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Examples of reflective writing

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					        Examples of Reflective Writing
Example 1

I arrived on the ward at 7:30 ready to begin a 12-hour shift. After receiving handover,
my mentor assigned me the job of bathing Mr B with the help of a healthcare
assistant. Mr B has Creutzfeldt-Jakob disease (CJD), a progressive disease of the
nervous system with rapid deterioration due to spongiform encephalopathy. He is not
expected to live to Christmas, even though he is only 19 years old. He is mentally
aware of what is going on but is physically unable to demonstrate activities of daily
living, including eating and drinking, has limited communication skills and is doubly
incontinent. He is unsafe on his feet so mobilises with a wheelchair.

I approached Mr B’s bed and asked his consent to take him for a bath. While the
bath was running we began helping him to undress. He looked rather nervous. At the
thought of myself being in his position, being the same age as him, I began to feel
embarrassed too. I thought that I could not possibly be a professional individual if I
let my embarrassment and sympathy get in the way of my nursing care.

We assisted Mr B into the bath and started his wash. I knew he was uncomfortable
and wanted to be able to wash himself, but was unable to do so. I was finding it
difficult to look him in the eye, especially when it came to washing his genitalia. I
tried to ease this by making conversation, but in a way this made matters worse.

After the bath we dried Mr B, dressed him and returned him in the wheelchair to bed.
To the healthcare assistant it was another job done, but the feelings I had
afterwards, as I am sure was the case with Mr B, stayed with me for some time.

This reflective account provides a good description of the nurse’s feelings but it does
not go much beyond that. What additional information is needed to develop it?

Adapted from Jasper, M. 2003. Beginning Reflective Practice: Foundations in Nursing and Health
Care. Cheltenham: Nelson Thornes.




                                                               studySMART@gcu.ac.uk
Example 2

Mrs James had been admitted to the ward following a fall and had multiple bruising
and cuts to her body. Throughout her time on the ward she had been mildly
confused, with a tendency to wander unsupervised. As stated by McConnell (1998),
this is a major concern for nurses within hospitals and care facilities. We were told
that Mrs James was unsteady on her feet and should not attempt to walk on her own
without assistance. This is reinforced by the work of Oliver et al (2001) who state that
greater disability may result from anxiety and loss of confidence following a fall.



This piece of reflective writing demonstrates the use of concepts to explain what
happened. Note that this allows the reader to demonstrate awareness of
professional values, and the ability to transfer learning into a professional practice.
Examples of understanding that you might draw upon in your reflective writing could
include practice guidelines, professional codes of conduct, or knowledge about
specific diseases/conditions.

Adapted from Jasper, M. 2003. Beginning Reflective Practice: Foundations in Nursing and Health
Care. Cheltenham: Nelson Thornes.




                                                              studySMART@gcu.ac.uk
Example 3
I will use a reflective model to discuss how I have achieved the necessary level of
competence in my nurse training programme. The reflective model I have chosen to
use is Gibbs model (Gibbs 1988). The clinical skill I have chosen to reflect on is the
administration of Intramuscular (IM) injections. I have chosen this as within my first
clinical placement this was a widely used method of drug administration and I
became involved in the process of IM injections. I therefore researched the topic of
IM injections and my knowledge within this area developed.

The site used in the IM injection was the gluteus maximus, this the most commonly
used site for the administration of IM injections (Greenway 2004, Workman 1999).
The gluteus maximus area is both thick and fleshy with a good blood supply (Watson
2000). It is located in the hip area and forms the buttock (Watson 2000). It has been
noted by Watson (2000) that the gluteus maximus is near the sciatic nerve and
Greenway (2004) suggests that this presents a risk of threat of injury in the
administration of IM injections. When I administered the IM injection to the patient, I
injected into the gluteus maximus muscle, as the evidence stipulates this is best
practice.

The first stage of Gibbs (1988) model of reflection requires a description of events. I
was asked to administer a drug to a patient via IM injection. I had observed this
clinical skill on a variety of occasions and had previously administered an IM
injection under supervision. On this occasion I was being observed by two qualified
nurses, one of which was my mentor. The drug had been drawn up and was ready to
be administered and the patient consented to have a student administer the
injection. My mentor was talking me through the procedure step by step and
informed me that I should use an alcohol wipe to cleanse the injection site, when the
other nurse interrupted and said that this was not necessary. This was in front of the
patient, who then requested that the alcohol wipe was omitted as on previous
occasions this had caused a stinging sensation. My mentor said that this was
acceptable and I continued to administer the injection, omitting the use of the alcohol
wipe. On the previous occasions when I had administered IM injections I had not
cleansed the site and had never been instructed to adopt this practice.
Although quite well written and referenced, this extract is a little too descriptive.
There is no clear analysis of events and, after the initial reference to Gibbs, it doesn’t
particularly apply the model. It could be improved with a more critical approach and
by moving beyond description to the later stages of reflection – a discussion of the
wider context (the why), application of theory perhaps, and some thoughts on what
action could be taken to perform better in the future. There is very little about what
the student learned from the experience.

Adapted from Student Nurse. 2005. Reflection on a Clinical Skill [online] Available from:
http://www.studentnurse.org.uk/reflection.html




                                                                  studySMART@gcu.ac.uk
Example 4

The purpose of this essay is to reflect upon an aspect of my professional practice or
development that I have encountered throughout my time as a student nurse. For the
purpose of reflection the essay shall be written in the first person. In accordance with
the NMC (2002) Code of professional conduct, confidentiality shall be maintained
and all names have been changed to protect identity. The purpose of reflection as
stated by John's (1995) is to promote desirable practice through the practitioner's
understanding and learning about his/her lived experiences. I have decided to reflect
upon the first time that I gave a nursing handover and in order to structure my
reflection I have decided to use John's (1995) model of reflection. This model
encourages practitioners to work through a series of reflective cues, the last of which
is concerned with personal learning. John's (1995) model provides a good example
of an approach to reflection on action (or reflection on practice). Reflection on action,
which takes place after the event, allows the practitioner to revisit an experience with
the intention of exploring and learning from an activity. Reflection on action is
particularly significant to nursing students, as it is often the basis of formal
assessment.

It was my final placement of my course in a children's ward. I was working towards
performance level 5 which involved working independently within a supervised
environment. I had been caring for one patient during my shift, a 12 year old girl
Claire who had been admitted for treatment of her diabetes. Although I had been
caring for her for the duration of my shift I was unprepared to give the next shift a
nursing handover. I assumed that my mentor would do it as she had been doing it on
all of my previous shifts. However on this occasion my mentor said to me to do it at
the last minute. I listened to her giving the handover for her patients then when it
came to mine I panicked and got information mixed up. I started with basic
information about Claire such as name, date of birth and reason for admission.
Unfortunately I became flustered after that and it was clear to both my mentor and
the other staff nurse that I was out of my depth and needed help. My mentor then
took over and continued the handover.

I therefore decided to action plan to develop my nursing knowledge in this area. I
looked at various nursing journals detailing how to give effective handovers. I also
used the advice that I found in the nursing journals to plan out how I would give
handovers. I also continued to give handovers on the ward. At first I wrote down all
the information that I wanted to convey to the receiving nurse and explained to the
nurse the reason that I had written the information down.

At first I found that I had to rely heavily on my notes and I felt as though I was merely
reading out a summary of the patient rather than giving a summary of care that had
been given. Once when I had built up a small bit of confidence I still used the notes



                                                         studySMART@gcu.ac.uk
but instead of writing down everything that I wanted to say, I wrote down the key
items that I wanted to say to ensure that I didn't forget. I found this to be extremely
helpful and continued to do this until I felt ready to give a handover without writing
anything down. The first time that I gave a handover without any notes I was
extremely nervous, however I also felt more confident in the knowledge that if I did
forget a piece of information or become flustered I simply referred to the patients
folder and used this as guide. Another reason that I feel more confident now is that I
feel more comfortable with the other members of the nursing team and do not feel as
self conscious as I did when giving a handover the first time.

This extract is well written and makes good use of the chosen reflective model,
clearly mapping the writing to the framework. There are good examples of the
student’s learning and development through the reflective process; they focus on
action planning and improving their performance in future reoccurrences. The writer
provides a reasonable analysis of events but could, perhaps, have included deeper
contextual information. It is mainly about the student and does not concern the wider
environment (should they have been suddenly asked to do the handover for
example?).

Adapted from Student Nurse. 2005. Reflection on a Clinical Skill [online] Available from:
http://www.studentnurse.org.uk/handover.html




                                                                  studySMART@gcu.ac.uk

				
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