Introduction
The purpose of this assignment is to provide a critical reflective account of teaching a patient the correct inhaler technique, utilising The Gibbs (1988) model of reflection. The cycle uses structured debriefing in order to affirm the type of reflection supported in Kolb’s experiential learning cycle (Kolb, 2014). The model implies that the practice of reflection is methodical and incorporates a number of unique steps in order to be effective. This model of reflection is a type of academic reflection which draws on research and offers a theory as to put into practice the process of reflection. The cycle can be conceptualised into six key steps: description, feelings; evaluation, analysis; conclusions and action plan. The method is popular for its focus on learning from experience rather than attempting to alter the experience (Helyer, 2015).
The Royal College of Nursing (2012), considers the Gibbs (1988) model of reflection to be notable because emphasis on the function of emotions and concedes their importance in the reflection process. Nursing can often be a physical and emotional demanding career. Consequently, reflection on these emotions and in-depth analysis of how to control them and improve control of them in the future is important in nursing.
Description
The patient a 69-year-old female, attended a nurse-led clinic for initial assessment and evaluation. The patient an ex-smoker was recently diagnosed with COPD during their most recent admission to hospital with a lower respiratory tract infection. In accordance with The Nursing and Midwifery Council guidelines (2015), the patient has been renamed under the pseudonym “Mrs. Smith” to protect and maintain confidentiality.
According to Vestbo et al (2007) chronic obstructive pulmonary disease (COPD) is a major determinant in global morbidity and mortality. One of the major characteristics of the disease is chronic airway restriction that progresses gradually over a period of time and is, regarded irreversible. Mrs. Smith at diagnosis was commenced on short-acting bronchodilators in the form of inhalers. This line of treatment is in accordance with the appropriate NICE guidelines (2010) on the diagnosis and management of COPD. The guidelines also require the patient’s inhaler technique to be assessed initially and throughout treatment.
On assessment Mrs. Smith’s inhaler technique was found inadequate and intervention was required. Recent studies have shown inhaler technique has been a main factor in exacerbations, proven to result in increased resource utilisation relating to the management of COPD (Bonini and Usmani, 2015). The patient was shown the correct inhaler technique and asked to demonstrate the technique to the writer.
Feelings
Initially after witnessing Mrs. Smith’s inhaler technique I knew immediately her technique was incorrect. However, at the time I was nervous to make the observation known to my mentor. I was unsure exactly what aspect of the technique was wrong so I awaited my mentor to make the observation. I also didn’t want the patient to feel uncomfortable due to my lack of knowledge.
My mentor explained the problem with the technique and asked me to show the correct technique to Mrs. Smith. I felt slightly apprehensive about showing the technique to the patient in my mentor’s presence. This feeling persisted despite having good knowledge of inhaler technique. My mentor provided me with support and supervision throughout the task. My initial apprehension subsided quickly after showing the correct technique to Mrs. Smith and observing her carry out the technique correctly afterwards. Afterwards, I was elated that my actions led to Mrs. Smith having overall greater management of her symptoms.
Evaluation
Overall, the experience was both negative and positive. The negative aspect was due the initial feelings of nervousness and apprehension at the thought of a demonstration in front of my mentor. However, after speaking to a fellow student about their experience, I felt much more positive. I quickly realised that most students feel nervous whilst carrying out activities in supervision of their mentor. This is highlighted in relevant literature which points out, seven out of ten nursing students found demonstrating practical skills under supervision incredibly intimidating (Wagner, Bear and Sander, 2009).
On the other hand, the positive aspects stemmed from being able to learn from a new experience as well as the satisfaction from the care delivered. I realised that I should have highlighted my initial observation of the poor inhaler technique to help further my learning experience. The best course of action would have been for me to highlight my initial observations and receive feedback from my mentor (Burke, Raeann and LeBlanc, 2016). Despite this full support was given whilst demonstrating the correct technique to Mrs. Smith.
Analysis
Reflection and reflective practice have been well-received in healthcare such that the importance of the concept and benefits are often cited by various literature; indeed, reflective practice is viewed by many as a fundamental component of nursing competence (Mann, Gordon and MacLeod, 2009). Continuous critical thinking and reflection should coalesce the division between theory and practice, enhance the quality of care and encourage professional development (Schon, 1983; 1987; 1995). Jasper (2013) demonstrated that reflection from experiences, in preference than education from academic tuition, could form the greatest principle of continuous professional development and development.
Learning is a complex process that is influenced by a wide assortment of factors (Kaaikinen and Arwood, 2009). Meleis (2010) suggested that in order to understand, describe and explain human behaviours, nurses should refer to related theories and models. Alligood (2013) expressed a similar view which concluded that various models or theories can act as a guide for developing patient education programmes by focusing on the key factors that need to be considered in order for it to be successful. The work of DeCoux (2016) indicates that examining different learning theories and applying them to a patient based on individual merits is an invaluable skill.
Social Cognitive Theory, the modern adaption of social learning theory proposed by Bandura (1986; 2004), defines human behaviour as a dynamic, interdependent system in which personal, environmental and behaviour interplay. A key principle of SCT is that individuals learn by observing the behaviours of others, the result of said behaviours not just on their personal experience (Rendell et al, 2011). Important aspects of SCT that are associated with health promotion include modelling, strengthening, self-governance, and self-actualisation (Annand, 2011).
Pike and O’Donnell (2010 observes the concept of self-actualisation as the patients’ expectations and intellectual understanding of their environments and how this affects their attention or the core aspects of what they will learn. A recent study concluded the correlation between how an individual’s beliefs about their abilities influence their route to learning and their results (Lucktar-Flude, Wilson-Keates and Larocque, 2012).
Modern nursing requires the nurse to fully comprehend their patients own beliefs about their ability as learners (Pelzang, 2010). As Murphy et al (2011) points out social cognitive learning theory is relevant and appropriate in nursing, it is considered highly effective when used in real life situations or simulation environments. Teaching skills in nursing regardless of the learner are based on models where the techniques are demonstrated by the instructor, then repeated by the students, who consolidate their previous experience, learned behaviours and then role-model for others (Lapkin et al, 2010).
Teach back strategies in health education can be fundamental in evaluating whether or not a patient fully understands what they need to know or do in order to effectively manage their condition (White et al, 2013). Although this was applied to teaching a skill, it can be applied to all health promotion scenarios. The work of Tamura-Lis (2013) has drawn attention to the fact that the teach back method allows the nurse to recognise concepts patients might not grasp and continue forward reiterating the key aspects. Furthermore, use of the method is promoted by Healthcare Improvement Scotland (2016) and would help facilitate the Scottish Governments Vision 2020 (Everyone Matters:2020 Workforce Vision,2013).
Action Plan
According to my experience demonstrating and teaching Mrs. Smith has made me realise the importance in ensuring patients can manage their condition. Throughout the experience, communication was fundamental in developing a positive relationship (McSherry et al, 2016). I aim to provide frequent learning experiences to patients in order to continue my professional development. In order to do this, it is important that I remain up to date with relevant literature relating to my practice. The NMC (2015) considers teaching a key aspect in continuing professional development, which is key factor in revalidation. Furthermore, continued reflective practice will enable me to develop my self-confidence, knowledge and skills (Aquino, 2008).
Conclusion
Recent literature has identified that health promotion interventions that are underpinned using the principles of social and behavioural science are more successful than those lacking a theoretical approach. COPD related emergency admissions are a large burden on the UK’s National Health Service. It is fundamental for nursing professionals to have a clear knowledge of the diverse elements of every individual patients’ specific adult learning needs. Thus would allow nurses to make the relevant clinical decisions with the best chance of success. This assignment has furthered my knowledge and helped develop my practice, importantly it has helped me relate my theory to practice.