Reflective Practice in Nursing Education

This assignment delves into the concept of reflective practice within the context of nursing education. It examines various theoretical frameworks surrounding reflection, such as lifeworld-based reflection, and explores its practical applications in enhancing student learning and professional development. The assignment also considers different perspectives on reflective practice, including critiques and alternative approaches, ultimately aiming to provide a comprehensive understanding of this crucial aspect of nursing education.

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Surgical Trauma Unit, Bega Valley Private Hospital
Name
Affiliation
Instructor
Date
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Introduction
Healthcare providers have many models of reflection to choose from (Maas,
Stocchetti and Bullock, 2008, pp. 728). My most preferable model of reflection is Gibbs
reflective model. It promotes proactive thinking and development which in turn promotes
autonomous clinical practice (Ekebergh, 2007, pp. 332). I have always been an autonomous
thinker and anything that makes my work easier. Classroom instruction and lectures alone
may not foster autonomous, and professionalism in healthcare practice (Finlay, 2008, pp. 15-
57; Maas, Stocchetti and Bullock, 2008, pp. 728); however, with some experience (through
internships), feedbacks and utilization of the Gibbs reflective model, students can gain
superior reflective abilities vital in dispensing impeccable healthcare services. To complete
one of my elective units, I was designated a one-month placement in the Trauma Unit at Bega
Valley Private Hospital. This facility is among the busiest and largest medical providers in
Australia. It is also famous for using up-to-date technologies (McCarthy and Murphy (2008,
pp. 307-309 & Maas, Stocchetti and Bullock, 2008, pp. 728). It is well equipped to offer
emergency healthcare services for traumatic injury patients. The facility provided an
incredible opportunity for me to put into test Gibbs reflective model teachings on
autonomous thinking in healthcare practice.
Before I embarked in piecing together this management journal, I started making
small but meaningful entries with dates and corresponding observations. These observations
were accompanied by my thoughts regarding the issues at hand and how they related to
various other incidences taking place at Bega Valley Private Hospital. I then revisited each
observation twice at later dates during which I made addition notes after reading materials
with similar information. To make sense of the situation, I read my notes alongside Gibbs
reflective model as described by Wilding (2008, pp. 34-7) and Maas, Stocchetti and Bullock
(2008, pp. 728).
March 2017
During the second half of placement period, I began to reflect on the goals. In the
course of contemplating on this essential know-how within my medical education, I purpose
to pinpoint the themes that made it possible for me to gain the right skill sets, both in the
professionally and individual fronts and offer further descriptions how this understanding will
guide my future practice as a healthcare practitioner. I am intent to illustrate the experience
that gained during my day to day endeavors as a healthcare provider in the Trauma
department as encouraged by Bulman and Schutz, eds. (2013, pp. 27-30). Further
descriptions will be provided to offer insight into the nurses in the Trauma team in Bega
Valley Private Hospital and other facilities with similar capacities with regards to
collaboration with other departments as guided by Torsvik and Hedlund (2008, pp. 389).
I make considerations with regards influence that culture and political environments
pose on the delivery of healthcare services in Australia, predominantly in regions where this
is explicitly distinct from what I have witnessed in the USA. In addition, I will investigate
how my personal interpretations on moral issues concerning the management of patients were
put to the test in the course of the entire placement period and my ability to obtain a more
profound comprehension of these issues by interacting with my peers and seniors.
The reflective approach has opted to use anchored on Gibbs reflective model. The
reflective cycle constitutes four steps and entails recounting an experience, ruminating on
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happening observed, hypothesizing the experience while using both current knowledge and
more inquiry, and ultimately deliberating how the knowledge I have obtained can be put into
use in future practice (Staun, Bergström and Wadensten, 2010, pp. 635 & Maas, Stocchetti
and Bullock, 2008, pp. 728).
There is a rationale as to why I have used Gibbs reflective model as the suitable
approach for pondering on and learning from gained skills during placement. Candid insights
can be gained from an article authored by Sawatzky et al. in 2009 titled ‘Teaching excellence
in nursing education: a caring framework.' The book was authored by Sawatzky in
collaboration with team of professionals and published in the Journal of Professional
Nursing. The authors elucidate that the Gibbs reflective model on which his model is
anchored, experience blossoms from the blend of gripping and transforming knowledge”. In
applying this to my placement experience, the statement accentuates both on the significance
of acquiring knowledge by observing and partaking as well as through analyzing such
experiences into progress skills to be harnessed during my future medical practice (Sawatzky
et al., 2009, pp. 260 & Maas, Stocchetti and Bullock, 2008, pp. 728).
Reviews
Just like in many areas of nursing practice, constant assessment of trauma care is vital
to characterize areas in need of improvement and develop stratagems for effecting mandatory
amendments (Moon, 2013, pp. 120; Chong, 2009, pp. 111). Following the institution of a
country-wide trauma system in Australia, a lot of modifications have been made to advance
healthcare services and minimalize death in trauma patients (Gimenez, 2008, pp. 520). Great
efforts have gone to lessening of trauma deaths in Australia in the last ten years (Dawley,
Loch and Bindrich, 2007, pp. 61-65 & Timmins and Dunne, 2009, pp. 331 & McPeake, 2012,
pp. 855).
The 2013 National surveys conducted by the Australian National Center for Trauma
and Emergency Medicine Research recaps the answers of the ITR in the last decade (Ixer,
2009, pp. 513). It reveals that more in the course of this timeframe; nearly half of all trauma
victims in Australia was because of fall related injuries, one-quarter as a result of road traffic
injuries, about 6% through violent crimes, while the remaining 4% had injuries related to
burns (Dubé and Ducharme, 2015, pp. 91).
The report focuses on the extent of provision of trauma healthcare in Australia,
affirming that one every three individuals will be hospitalized as a result of injury while one
in thirty will be receive treatment for severe injury at least once in a life time (Maas,
Stocchetti and Bullock, 2008, pp. 728). It notes further that over the last decade, statistics
indicate considerable decline of 20% in deaths related to severely and gravely injure (Torsvik
and Hedlund, 2008, pp.390). This assignment also ascribes this degeneration principally to
the effectiveness of the Australian trauma procedure and those developments made early this
decade (Maas, Stocchetti and Bullock, 2008, pp. 728).
Case Study
On my second week working as a member of the Trauma team, a male patient aged
twenty-three was admitted. He had a tear in his axillary artery and a fracture on his humerus
due to a collision involving motor vehicles. He was one of a Palestinian group of men
originating from Bankwest working illegally in Australia. For this reason, they were being
pursued by law officers when the collision occurred. Despite being an illegal immigrant, he
was given proper medical care and treatment as soon as he was admitted to the hospital.
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My supervising consult raised some concerns after visiting the Palestinian patient who
had been admitted to the Trauma team’s ward. He normally performs round check of patients
to gauge their progress and recovery after surgery. The supervisor claimed that the patient
might not obtain maximum health care and follow-up after his release from the Australian
Hospital. He claimed that, despite the fact that all patients are entitled to emergency care in
the hospital, this particular Palestinian immigrant is not supposed to get any non-emergency
medical treatment in Australia Healthcare Institutions since he is among a group of people
who do not pay for the Australia Health Insurance. To address this challenge, my supervisor
claimed that the patient ought to obtain required permission that will enable him to re-enter
the Australia territory to receive a follow-up healthcare by the Australia hospital. However,
the patient could also be able to receive further treatments form Palestinian health institutions
though they are less advanced compared to the health services in Australia.
Due to my curiosity, I decided to do research that evening to understand how an
individual is entitled to treatment as far as the Australia healthcare system is concerned. In
my study, I found out that every Australia resident is entitled to a healthcare insurance by the
National Health Insurance Law, through a mandatory payment of monthly subscriptions
made by individuals who have eighteen years and above. These payments are made to the
National Insurance Institute (Torsvik and Hedlund, 2008, pp. 390 & Maas, Stocchetti and
Bullock, 2008, pp. 729). Additionally, each resident must be a registered member by one of
the Nation’s four Health Maintenance Organizations that offer similar standardized ‘health
baskets’ concerning the law.
My analysis of this case opened my eyes and enabled me to appreciate the importance
of being political impartial as a healthcare professional. The impartiality will help to keep
political matters at bay when serving the patients as recommended by Torsvik and Hedlund
(2008, pp. 390). Despite the fact that politics have an impact on these professionals as well as
the lives of their patients, it is important for a doctor or any other healthcare practitioner to
provide the best health care to all patients irrespective of their circumstances, political or any
other.
My time working in the Trauma department made me identify and learn from many
critical decisions that doctors and other healthcare officials ought to make daily regarding
their patients. Moreover, I became aware of possible ethical, medical and legal consequences
that can arise due to such decisions. Normally, there exists no clear nor a correct solution as
far as the management of a patient’s health is concerned, in many cases, the doctor ought to
make a decision based on the best interests of the patient and their knowledge, and according
to the existing law.
In another instance, the Trauma team had to make such decisions in assistance of
senior doctors who were specialized in the Cardiac Intensive Care Unit. A decision had to be
made regarding the stabilization of the cervical spine of a male patient aged nineteen
seriously injured in an accident. When the patient was previously admitted to the hospital, his
neck was restrained using a collar due to a possibility of a significant injury of the cervical
spine. Additionally, a CT scan was carried out the way it is usually done in many trauma
cases as a first-line imaging method (Maas, Stocchetti and Bullock, 2008, pp. 7231). The first
CT scan never showed any signs of spinal cord injury. However, the immobilization collar of
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the cervical spine was left intact until further steps are taken to ascertain the absence of spinal
cord damage.
Through further consultation with the doctors, I was made aware that the collar is not
removed until an MRI scan has been conducted on the patient to accurately assess possible
soft tissue disruptions as well as those of neural elements of the spine. I also learned that
another option is for the patient to be conscious to be able to communicate to the doctors if
there was numbness or any pain that could be the cause for concern. After about three weeks
of admission, it was evident that none of the reassuring measures was ever going to be a
possibly realistic. The patient remained in a critical condition, unconscious and connected to
several medical machines that were working together to keep him alive. According to
analysis, the risk of moving the injured patient to the MRI scanner could be catastrophic and
far much worse than the potential benefits (Maas, Stocchetti and Bullock, 2008, pp. 729).
Nevertheless, the patient had started developing a far-reaching ulceration of his chin and
upper neck as result of an uninterrupted pressure of the cervical spine collar on his skin.
The concerned team made me aware of the devastating dilemma that they were locked
into. They had an option of removing the cervical spine collar and risked intensifying any
damage that could have occurred on the spinal cord, or they could decide to leave the cervical
spine collar unaltered that could, in turn, continue to cause adverse necrosis and ulceration of
the patient’s skin. Two Trauma team consultants together with a consultant of the Cardiac
Intensive Care Unit were debating on possible potential harms and expected benefits that
surround the possibilities that they faced. In a unanimous decision, they claimed that it was in
the best interests of the patient to remove the cervical spine collar. This situation made realize
the importance of collaboration among healthcare professionals especially those who are
directly involved in a patient’s care. The collaboration makes it possible to deduce the best
decision when faced with dilemmas about their treatments (Maas, Stocchetti and Bullock,
2008, pp. 729). It makes it possible for a majority decision to be reached that is in the best
interest of the patients compared to a decision made by one individual that can lead to the fate
of a patient.
By considering how the doctors managed this case, I learned of the legal
considerations that ought to be looked into before and after making such a decision
concerning a patient’s care. When such decisions are made, it is important that an accurate
record is kept concerning the reasons that made the doctors decide to remove the cervical
spine collar. The report also must justify how the doctors believed that such a decision was in
the best interests of the patient. Additionally, documentation on the details of the personnel
who made the decision must be kept. In this case, it was essential to explain that the decision
made by the doctors was not made due to negligence but through a thorough analysis and
consideration of the best patient management options (Maas, Stocchetti and Bullock, 2008,
pp. 729). This documentation was to be used in the future if there is any legal investigation or
query to explain why such a decision was made. It could be used to justify the decision of the
doctors as far as the patient’s health is concerned.
When I decided to for my elective placement in Australia, I was far much aware that
key obstacle that could affect my leaning would be the language used. I speak not more than
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a few words of Hebrew, a language that most hospital staff uses. Despite the fact that the
hospital staff was happy to share in English, it was not enough since they spoke in Hebrew
when addressing each other most of the time. Fortunately, my supervising consultant and
Trauma department director was fluent in English. He kept updating me on what was being
discussed and what was happening all time.
In spite of being unable to understand the conversations between the doctors, patients
and their relatives, I was still able to learn the skills that were used when communicating with
the patients. All through my placement period in the Trauma department, I have unilaterally
learned that the discussions that are done between the doctors and the relatives of the patients
involve the breaking distressing and very serious news concerning the health of the patient.
One incident that stood out during my placement there was a certain conversation between
the consultant of the Trauma team and the parents of the male patient aged eighteen who had
suffered several critical injuries when the car he was driving overturned (Maas, Stocchetti
and Bullock, 2008, pp. 730). Beforehand, the consultant confided in me that he would be
informing the patient’s parents that the surgery was performed successfully, however, their
son remained in a critical condition with little probability of recovery and survival.
Being aware of my inability to understand most conversations, I drew my attention
vividly to the non-verbal communication methods used by the doctor that comprises of body
language, tonal variations, and facial expressions. The doctor used to speak kindly and calmly
to the patient’s parents. He also leaned towards them throughout and at times paused to allow
the parents to absorb the message and to ask questions if need be. Despite many patients’
relatives waiting to hear the news, the consultant only took the patient’s parent into a private
room for the discussion. This was better than breaking the devastating message to such a
crowd in the hospital corridor.
In the entire course of my medical training, I have always deliberated how problematic it can
be a nurse to choose the correct words to give bad news to patients as well as their kin.
Nonetheless, observing this discussion made me aware quite openly in the manner in which
things are said that can be just as vital as the words used. In the conversation, I notice that
emphasis on the need of finding a quiet, secluded place to carry out such a discussion with a
patient’s kin and friends in so that they feel as relaxed and calm as achievable (Bowyer et al.,
2010, pp. 462). I am yet to be in a state of having to break bad news such clientele myself,
but I believe I am poised enough to conduct having learned a considerable deal during the
placement period about the imperative qualities that I would have to take into consideration
before the time comes. In similar circumstances that are bound to occur throughout my future
nursing career, I will purpose to a similar an equal level of compassion, serenity, and
professionalism to that I witnesses among the consulting Trauma team in the occasion
discussed.
Conclusions
My one-month placement in an Australia Trauma Department was valuable in the
development of my expert skills as well as my perception of a wide array of legal and moral
concerns associated with the practice of nursing. I am confident that the incident has
equipped me any possible, demanding circumstances concerning patient management that I
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will come across in my work as a nursing practitioner. I also learned some essential abilities
for handling such situations. I am certain that the skills I have obtained related to nursing
services needed in a hospital Trauma team as well as therapy of trauma injuries. These skills
are very vital in my future academic undertaking as well as clinical duties. I was exceedingly
fortunate to be engaged by the facility and to belong in such as wonderful medical team that
was excited to tutor me and responds all of my inquiries during sessions. I extend my
gratitude to this incredible enlightening prospect as look forward the skills gained to work.
With this in mind, I walk tall towards the future of my nursing career knowing that I will
deliver my absolute best in healthcare delivery.
References
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Chong, M.C., 2009. Is reflective practice a useful task for student nurses?. Asian Nursing
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Dawley, K., Loch, J. and Bindrich, I., 2007. The nurse–family partnership. AJN The
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