Reflection. A mirror into your very soul, or in the case of student nurses, a dreaded word that comes attached with a hefty word count and a massive graded essay. Sadly – for some – reflection doesn’t just end when we graduate. No, reflection is part and parcel of being a nurse and when we get that sought after pin is when reflection really kicks up a gear. Reflective essays are part of life now.
You’re not studying to be a surgeon, but trust me, you’ll be dissecting every thought and feeling in your reflective essay.
I won’t bore you to tears with the ins and outs of why reflection is important (purely because I stand a decent chance of plagiarising myself here) but it is. No one stands a chance of learning new skills unless they think about what could be done better and what needs to be thrown in the bin (figuratively speaking) So, say you’re a student nurse. Say you’ve been tasked with a 3,500-word reflective essay all about something that happened to you in placement. How the heck can you get it started?
Nursing student tips: Which model of reflection is best for my reflective essay?
Gibbs’, Rolfe’s, Driscolls’, Johns’, Kolb and Schon and carry on. Seriously there are a good handful of reflective frameworks that all work in their own ways, all have their pros and cons and all demand their own attention. Some are more about learning while you’re doing things, others are about sorting all the jigsaw puzzles once it’s already happened. Some allow free through to flow like a river made of glitter, others are more like a wander in the Crystal Maze. You need to find what works best for you. I personally love Johns. Why? All the others are general, anyone can use them to reflect from teacher to managers to accountants. Johns is adapted for healthcare and nurses in particular. It makes the job easy by its very design.
Choose a model, then outline all the steps you need to take. That’s the start. STICK TO THIS FRAMEWORK and ensure you keep your heading for your reflection.
Student nurse tips: What should I reflect on in my essay?
You’ll need to take a few pointers from your module leader here. Ours was specifically to revolve around a positive experience in placement. Nothing incriminating. Nothing that’ll leave you questioning whether you should even be alive, let alone a nurse in charge of people’s healthcare. So read the brief and have a think about a patient or two that stick out in your mind.
Create a mind map of: who they are,why they came to need your help (e.g. why they were in hospital, why they needed a community nurse visit), their previous medical history, any family or relatives you interacted with, and why the event sticks out in your mind. Did they say something or do something that helped or hindered your progress? Did treating them make you feel proud? Scared? Overwhelmed? If you can link a tangible feeling to the experience, then you’re on to a winner.
Remember, reflection will be getting all deep and personal about your feelings and beliefs, about why you think and feel that way and why you reacted as such. Ain’t no use writing about something you really have no connection to. Unless you’re a martyr of course.
Nursing student tips: Your reflective essay description a.k.a the critical event
When you start writing your description, it helps to follow a logical template. Plot out each point as a simple bullet list or another mind map. This will be your cue for when you start writing it out.
1. The patient
Introduce us to the main star. For the love of Pete never, ever, ever use their full name or anything that could identify them. Change their gender if you have to, and change their name completely. But start with their age range, their reason for needing care, previous medical history and any other little snippets that give us, the reader, some clue as to what’s going on.
2. The context
Now, start with where you were placed (again, no names), the setting (e.g. community, small local hospital, large regional hospital) and what happened upon handover. What were you told about this person before you even met them? Had you met them before? That’s ok, but what’s changed since? Give the reader insight into how you fit into this story.
3. The event
You might only be talking about giving your first successful IM, or helping someone off the loo. So jump right to that. ‘After completing my nursing tasks for the day, Patient June pressed her call buzzer…’ and take it from there. You don’t need to get bogged down into what you had on your fifteen-minute break or how the consultant lost a set of notes and sent you scrambling to find them. Focus only on the experience, and only on what happened there and then.
The feelings part comes in the main body of reflection, so try and keep these to a minimum within the actual description itself. If course, if you felt apprehensive about assisting as a scrubs nurse for the afternoon make a brief note in your description, but keep the main crux of your emotional reaction for the reflective cues later. It’s ok to say ‘I helped so-and-so when they fell’ and leave feelings out, as long as you refer to them in the reflective process below.
End your description in a neat way. Did you see them again? Did they return home? Did they thank you for helping them? Was the family pleased? A short little sentence just to end the experience nicely for the reader.
Student nurse tips: Getting all emoshe with reflection
Now, this is where it gets very generic because it all depends on which framework you’re using. But as a good rule:
- Read back through your description
- Note down any feeling, anything you can draw on that will help you analyse why you did what you did.
- Note down anything that ma have influenced that feeling.
Example: I helped Patient May to see the importance of drinking more water than she had been to help her blood pressure. This made me feel proud, experienced, and competent.
Now, write WHY you felt that. I felt proud because I gave information in a simple and clear way
I felt proud because I gave information in a simple and clear way, information I had learnt from my bioscience lectures. I felt experienced because I knew I could do it again.
I felt competent because my mentor allowed me to help the lady without supervision.
Whatever. Talk about why you felt that way. For point three, acknowledge the effects others have on your feelings.
I felt scared, but my mentor reassured me which helped me feel a little more courageous. I felt confident, but my patient was nervous about her injection, which made me feel like I wanted to reassure her. Etc.
Student nurse tips: Learning and moving on, ending your reflective essay neatly
Ok, so you’ve talked about the ethics of care, and the importance of the 6Cs. You’ve applied these to your experience, and you know why you felt like you did. You’ve explored the influence other people had on you that led you to act in familiar ways, and new ways. You’ve followed your reflective pathway and now need to figure out how you’ve learnt from the whole shebang.
This is up to you. But if you felt proud, then identify how you could do better next time. How will you improve yourself to help other people? How will you adapt to get a better placement grade? How will your experience help you be a better team player? This is time to focus on the good stuff, and also the stuff that needs a little bit of work. Don’t be too dramatic here, but also don’t say you haven’t learnt anything and you’ll do the same thing next time.
That’s completely missing the point.
So that’s a super quick way to structure your reflective essay. Break it down into bite-sized chunks. Choose the pathway that works for you, and don’t be afraid to change to another if you can’t quite make it stick. If you want something easy to follow, use Gibbs’ or Johns. Create a picture of your patient. Create a simple breakdown of the description. Read through your description and note down your feelings. Note down why you felt that way, what and who influenced you thinking that way.
Before you know it you’ll have worked through all your steps one-by-one. Now, that wasn’t too hard, was it?
TAGSnursing, student nurse
A reflective essay based on an episode of patient care.
rodrigo | December 3, 2012
WritePass - Essay Writing - Dissertation Topics [TOC]
This is a reflective essay based on an episode of care that I was directly involved in managing during a community placement. This episode of care will be analysed using up to date references, health care policies and relevant models. Issues and theories relating to leadership qualities and management styles will also be explored, taking into consideration any legal, ethical and political factors that may have impacted on patient care. Care delivery, delegation and prioritisation will be examined along with team working, risk assessment and patient safety. I will also take into consideration my role as a supervised student nurse and analyse the roles and responsibilities of those supervising me and what influence this has on my practice. These issues will be debated and questioned within the framework of leadership and management theory
In order that I could use this situation for my reflection the patient will be referred to as “Mrs A”. In this assignment confidentiality will be maintained by the use of pseudonyms, this is to maintain privacy and confidentiality in line with the NMC Code of Professional Conduct (NMC, 2008), “as a registered nurse, midwife or health visitor, you must protect confidential information”, and to “Treat information about patients and clients as confidential and use it only for the purpose for which it was given.”
Starting an extended practice placement as a third year nursing student enables the student to develop their knowledge and skills in management and leadership ready for their role as a qualified adult nurse. During my extended practice placement there were many opportunities to develop these skills and manage my own caseload of patients and arrange many complex aspects of their care.
During this placement an 88 year old patient, to be known as Mrs A, was due to be discharged from a rehab centre following recurrent falls, issues with safety at home, and self neglect, the referral had been made by a concerned General Practitioner. Mrs A had spent the last 6 weeks receiving holistic multidisciplinary care, including; intensive physiotherapy, occupational therapy and nursing care. Mrs A had made much improvement and was able to safely administer her own medication.
One of the Physiotherapists called Ken, had commented during handover, that Mrs A had seemed confused during their session together, and asked if the nurses would go in and review her. Upon visiting Mrs A it was clearly evident that she was not herself, and seemed confused. Following discussion with my mentor I felt that Mrs A was not safe to administer her own medication. I recommended to the patient to let the rehabilitation staff administer her medication. Mrs A consented to this, thus reducing a great risk of Mrs A causing her-self harm. I delegated to the support workers to obtain a urine sample which was tested and confirmed that Mrs A had a urinary tract infection, antibiotics were prescribed by her GP. The team leader at the rehabilitation centre was informed of Mrs A’s infection and plan to handover the administration of her medication to them, she was happy with this decision and pleased that I had informed her.
This episode of care was managed effectively as the underlying cause of the patients confusion was discovered and treated, a risk assessment was completed and a referral was promptly made to medicine management and a dossett box was supplied to Mrs A, to help her manage her own medications safely. All members of the multi-disciplinary team were fully committed to the team approach to care delivery and this facilitated efficient and organised care delivery. The care delivered was patient-centred and teamwork was integral to providing this care.
First will be a discussion on the importance of self awareness and how this awareness enabled a more assertive and confidant approach to be made to managing patient care.
Self awareness must be considered as the foundation for management and is a vital skill and quality needed in leadership. If you wish to provide care that is of a high standard and improve your own performance as a skilled health care professional you need to manage the cognitive, affective and behavioural self in order to engage effectively in therapeutic relationships. Self awareness is the process of understanding one’s own beliefs, thoughts, motivations, biases and limitations and recognising how they affect the care and services provided (Whetten and Cameron, 2010).
Without being self aware, recognising personal and cultural beliefs, and understanding interpersonal strengths and limitations, it is impossible to establish and maintain good relationship with co-workers and patients. Maslow’s Hierarchy of Needs Theory (1954) depicts self-actualisation at the highest level of the hierarchy of needs. This relates to the need to maximise potential and achieve a sense of personal fulfilment, competence, and accomplishment (Maslow, 1954). It is important as a student nurse to be completely aware of strengths and weaknesses, and to be conscious of any limitations, self-awareness helps to exploit strengths and cope with weaknesses (Walshe and Smith, 2006).
When organising and planning patient care it is vital to have effective management and leadership skills, this is part of every nurse’s role, and involves planning, delivering and evaluating patient care. These management responsibilities are part of every nurse’s role (Sullivan and Garland, 2010) and to exhibit these professional behaviours demonstrates their value to the organisation (Huber, 1996). To understand nursing management it is crucial to understand what nursing management is and the theory behind it.
Managers are defined as “a member of a specific professional group who manages resources and activities and usually has clearly defined subordinates” (Gopee & Galloway, 2009). Another definition of management is a process by which organisational goals are met through the application of skills and the use of resources (Huber, 1996).
Borkowski (2010) argues that Douglas McGregor made a significant impact on organisational behaviour and was an American social psychologist that proposed the ‘X-Y’ theory of management and motivation. McGregor (1966) describes the ‘X-Y’ concept as the theory that underpins the practices and attitudes of managers with regard to their employees. Huber (2006) states that theory ‘X’ managers assume that employees are lazy, that they dislike responsibility, would rather be directed, oppose change and desire safety. Theory ‘X’ implies that employees are rational and easily motivated (either by money or threat of punishment); therefore managers need to impose structure and control and be active managers (Huber, 2000).
Huber (2000) asserts that the opposing theory, (‘Y’) assumes that people are not lazy and unreliable by nature rather that they are self-directed and creative if well motivated in order to release their true potential. Businenessballs.com (2002) asserts that most managers are inclined towards the ‘X’ theory and usually obtain poor results whereas managers who implement the ‘Y’ theory produce better performance and results thus allowing people to grow and develop (Businessballs.com, 2002).
Borkowski, N. (2009) Organizational behaviour, theory, and design in health care , USA: Jones & Bartlett Publishers
Cameron, K. and Whetten, D. (2010)Developing Management Skills, USA: Prentice Hall
Gopee, N. and Galloway, J. (2009) Leadership in Management in Heathcare, London: Sage Publishers
Huber, D. (2006) Leadership and Nursing care Management. 3rd Edn.USA: W.B Saunders Company
Maslow, A. (1954) Motivation and Personality, New York: Harper & Row
McGregor, D. (1966). The human side of enterprise. Leadership and motivation. Cambridge:
MA: The MIT Press.
Sullivan, E. And Garland, G. (2010) Practical Leadership and Management in Nursing, Essex: Pearson Education Limited
Walshe, K. And Smith, J. (2006) Healthcare Management, New York: Open University Press
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