Caring for a Patient with COPD: A Reflective Account

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: [e-mail]

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

References: Atkins S, Murphy K (1995) Reflection: a review of the literature. Journal of Advanced Nursing. 18, 8, 1188-1192. Bellamy D, Booker R (2003) Chronic Obstructive Pulmonary Disease in Primary Care. Class Publications, London. Benner P (1983) Uncovering the knowledge embedded in practice. Image: The Journal of Nursing Scholarship. 15, 2, 36-41. Benner P, Wrubel J (1989) The Primacy of Caring: Stress and Coping in Health and Illness. Addison-Wesley, Menlo Park CA. Boud D, Keogh R, Walker D (1985) Reflection: Turning Experience into Learning, Kogan Page, London. Boyd E, Fales A (1983) Reflective learning: key to learning from experience. Journal of Humanistic Psychology. 23, 2, 99-117. Carper BA (1978) Fundamental patterns of knowing in nursing. Advances in Nursing Science. 1, 1, 13-23. Eraut M (1985) Knowledge creation and knowledge use in professional context. Studies in Higher Education. 16, 2, 117-133. Eraut M (1988) Learning about management: the role of the management course. In Day C, Poster C (Eds) Partnership in Education Management. Routledge, London. Fry ST (1989) Toward a theory of nursing ethics. Advances in Nursing Science. 11, 4, 9-22. Glaser BG, Strauss AL (1965) Awareness of Dying. Aldine, Chicago IL. Heidegger M (1962) Being and Time. Harper and Row, New York NY. Irurita V (1999) Factors affecting the quality of nursing care: the patient 's perspective. International Journal of Nursing Practice. 5, 2, 86-94. Johns C (1994) Clinical notes: nuances of reflection. Journal of Clinical Nursing. 3, 2, 71-75. Johns C (1995) Framing learning through reflection within Carper 's fundamental ways of knowing in nursing. Journal of Advanced Nursing. 22, 2, 226-234. Johns C (1996) Visualizing and realizing caring in practice through guided reflection. Journal of Advanced Nursing. 24, 6, 1135-1143. Karlsen S, Addington-Hall J (1998) How do cancer patients who die at home differ from those who die elsewhere? Palliative Care Medicine. 12, 4, 279-286. Kubler-Ross E (1973) On Death and Dying. Tavistock Publications, London. Loftus L (1998) Student nurses ' lived experience of the sudden death of their patients. Journal of Advanced Nursing. 27, 3, 641-648. Luker KA (1997) Research and the configuration of nursing services. Journal of Advanced Nursing. 6, 4, 259-267. Luker KA (2000) The importance of 'knowing the patient ': community nurses ' construction of quality in providing palliative care. Journal of Advanced Nursing. 31, 4, 775-782. Maeve MR (1998) Weaving a fabric of moral meaning: how nurses live with suffering and death. Journal of Advanced Nursing. 27, 6, 1136-1142. May C (1991) Affective neutrality and involvement in nurse-patient relationships: perceptions of appropriate behaviour among nurses in acute medical and surgical wards. Journal of Advanced Nursing. 16, 5, 552-558. McCormack B (1996) The Ethics of Care. Nursing Times 11th National Ward Leaders’ Conference: Managing Care. Kensington Town Hall, London. McQueen A (2000) Nurse-patient relationships and partnership in hospital care. Journal of Clinical Nursing. 9, 5, 723-731. Mitchell A (1995) The therapeutic relationship in health care: towards a model of the process of treatment. Journal of Interprofessional Care. 9, 1, 15-20. Morse JM (1991) Negotiating commitment and involvement in the nurse-patient relationship. Journal of Advanced Nursing. 16, 4, 455-468. Murray Parkes C (1988) Bereavement as a psychosocial transition, processes of adaptation to change. Journal of Social Issues. 44, 3, 53-65. Radwin LE (1996) ‘Knowing the patient’: a review of research on an emerging concept. Journal of Advanced Nursing. 23, 6, 1142-1146. Ramos MC (1992) The nurse-patient relationship: theme and variations. Journal of Advanced Nursing. 17, 4, 496-506. Roper N, Logan W, Tierney J (2000) The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living. Churchill Livingstone, Edinburgh. Schön DA (1983) The Reflective Practitioner: How Professionals Think in Action. Jossey-Bass, San Francisco CA. Somerville D, Keeling J (2004) A practical approach to promote reflective practice within nursing. Nursing Times. 100, 12, 42-45. Watson J (1988) Nursing: Human Science and Human Care. National League for Nursing, New York NY. Webb C (1995) What kind of nurses do patients want? Journal of Clinical Nursing. 4, 2, 101-108. 46 may 18 :: vol 19 no 36 :: 2005 NURSING STANDARD