Using Johns Model, reflect on a current episode of care in your area of practice.
USING JOHNS MODEL TO REFLECT ON A CURRENT EPISODE OF CARE
IN MY AREA OF PRACTICE
This writing presents my reflection on a current episode of care in my area of nursing practice. I reflected on this episode using Johns model of reflection (1994). The episode of reflection is that of my implementation of the Nursing Care Plan I developed for a twenty-eight- year old woman with a fairly severe hearing impairment.
2.0. NURSING CARE PLAN
My nursing care plan is summarised as follows:
2.1. NURSING DIAGNOSIS: Moderate Hearing Impairment
- The patient frequently asks people to repeat what they say to her.
- She gives inappropriate responses to questions.
- She is withdrawn.
2.2. NURSING MODEL EMPLOYED: Roper, Logan and Tierney Activities of Daily Living (RLT) (Roper et al 2003)
2.3. NURSING INTERVENTIONS:
Objective: To optimise her hearing and communication.
Assessment Outcomes using the RTL model as a Frame of Reference:
- Her habits with respect to the RTL’s 12 activities of daily living are satisfactory except for mobility and work and play.
- Her dizziness and ear pains suggest the presence of infectious pathogens.
- She uses no ear drops and has no hearing aids.
3.1. “DESCRIPTION OF EXPERIENCE
DESCRIBE THE EXPERIENCE AND WHAT WERE THE SIGNIFICANT FACTORS?”
(Reflective Templates – Association for Perioperative Practice, 2009)
When I began, my self-assurance was much greater than it currently is. I imagined that the practical application of what I had learnt would be relatively easy. However, I do occasionally pause and hesitate, and my occasional consultation with doctors and fellow students even over some details I know and have committed to memory affects my composure and the fluidity of my activities.
Replaying the experience, I have identified the following two factors as significant:
3.1.1. My Experience in practicalising Theory: Transferring theory to practice has been a major challenge for me. I have realised that I have very little experience in this respect, and I had thought things would develop as I simplistically imagined.
3.1.2. The Physical Environment: The nursing home where the patient is hospitalised facilitates my physical, verbal communication with fellow students and with doctors. I find verbal communication more helpful than telephoning because my anxieties are always visible on my face when I make some urgent request for clarification. This fact brings me very strong and timely support.
WHAT WAS I TRYING TO ACHIVE AND WHAT WERE THE CONSEQUENCES?” (Reflective Templates – Association for Perioperative Practice 2009)
According to the Nursing theory, the duty of a nurse is to assist patients towards the performance of recovery and health-promoting activities (Models and Theories of Nursing, 2007; Kim & Kollak, 2005). Therefore, I have been trying to manage the patient’s hearing impairment according to Roper, Logan and Tierney’s Model of Activities of Daily Living (Bellman LM 1996). With this model, I hope to manage the impairment and to forestall deterioration and complications.
The consequences: Observing my alleviative prescriptions, the patient has been improving in her communication—slowly but steadily. But she does not yet socialise normally. This fact has affected her mobility: in the nursing home, socialising seems the strongest activity that can necessitate her mobility. She also does more intellectual work than she engages in recreation. According to the RTL model, these shortcomings are detrimental to her health. They unsettle me.
3.3. WHAT INFLUENCED MY DECISION MAKING AND ACTIONS? WHAT SOURCES OF KNOWLEDGE DID INFLUENCE OR SHOULD HAVE INFLUENCED MY DECISION MAKING AND ACTIONS? (Using a Model of Reflection, nd)
My decision-making and actions have been influenced by a set of positive and negative internal and external factors. The positive factors are the RTL nursing model, which enabled me set out a priority list of the patient’s needs; my knowledge of nursing theory and practice, which informed my primary objective in this hearing-impairment episode; and recommendations from doctors and fellow-students, which supported me when my understanding and stability failed me. The negative ones comprised my psychological maladjustment and emotional instability; my insufficient theoretical bases and deficient application of knowledge.
Given the level of success thus far, I believe the following sources of knowledge should have influenced my decision making and actions:
- Works that comprehensively define what a nurse should be concerned about in every Such works include Theory and Practice of Nursing: An Integrated Approach to Caring Practice by Lynn Basford and Oliver Slevin, and Nursing Theories by Hesook Suzie Kim and Ingrid Kollak.
- Such practical theories as the Management theory and Change theory, which would have strengthened my care plan in its methodological and psychological aspects.
3.4. “COULD I HAVE DEALT WITH IT BETTER?
WHAT OTHER CHOICES DID I HAVE AND WHAT WERE THOSE CONSEQUENCES?” (Reflective Templates – Association for Perioperative Practice, 2009)
From records of the successes of the doctors and nurses with young women with hearing impairment, I certainly could have dealt better with my patient. As suggested in section 3.3, the unsatisfying consequences of my not making the choice of a prior exhaustive theoretical and practical research are the incomplete successes I have recorded.
3.5. “LEARNING” (Reflective Templates – Association for Perioperative Practice, 2009)
3.5.1. “HOW DO I NOW FEEL ABOUT THIS EXPERIENCE?”(ibid)
I feel unsettled, yet more enlightened.
3.5.2. “HOW HAVE I TAKEN EFFECTIVE ACTION TO SUPPORT MYSELF AND OTHERS AS A RESULT OF THIS EXPERIENCE?”(ibid)
I have increased the scope of my application of the nursing theory to include adequate prior practical preparation for every episode of care. I will share these decisions with others and recommend to them the new sources of knowledge I have chosen.
3.5.3.. “HOW HAS THIS EXPERIENCE CHANGED MY WAY OF KNOWING IN PRACTICE?” (Using a model of reflection, nd)
The experience has led me to further explore the concept of knowing in practice and to arrive at the discovery that knowing in practice is a function of practice itself (Orlikowski, 2002). What a practitioner knows is “generated” and “re-generated” in and with every practice he/she performs. Consequently, my way of knowing in practice has become one of a more meticulous application of a wider knowledge of Nursing theory and practice.
This reflection with Johns model has shown that the reflective process is so indispensable to vocational practice that total progress in practical competence will hardly be possible without it. To closely and critically assess the fundamental steps and stages of one’s vocational experience using Johns reflective model lends a special broadening to one’s abilities for self-criticism. This reflective exercise has enhanced my learning because most of the shortcomings I realised derived from unsuspected gaps in my learning, in my method of learning and in my practical application of what I have learnt.
Bellman, LM (1996), “Changing Nursing Practice through Reflection on the Roper, Logan and Tierney model: the enhancement approach to action research” Journal of Advanced Nursing, 24, 129-138
Department of Practice Learning (2005) [on line] (cited 24th March 2009) Available from: <http://www.hcc.bcu.ac.uk/dpl/nursing/Placement%20Support/Model%20of%20Reflection.htm>
Kim, HS, Kollak, I (2005) Nursing theories: conceptual & philosophical foundations (edition 2, illustrated) Springer Publishing Company
Models and Theories of Nursing (2007) [online] (Cited 24th March 2009) Available from <URL:http://library.stritch.edu/research/subjects/nursingtheorists/NursingTheory.pdf>
Orlikowski, WJ (2002) “Knowing in Practice: Enacting a Collective Capability in Distributed Organizing” Available from <URL:http://opensource.mit.edu/papers/orlikowski.pdf>
Roper, N, Logan, WW, Tierney AJ (2000) The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living (illustrated edition) Elsevier Health Sciences
Reflective Templates – Association for Perioperative Practice [online] (Cited 23rd March 2009). Available from<URL: http://www.afpp.org.uk/careers/reflective-templates>
Wilkerson E, (2005) “Nursingtheory.com” [online](Cited 24th March 2009) Available from <URL:http://www.nursingtheories.net/>