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In this assignment, I will examine an incident which I experienced during practise on my placement at a local care home and reflect on how I carried it out. The reflective model which I will be using is the Driscoll by Borton model. According to The University of Nottingham (no date) the model is based on 3 questions What?, So what? and What now?. The Open University (2018) states that reflection allows you to improve personal skills and look back on how effective it was, why you did it that way and how you can improve it.
I am doing this reflection so that I am able to identify the specific things which I believe I could work on, allowing me to become a better clinician. HCPC (2019) states that reflection also benefits the patients you make contact with in the future, therefore suggesting that once you have reflected on an event, you are likely to have a bigger understanding on what you can do within a similar situation for the future.
My patient encounter was on placement at a local care home. A resident had to go to Accident and Emergency as he had broken his wrist by falling. Due to Resident H’s severity of Dementia, it was recommended by paramedics from a local ambulance trust that a member of staff should ideally go with him for reassurance and a familiar face to comfort him. I offered to go with resident Has Dementia Solutions Inc (no date) states that being in an unfamiliar environment can cause a person with Dementia to feel restless or confused and by myself going with him prevented this from happening.
One factor from the scenario I would like to discuss is my communication – Caring Connection, Inc (2018) advises that before speaking to a person with Dementia it is best to be aware that you should not speak to the patient how you would speak to a child as it can come across as degrading towards them. Also, it is recommended that you talk clearly, calm and in short sentences to avoid any confusion. It is also advised to allow them time to answer you, as they may need to process what you said and make sense of it. The final piece of advice which is advised, is that you listen carefully and to expect delays in conversation, interruption may confuse the patient.
From when we left the residential home and got to Accident and Emergency, I spoke clearly to Resident H at all times to reassure him and would only ask short and simple questions which I knew he had the capacity of answering. When I spoke to him, I ensured that I did not sit too close to him as it may have caused distress.
I communicated well with Resident H and also followed how the experts recommended to, I also made an attempt to distract him from the fact we were going to A&E and got him to focus on something different. I knew he was a fan of sports so I used that topic of conversation as a method of distraction.
However; I did not consider the fact that it may take more time for Resident H to process what I was saying to him, luckily this did not cause any confusion, but in the future, if I was to find myself in situation similar to this one, I would consider that interruption could lead to the service user to feel confused.
Staff must consider equity when with patients – According to World Health Organization (2019), equity means that a service users health should not be disregarded because of their sex, ethnicity or race. To achieve health equity, it means to allow service users to have equal opportunities. Furthermore; Roemer.J (1999) states that equity is when all service users with alike health needs receive similar or the same treatment and opportunities whatever their background. This is very important because it shows that all healthcare professionals are expected to treat all of their patients the same and provide them with the correct information about their health. In addition to this; Mcintyre.D (2007) states that equity in health care settings will develop over the years, this shows that professionals are aware that the service users they come in to contact with are more likely to be of different backgrounds and ethnicities.
I treated Resident H fairly throughout the whole time of the incident, throughout my placement, I ensured that I treated all of the residents equally and fairly.
During the incident, I was kind and I made resident H feel like he could speak to me if he needed to. When he would ask me questions, I would be honest with him and I believe that this linked to equity as I was willing to be open about why he needed to go to A&E.
Looking back on the scenario, I don’t believe that there is anything that could have gone better, as throughout my time at placement and during the incident, I was always promoting kindness and ensured that if the residents felt if they needed to talk to me, then they were able to. However, an improvement which I believe I could make for the future is to look into equity further, this is so I can extend my knowledge on the topic and so I can find ways in which I can promote it in situations such as this one.
Another factor which staff must think about is their patients dignity – Hicks.D (2011) states that working as a clinician means that you must accept all individuals by treating them equally and giving the patient the attention which they need by listening to their concerns and responding to them. Another factor which Hicks.D (2011) identifies is to put people at ease, for example; if a patient was to be incontinent, you should not criticize them for that, as they may have not been able to help it if they have a disease such as Alzheimer’s. Furthermore; Royal College of Nursing (2015) advise staff to ensure that the service users privacy is taken into consideration, this can be done by staff ensuring that their patients are not needing to go to the toilet or that their modesty is protected.
Throughout, I ensured that his dignity was protected. I promoted this by ensuring that he had not been incontinent, due to his severity of Dementia, Resident H has a history of being incontinence, however he was clean before leaving the home. if he had an accident before leaving, instead of saying out loud, I would take a carer to the side and explain to them that he will need to have his clothes changed before leaving to go to the accident department.
Moreover, I ensured that I was getting permission before entering his personal space, I did not want to intimidate him or make him feel stressed in a high pressured situation, so when I had to help him sit on the bed of the ambulance I would ask him if he was happy for me to support his back whilst he sat down.
I thought about Resident H’s dignity also, I considered a variety of factors which could have an impact on him, for example; even though he was not incontinent, I still thought about the ways in which I could help him if that was to occur when he was en route.
Although, I did not let him choose his own clothing. When Resident H was leaving to go to the Ambulance, I should have given him the opportunity to choose what coat he would like to wear and asked if he needed help putting it on, I assumed he needed the assistance. If this scenario was to occur again the the future, I would promote the service users independence by letting them choose their own items of clothing and ask if they need assistance when dressing, instead of assuming that they are in need of help.
I would also like to assess my manual handling during the event – Journal of Nursing Education and Practice (2013) advises that the patients shoes or slippers are fitted correctly to minimize the risk of falling, also explain to them what the task is and its purpose, then to repeat it and finally to place the correct walking aid such as a frame in position and to let the patient know that it is there.
In addition to this; the Health and Safety Executive (no date) evaluate the risk factors associated with moving and handling by using TILE. TILE is an acronym for Task, meaning you must consider any obstacles which can become a risk to yourself or the patient; Individual, means that the task may have to be approached differently. Load means to contemplate the weight or size of the load. Finally, the last factor to consider is environment, to aim to think about any confined spaces which could have an impact on the task.
Throughout this, I remained patient because it took the resident in my care time to walk from his chair to the ambulance. I ensured that he did not feel like he was being rushed because this could have lead to him falling and therefore causing more damage to his wrist or injuring himself. Additionally, I positioned a frame in front of Resident H so he could have some support in getting up out of his chair I also informed him that it was there so he was able to use it. However, I did not repeat what I said to Resident H before assisting him on to the bed in the Ambulance. Ideally, I should have repeated what I said because he may have not understood what he was going to be doing and this potentially may have caused some confusion. If I find myself in a similar situation, I would improve by ensuring that the patient has an understanding on what they will be assisted in doing and I will also aim to consider TILE when it comes to moving and handling patients.
I would like to reflect on my awareness of Safeguarding throughout my scenario.
According to EduCare (2017) an adult who has a physical disability or mental disability such as Dementia, their safety is at a higher risk than a service user who has capacity or is not physically disabled. If a vulnerable adult was to be dependent on someone it could possibly lead to abuse and for this to be avoided then the staff giving that vulnerable person the support they need should know their safeguarding responsibilities.
In addition to this, the Royal College of Nursing (2019) states that there is a Duty of Care where every professional is expected to follow and act a specific way towards service users. If staff were not to meet the standards of care mentioned in Duty of Care, then it can be seen as them neglecting their service users.
Furthermore; Social Care Institute for Excellence (2014) states that there are safeguarding principles put into place specifically for adult safeguarding, these principles are; empowerment, prevention, proportionality, protection, partnership and accountability. By the six key principles being put into place by the UK Government, any risk of harm is reduced as professionals are more aware on how to make informed decisions by following the principles.
During the incident which occurred, there were no safeguarding issues which I came across. The situation was controlled well by professionals and all followed the key principles in order to ensure Resident H was receiving the best care possible.
I believe that I thought about confidentiality during this scenario. I had known the patient for 5 weeks and had spent a lot of my placement caring for and assisting him which aided me to learn a lot about him and when speaking to the paramedics, I ensured that I was not giving any of his personal information away as that would have been breaching confidentiality.
However, during the time of the incident I did not think much about safeguarding as we did not occur any safeguarding issues and all professions carried out their safeguarding role correctly so maybe I should have thought about what to do if any potential safeguarding issues occurred. Finally, if I was to come across this situation again I would try and think about the key principles if I believed that a safeguarding issue had to be put into place and I would do this by looking into what the key principles are in detail.
In conclusion, I have identified why all of the factors I have mentioned are important for patients and in healthcare environments, such as safeguarding. In addition, I established what I believe I did well during this scenario and why I did it, then reflected on what I didn’t do and how I can improve on that. This shows that I am able to reflect on previous events and find ways in which I can improve so I am able to become a better clinician for the future.
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