Utilizing Rolfe's Model of Self-Reflection

Case Reflection

The reflection of a practice or a case helps learners in determining the progress they have made in particular areas of the learning process. The process helps students in assessing their strengths and weaknesses. Specific areas of improvement are highlighted and addressed either with the help of group members or a tutor. Clinical supervision groups enable students to share their experiences in the nursing practice and raise issues of general concern. These issues are discussed by the group members using the relevant classwork and available literature materials. In this paper, I will reflect on a case that was narrated to us by one of our colleagues during a clinical supervision group discussion. I will make use of Rolfe’s model of self-reflection (Skinner & Mitchell, 2016). To observe the confidentiality requirement, I will not reveal the name of our colleague and I will use fictional names to conceal the identity of the patient.

What?

At one time in our clinical supervision group, a colleague narrated to us a touching experience she encountered during her clinical supervision. She was working alongside other members in the hospital to support older adults of age 65 and above. In her group, they mostly specialized in the cognitive evaluation of patients. At one time, Mrs. Jones (Not her real name) accompanied by her daughter approached the hospital for assessment. Mrs. Jones was 95 years old. Her daughter reported that Jones was suffering from frequent memory losses. According to the daughter’s report, Mrs. Jones had the tendency to easily forget things. At times, Mrs. Jones would misplace items and later spend long hours looking for them. After hearing their case, the doctor in charge referred Mrs. Jones and her daughter to our colleague’s team for assessment. Our colleague was requested to conduct the assessment test but under the supervision of a senior doctor. Only Mrs. Jones, her daughter, our colleague, and her supervisor were allowed into the examination room. Our colleague started by explaining to the clients the purpose of the assessment and how it would be conducted. She outlined all the procedures to be carried out during the assessment and requested to have consent from the clients. Mrs. Jones responded well to the assessment. She could understand and give proper answers to all the questions asked during the exercise. She addressed every question in detail and there were no instances where she exhibited memory losses during the short duration she was at the hospital. At one instance, our colleague asked Mrs. Jones to repeat what had been said to her and she repeated everything correctly. In another instance, Mrs. Jones was asked to draw a cat and she did it well. In drawing the cat, our colleague set a minimum time to complete the task and sure enough, Mrs. Jones completed the drawing even before the scheduled time. Our colleague narrated to us about worrying moments where Mrs. Jones's daughter interfered with her mother’s medical assessment procedure. In some instances, the daughter would openly disagree with her mother’s responses. In one instance, the daughter claimed that her mother was not eating properly back at home. Mrs. Jones strongly denied this statement and went ahead to claim that they did not live together. After completing the assessment and upon checking Mrs. Jones's hospital records, our colleague and the supervising doctor discovered that she was previously subjected to a CT scan and there were no signs of cognitive impairment. The scan was considered to be still valid at the time and it was established that there was no need to conduct another one. Mrs. Jones was consequently discharged without any further medical action. A few weeks later, Mrs. Jones fell ill. The daughter called the ambulance and Mrs. Jones was rushed to the hospital where she passed away. Mrs. Jones’ daughter sought to hold our colleagues’ team responsible for her mother’s death. She claimed that our colleague and her supervisor did not perform a proper assessment on Mrs. Jones and this contributed to the loss of her mother. It was later discovered that Mrs. Jones's death had nothing to do with cognitive impairment.

So What

As our colleague narrated her experience to us, I could not help but imagine if I was in her situation. According to her words, she had done everything she could to help the aged lady and there was no negligence on her part. I tried to imagine what would have happened if Mrs. Jones's daughter had sued our colleague and her supervisor for the mother’s death and what would have happened if it was concluded that the death was a result of cognitive impairment. Our colleague seemed confident as she narrated the ordeal. One could tell that she regretted the situation even though she had nothing to do with it. At one instance, I asked myself if I would have the confidence to narrate such an experience to my colleagues without breaking down into tears and how long it would have taken me to recover from such a haunting experience. After our colleague was done narrating her experience, the group members sought to give out their opinions on the case. I took this opportunity to discuss my thoughts with the group members. I based my opinions on the general theoretical knowledge that I had acquired in class. I tried to relate my points with some of the case studies I had read about before and the experience I had gained in my clinical experience practice. I first acknowledged that my thoughts might not be perfect and I was open to criticism and correction from the group members. I started by recognizing and acknowledging our colleagues' good intent to help Mrs. Jones. On her part, I felt that she demonstrated a high level of professionalism during the clinical experience. Almost all the other group members agreed with this statement. However, I raised some concerns about how the whole issue was carried out. During Mrs. Jones's assessment session, our colleague had told us of instances where the mother’s responses conflicted with the daughter’s responses. I raised a question to the group members on whether this issue should have been taken into consideration. I expressed concern over the manner in which Mrs. Jones was discharged from the hospital. In my expression, I stated that even though the scan showed that Mrs. Jones had no signs of cognitive impairment, there was a need to make some further assessment on her health status. More tests should have been carried out before making a decision on whether to discharge her or not. At one instance, a group member asked me what I would have done differently if I was in our colleague’s situation. In my answer to the question, I ascertained that I would have changed the assessment procedure the moment Mrs. Jones started conflicting with her daughter. I explained to the group members that this could have been an indication of some other underlying issues concerning a family and that these factors could have affected the assessment results. I suggested that it would have been a good idea to keep Mrs. Jones under medical supervision for a few days. In addition, I explained to the group members that it would have been advisable to find out how Mrs. Jones and her daughter related to each other at home and whether this had any effects on the mother’s health. I raised a number of issues that would have emerged from Mrs. Jones's incident. One of the issues is perceived negligence on the part of medical practitioners. Mrs. Jones's daughter felt that the hospital should have done more to save her mother. I felt that the clients were to blame in this case. Their narratives revealed a lack of openness, care, and responsibility. Conflicting attitudes may prevent the proper assessment of a patient and interfere with the patient’s safety (Hågensen et al., 2018). This was the case for Mrs. Jones. Some of the group members were disappointed that our colleague and her supervisor failed to consider the different versions given by Mrs. Jones and her daughter. They argued that given Mrs. Jones was the patient, there were chances that her statements would be flawed. Other group members questioned the need to discharge Mrs. Jones from the hospital too early. One member suggested that there was possible negligence in the manner in which this issue was handled and insisted that the daughter should have sued my colleague’s team for the error of omission. Under the error of omission, the healthcare provider fails to take the correct action on a patient and the patient suffers or dies as a result (Berlin, 2017). She based her arguments on the fact that Mrs. Jones died as a result of our colleague’s team failed to make a proper diagnosis.

Now What

I have significantly improved my knowledge of the clinical practice from the clinical supervision group. The most valuable clinical practice lesson I learned was how to take care of the patients properly with the help of a competent supervisor. I have now realized why good listening and communication skills are always emphasized in the clinical setting. Most importantly, I have discovered the need for being keen and attentive to every detail provided by the patient or their relatives. In reference to the case that was narrated by our colleague, I have learned the need to always remain assertive during practice. Any form of negligence in the hospital however minor it may seem to be could lead to serious effects on the health and life of the patient. In the case of our colleague, it seems that her team disregarded the information provided to them by Mrs. Jones's daughter. From the group discussions, I have realized that I have the potential to improve my academic knowledge and skills further. I actively participated in the discussion and gave my opinions and suggestions which were welcomed by other group members. I am happy that I can confidently address a group of people and respond to criticism without exhibiting a negative attitude to my critics. I have gained the confidence to make a point and support it with all the relevant evidence and answer to questions arising from the group members. I now recognize and acknowledge the importance of group work and how it helps students in conceptualizing topics learned in classrooms. I learned that other people can have different opinions from mine and that I should be ready to welcome them. We cannot all have the same thoughts and attitudes. From the case by our colleague, for instance, different members suggested different ways in which they would have handled the situation. From this, I learned that my way of doing things cannot be always the best. I should be ready to consider advice and alternatives from other people. In addition, I have learned that there is no fixed way of handling a problem in the nursing practice. The situation at hand is what matters the most and only the best procedure at that moment should be adopted in solving a patients’ issue as long as all the healthcare guidelines are not compromised.

From the experience, I have realized that professionals embrace serious risks in discharging their duties. In Mrs. Jones's case, for instance, the daughter blamed our colleagues’ team for her mother’s death. It feels bad when someone accuses you of such a serious incident even though you did your best. I learned that I should be ready for such incidents as a professional and that I should always do my best to save the patient. My practice will be positively altered as a result of being involved in the supervision group. The clinical experiences shared by our group members and member contributions towards these experiences have made me rethink my approach. In the future, I will consider making a follow-up on the patient’s progress even after they are discharged from the hospital. I will for instance request the client to be reporting for checkups at least for few days after being discharged. I recognize that this might be expensive for the client but it is necessary for the client’s safety.

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References

Berlin, L. (2017). Medical errors, malpractice, and defensive medicine: an ill-fated triad. Diagnosis, 4(3), 133-139. https://doi.org/10.1515/dx-2017-0007 Hågensen, G., Nilsen, G., Mehus, G., & Henriksen, N. (2018). The struggle against perceived negligence. A qualitative study of patients’ experiences of adverse events in Norwegian hospitals. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3101-2 Skinner, M., & Mitchell, D. (2016). “What? So What? Now What?” Applying Borton and Rolfe’s Models of Reflexive Practice in Healthcare Contexts. Health and Social Care Chaplaincy, 4(1), 10-19. https://doi.org/10.1558/hscc.v4i1.28972