Understanding the Unpopular Patient

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Understanding the unpopular patient.

The intention of this reflection is to raise a personal awareness of patients who have a chronic diagnosis and the importance of identifying potential issues surrounding their care. The model of Bowers (2008) will used to structure and guide the reflection as it allows for an accurate analysis, whilst acknowledging both good and bad practice. This model promotes forward thinking as well as retrospective study by future recommendations and the use of an action plan, which is an important part of professional development. Other models were considered such as Driscoll&Teh(2001) and Stephenson(1993), however due to the reflection being patient focused they appeared to ask questions that were aimed at the writer and very little about the patient. Throughout the research it has become apparent that patients’ with chronic illnesses have to endure and over come many personal compromises in order to sustain some quality of life, however occasionally these compromises are life saving. Experiencing this event and undergoing a detailed reflection of this situation has allowed for a far deeper understanding of patients’ experience of a renal failure diagnosis, and how they adapt to the gruelling regime that is haemodialysis. Fronek et al (2009) believe critical reflection creates a direct and personal dialogue between the practitioner and their practice regardless of role or educational background. Allowing practitioners to locate and evaluate their relational activities with patients’ plays a vital role in the development of training, and essentially throughout a professionals’ career(Fronek et al,2009).

The pseudonym Mabel will be used in this reflection to protect patient anonymity and maintain confidentiality in accordance with the Nursing and Midwifery Council(NMC)(2008).Whilst on a day shift on a renal unit I was asked by my mentor to begin the initial pre-dialysis assessment which included recording of weight and the first set of observations for Mabel. Mabel a 65 year old lady who had been diagnosed with End Stage Kidney Failure(ESKF) last year , was known on the unit to be a difficult patient. Mabel displayed her feelings and anxieties in a manner which could be portrayed negatively, as she would verbally attack if she felt that something was being done incorrectly. Her weight was documented and she was escorted to her chair where my mentor was waiting, Mabel started to discuss a previous session that had not gone well, and proceeded to criticize another member of staff on her needling technique. My mentor managed to diffuse the situation and calm Mabel down, although at the same time supporting her colleague. Whilst this was happening I was instructed to proceeded with her observations, she put her arm out for the blood pressure cuff, a cue that was taken as consent, as the MAP machine progressed with the reading it became apparent that something was wrong, Mabel and I realised simultaneously that the cuff was on her fistula arm, and before having chance to remove it, she had ripped it of and screamed “What the hell are you doing?”. I immediately apologised and tried remain composed, my mentor continued to pacify Mabel and asked if I was alright as she could see that I had been distressed by her outburst. She gave verbal reassurance that it was okay, and that perhaps a break was the best course of action. Unfortunately there was no opportunity to make further contact with Mabel for the remainder of the shift. The three main points for discussion and exploration in this reflection are the unpopular patient, and the influencing factors on patients receiving haemodialysis that might cause them to be labelled so, consent and the importance of obtaining the correct consent for the appropriate circumstance, and communication and its significance within the nursing role. Several positive aspects arose from this event one being the advocacy the nurse provided for her colleague and...
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