Reflection

Reflection-Leg Ulcers Essay Reflecting Writing Leg ulcers Reflecting on the situation that had taken place during my second placement working in the community. This will give me the perfect opportunity to develop and utilise my commutation skills in order to maintain the relationships with my patient. In this reflection, I am going to use Gibbs (1988) Reflective Cycle. This model is a recognised framework for my reflection. Gibbs (1988). Baird and Winter (2005,) give some reasons why reflection is require in the reflective practice. They state that a reflect is to generate the practice knowledge, assist an ability to adapt new situations, develop self-esteem and satisfaction as well as to value, develop and professionalizing practice. However, Siviter (2004) explain that reflection is about gaining self-confidence, identify when to improve, learning from own mistakes and behaviour, looking at other people perspectives, being self-aware and improving the future by learning the past. In my context with the patient, it is important for me to improve the nurse-patient relationship. In this relationship, there is a sense of trust and a mutual understanding exists between a nurse and a patient that build in a special link of the relationship (Harkreader and Hogan, 2004). (Peplau 1952, cited in Harkreader and Hogan 2004) note that a good contact in a relationship builds trust as well as would raise the patient’s self-esteem which could lead to new personal growth for the patient. Besides, (Ruesch 2007) mention the purpose of the therapeutic communication is to improve the patient’s ability to function. So in order to establish a nurse-patient interaction, a nurse must show up caring, sincerity, empathy and trustworthiness (Kathol, 2003). Those attitudes could be expressed by promoting the effective communication and relationships by the implementation of interpersonal skills. Johnson (2008) define the interpersonal skills is the total ability to communicate effectively with other people. In my reflective writing I will be discussing my development of relationship in the circumstance of the nurse-patient relationship using the interpersonal skills. My reflection is about one patient whom I code her as Mrs. Smith, not a real name to protect the confidentiality of patient’s information (NMC, 2009). In this paragraph I would describe on the event takes place and describe that event during my second placement. I was in the community for five weeks; Mrs. Smith is 85 years old and has a five-year history of chronic venous ulceration affecting her right leg. When I first met Mrs. Smith, her leg ulcer was treated with an alginate dressing and a four-layer compression bandaging system. In the previous six months, she had detected an offensive odour from her ulcer and this had stopped her mixing with other people. The odour had got worse in recent weeks to a point where she described it as unbearable. The ulcer had signs of infection including localised heat and erythema combined with a purulent discharge. The alginate did not absorb all the wound exudate and slight maceration was noted to the skin surrounding the wound. Mrs. Smith also experienced chronic pain from her leg ulcers and regularly took paracetamol. However, this did not reduce the pain associated with dressing changes. The nursing team decided to reassessment Mrs. Smith in order for effective wound healing to occur, a holistic approach to care needs to be implemented. This must include a comprehensive understanding of the wound-healing process and patients psychosocial needs. If all of a patients needs are met, the transition from ill health to health may proceed rapidly and more efficiently (Flanagan, 1997). The two areas of concern for Mrs. Smith were odour and pain associated with dressing changes and reducing these symptoms was more important to her than wound healing. Mrs. Smith had noticed that there was an odour coming from her legs, this meant that she no longer socialised with others because of the smell from her ulcers and avoided physical interaction where possible. Living with a leg ulcers wound is devastating (Hack, 2003). Van Toller (1994) noted that malodour associated with skin ulceration can lead to serious psychological problems, ranging from general depression to becoming a virtual social outcast. The community nurses had actively encouraged Mrs. Smith to re-establish social interactions with old friends. However, Young (2005) observed that patients can interpret this type of encouragement as a lack of understanding by nurses of the effect that their condition is having on their life. Wilkes et al (2003) conducted a qualitative study on the effect of malodour on nurses and found that adverse feelings such as nausea were common. However, nurses hide these emotions from their patients to protect the patients feelings. The community nurses decided that they needed to talk to Mrs. Smith about the odour and involve her in selecting a dressing product that was designed to alleviate or reduce the problem. Synthesis - Preserving Artifacts EssayThe fibres of the dressing absorb substantial volumes of wound exudate, forming a gel that is removed in one piece (Robinson, 2000). A comparative randomised study comparing alginates and hydrofibres demonstrated a significantly longer wear time for a hydrofibre than an alginate (Harding et al, 2001). The authors also found that 82% of people experienced no pain when a hydrofibre dressing was removed compared with 62% with the alginate, and the hydrofibre was less likely to adhere to the wound bed (Harding et al, 2001). A visual numerical ain scale using a 0-10 rating system was selected to assess pain as it is easy to use and analyse (Choiniere et al, 1990). Mrs. Smith completed the pain chart immediately after every dressing change for the first four weeks of the new treatment protocol and the progress of the ulcer was evaluated using the established wound assessment tool on a weekly basis. Mrs. Smith assessed her pain as eight with the algin ate dressing (severe pain) but, by the end of the first week of using the new dressing, she noted an immediate reduction in pain (score of six). There was no further change in pain severity in the second week. However, in the third week, Mrs. Smith noted a further reduction in pain (score of four) and it remained at this level until the completion of the fourth week. Conclusion After caring for Mrs. Smith for 5 weeks, I noticed a change in her attitude towards her dressing changes. She no longer feared them being changed, although she still continued to experience some pain, but she did not complain much. She is regaining her confidence and now attends the leg ulcer clinic twice a week where she socialises with other patients; this should help raise her self-esteem. his could also lead to new personal growth for Mrs. Smith so therefore she should start to feel well again. I hope Mrs. Smith legs continue to keep healing and she keeps up her socializing. References Briggs, E. et al (2002)Pain at Wound Dressing Changes: A Guide to Management. EWMA position document: Pain at Wound Dressing Changes. London: MEP. Choiniere, M. et al (1990) Comparisons between patients and nurses assessment of pa in and medication efficacy in severe burn injuries. Pain; 40: 2, 143-152. Clay, C. S. Chen, W. Y. J. (2005) Wound pain: the need for a more understanding approach. Journal of Wound Care; 14: 4, 181-184. de Laat, E. 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