Analysis of Reflective Practice in Nursing: Driscoll's Model, NMNF5104

This report provides a comprehensive reflection on the challenges of dealing with 'difficult patients' in a nursing context, utilizing Driscoll's Model of Structured Reflection. The essay begins with an introduction to the concept of reflective practice and its importance in nursing, highlighting the significance of self-awareness in managing patient interactions. It then provides an overview of Driscoll's model, explaining its three stages: 'What?', 'So what?', and 'Now what?'. The report includes a detailed account of a personal clinical experience involving a difficult patient, focusing on the feelings of annoyance and puzzlement encountered. The analysis applies Driscoll's model to dissect the event, exploring the nurse's feelings, attitudes, and values related to the patient's care. The report emphasizes the importance of understanding the root causes of patient behavior, managing personal frustrations, and connecting with patients on a deeper level. The reflection concludes with actionable strategies for future practice, emphasizing the need for remaining calm, seeking support, and prioritizing patient needs. The report draws on various scholarly sources to support the analysis and provide a well-rounded perspective on reflective practice in nursing. The aim is to improve the quality of care and improve patient outcomes.

Running head: REFLECTION IN NURSING
Reflection in Nursing

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Table of Contents
Introduction.................................................................................................................................................3
Understanding on Driscoll’s Model of Structured Reflection (1994)..........................................................3
Exemplifying a reflective account on the moment of annoyance and puzzlement during clinical
experiences dealing with ‘difficult patient’.................................................................................................4
Utilization of Driscoll’s Model of Structured Reflection to help explore reflective feelings, attitude and
values to interpret care required by the patient............................................................................................6
Step 1 Describe an event or action...........................................................................................................6
Step 2: why that action was significant....................................................................................................8
Step 3: Explain how you will use that information to inform future practice........................................11
Conclusion.................................................................................................................................................16
References.................................................................................................................................................17

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Introduction
This report focuses on assessing the reflective practice competencies of learners through
adequate utilization regarding the reflective model. It also explores inference created from
previous clinical experiences. Nurses regularly encounter patients who they address
professionally and personally challenging. There are some patients that are suffering from poorly
defined medical issues and with interpersonal complexities, and it is recognized as ‘difficult’. It
also entails perception about nurses and other healthcare providers entailed (Kahkoska, et. al.,
2018). Difficult patients may demonstrate a challenge for the assumption of nurses either
regarding how illness should progress and how patients should behave. In addition to this,
addressing emotional responses towards patients are supportive. Furthermore, structured
practices that increase self-awareness would be supportive of doctors in terms of monitoring
their doctor-patient associations (Ng, et.al., 2018). This reflective essay would assess my
knowledge and skills that I developed from contributing to a nursing project.
Understanding on Driscoll’s Model of Structured Reflection (1994)
This reflective essay has relied on cycles demonstrated through Driscoll’s model. The three
procedures presented through the model and it is effective in terms of reflecting the individual
performance as compared to group performance. The model is significant for us in terms of
creating adjustments that I would make to enhance my potential knowledge regarding nursing
activities. The procedure under Driscoll’s model considers what, so what i.e. the feeling
regarding experiences as well as, now what i.e. if it would happen again what you would practice
distinctly. I would, therefore, emphasize on model for linking theories to nursing practices
(Rowell, et. al, 2017).

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For example, I was in a ward on my two-week introductory period related to practicing
experience. On my initial day, the ward manager has introduced me to her team. She had
discussed to me that my mentor was not in around at that period, therefore, she handed me over
to one of the nurses in responsibility. As I came on an initial shift, I have pointed out that the
patients dealt with by night shift employees. They have also printed out handover sheet for each
one of the patients. At an initial level, I was a bit confused that how night shift nurses were
dealing with difficult patients, maybe, I was new and not aware of how to deal with these
patients. I have only awareness regarding medical terms hence I can understand even I am
superfluous and I want to be part of the team when learning (Kahkoska, et. al., 2018).
After the handover, nurses asked me to be with health care assistant at the moment for me in
order to be acquainted with patients as well as, adapting with the daily routine. I am also blessed
that HCA was significant and she taught me different things regarding assisting patients on
individual hygiene. She also demonstrated to me how to practice a blood glucose monitor as well
as, plotting it down on chart of the patient. Moreover, she taught me that they generally take
observation of each four-hourly when the patient is not on close thought (Brenner, 2018). The
days have spent very promptly because I was productive in my daily experience as a nurse. I
never wasted time just standing and without attaining anything at the end of shift. Due to my
passion for caring towards difficult patients, I become accustomed to respect to dealing with
patients as well as, assisted to go to the toilet and gave a hand to those who are not competent for
caring for themselves particularly difficult patients (Stige, 2017).
I became some on writing down nursing care plans for patients. It is pointed that Nasogastric
tube (NGT) and Electrocardiogram (ECG) processes are performed by staff nurses as well as,
HCA correspondingly. I have also volunteered myself along with, getting to take away the

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medicine of patient in pharmacy. Moreover, I have pointed that how to fill nursing assessment
forms for newly admitted patients. I have done the said forms through means of interacting with
family and patients. I have also addressed that word communicating as there was non-spoken
English patient admitted due to back pain (Stige, 2017).
Exemplifying a reflective account on the moment of annoyance and puzzlement during
clinical experiences dealing with ‘difficult patient’
Complex circumstances may create due to different hastening causes as well as, different factors
and it could be complex for nurses to manage it. My own situation such as whether I am tired
and stressed would plat a significant role to deal with a difficult patient. As a nurse, it is pointed
that when I was tired then my patients were angry with me and in pain as well as, due to a
shortage of employees in my shift, dealing with ‘difficult patients’ is more complex as compared
to when just one of the employee was available. It is observed that nurses are taught to be open-
minded (Karterud & Kongerslev, 2019).
Furthermore, labeling a patient as unpleasant could be obstructive as compared to think of
interaction as complex. It is pointed out that nurses should keep cool with ‘difficult patient’. One
of the significant challenges for nursing is to deal with both difficult people and to whom, who
loved ones. During the tenure of my working as a nurse, it was taught to me that one patient who
presses the call button every 5 minutes and family member who approaches the desk is ready for
battle to weigh on me. It is also observed that there are demanding patients who pose some of the
most complex challenges in nursing (Brenner, 2018).
It is pointed out that as I am looking for enhancing my career, as a nurse, I need to face
challenges for managing ‘difficult patient’. I have also identified that I need to focus on
addressing the root causes. There is a need to make efforts for addressing the reason that patient

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is demanding, overly critical and simply cruel patient is acting out. There are also some medical
conditions that can worsen the unfavorable aspects regarding the personality of the patient (Cil &
Dotger, 2017). Similarly, it is pointed that when patient is in pain and experiencing side effects
of some medications, they will not be themselves. When the patient seems to be critical,
aggressive and means as well as, looking for medication as well as, assessing when changes
require to be developed (Halter, et. al., 2017).
For benefit of patients, their family and I would demonstrate kind as well as, caring attention no
matter whatever. It was observed that several patients, particularly those elderly and alone, feel
extremely helpless in the setting of a hospital. In addition to this, there is a need to manage own
frustration with needy as well as, demanding patient. There is also a requirement to consider a
moment to let them know that I care (without neglecting the other patients) (Collington & Fook,
2017).
I have increased my learning that I need to focus on finding way for connecting. I would be
amazed to simply connect with the patient by supporting them in dealing with some of the
challenges of nursing. Each patient wants to feel special as well as, there is no one more than the
helpless hospital patient. I have also addressed some of the threads such as speaking to patients
with loved ones as well as, get to know them from a distinct way. There are two things that
would likely happen such as my patient would no longer cause me to grit my teeth as I start with
connecting the individual and my patient would feel get better as well as, dropping unfavorable
attitude completely (Stige, 2017).
I also care regarding all of my patients. Not only, it is my accountabilities but also it is part of
becoming a better nurse. Hence, while confronted with such dealings of nurses like confronting
‘difficult’ patients are remaining objectives. Nurses’ should not feel that the requirements of

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demanding patients could be met instantly when they can wait. I can attend more urgent patients
by learning priorities. I should never be bullied into putting “squeaky wheel” above other
patients (Charon & Marcus, 2017).
It is identified that some patients as well as, their families are tending to manipulative while it
comes to demanding my attention. In addition to this, I have learned that threating, ranting, as
well as, attempting for drawing into conflict could be the only way they know to get what they
wish. It can also learn to recognize those actions that push the buttons. It is identified that part of
meeting objective is relating to addressing those actions that trigger the responses (Bui, et. al.,
2016).
Utilization of Driscoll’s Model of Structured Reflection to help explore reflective feelings,
attitude and values to interpret care required by the patient
Step 1 Describe an event or action
It is addressed that there are many healthcare encounters that are emotionally charged, entailing
fear as well as worry, pain and distress for relatives and friends and patients can develop a
volatile condition. Furthermore, it was taught to me that communication tool could be supportive
for de-escalating aggression as well as, can even prevent it from arising in primary place.
I have pointed out that there are different factors that can affect the situation of the patient
encounter. For instance, considering the language proficiency and developing literacy among
patients. Furthermore, it is identified that miscommunication could easily create frustration and
perceived power imbalance among patients and healthcare provider (Cil & Dotger, 2017).
It is addressed that nurses should assess the physical environment. As a nurse, I have pointed out
that there are multiple people in the exam room, a restless child and controlling spouses can
negatively influence the encounter patient. I have also pointed out that Nurses should consider

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the nature of the encounter. Along with this, I have learned that a visit where the worried patient
is getting bad news may comprehensibly elicit different emotions as compared to routine visits
(Nicol & Dosser, 2016).
It is identified that remaining calm in case of a demanding and difficult patient is key challenges
for nurses. It is observed that difficult patient whether a family member can cause me to become
irritated, downright angry, and annoyed. These feelings could clatter the most experienced nurses
as well as, undermining their competencies for offering patient care (Howatson-Jones, 2016).
I have pointed out that avoiding the consequence of demanding patients by learning could remain
calm. It can also take some deep breaths and let the co-workers understand the need to walk
away the moment for restoring the composure, practicing mindfulness tool whatever it considers.
The patient can do all that they can for easing the tension as well as, preventing the situation
from escalating.
I have also created my knowledge that experience is a sound teacher (Coleman & Willis, 2015).
I would learn to recognizing those red flags and alerting them for these specific challenges
regarding nursing. Once I read a difficult condition for what it takes phases for diffusing
condition before it is becoming distressing. Furthermore, I learned that nurses should be
respectful and asking for help when required (Wald, et. al., 2019).
I have learned that nurses should not take it personally. When I faced the challenges of nurses
and it could be easy for taking some patient demand as well as, allegations individually. Nurses
should focus on the aspect that why a patient should care for nurses. They are also dealing with
the challenging conditions as well as, are possibly filled with anxiety. Nurses should address the
unfavorable action as it would aid to deal with the difficult patient (Sian Nicol & Dosser, 2016).

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I have also observed that nurses should stay emphasized on offering care. There is no matter how
difficult the patient can be and patient deserves quality care. Nurses should perform sound as
well as, recognizing that how challenging to deal with the patient at the end of shift. The difficult
patient still received the finest care as well as, attention from nurses. As a nurse, my
responsibilities are caring and healing the difficult patients. I also pride due to my competencies
for dealing with the requirements of difficult patients and supports them (Gimenez, 2019).
However, there are some patients that I find are difficult to understand. I need to keep a non-
judgmental and attentive way for each patient. It is observed that when the behavior of patients is
threatening, intimidating as well as, time-consuming then it should be highly focused by nurses. I
have also developed my knowledge that uncertainty, anger, frustration, manipulation of feeling
and controlled through patient creates difficulty for nurses to connect with them. These
complexities can origin from the side of the patient or nurses (Tesh & Kautz, 2017).
The emotions of nurses define the patient as an issue. For example, how much more complex is
it to provide care to someone who holds massively different feelings and values regarding
healthcare practices. It should not be complex but, should be real. It is evaluated that there is
some patient who has boundary concerns, anger issues, drug abuse issues, and hygiene issue. It is
also pointed out that patient could be ‘difficult’ on any given shift and on any given day. It is
pointed out that nurses should address the way in around the issues for offering the best care I
can (Fontaine, 2018). The key issue is how do nurses manage the difficult patient?
Step 2: why that action was significant
I have developed my understanding that effective care and compassionate have a requirement of
the objective. The initial phase is to separate the emotions through experience as well as,
restructuring into something that could be evaluated as compared to something that is only felt. It

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is identified that nurses should ask question with themselves and addresses the condition without
getting involved in anger and other ineffective emotions. Nurses should remember that action
and behavior of patients are difficult not the patient themselves. It should also try to look at the
circumstances from their aspect. It should also make efforts for reforming the own perception of
the situation as challenging as compared to difficult (Cassedy, 2017).
The emotions from both nurses and patient or other nurses can make the condition more taxing.
Nurses should not learn to take the behavior individually. It can also consider transferences as
well as, countertransferences factors. It is observed that the patient is expecting toward nurses are
based on bad experience with a healthcare professional. It is also pointed out that assigning
perception is about the patient that is based on past experience with a similar patient (Hardacre &
Hayes, 2016).
It is also pointed out that concerns with difficult patients can often create emotional feeders. It is
specifically appropriate while dealing with angry and hostile patient. It was also taught to me that
there are chances of creating issues as compared to potential action. In addition, it is observed
that challenging behavior could be related to mental illness, disease procedure, substance abuse,
social skills, life crises, poor coping and any integration of patient-specific factors (Craig, et. al.,
2017).
I have pointed out that difficult patient is making efforts for telling nurses that they are presently
living into complex life. I have increased my knowledge that patients may also face a lack of
trust in healthcare as a whole, feel mistreated, have personality issues and financial issues. It
could be something as basic as a breakdown of communication and misunderstood differences
among the culture. It is noticed that the real parameters of the condition require to be addressed
early before the issue can escalate (Snowdon, 2018).

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I have also increased my understanding that nurses should keep reasonable as well as, neutral
tone regarding all care and intentions. However, there is a need to deal with the disruptive
behavior instantly. These patients should have a requirement of support and knowledge with
developed parameters and limits. I have also developed my knowledge that nurses should
develop consistent parameters, expectations and rules, however permitting the patient time for
adjusting as well as, developing trust. It is identified that in different cases, resorting to
medication as well as, other techniques of restraining could be unsuitable and caustic as
compared to a solution (Driscoll, et. al., 2019).
It was also identified that nurses should practice verbal and non-verbal communication in an
effective manner. It should also control emotions and demonstrates the openness for resolving
conflict. I have also learned that nurses can ignore to place blame as well as, creating hasty
judgments. It is addressed that nurses should acknowledge the feeling of the patient and
objectively interact regarding how their behavior persuades the ability to care for them. Nurses
can also ensure practicing feasible language that patient can comprehend. I have also increased
that nurses should listen attentively to the patient as well as, identify their issues. When it is hard
then Nurses should give compliments as well as, supporting the difficult patients to make feel
them valuable (Bassot, 2016).
It is identified that acknowledging limitations is significant in offering the care to some patients.
I could be better competent in dealing with some kinds of behaviors better than co-workers. It is
also pointed that whenever possible these difficulties then there is a need to consider the patient
assignments. Along with this, I have also increased my understanding that care for the patient is
a collaborative effort as well as, there is a need of understanding, cooperation, and training at

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each level. While difficult situation creates, peer and staff support can ease different stress
related to challenge (Barr & Dowding, 2019).
There is also a need to remember for demonstrating the appreciation for others who is supportive
for care about patient and helps their own patient care efforts. It could be significant for keeping
supportive interaction with other nurses who help in keeping care for the patient. During my
working tenure, it was also taught to me that nurses should use supportive communication with
other nurses who care for the patient. I have also pointed out that additional staff nursing could
be supportive for addressing the ways for communicating with compassion and model. It could
be feasible behaviors for those difficult patients who actually need it (Darvill, Stephens, &
Leigh, 2018).
Step 3: Explain how you will use that information to inform future practice
I would use my improved understanding of the future in order to become a good nurse. In the
future, I would focus on remaining calm. While dealing with trying patient, the best strategy is to
remaining calm. There is a need to remember that patience is not attacking on nurses individually
but focusing on feeling about anxiety and perceived lack of attention and resistance regarding
what has happened with patients. I have pointed that remaining calm would permit the
researchers for keeping control as well as, identify patient in a manner that would resolve the
condition (Golaghaie, et. al., 2019).
I have also increased my understanding that one of the quickest manners for calming angry and
complex patients is by being vicarious. I have also developed my knowledge that nurses should
remind myself that it is not easy to become in hospital, in pain as well as, away from loved ones.
Rather than being apologetic, nurses should treat all patients with dignity and respect. I have also
increased my knowledge that nurses should comprehend regarding how offensive the situation