Essay Sample on Reflective Cycle: What, So What, Now What?

Introduction

Reflection is a deliberate process of thinking, examining, and contemplating one's experiences to improve future practice. The Driscoll model is the most used methods for reflection in a health care setting. John Driscoll devised the technique-in 1994, 2000, and 2007-, which majors on three questions that include 'what?', 'so what?' and 'now what?' The Driscoll reflective cycle is a framework that is recognised for reflection to demonstrate the caregiver's ability to reflect on different skills. The 'what' part of the meditation process will look at the events that took place. The "so what' process will evaluate my feelings together with my good and bad experience concerning the issue. Finally, the 'now what' section is going to investigate the things I would do differently if the event happened again (Hardacre & Hayes 2016). The Driscoll reflection cycle will be a useful tool to help in the linkage between theory and practice.

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The Driscoll Reflective Cycle: A Framework for Reflection in Healthcare

In this assignment, I would like to describe a scenario according to the Driscoll model (2007). It contains anti-discriminating practice and safeguarding according to trust policies. The incident made me reflect to learn more about the safeguarding and anti-discriminatory practices at work. When I was working in the elderly medical unit, I had a patient called Mr. J (87 years) admitted with dementia for cancer treatment. He worked in the army in his whole life and he still thinks that he is a captain in the military. He also believes that his family members and other patients are soldiers surrounding him. Sometimes he acts normal and explains war stories to other people. Notably, he often becomes aggressive and starts to abuse people physically. He is under treatment for prostate cancer and experiences insomnia. Most of the nights, Mr. J slept very few hours. His intake and output were deficient, and nurses were concerned about the situation due to his refusal to eat and drink. Moreover, his mobility is fragile; therefore, he uses a Zimmer frame to visit the toilet with the help of one assistant. When I spoke to him, I noticed that the patient was struggling to concentrate and continue his conversations with others. His mind was going back to his old memories. Moreover, he refused to maintain personal care despite encouragement from his supportive family.

Nevertheless, due to his worsening mental condition that often made him get physical, I noticed that some of my team members handling the patient's case were developing a lousy perception towards him. The nurses started refusing to help the patient to access the toilet, while others denied him proper care. According to NHS England (2019), the UK's anti-discriminative policies prohibit any health provider from discriminating an individual based on his age, gender, race or disability. Furthermore, during my engagement with Mr. J, he claimed that some nurses were rude towards him, which made him feel uneasy and depressed. On other occasions, the nurses would abandon him to attend to other calm patients. The condition led to the patient's refusal of primary care.

Factors Contributing to the Poor Nurse-Client Relationship

Because of the poor perception the client had developed concerning the nurses, he was not able to issue feedback concerning his health to the physicians in charge. The nurse-client communication, in this case, was poor in such a way that it hindered the provision of proper nursing care. According to the nurses, the patient occasionally issued false information concerning his body's response to various medical interventions. The situation made it difficult for physicians to continue administering various interventions with fear that it could lead to complications.

I wondered what I could do differently to aid the creation of a good patient nurse dyad given that Mr. J had been moved into seclusion due to his violent behaviour. I sought to engage all members of my clinical unit to devise an approach on how to aid in the development of attainable goals that would foresee adequate care directed towards the patient. Unluckily, the patient succumbed to his illness in unclear circumstances, which I suspect were influenced by his depressive state.

By applying Driscoll's 'so what' concept in this reflection, I focus on addressing the specific factors that could have led to the poor nurse-client relationship in the case of Mr. J Additionally I aim at identifying my experiences and feelings towards the medical situation. The reflective process will also aid me to determine if I made the right decision of reminding my co-professionals to mind about the anti-discriminatory policies, or I should have supported the team's decision to seclude the patient.

My meditation on the scenario proves that multiple discriminatory instances led to the provision of inadequate health care to the patient. Firstly, the patient faced discrimination based on his mental condition. Mr. J had dementia, which affected his daily activities. According to NHS (2017), dementia is a group of mental states that affects individuals' memory and ability to think correctly; thus interfering with their everyday life. In this case, the patient often forgot his family members and drug prescriptions. Therefore, he never responded well to medication as an outpatient, which led to his readmission to the hospital. Moreover, he often believed he was still serving in the army; hence, he thought nurses, his family, and other patients were soldiers around him. As a result, he would command nurses as opposed to engaging them politely. In some instances, he got aggressive and physically abused people thinking they were enemies or insubordinate soldiers.

Discrimination Based on Mental Condition and Age

Because of the above scenario, nurses developed a poor perception towards him and started prejudicing him in health care provision. I tried to convince several members of my unit to take into account his condition and specially treat him as opposed to neglecting him. However, given the complexity of the situation and increased workload in the hospital, the team chose to attend to other patients and reduced their time towards the patient. According to the Equity Act 2010, the law prohibits discrimination of individuals based on their disability status (Gov.UK 2019). Wintemute (2016) explains disability as any mental or physical impairment that has considerable and extended negative effect on an individual's ability to conduct his or her usual activities. In this case, the nurses discriminated the patient since they disregarded the patient's condition as a factor influencing his aggressive behaviour. Therefore, seclusion and neglect in providing him with primary resources and access to social sanitary amenities amounted to discrimination. On the other hand, I acknowledge I tried to change the situation; nevertheless, poor communication and lack of willingness from other members of the clinical team posed as significant challenges. Every time I reflect upon the case, I also feel that I failed as a medical practitioner since I ought to have reported the matter to the relevant hospital authorities.

Secondly, the patient was discriminated due to his age. In this case, nurses in charge of his chemo did not involve the patient in the formulation of medical goals stating that he was too old and senile to understand anything. In my opinion, I believe the patient and his family ought to have been involved in the process of provision of primary care. Additionally, I think that the above situation made him depressed unable to socialise with other patients. According to Caceres (2015), Imogene's theory of goal attainment stipulates that socialisation is one of the necessary components that contribute to the provision of better health care. Furthermore, I believe I made the right decision to inform team members on the adverse effects associated with inadequate provision of primary care due to discriminative practices. As a medical practitioner, I am obligated to disseminate my duties ethically and accordingly despite a patient's race, gender identity, age, and mental condition (Koy et al. 2015).

Legal Frameworks and Obligations in Healthcare

Notably, there exist various laws in the United Kingdom that discourage discrimination in all aspects of society. For example, the Disability and Discrimination Act 1995 prohibits discrimination of disabled persons in sectors such as education, employment, access to public services such as health, and acquisition of property (Disability Discrimination Act 2019). Moreover, the law stipulates that nurses have an obligation not to discriminate against patients or staff and stick to the provision of equal opportunities and observance of human rights. Furthermore, the act does not seek to stop discrimination only but also obligate the NHS to make appropriate adjustments to cater for their needs. In this case, as a team, I believe we violated the above stipulation by neglecting the patient since he was aggressive, which was caused by his dementia as opposed to free will. Additionally, the Equality Act of 2010 discourages any discrimination based on sex, disability, race, gender, religion, sexual orientation, pregnancy, and age (Gov.UK 2019). It was enacted to supplement existing anti-discrimination laws by incorporating emerging global trends.

Alternative Approaches to Improve the Nurse-Client Relationship

Using Driscoll's model 'then what' I believe there were various approaches that we could have applied as a team to change the experience and issuance of primary care towards Mr. J who was living with dementia. Firstly, the nurses ought to have developed a good perception of the client. The situation would have aided in eliminating the negative attitude that led to his poor treatment. According to Caceres (2015), how a nurse perceives a patient stipulates the nature of their engagement throughout the treatment process. A right attitude towards clients allows physicians to interact with patients amicably to identify any problems that may be causing their discomfort (Vermeir et al. 2015; Methley et al. 2015). For example, as a team, we could have engaged the client in a discussion to identify the causes of his aggressive behaviour instead of secluding him from other patients.

Secondly, I believe that the teams should develop a proper communication system to facilitate the creation of productive relationships between department members and clients (Harding et al. 2015; Kourkouta & Papathanasiou 2014). Provision of health care does not stop at restoring the body to functional status; instead, it also includes psychological and emotional healing. Therefore, communication would have facilitated the creation of an excellent nurse-patient dyad. Communication is a crucial element in the formulation of good interpersonal relationships (Crawford et al. 2017; Haugan et al. 2016). I think that if I engaged the family to identify if some family related issues were stressing Mr. J out, I would have been able to devise a method to approach him and help him overcome them.

Recommendations for Future Practice

If the situation happened again, I would ensure that I choose competent individuals to join in the interprofessional health care team. Working with experienced and trained personnel ensures that a clinical unit can overcome challenges concerning specific issues quickly (Vinall-Collier et al. 2016). For instance, in the future, instead of secluding an aggressive patient, I would organise a psychological session to identify factors causing mental disturbances. Notably, people with dementia have difficulties in remembering and reasoning (Donegan 2017). Therefore, the application of appropriate interventions to help patients recover eliminates cases of aggressiveness and dissatisfaction among clients. Additionally, when a patient observes that nurses are concerned and care about his or her health, they respond well to treatment unlike when they feel neglected.