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Introduction
Nursing care is one of the most common but underestimated services in hospital settings. While doctors focus on diagnosing and medical decision-making for patients, nurses are responsible for following prescriptions and treatment plans and supporting their patients in various ways. There are several types of nurses with specific obligations and skills. Compared to registered nurses who coordinate care or health assistants who monitor patients, nursing associates cover a gap in this role transition and participate in most care aspects, including patient assessment, planning, and evaluation (King et al., 2020). Doing a nursing associate is not an easy task, and reflection is a good way to understand what has been done well and what adjustments can be offered. In this paper, Gibb’s reflective cycle will be applied to describe my nurse experience in providing care for a patient with a learning disability. I will do my best to create a thoughtful description of a situation, share my feelings, evaluate my observations, analyze the environment, conclude knowledge, and develop an action plan. I believe that nursing associates play a key role in supporting patients with learning disabilities and sharing their experiences.
Model Choice
Today, students and practitioners are free to address different theorists and philosophers to organize their reflections and share their knowledge in a clear and comprehensible way. Using my practice as a nursing associate in one of the local hospitals, I would like to introduce a care setting where I cooperated with a patient who had a learning disability and his family. Gibb’s reflection model is a unique way for medical students to analyze situations and define possible improvements (Li et al., 2020). Graham Gibbs developed this approach in 1988 to differentiate between learning activities and real experiences and help healthcare professionals gain a sense of their actions (Li et al., 2020). I am going to reflect on my nursing associate practice according to Gibb’s cycle, specifying the description, my feelings, evaluation, analysis, conclusion, and action plan. Each step is a solid contribution to a better understanding of professional nurse-patient relationships, with attention to nursing roles, family involvement, and learning disabilities.
Description
In this case, I want to share my experience with a patient who had a learning disability and punched me because his mother was going home, and I would not let him follow. According to Louch et al. (2021), people with learning disabilities introduce a population characterized by a great vulnerability concerning health inequalities and need family and carers’ involvement to ensure safe outcomes. I could not ignore the principle of quality in the offered care environment. I knew that the presence of learning disabilities makes patients challenged in understanding information, developing new skills, and coping with tasks independently (Louch et al., 2021). Therefore, my role was not only to undertake some clinical tasks and perform observations but support individuals and share information. Despite unpredictable changes in the care environment and the necessity of managing challenging behaviors, a nursing associate must deliver safe care to pediatric patients with learning disabilities and reduce risks and harm (Louch et al., 2021). I followed my duties and ensured that the child was visited by his mother and received clear instructions about the offered care and treatment.
Unfortunately, violence at the workplace remains a serious problem in the nursing field. Nurses are exposed to physical and verbal violence regularly, leading to mental health disorders, anxiety, nightmares, and stress (Pich and Roche, 2020). Although cooperation with pediatric patients differs from the care of adult patients, I think it is wrong for a nurse to accept violence as a part of their job. Still, as it was a single time in my current profession, I did not pay much attention to the situation. I hoped the child punched me unintentionally due to his inability to understand and cope with his emotions. The mother did not see the moment of punching, and I did not find it necessary to report the case unless the same happened again. In the room, there were three people: the patient, his mother, and me. I could not make the child be accused of violence, and I did not say anything to anyone about the situation.
Feelings
During the situation, I had confused feelings, which could prevent me from making the right decision. On the one hand, I realized that the moment when the patient punched me because I followed the standards of care and promoted his safety was unfair. As a nursing associate, I should not accept it as something ordinary or not deserving of attention. I had to report this situation and discuss it with a registered nurse. However, I felt that complaining about the child with a learning disability hitting me because I separated him from his mother was something insignificant and even naïve. The level of damage was insignificant, and I had no signs of trauma. I think that some nurses could feel hurt about the same event because it challenged their dignity and made them vulnerable in the workplace. During the situation, I was confused because it was my decision either to report my colleagues and the patient’s mother or not.
On the other hand, I understood that I worked with a patient who had a learning disability. It was not his or someone’s fault that the child did not have enough abilities to comprehend what was right and what was wrong and how to behave (Louch et al., 2021). Before the situation, I was confident that people with disabilities should not be deprived of the same right to obtaining the highest quality care (Appelgren et al., 2018). After the situation, I wanted to know more about how to deal with the situation when a patient punched a nurse and what reaction was more or less appropriate. However, I could not neglect the mix of feelings, like surprise (the punch was totally unexpected), shame (my desire to complain about the child), and even fear (I had never been hurt at the workplace). Thus, I wanted to evaluate the situation on my own before involving another person.
Evaluation
In my attempt to evaluate the situation and what was good and bad about that experience, I addressed the hints Gibbs gave in his model. The task was to look at the clinical adverse event through the prism of my psychological experience (Li et al., 2020). The main negative aspect was the decision of the patient to punch the nurse and neglect all possible consequences. The situation proved that he could hurt another person, either intentionally or not if the desired goal was not achieved.
I would also like to underline the positive issues in that case. First, I did not publicly denounce the use of violence by the patient to show him my desire to develop personal and trustful relationships. Second, I did not prioritize my hurt feelings over the safety and care of the patient. Finally, I recognized that the situation was complex because of the patient’s specific condition and distinguished between my ambitions and the boy’s needs. In other words, it was my chance to strengthen my skills as a nurse associate and succeed in fast decision-making, emotional control, and a sound analysis of a particular situation.
Analysis
In addition to evaluating the event in a care setting, my goal was to ensure there was a sense of what happened and what outcomes were identified. A pediatric patient with a learning disability expects parental support and professional care, including managing behavioral reactions and communication difficulties (Appelgren et al., 2018). My silence helped maintain stable relationships between the mother and the child and avoid unnecessary explanations and discussions about morality and appropriateness. The situation went well because not many people were directly involved, no serious hurt was made, and no critical problems occurred.
However, at this moment, I think my neglect of such insignificant violence was the first step in misunderstanding my workplace obligations and rights. According to Pich and Roche (2020), violence in healthcare is a serious issue worldwide, and many nurses continue ignoring it, diminishing their working conditions. I was one of those nurses who did not report the patient’s violent behavior but contributed to the inability to explore a fair and safe nursing experience. Now, I am not sure if the decision was right for a nurse associate and what consequences could be expected with time.
In fact, I learned a lot from this situation with the pediatric patient and his violence during my shift. Despite a number of actions, like communication with my colleagues and the parent or official report, were not taken, I was able to achieve positive outcomes. The first lesson was the worth of cooperation and trust between a patient and a nurse. There are moments when a fast and unpredictable decision can be made. Instead of feeling sorry for doing or not doing something, it is high time to consider personal emotions and attitudes.
I relied on my compassion and desire to cooperate with pediatric patients. I knew that children with learning disabilities could demonstrate various behavioral and verbal reactions, and any nursing associate should be ready for them. Empathy, physical endurance, and critical thinking were the skills I used to predict unnecessary discussions. Still, I think I need to focus on the development of such qualities as communication and patient assessment. Instead of accepting punching as a possible reaction of a patient with a learning disability, my task was to consider it as another disorder symptom for evaluation.
Action Plan
The last step in this reflection is the creation of an action plan to check new alternatives and different approaches to the same situation. If I faced the same violent behavior, I would probably try to talk to my colleagues about the patient. I do not find it necessary to bother the mother because my notice could affect her feelings or desire to visit the child regularly. However, communication with another nurse would be a great chance to discuss the situation and make the necessary decision. At the same time, I should remember that not all registered nurses or healthcare practitioners are eager to cooperate because they are afraid of replacement by nurse associates (King et al., 2020). Thus, another step would be to examine an overall situation in a hospital and ensure that my situation does not create some threats to my employment or task completion. To make sure I can act differently next time, I want to improve my relationships with colleagues and be confident there are enough professionals around who want to help. Thus, observation, communication, and thorough evaluation are integral parts of my action plan.
Conclusion
In general, this reflection helps me understand that the level of readiness for and knowledge about nursing practice does not always determine the quality of decisions nurses make regularly. My obligation to take care of the patient with a learning disability did not presuppose the situation when he punched me because I did not allow him to follow his mother leaving home. Despite my awareness of nursing care standards and duties as a nursing associate, it was hard for me to predict the development of such a violent event. I did not want to talk about that situation with another person because I thought a pediatric patient was an insignificant threat at the workplace. Further evaluation and analysis made me conclude that communication with a colleague could be a good solution to understanding what went wrong or right and how to predict similar situations. Sometimes, patients need additional care and attention, and a nursing associate should analyze the situation and concentrate on the patient’s needs and reasons for behavioral changes.
Reference List
Appelgren, M. et al. (2018) ‘Nurses’ experiences of caring for patients with intellectual developmental disorders: a systematic review using a meta-ethnographic approach’, BMC Nursing, 17(1).
King, R. et al. (2020) ‘Motivations, experiences and aspirations of trainee nursing associates in England: a qualitative study’, BMC Health Services Research, 20(1).
Li, Y. et al. (2020) Nurses’ psychological feelings about the application of Gibbs reflective cycle of adverse events. American Journal of Nursing, 9(2), pp. 74-78.
Louch, G. et al. (2021) ‘Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review’, BMJ Open, 11(5).
Pich, J. and Roche, M. (2020) ‘Violence on the job: the experiences of nurses and midwives with violence from patients and their friends and relatives’, Healthcare, 8(4).
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