Reflection in Nursing Essay Example for Free

Reflection in Nursing Essay This assignment is a reflective account of events that arose for a nursing student during their first clinical placement in a community hospital. A brief definition of reflection will be given, with emphasis placed on communication. This reflection has been chosen to highlight the need for nurses to have therapeutic communication skills, to provide holistic care for those diagnosed with dysphasia or speech loss and the scope of learning opportunities it has provided to improve practice in this area. All names in this text have been changed, to respect the confidentiality of the patient and other healthcare professionals (NMC 2002). Reflection, in this instance, is a way of analysing past incidents to promote learning and improve safety, in the delivery of health care in practice. The Gibbs reflective cycle has been chosen as a framework for reflection (see appendix 1). Mr. Comer was admitted to his local community hospital for respite care. He has suffered multiple, acute strokes in the past, which has left him with severe disabilities. These include paralysis rendering him immobile, aphasia (speech loss) and dysphagia (swallowing difficulties). He relies on carers for all normal activities required for daily living (Roper et al 1996) and is advised to have a pureed diet and thickened fluids. My mentor asked me to observe her feeding Mr Comer. She had prepared my learning the week previously by providing literature on the subject of feeding elderly patients and discussion on safe practice for feeding patients with dysphagia. I was alarmed and unprepared for the physical sight of this patient, who was coughing noisily and laboriously and a thick, green stream of mucus was exuding from his mouth. I observed Mr. Comer being fed and noticed he was coughing more than normal during his meal, but was informed that this was quite normal for him. I was asked to feed him the next day. When I uncovered Mr Comer’s meal he started to cough in the same manner that I had witnessed before, but this time he evaded all eye contact. I was feeling extremely anxious, but proceeded to load a spoon with his meal. His coughing increased in intensity accompanied by rapid eye blinking, turning his head away from me and throaty groans that I can only describe as distressed vocal growling. I was terrified at this point and called for assistance, thinking Mr. Comer was having some kind of seizure. I discovered very quickly from another health carer who knew Mr. Comer well, that he was protesting profusely about the pureed dinner I was going to give him which he dislikes immensely. On the previous day, he had received an ordinary meal, mashed to a smooth consistency, which is what his carers provided for him at home. This experience left me feeling very uncomfortable and inadequate in my role. I tried to understand why he reacted so alarmingly by putting myself in his position. I felt anger and frustration, but more importantly the feeling of helplessness. Not being able to voice my dislike to the meal offered exacerbated the urgency of hunger or thirst. Although this experience was very frightening for me and frustrating for the patient, it has highlighted the need for me to improve my communication skills. NMC (2002) outlines that we must not add extra stress or discomfort to a patient by our actions and we must use our professional skills to identify patient’s â€Å"preferences regarding care†¦and the goals of the therapeutic relationshipâ€Å". Severtseen (1990) cited by Duxbury (2000) applies the term ‘therapeutic communication’ as the dialogue between nurse and patient to achieve goals tailored exclusively to the patients needs. In this case dialogue is used by Mr. Comer in the form of body language and noise to communicate his needs because of speech loss. Nelson-Jones (1990) states that facial expressions are an intrinsic way to express emotions and eye contact is one way to show interest. The avoidance in eye contact displayed by Mr. Comer showed his distinct lack of interest. Compounding these factors was his facial paralysis, which made it especially difficult for me to ascertain the exact nature of his feelings. The nurse must be the sender and more importantly the receiver of clear information. Patients with speech impairment or loss have a more difficult task sending the messages they want and are sometimes unsuccessful in making themselves understood. (Arnold Boggs 1995). It appeared to me that Mr. Comer’s cough was not only a physiological disorder caused by his condition, but a way for him to communicate, in this case, his displeasure. Critical analysis of this experience has pointed to the fact that I have inadequacies in my skills, to identify covert and overt clues provided by Mr. Comer to his needs. I had focussed too much on the presenting task to feed him, with my mind occupied on his safety due to the nature of his swallowing problems. I had not considered his other needs like his wishes or desires and I had not gathered enough personal information about him beforehand to know this (Davis Fallowfield 1991). I had been unsure about what to say or do to alleviate Mr. Comer’s apparent anxieties and had adopted what Watson Wilkinson (2001) describe as the blocking technique. By continuing my actions to carry on with the meal, I was cutting short the patients need to communicate a problem. I was influenced in this decision because I felt obliged to be seen to reduce his anxieties, knowing my actions would be judged by an audience of other care workers and patients on the ward. I did not respond efficiently to reduce his distress and this pressure led me to deal with the situation inadequately and for that I felt guilty (Nichols 1993). I should have allowed more time to understand what Mr. Comer was thinking and feeling by putting words to his vocal sounds and actions. I could have shown more empathy in the form of my own body language to promote active listening (Egan 2002) and not worried about other peoples views on my decisions and beliefs to act in a way I felt comfortable with and thought was best for my patient. Gould (1990) cited by Chauhan Long (2000) have suggested that â€Å"many of the non verbal behaviours we use to reassure patients, such as close proximity, prolonged eye contact, clarification, validation, touch, a calm and soothing voice, the effective use of questions, paraphrasing and reflecting thoughts and feelings and summarising are all sub skills with the totality of empathy†. There is an abundance of information about communication, especially for nurses because it is considered by many as the core component to all nursing actions and interventions. Lack of effective communication is a problem that still exists because the learning process that leads to a skilled level of ability may take years of experience to develop (Watson and Wilkinson 2001). It has been quite difficult for me to admit my inadequacies in communication, but Rowe (1999) explains that a person must identify their weaknesses as an initiative for becoming self-aware. Only with acceptance of ones self, can a person begin to acknowledge another persons uniqueness and build upon this to provide holistic care.

The Role of American NGOs in the Regulation of Cruise Ship Pollution Es

The Role of American NGOs in the Regulation of Cruise Ship Pollution Each year, thousands of tons of pollution are generated on cruise ships and dumped into the world’s oceans. This pollution threatens the marine environment, the cruise ship industry, and the people who depend on a healthy ocean. Neither historical nor current international oceanic regimes provide comprehensive regulation on cruise ship pollution. To address the threats posed by limited oceanic pollution regulation in American and international waters, several American nongovernmental organizations have pursued diverse tactics to generate government, industry, and consumer response. To the extent that NGOs are able to influence policy, the actions of these groups challenges the realist notion that non-state actors have little influence on policy. A case study of three prominent American NGOs demonstrates how different strategies can be implemented to influence oceanic policy. The Bluewater Network, Oceana, and Conservation International have tried to abate pollution from cruise ships by either lobbying the government for improved policies, generating public awareness of the cruise ship pollution issue, or working with the cruise ship industry to implement stronger pollution controls. These actors have responded to the weakness in the oceanic policy regime. Although cruise ship pollution remains a major threat to national and international waters, American NGOs have been successful in generating increased awareness of the issue and have been able encourage policies that will make cruises more sustainable for both the environment and the industry (Oceana). The Development of Oceanic Policy International agreements have established the United St... ... The cruise ship pollution campaign has been strengthened by the cooperation among organizations that the Bluewater Network petition facilitated. Heightened public awareness, engendered by NGO campaigns, has pressured the U.S. government and the cruise ship industry to respond. If policy changes, such as those presented in the Clean Cruise Ships Act of 2004, occur, the activities of Conservation International may allow the cruise ship industry to comply with environmental regulations while maintaining high profits. The confluence of each NGO’s actions may provide the means necessary for a strong domestic ocean regime. In the absence of international cooperation, a strong American ocean policy is an important step in safeguarding the world’s oceans. Various strategies have allowed NGOs to highlight cruise ship pollution as an issue that can not longer be ignored.

Being Cheyenne

Waking in the dark, the sun not yet lighting the where the land meets the sky, I build the fire and begin my work for the day. I step in line beside my sister in law as we walk the path down to the stream to begin collecting water for the day. Each day since we have come here the dirt along the path has become smoother, beaten down by the repetition of our feet as we women come daily to draw from the water source.When we once more move on to follow the herds as the season changes, the smooth expanse will be left behind to be swallowed once more by nature. It has been our path for a small time but has always belonged to nature, who will reclaim it once we are gone. Though each day we walk together, the early morning walk to the stream is largely silent as we each think of the daily tasks ahead. This morning, I quickly run over my tasks for the day, allowing extra time to help prepare the buffalo if the hunt is successful.A successful hunt means more work today but peace of mind as wel l since I know we will not go without. For now though, my task is simple – to gather the water as I do every morning. The first thing I do this morning, as I come upon the stream is to step out of the worn moccasins that will encase my feet for the rest of the day and let the cool water rush between my toes. It is here that I watch the sun begin to color the sky, changing from dark to day.Between the water needed for cooking and cleaning, there will be several trips this morning to the stream. On the third trip to the stream, I hear the splashing of the boys bathing and playing at being warriors and begin to hurry. My sister-in-law is no longer by my side but back beside her own fire, preparing the morning meal. I hurry up the path noticing that the camp is now fully awake, as my two boys rush past, impatient for a full belly before going to tend to the horses.

Cognitive Psychology - 863 Words

Cognitive Psychology Brian Shrum Psy/360 April 11, 2013 Dr. Turner Cognitive Psychology Hermann Ebbinghaus said, â€Å"Psychology has a long past, yet its real history is short† (Goodwin, 2008, p. 28). He was referring to the belief that while the study of human thought, emotion, and behavior is firmly entrenched in philosophy, psychology as its own discipline has only been around a short time. During this short time, different branches of psychology have come out, one of them is cognitive psychology, which is only roughly 50 years old. Cognitive psychology expands upon other fields of psychology to further reveal why human beings act in the way they do. This paper will define cognitive psychology, explore key milestones in its†¦show more content†¦The second, and most destructive shortcoming for behaviorism, was that it did not observe, nor could it explain, human language, or intrinsic drives (Willingham, 2007). From these short comings, it became evident that parts of the human psyche had to be studied, which is where cognitive psychology began t o form. However, this shortcoming has not been the only development to help cognitive psychology become what it is. The metaphor comparing the human mind to a computer was a big leap for cognitive psychology. It allowed new abstract ideas to formulate on how the human brain works like an information processing center (Willingham, 2007). The basic break down of this is sensory input gives way to processing, and from processing a behavior is chosen and performed. This behavior could be internal or external dependant on what the input necessitates. For instance the computer currently being used to write this paper is receiving input from the keyboard. This information is translated as a bunch of zeroes and ones, which are then output to the monitor in the form of the letters being typed on the keyboard. Combine this metaphorical approach with the onset of technology, specifically neuroscience, and cognitive psychology continues to evolve. Neuroscience has tremendously helped cognitive psychology evolve. With the development of brain studying equipment such EEGs, CT scans, and MRIs cognitive psychologists, and scientists, are better able toShow MoreRelatedCognitive psychology  . Essay5542 Words   |  23 PagesCognitive psychology  is the study of  mental processes. 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