Reflection Competency in Communication Skills
This reflective essay is based on my experience as a health care assistant in the operative theatre working as a circulating nurse for a vascular access list. It will also highlight the important aspect of communication within the theatre practitioners when working with patients who are under local or general anaesthetic. I will explore a critical incident and also reflect on my own personal experience. I aim to use this experience to bring out the different forms of communication, the potential barriers of communication and its consequences in the clinical setting. Gibbs Reflective model (1988) is what I have chosen to guide my reflective process, as it incorporates the stages of reflections, including the presentation of the situation, feeling, evaluation, analysis, conclusion and action plan if the event will happen again. The first stage of Gibbs's model of reflection requires a description of event. The event happened when I was circulating on my own as a health care assistant for one of the vascular access list. I was circulating for a patient who was undergoing `Right Arm Arterio-venous Fistula surgery’ procedure under local anaesthesia. During the `sign-in’ (WHO 2008), the surgeon emphasizes the fact that there are no specific concern about the patient or the procedure related. Under normal circumstances, when the patient walks into the operating room together with the anaesthetic practitioner, we have to introduce ourselves to the patient, in order to alleviate the patient’s fears and to make them feel comfortable as they are awake and aware of their surroundings. The anaesthetic practitioner then handover to me all the patients documents and necessary information to avoid the mishaps, then will check again with the scrub nurse if we have the right patient for the procedure listed and also check with the patient if they have metal implants. Most importantly check if the consent has been signed both by the patient and medical practitioner or the surgeon. The check continues further to check if the patient has any allergy to avoid reaction from medication and antiseptics in use during surgery. Also to ensure that there are no specific concerns which are more likely to cause harm to the patient if they are ignored or not considered (WHO 2008). Before the incision begins, the surgeon asked me to lift the patient’s right arm for him to clean the operative area with betadine antiseptic solution. As I was about to lift the patient’s arm, he screamed by saying `ouch! Be careful with my arm! My shoulder is dislocated!’ which made us aware that the patient was in pain. The information about the dislocated shoulder was not related to the team members or it might be that the patient failed to mention it during pre-assessment, therefore none of the team knew about it as nothing was mentioned during the sign in and time out. The second stage in the Gibbs reflective model asks that I should take my feelings into account, try to do some retrospection, and try to find out how I felt at the start of the event. First, I had mixed feeling of disappointment and nervousness that I might have hurt the patient and that made me panic at the thought that I might have increased the risk of breaking his arm. Second, I could not concentrate on the work I was doing as some feelings were running in my mind. Even though I was taught frequently that I should explain to the patient anything I am about to do before implementing it, however I was not able to be that much cautious. Third, I felt discomfort that I should be there to emphasize safety to all patients. I also thought that the patient might think that I do not care about his safety. Finally, I had this feeling of anger towards the surgeon and the anaesthetic nurse who were the first people to interview and do pre-assessment, who should have pointed out that the client has a shoulder injury during the sign in and time out. Furthermore I...
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