My reflective report will be about bed bathing. The format of the report is based on Gibbs’ (1988) guidelines to reflective writing. The service user will be identified as ‘Mr Jones’, so as to maintain patient confidentiality in keeping with the Nursing and Midwifery Council’s Code of Conduct NMC (2008), and the Data Protection Act of 1998. Reflective writing is a fundamental part of growing into a more confident healthcare practitioner; it highlights areas of strengths and weaknesses so that skills and can be reviewed and developed accordingly.
Mr Jones was admitted to hospital after having a stroke. He was bed bound and unable to communicate effectively, but he could still move his arms and was very strong. I was responsible for giving Mr Jones a bed bath along with another experienced colleague. I gathered together the necessary items to carry out Mr Jones‘ bed bath, and ensured that there were not any obstacles around the bed so that my colleague and I could work effectively. Treating people with care, respecting their individuality and their dignity is a fundamental part of our conduct as nurses (The Code 2008), therefore we introduced ourselves to Mr Jones and explained what we were going to do even though he did not seem to understand. As I closed the curtains around the bed, his behaviour began to change. He started using very harsh expletives and began to grind his teeth. He then clenched his fists and attempted to hit both us and despite this, my colleague and I had to persevere with the task and removed his gown, which was very difficult because he kept tightening his arms and fists. When we eventually succeeded, we began by washing Mr Jones in a logical order; firstly his face, then arms, his upper and lower body and lastly his back, sacrum and the back of his legs. We turned him on his side so that we could remove the soiled sheet from beneath him and replace it with a fresh one. Throughout the whole process, Mr Jones was clenching his fist and attempting to hit us and we had to take it in turns to hold his arms whilst the other person could wash the particular area of his body.
I was quite anxious about washing Mr Jones because his language and behaviour made me feel very uncomfortable. I didn’t have any previous experience of bed bathing a patient with communication difficulties; I have only ever received positive feedback from service users whilst giving bed baths, therefore this situation affected my confidence. I kept reminding myself that although I didn‘t feel prepared for this situation, my intuition and life experience would enable to me to complete the task efficiently. Chambers and Ryder (2009), describe intuition as the art of nursing. My intuitive skills helped me to think more deeply about the patient's feelings and frustrations, and I feel that Mr Jones eventually quietened because he realised that we were trying our best to make him feel at ease, and he sensed our genuine care and compassion for him. The patient benefits when nurses use their intuition either directly or indirectly, making it a skill that affects the quality of care and patient outcomes (McCutecheon, H.H.I. & Pincombe, J., 2001).
Critical thinking demonstrates the ability to solve problems by making sense of information using creative, intuitive, logical and analytical processes (Jones 2007). My colleague and I used our logical and analytical abilities when beginning the task by using methods that we have been taught. Each time he swore at us we and spoke to him in a very calm manner and explained that it was not very nice - neither for us or the other patients in the bay, and he did eventually quieten down. I felt that my obligation was also to consider the interests of all the patients on the ward as well as Mr Jones' (Fletcher 1995).
Understanding that a stroke can seriously affect a patient's attitude, behaviour and communication helped me to not take Mr Jones' behaviour and comments personally....
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