A clinical guide for nurse practitioners
Reflection is a method used in clinical practice, where one expresses the experiences from a given situation, thus helping to learn and improve skills by applying the knowledge gained for future practice (Cottrell, 2011 and Schon, 1984). It is my intention to use Driscoll (2007) model of reflection to present my understanding of the issues I faced during a recent presentation to the medical centre. This case study involves a reflective account of a patient that I provided care for following blunt trauma, eye injury, sustained during exercise.
Description of events
A 23 year old male soldier presented to the medical centre complaining that he could not see out of his right eye, following being hit in the face with a blunt object. He was clearly agitated and distressed, as he was repeatedly asking if he would be permanently blind. Therefore prior to commencement of any physical examination I felt it was important to create a good rapport with the patient, in oder to gain his trust in my ability (Platt et al, 2001). Good communication skills are vital in building a therapeutic relationship with the patient. Hence I offered reassurance and advised the patient what examination and tests I was going to perform, in order to effectively assess his condition.
Through the physical examination I was able to detect minor fractures in his zygomatic bone that where causing him pain. As the patient was concerned about losing his sight, I had to maintain a supportive environment while explaining the need for an Xray and further hospital input, without causing him undue stress. I assured him that he would regain sight in his eye and that the trauma had caused temporary blindness only due to the impact.
Analysis of events
It is important to take time to listen to the patient and understand how they are feeling following such injury (Barnes, 2003). However, due to the patient’s distress I was unable to begin a physical examination until I had calmed him down and reassured him that he was in good hands. Consequently, I found it difficult to deal with the patients’ behaviour initially as I was more concerned in ascertaining the extend of his injury. Although I soon realised that in order to gain his cooperation with the physical assessment I first needed to encourage the patient to relax and discuss his concerns. I feel I communicated well with the patient through the application of a well structured consultation and was able to gain an adequate history, to assist with the diagnosis of the patient’s injury (Seidel et al, 2010).
Action following events
Maintaining a therapeutic relationship with good rapport can be difficult in situations where the patient is uncooperative and/or distressed. Therefore, in order to find solutions for patients I treat it is imperative to learn many problem solving techniques, including effective communication skills (Egan, 1998).
This situation taught me that building a rapport with your patient is just as important as developing physical examination competence. As offering encouragement to the patient ultimately led to a more productive consultation and improved patient/practitioner relationship.
I intend to utilise the skills learned throughout this module to enable me to adequately adapt to stressful situations and communicate effectively with my patients.
BARNES, K. (2003) Paediatrics: a clinical guide for nurse practitioners. Edinburgh: Butterworth- Heinemann. COTTRELL, S. (2011) Critical thinking skills: developing effective analysis and argument. (Palgrave Study Skills): Palgrave Macmillan. DRISCOLL, J. (2007) Practising clinical supervision: A reflective approach for healthcare professionals. London: Bailliere Tindall. EGAN, G. (1998) The skilled helper: a problem-management approach to helping. London: Brooks/Cole. SCHON, D. (1984) The reflective practitioner: how professionals think in action. New York: Basic Books. SEIDAL, H.M., BALL, J.W., DAINS, J, E., AND BENEDICT, G, W. (2010) Mosby’s guide to physical examination. Philadelphia: Elsevier.