discussion with my supervisor, I have recognized the importance of using all communication skills and strategies, both verbal and non-verbal too get the necessary information from patients or their parents and guardians. The importance of teamwork has also been indicated in this clinical placement experience because in the end, the collaboration between me and my supervisor brought about good patient care and patient Y was finally discharged from this hospital.

This placement experience clearly indicates that I have to work extra hard on my communication skills when handling patients of all manners. There is also a need to improve my coping strategies when dealing with patients of different nationalities and with language barriers. In future, I will endeavor to be exposed to similar clinical placement experiences with people of all ages so as to sharpen my skills in handling patients with all manner of challenges and illnesses. I intend to have a detailed discussion with my supervisor on the strategies of developing communication skills when handling the young and elderly patients.

References

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Nordenström, A., & Thyen, U. (2014). Improving the communication of healthcare professionals with affected children and adolescents. In Understanding Differences and Disorders of Sex Development (DSD) (Vol. 27, pp. 113-127). Karger Publishers.

Riess, H., & Kraft-Todd, G. (2014). EMPATHY: a tool to enhance nonverbal communication between clinicians and their patients. Academic Medicine, 89(8), 1108-1112.

Shitu, Z., Hassan, I., Aung, M. M. T., Kamaruzaman, T. H. T., & Musa, R. M. (2018). Avoiding medication errors through effective communication in healthcare environment. Malaysian Journal of Movement, Health & Exercise, 7(1).

Stunden, A., Halcomb, E., & Jefferies, D. (2015). Tools to reduce first year nursing students' anxiety levels prior to undergoing objective structured clinical assessment (OSCA) and how this impacts on the student's experience of their first clinical placement. Nurse education today, 35(9), 987-991.