This reflective paper focuses on the experienced that I had in being unassertive in managing a patient who had unwitnessed fall. I have decided to use Gibbs reflective model (1988) to write my reflective paper in a systematic way through a specific number of steps including description, feelings, evaluation, analysis, conclusion, and action/plan. I chose Gibbs reflective model to help me understand my feelings and reflect on the experience I had during the situation. It would allow me to analyse and think on my strategies for the next time that I will encounter a similar incident. According to Tate & Sills (2004), people learn by reflecting through experience and exploration of knowledge in order to understand it and view it on a different perspective.
I started the first block of my clinical placement in the aged care facility and I would like to reflect on the experience I had with a client. In order to protect the privacy and confidentiality of the client, I shall refer to my client as Olivia Fairfield, an 80 year old resident in the aged care facility. I was with Emma Collin (not a real name), my supervising registered nurse. At around 0800, we were doing morning rounds to the residents in the lobby when we heard a loud sound coming from Olivia Fairfield’s room. We immediately went to her room and we found Olivia lying on the floor trying to get up. She had an open wound, abrasion and bleeding on her right elbow and right shin. I took her vital signs and talked to her to make sure that she’s oriented. Her vital signs were within normal range and we did neurovascular assessment to the resident. Afterwards, Emma told me to take her vital signs every 15 minutes as it was the policy if a fall happened to a resident. I usually remind Emma about the 15 minutes vital signs of Olivia and there was a time that she told me that we will finish the wound dressing of another client before getting Olivia’s vital signs since she’s conscious and can walk using her walker. Furthermore, she also told me not to write the abnormal vital signs that I took and if the next vital signs are within normal range, then I can write it. In that situation, I just did what she told me to do even though I know that it is not the action that I had to do. I felt that I should not follow her instructions to write the normal vital signs instead of the abnormal vital signs.
I had years of experience in working with different clients, but this is my first time to encounter an 80 year old resident who had unwitnessed fall. I was shocked about what happened to her, but I maintained my composure and realised that I should attend to her. Also, I am really concerned that Emma tends not to prioritise Olivia and she continued on her usual routine. I felt intimidated to asked about it because I know that she has much more experience than me especially on a situation where a resident had a fall incident. I was unable to ask Emma the exact reason for not documenting the abnormal vital signs and I felt that I am neglecting Olivia and not providing her the best care because she needs extra care and attention because of her age.
After the shift, when I had the time to reflect on myself, I felt irresponsible because I was unable to provide the best care to Olivia despite knowing the responsibilities of an RN. It made me realised that I should have done better during that time and become more assertive in communicating to Emma. “Assertiveness is considered healthy behaviour for all people that, when present, mitigates against personal powerlessness and results in personal empowerment. Nursing has determined that assertive behaviour among its practitioners is an invaluable component for successful professional practice.” (Kilkus, 1993). Therefore, if I can be more assertive I can be able to communicate effectively and be diligent in providing the best care to my clients.
In dealing with that situation, I was unable to adhere with NMBA Standards 1.4 and 6.5 about compliance to the policies, regulations and guidelines by the facility regarding 15 minutes observation for post fall management. I was unable to maintain the frequency of vital signs monitoring and documenting it on Autumn Care. Instead, I just followed what my supervising RN instructed me to do. Moreover, I was intimidated by Emma which inhibited me to meet the NMBA Standard 2.2 because I was unable to communicate effectively with her regarding my insights about not following the 15 minutes frequency of monitoring vital signs. I was not able to ask her the reason why I should not put abnormal vital signs on the Autumn Care which I should have insisted in a respectful manner. I realised that I should be more assertive in telling my colleagues about the patient’s condition because it is for the client’s welfare.
In recalling the situation, I think that it’s best to reflect on my behaviour about being unassertive towards expressing my insights. I should have the initiative to talk to Emma about my thoughts and my stand about the situation especially when it comes to the welfare of the clients. Furthermore, gaining more confidence in communicating with my colleagues in the future is the best care that I can provide to my clients and not to be intimidated by someone as long as I know that it is the right thing to do. At the end of my shift, the resident was fine, and her vital signs returned to normal range within our shift, thereby meeting the NMBA Standard 7.1 which states the evaluation and monitoring of progress towards the goals and outcomes.
Having to work in an unfamiliar situation made me reflect on my own practice and it made me realised that I should be more assertive when it comes to communicating with my supervising RN to express my own insights. On my next block of placement, I will not be afraid to tell my thoughts, feelings and insights. Effective communication is the key to the success in working in a professional environment.
References:
Gibbs, G. (1988). Learning by Doing, A guide to Teaching and Learning Methods. [Online] Available at https://thoughtsmostlyaboutlearning.files.wordpress.com/2015/12/learning-by-doing-graham gibbs.pdf?fbclid=IwAR2S9Mmjh9LE2NOCxjx9ijWPHINmQ07RFq9hfqROsZ3BPNZd2U7PGJOKaII [Accessed 10 November 2018]
Tate, S. & Sills, M. (2004). The Development of Critical Reflection in the Health Professions. [Online] Available at https://www.kcl.ac.uk/sspp/policy-institute/scwru/pubs/2015/conf/manthorpe-and-baginsky-15jan15.pdf?fbclid=IwAR1CYUmMf_0Xr-QB9Ur6RiBPBR5xMfXEpJvrMTd4Fv3-GYe0ClnJzq08hZM [Accessed 11 November 2018]
Kilkus, SP. [1993]. Assertiveness among professional nurses. [Online] Available at https://www.ncbi.nlm.nih.gov/m/pubmed/8376672/?fbclid=IwAR0uy7cLc1GJNtIO5n1IZPJ4GgfssSC6DxVQ8O557RZhyg0OHY1wZBIoSu0 [Accessed 11 November 2018]
Nursing and Midwifery Board of Australia (2016) Registered Nurses Standards for Practice. [Online] Available at https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx [Accessed 11 November 2018]