Reflective Evaluation of A Patient Care Episode

Running head: REFLECTIVE EVALUATION OF A PATIENT CARE EPISODE
REFLECTIVE EVALUATION OF A PATIENT CARE EPISODE
Name of the Student
Name of the University
Author Note

REFLECTIVE EVALUATION OF A PATIENT CARE EPISODE1
To develop prowess in professional practice, the ability to reflect on features of
caregiving or particular clinical episodes is indispensable. Reflection is a process beyond
examining experiences and instances; it is instead a method of thoughtful analysis of previous
actions and thoughts about evaluating a specific incident to achieve improvement in future
cases. Reflection, therefore, enables a nursing professional or a caregiver to inspect and
review their learnings and skills in a clinical setup in the light of awareness and evidence.
The purpose of this essay is to examine and reflect on an episode of individual patient care in
clinical practice, specific to nursing experience in mental health management, concerning the
processes associated with decision-making and rationale necessary for planning appropriate
clinical care and treatments. This essay will be structured using Rolfe’s Framework of
Reflection. It will address three parts, namely, description and self-awareness, analysis and
synthesis of action (Skinner & Mitchell, 2016). It will critically evaluate my experience as a
nurse in the caregiving process of an elderly patient diagnosed with dementia. The essay will
present a brief of the case history and disease symptoms, and then follow Rolfe’s reflective
model. As per Nursing and Midwifery Council (NMC) guidelines, the identity of the patient
shall be protected and for this case will be referred to as Mr A, to maintain confidentiality
(Price, 2015).
Mr A is a 69-year-old man who was admitted to the hospital four weeks ago with
complaints of confusion and hyponatremia. Mr A is married to Mrs B, who is 62, and both of
them are retired professors. According to the patient’s medical history, he was previously
detected with vascular dementia a few years back, and he has been facing a deterioration of
health ever since; precisely the symptoms of dementia. His condition has steadily worsened
with time. Mrs B is the chief carer for Mr A, and they receive financial support from their
children, two sons, both of whom stays out of the country. The couple lives in their own
home, where they have resided for the last 45 years.

REFLECTIVE EVALUATION OF A PATIENT CARE EPISODE2
When the patient was initially admitted to my ward with the present medical
complaints, he had other significant problems due to his prediagnosed dementia, like memory
loss and cognitive dysfunctions, apathy, fatigue, withdrawal symptoms, difficulty in
communication and ‘wandering’. It was then explained to the patient, his wife and sons that
due to his deficient sodium level, he will be under a strict fluid restriction of 750
millilitre/day. However, considering the patient’s mental instability, he repeatedly demanded
fluids, and if not provided, he started to behave aggressively with everyone. Such situations
created a ruckus inside the ward and disrupted the peace of other patients there. Hence, the
chief nurse requested a special attendant to provide individual care for Mr A.
I was assigned to his care one morning for arranging and supporting him in personal
hygiene. When I was about to begin my work, I noticed that he seemed scared to cooperate
with me. Upon asking about the matter, he fumbled and then started sobbing. He reluctantly
told me about an incident, where the special attendant physically abused him. She slapped
him on the arm and pinched him forcefully while giving him his medication. He also
informed that he waited to notify a staff nurse, but could not remember it later on. He
expressed that he wanted to convey this to his wife and sons but was afraid of not being able
to remember. I reassured him that such instances would not be repeated and apologised on
her behalf. I also told him that he would not be taken care of by that particular attendant any
more. Afterwards, I reported the incident to the chief nurse of my ward, and together we filed
an Incident Report Form.
When examined as an overview, one should take into account the main issues in this
scenario are that a patient with known case of dementia, who may, therefore, be suffering
from significant cognitive decline, and is undoubtedly confused due to his metabolic
disorders related to hyponatremia and possibly forgetful, has accused another staff attendant
of physically assaulting him. One should also note that the incident occurred three days ago,

REFLECTIVE EVALUATION OF A PATIENT CARE EPISODE3
and so the authenticity of the event cannot be confidently substantiated at this stage and there
is an uncertainty revolving around the patient’s reliability in such circumstances. With
relation to the case, appropriate analysis involves reflection on my actions and their
justification as to be considered essential or capable of improvement.
My role in the situation was that of a recipient of the accusation from the patient
himself. When I first heard the allegation, I tried to make sense of the incident from different
perspectives. On the one hand, I was mindful of the gravity of the claims if it were real while
also being aware of the consequences that could disrupt the professional integrity of the
special attendant on the grounds of a false allegation. Besides, I was privy to the distinct
conditions of the patient involving potential confusion and memory loss. Despite his potential
of mental inconsistency, I was surprised by the accuracy of Mr A’s recollection of the event
and by his emotional reaction to it. This compelled me to consider the possibility that his
claims might not be untrue. I realized that I had a moral obligation and responsibility to
reciprocate to his charges as his caregiver, not only to abide by the ethical values of
healthcare but also because I believed his account of the event. Therefore, as per existing
rules, I escalated the complaints to our chief nurse, who then asked me to fill up the ‘Incident
Report Form’, which would then be forwarded to the hospital authorities.
After completing all the formalities, I introspected for an extended period involving
reflection on my actions during the event. I was concerned about being inadvertently a part of
propagating a false allegation, considering the severe consequences that the special attendant
would face. With intense reflection, I came to realize that my actions were justified then. The
reasons being my professional ethics as well as for acting as the sole advocate for my patient
in such a situation.