During my first day of clinical, I encountered an issue that I believe is very significant. As a student nurse, our duty for this day was to follow our health care aide around the ward and assist in completing resident care. The resident required assistance in many of her daily tasks. The health care aide asked if I would perform one of those and do perineal care for her. I turned down her offer because I did not feel comfortable with my skill level. The resident had a bowel movement during the night. There was a significant odour in the room that overwhelmed me. I really wanted to leave the room because it was so unpleasant, but I stayed in the room so that the resident would not be embarrassed.
This feeling of embarrassment, I assume, was already present but I decided to continue with helping clean up and change her linens. The issue that seemed significant, in this experience, was my feelings pertaining to intimate care. One of the reasons why there is so little training in this area could be because the act of providing intimate care for others can be considered as dirty work and is undervalued both within services and by the wider society (Clark, 2006) In society, going to the bathroom is seen as a very private matter and is not done in public. During this experience, this was going against my beliefs of our social norm and understanding this, I went with my values of caring and supporting individuals in need by staying in the room.
During this situation, I was trying to achieve my role of a student nurse while being professional in my actions. I did what I believed was right instead of following societies norms. Evaluating the issue with patient and my own personal issues, I made a decision that followed my morals and values. I chose to react positively to the situation at hand while learning from experience and following what I believed was ethically right.
Consequences that may have arisen for the patient stem from the fact that my techniques were not like the health care aides and were stiff and uncoordinated, which I can only imagine caused discomfort. It took longer than usual for me to complete my tasks because of my personal doubt in my skill levels and amount of experience. The health care aide I was with initially mentioned that shifts were very tight for time and for getting things done she noted that she comes in early to ensure things run smoothly, just in case of complications such as my current situation. My health care aide may not feel as confident in my actions as she may have been if I chose to initially participate despite my personal issues with intimate care. Having a loss of confidence in my abilities to deal with difficult and new situations turned out to be the consequences of my actions. Having more confidence and being aware of situations that may go against my beliefs and personal issues may have allowed me to have a better first day.
The health care aide was very supportive of my actions and praised my efforts after the fact for stepping in during my first time in a difficult situation. I can imagine the resident was feeling some distress and embarrassment, as she could not control her actions and was very thankful afterward. Although feeling discomfort during the event, I was very pleased afterward.
There were a few factors that influence my feelings, thoughts and responses during this experience. The feeling of discomfort in performing intimate care became obvious after the fact when I began reflecting on my clinical experience. I was not prepared for the amount of intimate care that was present. Sensing others` feelings is a trait that I have developed while being present in the health care area and teaching field, and along with my skill level, in nursing played a big part in my thoughts and responses during this experience.
Although having cared for my great-grandmother in the past, this was my first day experiencing intimate care with a resident. Participating in practice labs, class discussions and learning activities allowed me to have the knowledge of performing such duties and an understanding of how personal we would be getting, but did not realize how it would affect me. Giving myself time to read up on nursing experiences, attending more clinical practice labs, participating and watching these duties in the health care setting will allow me to develop a secure level of confidence the next time that this type of situation may occur.
Staying in the room allowed me to experience the feeling of support while looking past social norms and how they are challenged. I met my personal values, and I believe that one should respect another person`s privacy. This understanding allowed me to be there to support the resident during her time of need. In the article `starting out` by Jane Schulz, a nursing student shares her experience of helping her colleague assist an elderly patient with daily care. Observing the compassion and care between nurse and patient from fundamental tasks, she took away a valued lesson of how our support and caring methods affect an individual. My relation to this story allowed me to reflect on the effects my care and supporting actions had on our patient.
Having completed perineal care on manikins in class has been my only previous experience that I have encountered with intimate care. When presented with new situations, I have a tendency of handling them quite well with confidence. My reaction to intimate care was due to the discomfort with the amount of contact one has with sexual body parts and bodily fluids. I know what to expect if presented with a similar situation in the future, having had the experience I believe that I will understand how to handle my emotions and present a comfortable environment to better care for the patient. The only way I can be comfortable with intimate care is to participate in fundamental caring of patients and learn through experience.
If I was to alter my actions by leaving the room instead of staying to help and support my resident, the consequences for my actions may have been due to a lack of confidence in my skill levels from my health care aides point of view, and my own. It was apparent that the resident was not comfortable and needed help. Not giving my resident the care she deserves may have left her feeling like she was not important. Leaving the room would add to my view of societys norm that going to the bathroom is a private matter and I would not have gained any experience to develop my skill levels and confidence.
Reflecting on my clinical experience has made me aware of my strengths and weaknesses in my personal and nursing skills. I have taken a lot away from this experience; as I have come across a personal issue of have trouble dealing with intimate care. I have developed an understanding of social norms and how they can affect ones opinions.
This experience has given me the ability to cope in new situations as it is and will always be a part of my job. Developing a way to deal with intimate care to the best of my abilities will allow me to care for my client and make sure their feelings [embarrassment] and privacy are being respected. Coming out of this situation realizing my mistakes, my level of confidence will surely ascend and prepare me for my chosen field.
In relation to Carpers ways of knowing (Carper, 1978), I showed aesthetics by evaluating the situation as a whole. Despite having the urge to leave the room, I recognized the residents need for support when being faced with an issue that defied our social norm. Moving beyond the surface and being physically and mentally in the moment with the resident allowed her to experience the care they deserves through my supportive and helpful actions. I showed ethic ways of knowing when I understood that perineal care is something I believe was morally right. I felt like I had to be there for my patient when they needed me and make sure the care and support was present. Confronting my beliefs changed my opinion on societys norms; I used my values and morals to guide my actions. My personal ways of knowing develop through my experience with intimate care. I completed a task that I was not comfortable doing and believed was a private issue.
I decided to help in the experience after evaluating the patients level of discomfort and need of assistance. Until I experience a similar situation, I will not know if my reactions will be the same, but I will know that I have the skills and ability to do it. I showed my empirical ways of knowing by analyzing the article Primary Care Nurse Practitioners Integrity When Faces with Moral Conflicts by Carol Ann Laabs in relation to my experience with intimate care. The purpose of this article was to show the study of nurses problem with moral integrity in primary care. It concluded that moral conflict is common within an entire group (e.g. staff, team, co-workers) and keeping ones moral integrity makes them feel great about their actions in a fundamental way while keeping on a professional level. This connects to my experience as I was in a situation where I had to make a decision involving my moral integrity and do what I believe I could do based on my values. This experience helped me to challenge my ethical beliefs and make decisions based on what I believed was right.
This experience has changed the way I will look at new situations with intimate care and ones that I will encounter in the future. I discovering that our education can only guide us, but it is the experience that allows us to develop our feelings and beliefs. By completing this reflection of my clinical experience I learnt that I had a hidden personal issue with intimate care. Intimate care is defines as care tasks associated with bodily functions and personal hygiene which demands direct or indirect contact with or exposure of the sexual parts of the body. (Cambridge and Carnaby 2000) With knowledge gained from this experience and from similar future situations, I believe I can develop a comfort in my skill level. Having to adapt to a variety of different situations and conditions is a part of a nurses career and with experience and further education, I may come to terms with it and develop as a nurse. Having reflected on my actions, I am confident in my ability to follow my values and ethical beliefs while giving my patients my full attention and providing them with the holistic care they are entitled to.
Cambridge P, Carnaby S (2000) Making it Personal: Providing intimate and personal care for people with learning disabilities. Pavilion Publishing, Brighton. Retrieved November 7, 2007.
Carolyn Ann Laabs (2007). Primary Care Nurse Practitioners’ Integrity When Faced With Moral Conflict. Nursing Ethics, 14(6), 795-809. Retrieved November 7, 2007, from ProQuest Nursing & Allied Health Source database. (Document ID: 1342892401).
Carper, B. A. (1978). Fundamental Patterns of Knowing in Nursing. New York. Aspen Publishers, Inc.
Jane Schulz (2007). Starting out. Nursing Standard, 22(3), 29. Retrieved November 7, 2007, from ProQuest Nursing & Allied Health Source database. (Document ID: 1352629031).
Johns, C. (1994). Model of structured reflection. In A. Palmer, S. Burns and C. Bulman (Eds.). Reflective Practice in Nursing: The Growth of the Professional Practitioner (p. 112). Osney Mead, Oxford: Blackwell Science.
Julie Clark (2006). intimate care: theory, research and practice. Learning Disability Practice, 9(10), 12-17. Retrieved November 7, 2007, from ProQuest Nursing & Allied Health Source database. (Document ID: 1196316821).
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