NURSING REFLECTION AND ITS USAGE

Running head: NURSING REFLECTION
NURSING REFLECTION
Name of the Student
Name of the University
Author Note

NURSING REFLECTION1
Diary entry
I will use Borton’s three levels of reflection in order to reflect on the incident that
occurred during my first placement in the geriatric department of the hospital. The Borton’s
model of reflection generally uses three steps for analysing the incident that has taken place,
what had happened, gives the account of the feelings and the lessons that has been learnt after
the incident. Nurses working in the geriatric ward, often have to deal with elderly patients
who had been suffering from dementia. Nursing dementia patients are quite challenging as
many of the patients come up with several behavioural challenges and often show aggressive
behaviours, show self-destruction attitude and violence towards the nurses. Such challenges
hinder the type of care. However, while I was in care for my patient, I witnessed one of my
peer nurses seemed too much anxious with her patient who had dementia. On asking, it was
known that the 65 years old patient suffering from progressive dementia has not been
receiving his food since, last night and is verbally abusing any nurses who is trying to go near
him. Since, the patient had been diabetic and needs to take meals after every 3- 4 hours. I
heard that the nurses wanted the authorities to grant them with the permission to the apply
restraints for nasal feeding. The patient was becoming more and more agitated each time the
nurses are trying to hold their hands. However, I suggested the nurses to leave him for a
while for giving him the chance to calm down. After few hours, I went to the patient for
pacifying him and to convince him to have food. Somehow, I managed to make the patient
eat some food, without applying any restraints.
Level 1
What?
The issue was about the application of restraints on a dementia patient, in order to apply the
nasal feeding for the enteral feeding. The problem was that restraint is generally applied as

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the last resort as long the clinicians are not left with any other options. But in this case the
restraint was applied even without trying all the feasible alternatives like trying empathetic
words, giving comfortable backrubs, taking the patient for a walk before the lunch or the
dinner. This incident came to my notice when I was taking care of my own patient. I
immediately intervened between the entire situations and eventually reported this matter to
the higher authority. I had been mindful enough to check to report this matter and fully
helped the administrators to the resolve the issue. Being a novice, I was not very sure to
interrogate the nurses but I tried to inform them about the pitfalls of the application of
restraints and the legal ramifications that might follow. However, the nurses had admitted
that they had been busy these days and cant afford to spend so much time on only one patient,
as the concerned elderly patient used to take long hours to eat.
The bad thing about this entire incident is that I was anxious by this situation, that
how would, the other nurses react to my action. But to my surprise, my mentor and the other
peer nurses appreciated my deed and asked me to be more careful to prevent other such
“misses” in the future. My mentor commented on what I did tight and what I could have
done. I would not deny, that this has helped me to understand my feelings, strengths and
weaknesses.
Level 2
So what?
I felt ashamed and angry to see that my peer nurse is experienced enough not to act
such callously. I was even surprised to see that none of the nurses who was witnessing this
entire things also did protested at the time of this incident. I was perturbed and anxious as the
patient was shouting, which was obviously disturbing the other members. I was even fearful
of the fact that the patient might inflict harm to the other patients present or might indulge in

NURSING REFLECTION3
some self-harming behaviour as she was becoming agitated seeing all the nurses approaching
towards him. The only good that happened in this entire incident is that the patient finally
agreed to have food and he became calm after sometimes and no restraints have to be put on
the patient. This information has been escalated to higher authority. I personally explained to
the nurse as what dangerous could have been happened. Physical restraints could have caused
psychological issues in the elderly patient, the patient could have hurt the nurse or the other
nurses that were present. Forceful feeding could have caused difficulties in aspiration or
choking of food. A health care professional should be knowledgeable about the restraint
policies and the laws of the particular organisation. Restraints should be minimum and needs
to be applied only after the approval of the doctor.
Normally, the staffs have a false sense of security as they apply restraints on the
elderly. But no researches could find out that restraints could manage the behavioural
symptoms in the dementia patients, instead usage of the physical restraints have led to a
threefold increase in the agitation of the dementia patients.
I believe that provision of restraints applied on elderly person can give rise to several
ethical issues. According to Simpson, Joesch, West and Pasic (2014), the research and the
clinical practice affected by dementia and their families present a set of complex ethical
issues. Putting on restraints might restrict the autonomy of the patient and he might feel that
his life will be threatened or that he cannot rely on the health care professionals. In health
care, it is the duty of the health care workers to act for the benefits of the patient maximizing
the utility of the patient considering the benefits and risks of the patient. Non-maleficence
ethics on the other hand means no harm and facilitate good to the patient (Yönt et al., 2014).
Hence, it is the duty of the nurse to estimate the severity of the harm that can be inflicted
upon the patients. The beneficence principle to an agitated patient is actually absolute, as it is
not clear whether the restraints can actually confer safety to the concerned patient. I should