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The Reflective Journal Anna Irwin

Introduction Reflection can be defined in many ways, in general it is known as learning through experience and from experience towards gaining new insights of self and practice (Boud et al 1985; Boyd and Fales, 1983; Mezirow, 1981, Jarvis, 1992). Reflection is a major part of learning in the health a social care sector and is increasingly becoming more popular in everyday practice. when reflecting we don’t see more, we see differently (Platzeret al, 1997). There are many models of reflection, these are frameworks for theories to be applied to practice to help make sense on reflecting in practice, each model has different stages throughout the cycle. Any model of reflection can be used; however, some will be more suited than others as they differ in structure and format, (Mckibbin. J, 2008). I will be using Gibb's. G (1988) reflective cycle to reflect on my chosen account as I have found this best suited to me and easy to follow, not doing so can have a negative effect by producing a lower standard of reflective work (Jasper 2013). I have looked at other models of reflection including Johns (1994), (Kolb,1984) and Driscoll (2000), however I did not understand them as easily. From using my chosen model, I will follow the 6 stages of Gibb`s reflective cycle; Description, Feelings, Evaluation, Analysis, conclusion and Action plan to aid building a reflective account. Using Gibb's cycle (1988) it will enable me to make a full account of what happened, what went well, and what went wrong and why, it will also help to establish what I could have done differently and what I will gain or change from the experience in the future, the Gibbs’ model is unique as it

Description Whilst at work in a residential care home looking after elderly residents, I started my morning shift after handover. One of the residents whom I was going to assist was a 70-year-old lady, she had been admitted the previous day and I had not met her before, to maintain her confidentiality I will refer to her as Mary, to follow the guidelines of the Data Protection Act (DPA)1998. Upon starting my round, I knocked on Mary’s door before entering the room, (Standard 7 of the Care Certificate; Privacy and dignity). Mary was sat up in bed, I introduced myself and asked her if she would like to get washed and dressed which she said she would. Mary was smiling and seemed like a very

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The Reflective Journal Anna Irwin sweet lady. I sat her up on the edge of the bed and had everything ready to wash her, Whilst washing her I realized I had forgotten the towel, I explained I would go and get the towel and come straight back, I covered her with her dressing gown to ensure she did not get cold and to maintain her dignity (Nursing

and Midwifery Council 2018). Upon arriving back Mary began to shout at me, telling me to get out and that I should not be in her room, I tried to explain to her that I had just gone to get the towel, however she became distressed, yelling and screaming for me to leave. I agreed with her that I would leave and I would come back later. I immediately left the room, leaving Mary on her bed with her dressing gown still round her. I spoke to my supervisor and explained the situation, she informed me that this was a normal response for individuals with dementia (Dementia is a syndrome (a group of related symptoms) associated with an ongoing decline of brain functioning as stated from nhs.uk (2017), and that I should return to the room and finish my task. I was unfamiliar working with dementia and had little experience. After a short while I returned to the Mary’s room where I found her calm and co-operative with getting washed and dressed, I finished all care for the Mary and left her settled in her chair awaiting breakfast. Feelings I felt calm and relaxed before going in to Mary's room and thought I was competent, one of the values of the 6Cs, defined as care, compassion, competence, communication, courage and commitment (Department of Health (2012). Having to leave Mary due to my poor organization skills I felt annoyed with myself, I also felt stupid and embarrassed. Once returning to her room I was shocked at her reaction at my return, I felt uneasy and cautious around Mary due to her outburst and unsure why I had got the reaction I received from her when returning to the room, which I thought was completely the opposite to the first reaction I had received. My instinct was to calm and reassure, however felt I had to respect her wishes and leave as she had requested. Upon leaving I felt awkward, I thought it was in her best interest (Mental Capacity Act 2005) to respect her wishes, which is stated in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 10. Upon returning to Mary’s room I felt relieved that she had calmed and allowed me to get her ready as I did not feel confident (6Cs) in handling the situation if she remained distressed.

Evaluation The negative point of the experience was that Mary became upset, however I felt I had informed Mary step by step what was happening ensuring she was fully informed to avoid any upset and gained consent for me to carry out the care, stated in The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to my organizational skills I was not fully prepared, therefore causing Mary undue stress which effected her mood and resulted in not being able to finish her personal care. I reported to my

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The Reflective Journal Anna Irwin supervisor and made her aware of the situation, ensuring good communication skills were maintained for up to date information on the residents within the home (6Cs). Giving Mary time and space defused the situation and allowed me to assist Mary in the support she needed to maintain her wellbeing. The response I received from my supervisor was a negative experience as I felt ushered away to carry out

care with an individual whom I was unfamiliar with, and had little experience with dealing with individuals suffering with dementia. I personally should have questioned my supervisor, another element of the (6Cs) is courage, in challenging my supervisor I would have met the element of courage within the (6Cs). Analysis Reflecting on the situation I should have spoken to my supervisor and explained that I did not feel confident (6Cs) in carrying out the task, as communication (6Cs) is vital to provide quality care, (Nursing & Midwifery Council (NMC, 2010). However I felt embarrassed to say anything regarding this at the time as I did not want the supervisor to think I was stupid and incapable of doing my job, It is suggested that poor communication has a negative effect on the delivery of care, (Hughes & Mitchell, Millis, Neily & Dunn, 2008). The Nursing & Midwifery Council (NMC, 2015) state employees must be open and honest within their organization to prevent harm or near miss under the duty of candor (NMC, 2018), which I did not adhere to when speaking to my supervisor. Lewis (2008) states negative evaluations regarding actions, thoughts and feelings are at the core of self-conscious emotions, feeling embarrassed left me feeling uncomfortable and not able to express my true feelings. When carrying out a task it is vital to be organized to ensure good quality care is delivered and to work in a professional manner for the individual to feel valued and at the Center of their own care (Mckibbin. J, 2008). Care plans are put in place to have up to date knowledge of each individual to ensure they receive adequate care that respects their needs, upholds their wishes and promotes their wellbeing (McCance, B. & McCormack, T. 2018), along with Person centered planning (PCP) which is a process for an individual life plan and is based around the principles of inclusion and the social model of disability, ( The Circles Network, 2008), and runs in line with care plans and ensures individuals needs are met (Mckibbin, 2008). Providing care to individuals I should be aware of the illnesses they are suffering from to ensure the care given is delivered in a way that respects their wishes, needs and promotes their wellbeing. Within this reflection I can see some positive element, knocking on a door before entering shows respect, the simple things that maintain a person’s privacy and dignity (woogara, 2005), also following policies regarding consent and working within the legal frameworks shows professional conduct. Conclusion Reflecting on this account I would have done things differently, firstly by being more organized, I have realized organizational skills are very important to ensure the smooth running of the care home and good

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The Reflective Journal Anna Irwin patient care is maintained to give the best possible care to the individuals needing care and support. I have learned I need to work on my communication skills to be able to speak out when I feel I need assistance and support, thus ensuring I follow the 6Cs. Looking at Gibb’s model of reflection throughout this assignment It has made me aware that I need to reflect more in my work practice as this will give me

future knowledge in similar situations, this then becoming reflection in action (Schon, 1983). I also need to be assertive when realizing I am not able to carry out a certain task and communicate this effectively to my supervisor, in the event the issues have not been dealt with I need to be more confident and seek advice from my manager.

Action Plan In the future I will reflect on this account and put my knowledge in to practice ensuring the wellbeing of the individuals I provide care for. I will also look at training which can further my knowledge in Dementia and other illnesses relevant to my profession. I will communicate clearly with my supervisor regarding training needs and any other sources of help available to enhance my skills, and to ensure I express my concerns and worries. Regular supervisions and a clear understanding of the areas I need to work on from my supervisor will enable me to enhance my skills and become a competent health care assist. I will look at in house training which I can access from work and read up in the areas I need to build my skills on. I will communicate with my supervisor on how to access the modules I can work towards to further my knowledge. I will research in detail the effects of dementia and how to provide care and support to individuals with mental health illnesses, this will enable me to feel more confident and give me the courage to deliver specific care in the areas I need help with. Gaining experience in these areas will benefit myself, the individuals I care for and the company I work within to promote and deliver good quality care. By continuing with the experience, I have and building on my skills I will be able to deliver a high standard of care. Swot analysis Below is a table consisting of my strengths, weaknesses, opportunities and threats known as a swot analysis.

Strengths I am honest , reliable and compassionate. I am a good listener and can empathize with individuals. I perform at my best when I am fully informed and know what is expected of me.

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Weaknesses My communication skills are an area for concern within my profession as I find it difficult to express myself to senior or

The Reflective Journal Anna Irwin I can work solely or as part of a team, working collaboratively with different professions to deliver the best care possible. My advantages are having experience within a care setting. I currently hold level 2 NVQ certificate in health and social care which has given me knowledge in the area I work in. Working in a fast paced environment challenges me and I enjoy doing different things and meeting new people. I have a good eye for detail and can implement new things easily. Others see me as approachable, fair and a good listener. I am non-judgemental and treat each person with respect and dignity. I am proud of achieving my level 2 NVQ qualification in health and social care The personal values I possess are to be caring, honest and responsible, I have a genuine interest in how people feel and like to help others.

higher ranking professionals Knowledge with Legislation, policies, and procedures are poor and need to be researched for a clearer understanding of these Concentration when learning is lacking, finding a learning style to aid me to learn more efficiently needs attention Time management worries me the most, not having enough time to get things done I would like to enhance my management skills to show efficiency and leadership my personal development aim is to progress in my academic studies and gain a degree tasks I avoid due to confidence are dealing with challenging behaviour People may see me as to polite and lack in confidence expressing myself my negative work habits are not planning ahead for time and being organized. personality traits that hold me back are being reluctant to express my opinions and say what I think or feel

Opportunities

Threats

I have the opportunity of gaining a degree in health and social care through attending university, gaining knowledge through attending lectures and seminars and researching the topic areas of the course, attending and interacting will enhance my opportunity for learning. Opening up and expressing my thoughts will aid in receiving feedback and acting on the opportunities available to me. I would like the opportunity to expand my knowledge further and enhance my qualifications to further my career Working on my weaknesses will give me more opportunity for growth within my profession The care industry is vastly growing and the opportunity for a change in career to gain further insight to care would be advantageous Liaising with my manager and other professions could give me the opportunity to grow and build on my experience and knowledge, to gain good advice and available to support me through to progress in my career.

Work commitments threaten learning and research as it restricts time Family life is impacted on through working and attending university. Weakness in my communication threatens progression in work Experienced and more qualified colleagues looking to enhance in to the same role Time management, not being able to keep up with changes Weakness in Concentration for learning and securing a degree is a threat Keeping up to date with changing policies and procedures, knowing how to work in the correct way at all times.

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The Reflective Journal Anna Irwin Within carrying out the swot analysis I can improve by looking at my strengths, weaknesses, opportunities and threats and reflecting back to these regularly to improve my skills. My time frame for improving will be six months, I will then review my swot analysis to see if I have progressed.

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The Reflective Journal Anna Irwin

List of references Bassot, B. (2016). The Reflective Practice Guide. London: Routledge.

Donaghy, M. E & Morss, K.T. I. (2000). Guided reflection: A framework to facilitate and asses' reflective practices within the discipline of Physiotherapy. Physiotherapy Theory and Practice,16(1), 3-14

England, N. (2018). NHS England » The 6Cs. [online] England.nhs.uk. Available https://www.england.nhs.uk/leadingchange/about/the-6cs/ [Accessed 11 Dec. 2018].

Gibbs G (1988) Learning by Doing. A Guide to Teaching and Learning Methods. Further Education Unit, Oxford Polytechnic. Oxford.

http://www.skillsforhealth.org.uk/standards/item/216-the-care-certificate

https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regu Lation-10-dignity-respect

https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/openness-andhonesty-professional-duty-of-candour.pdf

https://www.scie.org.uk/publications/guides/guide15/legislation/otherlegislation/informatio nlegislation.asp

Jasper, M (2013) Beginning Reflective Practice. Second edition. Cengage Learning, Andover.

Lawrence, J., Perrin, C., & Kiernan, E. (2015). Building professional nursing communication. Cambridge University Press, 2015.

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The Reflective Journal Anna Irwin Lewis, M. (2008). Self-conscious emotions: Embarrassment, pride, shame, and guilt. In M. Lewis, J. M. Haviland-Jones, & L. F. Barrett (Eds.), Handbook of emotions (pp. 742756). New York, NY, US: Guilford Press.

McCance, T., & McCormack, B. Person-centered practice in nursing and health care. John Wiley & Sons, 2016.

Mckibbin, J & Walton, A. (2008) Leadership &Management in health & social care for NVQ/SVQ Level 4.

Revalidation: Written reflective accounts | The Nursing and Midwifery Council. (2018). Retrieved from http://revalidation.nmc.org.uk/what-you-need-to-do/written-reflectiveaccounts/

“Dignity in Care - The Dignity Factors: Privacy.” Social Care Institute for Excellence,www.scie.org.uk/publications/guides/guide15/factors/privacy/. “The Code.” The Nursing and Midwifery Council, www.nmc.org.uk/standards/code/.

“The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” Legislation.gov.uk, Queen's Printer of Acts of Parliament, www.legislation.gov.uk/ukdsi/2014/9780111117613/regulation/1

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The Reflective Journal Anna Irwin

Wbl refs to copy and paste Care Certificate Workbook. (2019). Retrieved from https://www.skillsforcare.org.uk/Learningdevelopment/inducting-staff/care-certificate/Care-Certificate-workbook.aspx

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