Surgical placement in a local hospital

Surgical placement in a local hospital This is a reflective essay based on my own experiences, whilst on my five week surgical placement in a local hospital. The aim of this essay is to explore the use of communication and interpersonal skills in clinical practice. I have chosen this particular incident as I spent a considerable amount of time communicating verbally and non verbally with this particular patient. To protect the identity and maintain confidentiality of the patient I have chosen to discuss, they shall be known as John. This is in accordance with the NMC code of professional conduct (NMC, 2008). To assist me in the process of reflection I am using Gibbs (1988) reflective model. This cycle provides a description of the event, feelings towards the outcome, an evaluation, analysis, conclusion and an action plan. Jasper (2003) suggests that reflection is one of the key ways we can learn from our experiences. There are numerous reasons why reflection is important to nurses. Through reflection we can learn more abo ut our role and the elements that limit our abilities; this allows the opportunity to improve the way we care (Ghaye Lillyman, 2001). John was a 74 year old man admitted onto the ward from the emergency department, two days previous to me starting my first late shift of that week. He had been suffering from retention of urine, and was in considerable pain. My mentor and I were informed during handover that we would be looking after John on this particular shift. We were asked to change the dressing on his right leg. It had become ulcerated due to suffering from a condition known as Peripheral Vascular Disease (Alexander, Fawcett Runciman, 2004). As a result of this disease the patient had undergone amputation of the left leg below the knee some years ago, resulting in him becoming immobilised and requiring the use of a wheelchair. It became clear during the handover that Johns behaviour had become very difficult over the last couple of days. The nurse in charge went on to describe the nature of his behaviour including; that he had thrown items across his room, was constantly pressing his nurse call button, was sho uting all day and he had also refused to have a wash and change his pyjamas. As we left the room where the handover had taken place, my mentor suggested that we should change Johns dressing now, but firstly we should get him washed and changed with my assistance. I knocked on his door and introduced myself as a student nurse. I proceeded to ask John for his consent in order for me to assist him in having a wash and change of clothing (NMC, 2008). John was sat on his bed and appeared to be quite tense. He looked up at me and shouted no, I want to see a doctor and I havent had a cigarette for two days. I explained that I was here to assist in changing the dressing on his leg and to help him to have a wash and change. I moved closer towards his bed and lowered myself to his eye level. I then began to engage in conversation with him by maintaining a soft tone of voice and asking him if he would like a cup of tea after we had finished. His body language softened and he looked up and smil ed, he said I would love one. I smiled back at John, I then repeated the question of assisting him with having a wash and change, whilst maintaining a relaxed posture and eye contact. John gave me his consent and I proceeded to assist him in maintaining his personal hygiene with respect and dignity (NMC, 2008). With Johns co-operation my mentor and I were then able to go on and change the dressing on his leg. Through this learning experience I encountered a combination of feelings towards the situation. From the initial handover, the staff nurse in charge did not paint a positive picture of John. I wondered why this particular patient was so aggressive and demanding and the staff described him as being difficult. I felt anxious, as this was my first placement as a first year student and I did not feel experienced enough to deal with the situation. During my encounter with John it became clear why he would feel so angry and frustrated. I noticed he didnt have a wheelchair in his room, and it became apparent that he was a smoker. He also hadnt been given any nicotine replacement therapy to help him cope with his withdrawal symptoms. When the full extent of Johns situation became clear to me, I felt immense frustration for him. According to the NMC Code of Professional Conduct (2008), nurses should treat patients with respect and maintain their dignity. With John not having a wheelchair, he was confined to his bed and therefore had lost his autonomy. The situation also made me very angry, reflecting back I feel I should have been more assertive and maybe questioned why Johns requests had been ignored by the staff. It was unfortunate that the professional staff had acted the way that they did; overlooking how angry and frustrated John had become and failing to act upon it. The nurses compassion and communication skills seemed to be very much lacking; not listening to his requests and showing no feeling towards him. This breakdown in communication in the nurse patient relationship with john, left him feeling frustrated and not in control of his own wellbeing (Garnham, 2001). At first, I could not see any good points in this situation; however looking back I can see that it did have its positive side, in as much as allowing me to examine myself and to search for my short fallings in relation to the incident. The incident has also given me the opportunity to link theory to practice. The way I communicated with John had a positive outcome for both of us in that his personal hygiene needs were met and I learnt that effective communication is essential in building a trusting bond between the patient and the nurse (Almond Yardley, 2009). The bad points of this experience were that I judged John based on the information I received during the initial handover without having met him first. This could have created a barrier between the patient and I. Accepting a patient as a unique individual and without judgment is very important in the communication process. I have learnt from this experience that as nurses we should respect a patients beliefs and values and we should not let our own beliefs and values affect our decision making in patient care (Rogers, 1957). I also feel that I should have been more assertive when it came to the way John was being treated by the staff. As a first year student I did not feel comfortable questioning the way a professional staff nurse carried out her nursing care. However, from this experience I will question bad practice in future, as the NMC (2008) states that I am personally accountable for my actions and omissions in my practice and that I must always be able to justify my decisions. According to Maxim Bryan (1995 cited in Briggs, 2006), Communication is the process of conveying information between two or more people. Communication is essential in building relationships with patients and gaining trust. In the NHS, the majority of the complaints brought against them were for poor communication from healthcare staff (Pincock, 2004). To highlight how important communication is in the nursing profession, the NMC identified it as being an essential skill and only if a student is competent in this skill can they then go on and register as a nurse (NMC, 2007). In order to communicate with John the situation required the use of interpersonal skills, known as non verbal and verbal communication. Non verbal communication is described by (Dougherty Lister, 2008 p.62) as being information transmitted without speaking. Johns body language indicated that he was tense and anxious, therefore approaching him with empathy ensured that he was being understood and that his participation in communication was valued (Peate Offredy, 2006). Given the history of Johns aggressive outbursts it was necessary to consider the proxemics in the situation. It is recommended that keeping within a distance of 4 to 12 feet away from a person is less intimidating for them (Egan, 2002). In order to engage in conversation with John, Egans (2002) acronym SOLER was used. This is a process of using body language to actively listen to a person. By sitting squarely towards John, having an open posture, leaning in towards him, maintaining eye contact and a relaxed posture, t his in turn encouraged him to relax and feel less intimidated, therefore able to talk more openly (Dougherty Lister, 2008). Verbal communication with John was enhanced by the use of facial expression and paraverbal communication. According to (Delaune Ladner, 2002, p195) Facial expressions give clues that support, contradict or disguise the verbal message, therefore the use of a smile when approaching John indicated warmth and friendliness. This was assisted further by the use of paracommunication; these are the cues that accompany verbal language. These include tone, pitch, speed and volume of the person speaking; therefore communicating with John using a soft tone of voice added further meaning to the spoken words (Delaune Ladner, 2002). The barriers in communication during this incident were Johns aggressiveness. This could have been due to the withdrawal from cigarettes, as according to Bruce (2008) irritability is a symptom of nicotine withdrawal. If a patient is unable to smoke in hospital then nicotine replacement therapy should be introduced and the patient should be treated like any other dependant. Bruce (2008) states that Withdrawal from nicotine needs to be recognised and treated appropriately in the acute hospital; it will often be the ward nurses who are relied upon to recognise the symptoms. These symptoms were overlooked by the staff and to add to his frustration he had no means of mobility in order to allow him to leave the ward for a cigarette. This may account for his outbursts of anger. Peplau (2004) suggests that when there is an obstacle or obstruction preventing a person from achieving their goals this may lead to frustration which in turn often leads to anger. Using Gibbss reflective cycle has assisted me in analysing the situation and to put things into perspective, recognising how I can put this learning experience to positive use in my future practice as a nursing professional. If this situation were to arise again I know I would now have the courage to question the nurses attitude at an earlier stage pointing out that bad practice by anyone is not acceptable. From this experience I have learnt that I need to be more assertive and if I feel the needs of a patient are not being met, my first consideration should be to protect the interests and safety of patients, in line with the NMC (2008) Code of Professional Conduct. This reflection has highlighted the need to increase my knowledge and understanding of the process of communicating with patients from different cultural backgrounds, I will address these issues by, listening and learning from the qualified staff and by reading relevant literature. In conclusion it can be seen that the nurse has a very important role in communicating with patients throughout their treatment. When a patient is admitted to hospital, assessments should be made based on the activities of daily living, (Roper, Logan Tierney, 2000). Johns assessment not only should have identified the level of care required, it should also have established his normal routine and the fact that he was a smoker and also required a wheelchair for mobility. If Johns needs had been assessed correctly the breakdown in the relationship between John and the professional staff could have been prevented. Overall, through this reflection I have learnt that communication is an essential skill that requires as much practice and consideration as any other aspect of nursing. References Alexander, M., Fawcett, N. Runciman. P, (1994) Nursing Practice Hospital and Home The Adult London: Churchill Livingstone. Almond, P. Yardley, J. (2009) An Introduction to Communication. Chapter 1 IN Childs, L., Coles, L., Marjoram, B. (Eds.) (2009) Essential Skills Clusters for Nurses Basingstoke: Palgrave Macmillan. Briggs, D. (2005) Communication and Interpersonal Skills in Nursing. Chapter 4 IN Peate, I. (2005) Compendium of Clinical Skills for Student Nurses London: John Wiley Sons Ltd. Bruce, G. (2008) Smoking Cessation in Hospital London: Nursing Times. [Online] last accessed 18th November 2009 at http://www.nursingtimes.net/nursing-practice-clinical-research/smoking-cessation-in-hospital/1646376.article. Delaune, S. Ladner, P. (2002) Fundamentals of Nursing: Standards Practice (2nd Edition) Albany: NY Thomson Delmar Learning. Dougherty, L. Lister, S. (2008) The Royal Marsden Manual of Clinical Nursing Procedures (7th Edition) Oxford: Blackwell Publishing. Egan, G. (2002) The Skilled Helper: A problem management approach to helping (7th Edition) California: Brooks / Cole. Garnham, P. (2001) Understanding and dealing with anger, aggression Nursing Standard Vol. 16, No. 6, pp 37-42. Ghaye, T. Lillyman, S. (2001) Reflection: Principles and Practice for Healthcare Professionals. Wiltshire: Mark Allen Publishing ltd. Gibbs, G. (1988) Learning by Doing: A Guide to Learning and Teaching Methods Oxford: Further Education Unit, Oxford Polytechnic. Jasper, M. (2003) Foundations in Nursing and Health Care: Beginning Reflective Practice Oxford: Nelson Thornes. Nursing and Midwifery Council (NMC) (2007) Essential Skills Cluster for Pre- Registration Nursing Programmes. Annex 2 to NMC Circular 07/2007, [Online] Last accessed 1st December 2009 at http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=2690. Nursing and Midwifery Council (NMC) (2008) The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics London: NMC. Peate, I. Offredy, M. (2006) Becoming a Nurse in the 21st Century Chichester: John Wiley Sons Ltd. Peplau, H.E. (2004) Interpersonal Relations in Nursing New York: Springer Publishing Company. Pincock, S. (2004) Poor communication lies at the heart of NHS complaints, says ombudsman British Medical Journal January Vol. 328, No. 7430, p10. Rogers, C. R. (1957) The Necessary and Sufficient Conditions of Theraputic Personality Change Journal of Consulting and Clinical Psychology Vol. 60, No. 6, pp 827-832. Roper, N., Logan, W. Tierney, A. J. (2000) The Roper Logan and Tierney Model of Nursing London: Churchill Livingstone.

How Modern Technology Affects Library Books

The importance for polished English remains high on the priority among many firms as a basic requirement. The emphasis for proficiency in the English language starts from school for most, but most adults do not maintain a habit of constantly improving and updating their ability to read and write. Speaking has become a part of our daily lives and our reliance on English has turned it into the first language of many Singaporeans. Our heavy reliance on English gives us an edge when practising it throughout our daily lives. This however comes at the cost of having too much comfort and usually leads to arrogance that stops us from constantly improving and updating our language skills. The habit of good English could not only help with a person's daily life but also with any possible career prospectus. The ability to be more qualified than your competition in terms of articulation gives the everyday working adult an edge towards a better prospectus. It's a form of communication that exceeds the boundaries of Singapore, reinforcing its importance as a major world language. Other than simply being a means of communication, it also serves as the most universal form of articulation. A person can express his or her thoughts more concisely when using the appropriate language in a certain context. This means of expression precedes many generations before and was passed down to most citizens as their first language. Language proves to be timeless in its use and the relentless pursuit of self improvement can begin with good English.

My Struggle With Worry and Anxiety - Free Essay Example

Sample details Pages: 6 Words: 1852 Downloads: 4 Date added: 2019/03/26 Category Psychology Essay Level High school Tags: Anxiety Essay Did you like this example? Something I have struggled with ever since I was young is worry. I was homeschooled for a large portion of my life, and finally attended a brick-and-mortar school in 2nd grade. I would experience constant worry throughout the two years I was there. Don’t waste time! Our writers will create an original "My Struggle With Worry and Anxiety" essay for you Create order I would worry about almost anything and everything. It could be a test, something I said at recess, an event I am going to after school: it didnt matter what it was I worried. It got so bad in third grade that I worried to the point I was physically ill and was sent home vomiting. My worry had changed to what I believe was anxiety. Anxiety has three main components: emotional, physiological, and cognitive (Marques, 2018). For me, all three of these behaviors were present: worry being my cognitive response, my emotional being many things including fear, while my physiological was vomiting (along with sweating and shaking). My mother quickly removed me from school after 3rd grade and homeschooled me. I improved, but not because I had learned how to deal with my worry and anxiety but because I was removed from the situations. For years afterword, I struggled with worry and anxiety. There were times I would again bring myself to the point of physical illness obsessing over something that had happened in the past or could happen in the future. I remember times when I would bring myself to the point of shaking, and hyperventilating. This lasted up until my junior year of high school, where I re-entered the brick-and-mortar school system. In that environment I had to learn to deal with this behavior, because if I didnt I knew that I wouldnt succeed in school. My old behaviors didnt go away completely its just wasnt as extreme to where it impacted my daily life (therefore, no longer anxiety type symptoms vomiting, shaking, sweating). Today, this behavior is again becoming a problem. I now, again, get so worried my stomach knots up and often to deal with these emotions I use food. This is not the way I want my life to continue: its damaging to me physically and psychologically. Eating junk food when I am worrie d leads to me gaining weight which effects my confidence and self-esteem. Not only that, but overall because I am unhealthy I feel terrible: tired, weak, and unable to focus like I should. Then all of this brings me to feel emotionally drained and unable to handle normal everyday interactions with the ease that I used to (not to mention I am now feeling a deep sadness throughout most of my days). I have had too many nights this past year where I have just broken down and been unable to function because my anxiety and worry got out of control, and I couldnt stand it any longer. As I get older, if I dont take care of this now, its only going to get worse. One thing that I discovered through this term was that I could relate to neuroticism at a certain level. In the book, there are two tables of The Five Factor Model traits and what they consist of and in the neuroticism row worry and anxiety is present. Neuroticism has quite a few different factors, including: being insecure, feeling inadequate, and being hypochondrial (Diener Lucas, 2016, p. 372). Other factors include being depressed or getting angry (Diener Lucas, 2016, p. 373). I experience many these factors in varying degrees (though anger isnt a true struggle for me) and they are often a part of my daily life. I tend to, respond emotionally to events that would not affect most people, and [my] reactions tend to be more intense than normal (Five factor test Result, n.d.). The worst out of all the behaviors associated with neuroticism is my worry. I worry about a lot of things in my life: from how I might have done on an assignment, to one comment I made to somebody three days ago and if they took it the wrong way. Worrying over these things can last for days. Worry isnt the only thing that I can relate to with neuroticism, but its the one I am focusing on in my life right now. One site I found states how one who has neuroticism may experience worry due to a need for perfectionism and I think this may be the root of many of my struggles (Waude, 2017). My academic life is a big area where I struggle with perfectionism. I will often worry about how well I am going to do on something before the assignment/test has even been started. And it often is hard for me to accept in my daily life that: yes, I did do my best. This can be something that trips me up at work a lot, and it can make my day a miserable one. My mistakes are something I obsess over, when I do something successfully I cant enjoy it because I am concerned about whats next, and I often think that people wont like me if Im not perfect enough or good enough for them (Tabaka, 2017). These are all ex amples of how I worry over my perfectionism. I have often looked back on my worry and wondered how it came to be in the first place. Its the age-old nurture vs nature question. Was I born with a susceptibility to worry or is it something I learned from my experiences. As the psychologist Amy Przeworski, PhD states, Individuals inherit a predisposition to being an anxious person, [and] about 30 to 40 percent of the variability is related to genetic factors (Van, 2015). The textbook also states that, No single gene directly causes anxiety or panic, but our genes may make us more susceptible to anxiety and influence how our brains react to stress (Drabant et al., 2012; Gelernter Stein, 2009; Smoller, Block, Young, 2009) (Barlow Ellard, 2016, 424). Although some of what I experience may be genetic, I believe much of my behavior is something I learned growing up. It is important when investigating a behavior I want to change, to look at where in my life it may have been learned. I can engage in autobiographical reasoning to aide in this search: this means that I look at my past and what I have gone through to create an explanation for the behavior or what I am doing with my life in the present or plan to in the future (McAdams, 2016, 412). I think that one huge contributor to this behavior is my mothers influence. She is a constant worrier and has been for as long as I can remember. When my father lost his job when I was in middle school, she verbally expressed her fear and panic about how we were going to have to give the dogs away, sell our clothes, and live on the streets. It wasnt uncommon for her to see the worst-case scenario in her panic, and often it was her children she told those to. This is one example, but most definitely not the only one I was privy to throughout my life. An experience in my childhood that may have also helped guide to me where I am today in my perfectionism is that my father very rarely expressed approval or pride in my sister and me. The only times I was praised by him was wh en I came home with a good grade on an assignment or did something particularly great and so that became something I craved. The better I did, the more praise I could acquire. Knowing what experiences in my life has led me to worry the way I do doesnt necessarily change anything. It doesnt stop me from continuing such behavior, but paired with my motivation to change it, it can help me see which areas in my life I need to work on so that I dont worry like I have been. My perfectionism, as I have states above, is something that feeds into my worry. A good place to start in focusing on this behavior and training myself to better deal with it would be to remind myself that I am doing my best, and that is all I can do. What happens afterword will just happen, and it can be something I learn from or choose to wallow in. I worry so much about the what ifs, when there is no guarantee any of those worries will come true. One way to combat this might be to understand and accept that worrying wont change anything, and maybe even repeat my worries repeatedly in my head or out loud until they dont hold the same power over me (Mann, n.d.). If self-treatment doesnt work , considering how long this behavior has continued, I could always investigate cognitive behavioral therapy. Im not going to sugar coat it: even in the years my worrying wasnt horrendous, it still wasnt good. I would even say that it was never taken care of (even during my junior year as stated above), as much as the stress I was under wasnt so bad that my worrying and anxiety became chronic issues after high school. As I grow up, there is going to be more and more stressors in my life they arent things I can just hope will go away. I must deal with how I respond to those stressors, and I dont think I have ever truly done that. I can try to self-treat my behavior, but if I need help: there is no shame in that. I doubt I would ever need a psychotropic drug, but if it was considered whats best for me I dont think I would say no. I am just at that point in my life where it has almost become too miserable to say no to treatment. I think tomorrow may be a good day to start attempting to control how much anxiety I am experiencing. The reason I state tomorrow, is because this week is going to be the most stressful week of this term. I have a review from the state of Oregon coming up at work, I have plenty of assignments to submit, and all my bills are coming up. This week is the perfect time to do everything I can to calm myself down, accept things how they are, and move on. Breathing exercises may help me, by slowing my heart rate and sending oxygen to my brain, I am giving my mind time to come to terms with what is coming up. I can then repeat in my mind what it is I am worried about, and strive to accept the inevitably of the situation and that I can only do the best I can and learn from any mistakes I may make. If these exercises dont work, maybe I can look into yoga classes. If my symptoms dont subside after a length of time (within half a year), and I have looked up all the solutions I can, it may be time to talk to my doctor and schedule an appointment with a therapist in town.

Reconciling Religious and Scientific Perspectives of...

Reconciling Religious and Scientific Perspectives of Creation â€Å"In the beginning was the big bang,†[i] writes John Polkinghorne, a physicist turned theologian. As the reader follows through the remainder of his cosmic creation story, the reader is intrigued at how mystical and religious the story sounds. â€Å"The space boiled, in the rapid expansion of the inflation era, blowing the universe apart with incredible rapidity in the much less than 10-30 seconds that it lasted. . . . The world suddenly became transparent and a universal sea of radiation was left to continue cooling on its own . . .†[ii] Then, the story unfolds to tell of the creation of hydrogen and helium and the creation of stars. The death of stars follow, which†¦show more content†¦He has scaled the mountains of ignorance, he is about to conquer the highest peak: as he pulls himself over the final rock, he is greeted by a band of theologians who have been sitting there for centuries.†[v] Though Jastrow treats the issue as settled and declares that scientists have finally been â€Å"defeated,† it is too early to reach any judgements on the implications the new cosmology has for both science and religion. Our image of the origin of the universe is not yet complete and further investigations must be conducted before the towel is thrown in. Science has still much to offer to help us understand how the universe came to be. Therefore, let us now attempt to solve the cosmic mystery of creation by referring to the great scientific minds as our guide. Let us now rewind the story of the big bang and look into the origins of the universe. The idea that the universe had an origin was a result of the discovery of the expansionary universe.[vi] The theoretical groundwork for the expansionary universe theory was conceived, ironically, by Albert Einstein (a firm believer in the infinite and unchanging universe) in his work concerning relativity.[vii] The expansionary universe theory was later confirmed by Edwin Hubble in the 1920’s when he showed through careful observation of theShow MoreRelatedReligion : Religion As A Culture2134 Words   |  9 PagesReligion in America has helped change and design the American landscape into a unique cultural experience. Early colonists came to America to avoid religious persecution. Many European countries had official religions. Those that wished to practice a religion other than the official religion were persecuted. The New World offered a place of religious freedom for people such as the Pilgrims. 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