Free Research Paper on Reflection:
Introduction
The aim of this paper is to reflect upon a critical incident from my experience that affected me in a significant way. The desired outcomes of working on this paper are enhanced introspection skills as well as an ability to use reflection and self-examination as tools to arrive on important decisions. Both of these sets of skills are of paramount importance in any medical profession since it involves undergoing stress and emotional shocks on a regular basis. Good medical practitioner should be able to control his or her emotion; however, control over one’s emotions does not necessarily means dismissing all emotional responses. Instead, emotions should become a useful guide to action, and this is achieved through careful introspection.
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There is another perspective on the significance of reflection and introspection in any medical profession. Taking into account the fact that stress and emotional shock are inalienable elements of professions of such kind, medical practitioners often encounter situations and experiences they need to make sense of. In-depth reflection can alleviate negative emotions associated with certain experiences and develop skills necessary to cope with situation of the like nature in the future. Additionally, if no reflection takes place and negative feelings are suppressed, they can become a source of persistent anxiety and depression.
Finally, the third and probably the most important function of reflection is that it is an essential learning tool. For every medical practitioner, it is necessary to embrace life long learning and develop skills to become a self-directing and highly competent professional.
For all the aforementioned reasons, reflection paper is an essential exercise for any medical practitioner.
Methodology
According to Gibbs1, reflection is best viewed as a cyclical process. Firstly, an event must happen, and this occurrence is called a critical incident. Secondly, emotions, both positive and negative, must be analyzed and the result evaluated. At the following stage, the conditions of the incident should be considered and understanding needs to be achieved, with due attention being paid to alternative ways to solve the issue. Finally, there is a need to think about what actions are most appropriate if having to operate in the same conditions in the future.
Gibbs’s cycles consists of six interrelated stages. The first stage — Description of the event — is devoted to a detailed description of a critical incident that requires reflection. The questiona that the one needs to pose to him/herself are as follows: where were you; who else was participating or observing the event; why were you there; what were your actions; what were other people’s actions; what was the context of the event; what happened; what was your role in this; what parts did the other people play; what was the result of the incident.
The second stage focuses on feelings aroused by the critical incident. Here it is necessary to recall and analyze the reasons why the event produced a powerful effect on the person. The questions that might be helpful at this stage are as follows: how you were feeling when the event commenced; what you were thinking about at the time; what emotions did it arouse in you; what emotions did it arouse in other people; how did you feel about the result the incident; what do you think about it from the current perspective.
The following stage — Evaluation — should focus on making a judgment about what has occurred. It is necessary to think about the positive value of the experience and negative sides of it as well; it is also a starting point for reflection on what went wrong in the course of the incident.
The forth stage — Analysis — requires break the incident down into its elements for separate examination. The set of question to be asked at this stage is aimed at exploring concepts similar to those analyzed at the previous stage, for instance, what went right; what did you do in an appropriate manner; what did others do appropriately; what went wrong or failed to bring expected outcomes; in what manner did you and other people contribute to this.
The fifth stage — Conclusion — should not be confused with the previous stage, since by this point the one is expected to be able to view the issue from different perspectives and have a command of maximally full information to develop a judgment. At this stage, an analysis of own behavior and behavior of other people is necessary in order to understand how it contributed to the course and outcome of the incident. It is also necessary to reflect on the possibility of alternative outcomes of the incident.
The last stage — Action Plan — is directed at developing coping skills to be able to deal with a situation of the like nature upon future encounter. The conclusion should concern the decision whether to act similarly or different if the same incident happens in the future. However, it is not an end of the cycle, since if similar incident occurs in the future, it should also become a subject of a reflective cycle.
Reflective Cycle
Description of the event
Being a trainee operating department practitioner, I an often exposed to patients undergoing serious operations or suffering from acute pain. However, one recent incident can be referred to as critical from my personal perspective.
A middle aged female patient underwent an operation called Girdle Stone procedure. Girdle Stone procedure, sometimes referred to as a resection arthroplasty of the hip, is an operation that implies a removal of femur, so the thigh bone can fuse with acetabulum in the straight leg position. It is a widespread procedure in case of complications after a hip operation. It helps to get infection under control and is successful in the vast majority of cases. It is also helpful when a patient is suffering from post-operative pain. Pain relief is one of the main challenges associated with this operation, yet there are means to achieve satisfactory pain relief within a reasonable timeframe2.
The incident happened in a recovery area after she underwent this operation. I was in a recovery area since I was sent there to look for a doctor specializing in IV sedation. I looked around and was about to leave from the area when I noticed a patient with an expression of pain and fear on her face. It was crystal-clear that the patient was very confused due to the acuteness of pain she was suffering from. Although it is not a part of my duty, I decided tom facilitate the solution of this issue and called a pain nurse. At first, I wanted to leave this matter to the nurse, but then my intuition told me to stay there and look how it goes. Another reason for my decision to stay and offer my help if needed was the impression that the pain nurse was also confused and at a loss. There was also a trainee LPN in the area and nobody with greater experience or higher qualification. Without doubting the competence of the pain nurse, I thought that my assistance at some point might be helpful. It was also of interest to me how to deal with situations like this when I become a medical professional myself.
The nurse’s first drive was to administer morphine right away. However, she returned and informed me and LPN that she opted for Nurse Controlled Analgesia (NCA).
I inquired whether nursing staff was entitled to administer NCA, since usually medical officer is needed to prescribe or alter NCA. I also inquired why she dismissed morphine as an option. She said that she was reluctant to administer morphine since she was unaware of contraindications the patient might have had. She told that NCA is more appropriate for patients suffering from moderate or severe postoperative pain.
In determining the acuteness of pain, the nurse did not rely on any of well-known pain assessment methods. While middle-aged patients are usually able to provide useful information about their state and progress of treatment through self reporting, the nurse decided not to ask the patient about her state. I could guess that she relied on physiological signs and observation of behavior only.
After being administered NCA, the patient was placed in a side room. Since her pain was slightly relieved, the nurses stopped paying attention to her. I pointed out that NCA requires constant observation of patient’s state and alteration as the need arises. The nurse responded that she had other things to do and other patients to take care of. She also asked me not to intervene with questions or remarks and focus on my own duties.
Feelings
During the incident, I experienced a variety of emotional states; many thoughts were running through my head. First of all, I felt concern for the patient and was anxious about her receiving proper analgesia. Then I also become interested in the process of administering analgesia since it might be helpful for my future career. Eventually, interest gave way to frustration because I had never seen a person in such pain before the incident. My anxiety increased and I felt a drive to do something. For a moment I thought that I had to wash my hands of it and entrust the pain nurse with helping that patient. However, I was able to get control of my emotions and stay in the recovery area. I felt that it was my moral obligation to stay there and help.
When the nurse left for morphine, I had a feeling that ages had passed before she returned with NCA. It took me a couple of instances to realize that it was a different type of analgesia. I thought that the nurse might have taken a different kind of analgesia by mistake. I also was concerned about her not using any pain assessment table.
I had an impression that all actions of the nurse were not prompt enough. Since the patient was in acute pain, I was horrified by the inability of medical professionals to help immediately and effectively.
She seemed to be very reserved and I wondering how a personal can retain control over oneself when witnessing another person in such a terrible condition. I thought whether I could be able to stay as calm and reserved as she was in such extreme situations.
However, my adoration of the nurse’s reserve nature soon gave way to uneasiness and doubt. When she did not answer my question about NCA being a part of her responsibilities or not, I started to feel irritation. Yet I also felt that my irritation was wrong as the nurse was the only one able to help that patient. Furthermore, I am always trying to offer constructive and not merely critical remarks. Thus, I took a decision to be a mere observer as the situation developed further.
When the nurse managed to get the patient’s pain under control, I felt relieved for a couple of instances. I was also emotionally tired from the stress and shock I experienced. Yet when the patient was placed in a side room and forgotten, I experienced another outburst of emotions. I felt very angry at the nurses that were not fulfilling their duties diligently. In addition, I was shocked by the absence of human touch in those nurses. I felt more competent than they seemed to be and very sorry that I was not in the position to help. When the nurse told me to get busy with my own stuff, I was frustrated and in a chafe.
Evaluation
The positive value of the incident can be perceived from two different sides: rational and emotional. In term of rational perspective on the incident, I gained valuable experience from observing how analgesia is administered. It also encouraged me to get more information concerning different methods of pain assessment, analgesia, and nurses’ roles and responsibilities in hospital settings.
On the emotional level, it is hard to give such a clear-cut answer about whether the experience was positive or negative. It was very distressing and tiring for me; it also left an unpleasant aftertaste. Over time, it became a source of never-ending anxiety and guilt. I had an impression that all my actions in that situation were either irrelevant or even harmful. However, reflection and introspection helped me to deal with these negative emotions, and I started to see positive sides of this incident for me emotional development. For me, it often takes an effort to hold back my emotions, especially in critical situations. This incident demonstrated how important it is to retain control over one’s emotions. Giving in to them means inability to take swift and effective actions which are the key to the profession of a health care practitioner.
Analysis
From my current perspective, I understand that my thoughts and emotions were appropriate in that situation. Pain has a profound effect on the recovery of a patient and the healing process; therefore, it is the primary responsibility of a medical professional to offer the patient optimal analgesia with minimal side effects. Side effects can include over-sedation, respiratory depression, pruritis, nausea and vomiting, thus continuous review of the patient by the pain nurse is necessary3. Such review should be coupled with hourly observations and careful monitoring by the nurse caring for the patient. Putting the patient in a side room and stopping to pay attention to her was definitely a wrong decision by the pain nurse and LPN.
I remember that for a moment I got a desire to report nurses’ inappropriate behavior to hospital management. Yet as a trainee I would not be perceived as a credible source of information; furthermore, friendly relations with hospital stuff would be spoiled. I also did not know what the accepted method of helping patients in pain in that hospital was. I thought that their actions that seemed wrong from my perspective might have been right from the perspective of the pain nurse who is in the position to deal with issues like this.
Therefore, I decided to double-check my knowledge of different methods of analgesia before making my final judgment about the actions of nurses in this incident. When my knowledge about analgesia turned out to be quite comprehensive and correct, I started to feel guilty for not offering more help to the patient.
This incident can be regarded as critical since proper analgesia is important not only because it may produce side effects that, in turn, may have long-term influence on patient’s health. Unrelieved pain has detrimental effects on the healing process. It also results in emotional trauma and deterioration of doctor-patient relations. Adequate and quality nursing care is essential for safe pain relief and accelerated healing process. To achieve that end, hospital administration should oversee the implementation of guidelines and protocols, which can increase the basic standard of care whilst the support of pain teams or professionals may offer much needed direction and consistency to strategies for pain relief4.
Having demonstrated the importance of pain relief for the healing process, I will move on to discussing the ways to address problems of such nature.
Conclusion
In the situation like this, there were three possible scenarios for action. First of all, I could entrust the pain nurse with handling the situation and get back to my duties. From the perspective of the pain nurse, this scenario was the most optimal, since I would not have interfered within her work and challenged her authority. Yet from the ethical perspective of a health care practitioner, this would have been wrong, taking into account my personal commitment to providing quality health care to all patients.
The second scenario was to act like I did by offering limited help and pointing out possible mistakes. However, there are some week sides of this approach, too. Limited help is sometimes worse than no help; in addition, pointing out the nurse’s mistakes did not make her fix them.
The third scenario was to report the pain nurse’s incompetence to the hospital management, despite it would have diminished friendly relations with colleagues. This action is a post factum one, so it is little help to the patient who was not given adequate care, yet it may be necessary to prevent such cases in the future. If to analyze this issue from an ethical perspective, deontological ethic will suggest that it is still the correct thing to do as it is morally right even despite it is a post factum action.
The most optimal approach will be discussed in the concluding chapter of this reflective cycle. Yet one important conclusion that should be made after this incident is that health care practitioners should always remain in control of their emotions in order to be able to think clearly and correctly. Also, they should never be afraid to question the authority of their superiors or colleagues from other departments.
Action Plan
If I encounter a situation like this in the future, I will act depending on circumstances. If a health care professional involved in solving an acute and serious problem like this acts in an appropriate manner, accepts advice from other parties, and is ready to cooperate, I will offer him or her all the necessary help. I will not be too intrusive or importunate in offering my assistance, but it is always easy to reach common ground with a qualified practitioner. In addition, I will offer my help only if I have no other urgent and more important duties to discharge.
If the practitioner seems to be unqualified or non-cooperative, I will first of all look for somebody who has greater expertise in the issue in question or is in a superior position to that practitioner. I will ask that person to double-check if the situation is resolved in the most effective way; if not, I should ensure that the superior or more qualified professional takes over the situation. Furthermore, I should not be afraid to report my colleague’s misconduct to the administration of the hospital.
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