Caring for a Patient with COPD: A Reflective Account

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Caring for a patient with COPD: a reflective account
Barnett M (2005) Caring for a patient with COPD: a reflective account. Nursing Standard. 19, 36, 41-46. Date of acceptance: October 15 2004.

Summary
Reflective practice has been a familiar topic in nursing journals and the term is regularly used in professional nursing practice. However, it was not until I used Johns’ (1994) model to analyse and explore my feelings and actions in daily practice that I fully understood the concept of reflective practice and discovered how it can enhance professional development. This article describes a reflective experience related to caring for a patient with chronic obstructive pulmonary disease in the community. The professional implications of this experience are explored through reflection. This exploration raised two main issues: the development of a therapeutic nurse-patient relationship and the feelings of guilt experienced when reflecting on whether I had let the patient down when most needed, in the final stages of her life.

obstructive pulmonary disease (COPD) in the community. This has enabled me to explore the meaning and significance of my clinical practice and to recognise the complexities within it. The experience raises a number of issues frequently encountered in daily nursing practice. However, for the purpose of this article, two issues will be discussed in depth. These relate to the development of a therapeutic nurse-patient relationship and dealing with feelings of guilt. The reflective process allows practitioners to question and analyse their experiences and actions as a means of developing their knowledge, skills and behaviour, to enhance clinical practice.

Author
Margaret Barnett is COPD nurse specialist, Derriford Hospital, Plymouth. Email: margaret.barnett@pcs-tr.swest.nhs.uk

Description of the experience
My work as a specialist nurse involves caring for and managing patients in the community with COPD. I had been caring for Mary (not her real name) for two years. She was in her early 50s but had severe COPD. Initially, Mary was fairly stable and during exacerbations of COPD she could be managed at home effectively. She had a caring and supportive family and husband. Last year we had discussed her being referred to Harefield Hospital in London for consideration for a lung transplant, but after her first visit for assessment she withdrew and said she could not go through with the investigations. Over the last six months her condition showed signs of deterioration with frequent chest infections that required management in hospital. Because of her deterioration she had been receiving weekly visits from the COPD home care service. I visited Mary at home a week after she had been discharged from hospital, as she had an exacerbation of her COPD. On my visit she was in good form and cheerful. She looked well, in fact the best I had seen her in some time. may 18 :: vol 19 no 36 :: 2005 41

Keywords
Reflective practice; Respiratory system and disorders These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review. For related articles and author guidelines visit the online archive at www.nursing-standard.co.uk and search using the keywords.

THE ESSENTIAL purpose of reflective practice is to enable the practitioner to interpret an experience in order to learn from it (Johns 1995). It is a process that involves examining individual personal thoughts and actions in daily practice (Somerville and Keeling 2004). This reflective account relates to knowing-in-action (everyday practice), which Schön (1983) identifies as reflection-on-action. This article describes a reflective experience while caring for a patient with chronic NURSING STANDARD

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