Using Johns Model, reflect on a current episode of care in your area of practice
RFFLECTION ON A CURRENT EPISODE OF CARE IN MY AREA
OF PRACTICE
This writing contains a brief presentation of my recent reflection on a current episode of care in my area of nursing practice. The reflection was done using Johns model of reflection (1994), a five-question model (Johns Model of reflection nd [online]) which offers such broad scope for constructive self-assessment and criticism as to make the matter under consideration both a worthwhile and memorable experience. The episode of reflection is that of the Nursing Care Plan I developed and implemented for a twenty-eight-year old woman with a fairly severe hearing impairment. I am employing Johns model with a view to appraising my successes, and what I may have neglected and omitted, especially in respect of such areas as I or my critics might have overlooked or considered not very significant.
2.0. THE NURSING CARE PLAN FOR THE TWENTY-EIGHT-YEAR OLD
My Nursing Care plan is summarised in the following structured descriptions:
NURSING DIAGNOSIS: Moderate Hearing impairment
Defining Characteristics: (1) Frequently asks people to repeat what they
say to her
(2) Gives inappropriate responses to questions
(3) Withdrawn
(4) Irritable
(5) Has difficulty in learning and following
instructions
NURSING MODEL EMPLOYED: Roper, Logan and Tierney Activities of Daily Living
NURSING INTERVENTIONS:
Objective: To assist her in effective communication and towards the best possible
participation in meaningful activities in spite of her loss of normal hearing, and to
encourage and support her in her fulfilment of the 12 hierarchical human functions of the
Daily Living Model that will guarantee optimum health , independent living and self-
realisation. Her upward progress in the hierarchical pyramid will expectedly reduce future
risks of deterioration in her hearing ( into deafness, for instance) and will reduce her
chances of general ill health. Thus, in addition to managing her hearing impairment, I
wished to see her function optimally in maintaining a safe environment, communication,
breathing, eating and drinking, elimination, washing and dressing, thermoregulation,
mobilisation, work and play, expressing sexuality and sleeping.
Assessment Outcomes:
- Her dizziness and ear pains suggest the presence of infectious pathogens
- She uses no ear drops
- She has no hearing aids
- My investigations revealed that: She has no breathing dysfunction ( her
breathing is deep enough); she eats and drinks nutritiously; her elimination
is regular; she bathes, washes and dresses hygienically; her environment is
well-ventilated; she balances work with play; she is fairly mobile; and she
has no sexuality problems.
- However, her communication practices have been particularly weak since the hearing impairment – understandably. Her sleeping habits, too, have been poor. She also tends to keep more solitary and avoid company in spite of the general absence of discrimination against her from her family, peers and colleagues
Therapeutic Interventions:
- On the recommendation of a medical doctor, I administered ear drops to her,
prescribed a dosage and encouraged her strict, untiring compliance.
(2) I also (on a doctor’s recommendation) prescribed her a suitable hearing aid, and encouraged her to use it, especially in especially noisy environments.
(3) In a suitable environment, I trained her to lip-read, and advised her to stay away as much she could from noisy environments.
Preventive Interventions:
- I have been encouraging her to move around more regularly
- I have strongly advised her to sleep regularly and have seen to it that she does so. For this purpose, I have encouraged her husband to have her hospitalized in the nursing home so I could monitor her closely,
- I have referred her within the nursing home to a psychologist for counseling on communication necessities,
3.0. REFLECTION ON MY CARE PLAN USING JOHNS MODEL
I used Johns five-question model to reflect on my current care plan as follows:
3.1. DESCRIPTION OF EXPERIENCE: DESCRIBE THE EXPERIENCE AND WHAT WERE THE SIGNIFICANT FACTORS?
The experience of developing and implement the care plan was challenging, revealing and informative. It was my first opportunity to manage a care plan single-handedly, and it tested my ability to transfer theory into practice, highlighting many a thing I had wrongly assumed I could easily ‘practicalise’. There were two significant factors: The availability of a conducive environment of a Nursing Home and the non-availability of ready information on the patient’s medical background, a hindrance which I ultimately managed.
3.2. REFLECTION: WHAT WAS I TRYING TO ACHIEVE AND WHAT WERE THE CONSEQUENCES?
I was trying to manage the patient’s hearing impairment in a therapeutic and preventive manner, according to Roper, Logan and Tierney’s Nursing Model of Activities of Daily Living, so that not only would the impairment not aggravate, other related and unrelated health problems would not arise in the short and long terms.
The consequences were quite rewarding: The patient joyfully kept to prescriptions, and her communication clearly and steadily improved; she observed the recommended preventive measure, and assured me thereby and her family of a prospective comprehensive healthy living.
3.3. INFLUENCING FACTORS: WHAT THINGS LIKE INTERNAL/EXTERNAL KNOWLEDGE AFFECTED MY DECISION MAKING?
My decision making was influenced by two main sources of knowledge: The profession, internal knowledge of a holistic Nursing care plan, which informed my choice of Roper, Logan and Tierney’s Nursing Model of Activities of Daily Living, and the external knowledge of the patient’s medical background, communicativeness and sociability, which made me come up with a psychological and medical plan for the patient, according professional prescriptions.
3.4. COULD I HAVE DEALT WITH IT BETTER? WHAT OTHER CHOICES DID I HAVE AND WHAT WERE THOSE CONSEQUENCES?
My comparison of my speed of progress with the young woman with the progress with older women with similar and worse hearing impairments being handled by my three of colleagues and friends has given me cause to suspect that I could have dealt with the patient better. Through the comparison, I have seen it was possible to complement my current model with Henderson’s list of 14 functions to achieve faster results in the psychological health and rehabilitation of the patient, especially in respect of communication and mobility.
3.5. LEARNING: WHAT WILL CHANGE BECAUSE OF THIS EXPERIENCE AND HOW DID I FEEL ABOUT THE EXPERIENCE?
I will henceforth ensure that I thoroughly discuss with colleagues, seeking their advice before developing a nursing plan. Nevertheless, I believe the experience has been very worthwhile.
3.5.1. How has the experience changed my way of knowing regarding:
(1) Empirics? – I now view empirics as dependent entirely upon direct, personal practice and
experience.
(2)[Professional] Ethics? – [Professional] Ethics is concerned with the norms of “….[professional]
conduct “(Encarta 2005). The experience has made me regard professional ethics as a philosophy
of continuous progress and development.
(3)Self-awareness? – I have come to know myself as lover of challenges and of continued
development
(4)Aesthetics? – Aesthetics is about evaluation of worth (Beardsley 1981). My thinking about
aesthetics has become one of forward movement and progress, i.e. I now see the worth of something
as depending largely on its furthering and developmental possibilities.
4.0. CONCLUSION:
The writing has attempted to capture my reflection of my current episode of care using Johns model of reflection. My nursing plan was outlined and my reflections were summarised. My reflections have led me to view Johns model as a critical and informative model with broad scopes for personal and professional development.
References
BEARDSLEY, C. (1981) Aesthetics, Problems in the Philosophy of Criticism: Problems in the Philosophy of Criticism (2nd edn), Hackett Publishing, Chapter 1
ENCARTA 05 ENCYCLOPAEDIA (2004) CD-ROM, Microsoft, Redmond, WA
Johns Model of Reflection [online] (Cited 30th January 2009) Available from<URL:http://www.afpp.org.uk/filegrab/johnsmodelofreflection.doc?ref=45.htm
OXFORD TALKING DICTIONARY (1998) CR-ROM,
Using a Model of Reflection [Online] (Cited 30th January 2009) Available from<URL:http://www.health.uce.ac.uk/dpl/nursing/Placement%20Support/using_a_model_of_reflection.pdf>