PRACTICE ON PATIENT

Practice Involving a Patient

Practice Involving a Patient

Introduction

The aim of this essay is to reflect on a case experienced in practice in relation to pain and its assessment using Johns model of refection (1994). Reflective practice is a way of exploring and evaluating previous experiences, and appreciating their impact on personal practice and self. Reflection assist's the individual to be aware of themselves and their practice. This enhances the individual's skills in day to day practice. Confidentiality will be maintained in accordance with the NMC (2010), therefore the names of the people involved as well as the clinical area will not be disclosed.

Reflection and reflective practice is not a new concept and not only nursing professional's use reflection. It has been around for a long time and Dewey (1993) was the one person who is known to have brought reflective practice into his work (Clarke, 1994, 11).. It is also noted in the Nursing Standard that Dewey (1993) is acknowledged as the first educationalist to wright about reflection and learning through experience (Atkins and Murphy 1994). There are many definitions of reflection most of them agree that reflection is an active, conscious process (Johns, 1995, 226).

Discussion

Critical Incident

Polit and Hungler (1999) (P.332) defined a critical incident as: “an observable and integral episode of human behaviour. The word 'critical' means that the incident must have a discernable impact on some outcome; it must make either a positive or negative contribution to the accomplishment of some activity of interest."

A 48-year-old lady was brought in by ambulance into the Emergency Department complaining of all over body pain. The patient was known to have Sickle Cell said she was in SCD crisis. When a patient presents in SCD crisis, the first thing to establish is how bad the pain is and what opiod analgesia they have taken in the last 24hours. This is to ensure that the pain management is delivered appropriately as to the plan for the individual patient care. The doctor assessed the patient on arrival. The patient was known to the department as she attended at least once or twice a year in SCD crisis. The Doctor wanted to give her pethadine intra venously (IV) as this had worked in the past. The patient stated that she had been advised by her haematology consultant to avoid pethadine even though it seemed to work for her but could not remember why (McNulty, 1999, 12)..

The author brought this to the attention of the doctor who still insisted that it was better to use something that was known to work for the patient. The author made the doctor to be aware of Local Trust Guidelines (Woods, 2009) when treating / managing Acute Sickle Cell Pain to the doctor, which states that pethadine should be avoided unless the patient has a severe allergy to morphine, for example bronchospasm or severe pruritis then they may initially be given pethadine intra mascular (IM) (James, 1994, 82).

Reflection

In accordance with the Trust Guidelines (Wood, 2009), a numerical pain ...