I was very nervous when I informed my mentor as to what effect her actions had, had upon Mary, as I have never had to confront someone senior to me.
However this turned to sympathy when she told me about her brother, but I also felt that she hadn’t respected Mary’s equality and diversity as an individual. Ellis, Gates, Kenworthy, (2003) claim that assumptions are sometimes made by nurses which can lead to people being grouped together as all the same, without considering the individuality and holistic aspect of each case, I believe in Mary’s case, my mentor had made these assumptions based on her previous experience with her brother.The third stage of the reflective model moves to evaluating.
In attempting to evaluate the example this looks at what was good and bad about the experience. A positive aspect of this example is that I now understood how spending time just listening to a patient is really beneficial as it makes a huge difference. Rogan Foy, Timmins, (2004) assert that the use of interpersonal skills vastly improves nurse-patient relationships.
Another aspect is that now having seen how some nurses relate to patients I know that I definitely do not want to interact that way. I want to be able to empathise with the patient and treat them with respect and dignity at a time when they need reassurance and understanding (Alexander, Fawcett, Runciman, 2004).The fourth stage of the model is to analyse the example, this looks to see what sense can be made of the situation. From this example I have come to the conclusion that people can be influenced very easily in a group setting by the comments and non verbal actions of others. So much so that it can impact on the provision of care offered to patients, this comes about due to the improper thought or questioning of the person involved. I also found that many people draw from their previous experiences with little or no regard as to whether the situation is truly the same or different, I realise my mentor judged Mary by the degree of effort that she thought she should meet due to collective previous experience’s with her brother.Reflecting on this example has made me realise that I have an issue with being new and relatively inexperienced, I tend on occasion to feel that the other members of staff are often more experienced than I am, and that I am an outsider. Whilst training to become a family planning nurse this will constantly be a factor for me to consider and overcome.
If in the future I should witness practice that I feel is unacceptable in accordance with the Department of Health (1999) benchmarks regarding clinical incidents and poor practice, I must and will, continue to appropriately question or speak up regardless of my level of experience.After the analysis process the model moves to the conclusion of the example, during this stage I needed to look at what else if anything I could have done better. I feel that looking back on the situation involving Mary; I could have done a number of things to improve the situation. By appropriately speaking up and questioning the staff I could possibly have prevented them from treating Mary the way they did. If I had recognised the verbal and non verbal cues that my mentor and other staff displayed whilst interacting with the patient I could have possibly intervened and diffused the situation before it got to the stage that it did.The last area of the reflective model is to formulate an effective action plan. This action plan involves considering what I would do if a similar kind of situation arose again.
If this kind of situation were to occur again in the future I would definitely intervene, by firstly speaking up as the patients advocate and asking the staff to question whether they had got all the information necessary to make the type of judgement that they did.I would also try to ensure the staff communicated properly to the patient by taking the time to understand what she was saying and ensuring that they follow the guidelines set in place for respecting a patient at all times when communicating with them. I feel that training in communication and interpersonal skills should be mandatory to ensure that all members of staff are able to deliver high grade quality care in all areas of health care.My second example from practice is Marie she had come to the young people’s family planning clinic for condoms as she had a new partner; Allegedly Marie and her partner were drug users and known risk takers “Risk taking” behaviours are common when adolescents start being sexually intimate, (Tripp and Viner 2005) and are often associated with the taking of illicit substances. Marie had attended the clinic in the past.
Marie had been labelled as a teenage mum and difficult to deal with by some of the family planning nurses. Goffman (1968) believed that labels stigmatised people and for some people all sorts of other negative characteristics are conferred on the individual.Marie was suffering from post natal depression and had stayed in hospital in the past for this condition. The family also had other factors to consider. Housing was a major problem, in that it was a local authority funded flat in an old Victorian house. In addition the flat was without heating or beds. Marie also had the extra responsibility of having to look after two other children who were all less than three years of age.
Another consequence of unprotected sex is unwanted pregnancy. The incidence of teenage pregnancy across Europe varies considerably (Dickson et al 1997). The United Kingdom has the highest rate in Western Europe and is lower only than Bulgaria, Russia, and Ukraine in Europe as a whole. Throughout most of western Europe, teenage birth rates fell during the 1970s, ’80s, and ’90s, but in the United Kingdom, rates have remained high at or above the level of the early ’80s (Tripp and Viner 2005). It is important to recognise that for some young women, particularly from certain ethnic or social groups, teenage pregnancy can be a positive life choice (Tripp and Viner 2005).My mentor asked Marie to come into the consulting room and was initially pleasant to her but when Marie began to explain about her needs regarding condoms she became antagonistic and said to her she needed to look at a better long term contraceptive method. Marie got angry and started to swear and stand up in an aggressive way.
My mentor then started to raise her voice and asked Marie to leave; Marie refused to do so and asked to see a different nurse. My mentor then left the room to talk to her team leader.I stayed and listened to Marie who said she felt that my mentor was looking down her nose at her. She had said her day was getting worse and this had been the last straw and began to cry. I tried to comfort her by offering her a drink, which she accepted and explained she was sorry for shouting.
The team leader then entered the room and dealt with Marie more sensitively and made her feel at ease. The team leader also gave her a supply of condoms and information on Implanon and other contraceptive methods.The second stage are the feelings and I felt unhappy about the inappropriate way the nurses including my mentor had labelled Marie, and had openly discussed her during lunch break. I then became angry and felt I needed to confront my mentor which I did in front of all the staff. On reflection I should have spoken to her in private, but due to my anger it all came out and my mentor looked embarrassed by my outburst.
She tried to say that Marie had been aggressive in the past and she wasn’t going to put up with it. Then she became angry with me and said we can talk later and walked out. I felt self-conscious and I also left the room maybe with some regret at my outburst.Then Gibbs (1988) asks you to evaluate and analyse the experience, and look at the good and bad about the situation dealing firstly with the bad points.
Giddens (1997) felt Prejudice could occur due to this type of stereotypical thinking displayed by my mentor, also the mechanism of displacement where feelings of anger or hostility can be directed towards an innocent individual. Nursing should be a wholly non-judgmental profession and clinical areas should work towards this at all costs.Any members of staff who display such characteristics and behaviours should be sent for training in this area. During our lunch break similar such thoughts were discussed about a number of patients who had been seen including Marie, it was apparent to my dismay that this type of stereotyping was openly accepted. Cartwright (1968) discussed cohesiveness in groups, normative influences and informal influences. This can mean that on occasion members of the group can jump on the band wagon and agree with colleagues because of self-preservation and wanting to be accepted and liked.I felt that I had needed to express my views but maybe I should have done this in private and also when I had sufficiently calmed down and I was not so angry. From my previous example I had felt that I should have spoken up, so this time I did.
Next time I will try to handle the situation differently and speak to my mentor without an audience as it was unprofessional and had made us both feel uncomfortable. The good was the team leader entering the room and taking charge of the situation with experience behind her and training she made Marie feel at ease and I too felt happier to see Marie calmer and happy to leave with condoms and advise about further contraception.In conclusion Marie could have been given a further appointment to explain the methods she had been given leaflets about and time to talk about her choices with a family planning nurse trained to look after young people with good communication skills. I would also suggest further training in communication for all staff on an annual basis. Communication is an essential and skilled part of the nursing profession, not only with patients and their relatives but with other members of your team.Kenworthy, Snowley and Gilling (2005) suggest that communication has three fundamental components of which are necessary, for it to be successful; these include the sender, the receiver and the message.
Simpson (1991) would suggest that communication skills require practice and there are many factors that are essential for the effective dialogue with a patient, which include listening skills, language skills, questioning skills, linking and clarifying skills, extending skills and hypothetical questions.I feel that I have significantly developed my reflective skills by using the Gibbs model; it has enabled me to think critically about my feelings, actions and thoughts, in particular in the way that I intervene in difficult situations, whilst I will continue to advocate for my patients I will also consider the impact and appropriateness of my words and actions towards other members of staff. I also feel that it has helped me to identify areas of my practice that I can develop, improve and build upon. I can achieve this by attending further teaching sessions and continuing to update my professional practice. I will also ensure that in the future I pass on my gained experience through structured teaching practices to other members of staff.
By using a reflective model I have come to recognise just how important reflection is to the improvement of practice.Reference ListAlexander, M. F., Fawcett, J. N., Runciman, P.
J. (2004) Nursing practice hospital and home the adult. (2nd Ed) London, Churchill Livingstone.Cartwright, D. (1968) The Nature of Group Cohesiveness. London: Tavistock.
Department of Health (DH) (1999) Making a Difference: Strengthening the nursing, midwifery and health visiting contribution to healthcare. London: HMSO.Department of Health (DH) (2003) Protocol on consultation with patients and carers during the care planning process. [online] last accessed 1st March 2008 at URL http://www.
dh.gov.uk/assetRoot/04/03/53/54/04035354.pdfDickson R, Fullerton D, Eastwood A, et al. (1997).