Reflection On A Significant Incident From Paramedic Practice Nursing Essay

Reflection On A Significant Incident From Paramedic Practice Nursing Essay The intention of this written essay is to demonstrate an understanding of my views on the art and science of reflection and the issues surrounding reflective practice. It is based on a significant incident from my own area of clinical practice as a state registered paramedic employed by a large provincial Ambulance Service N.H.S. Trust within the U.K. There is a discussion appraising the concept of reflection both generally, and in my particular area of practice. This is followed by an analysis of the incident using The What ? Model of Structured reflection suggested by Driscoll (2000). A rationale is given for the selection of this particular incident and also for the selection of the chosen model as a framework. It will show how the model has been used to reflect on the incident, what has been learnt, and the outcome on both current and future practice. Reflection is an active process of witnessing ones own experience so that we can take a closer look at it. It has its foundations in the discipline of experiential learning. Dewey (1939 cited in Rolfe, Freshwater, Jasper 2001) claimed that we learn by doing, and realising what came of what we did. Reflective practice is something more than thoughtful practice. It is that form of practice which seeks to problematise many situations of professional performance so that they can become potential learning situations and so the practitioners can continue to learn, grow and develop in and through their practice Jarvis P. (1992) pp174 -181. Johns, C (2000a) pg 34, describes reflection as a window through which the practitioner can view and focus self within the context of his own lived experience in ways that enable him to confront, understand and work towards resolving the contradictions within his practice between what is desirable and actual practice. All professionals experience physical, hands on , doing parts of their roles, but unless they search for the knowledge that comes from realising what came of what they did, then the standard of their practice can stand still. In other words if you always do what you have always done you will always get what you have always got. Roth (1989) summarized the basic elements of a reflective process as follows, à ¢Ã¢â€š ¬Ã‚ ¢ Keeping an open mind about what, and how we do things. à ¢Ã¢â€š ¬Ã‚ ¢ Awareness of what, why and how we do things. à ¢Ã¢â€š ¬Ã‚ ¢ Questioning what, why and how we do things. à ¢Ã¢â€š ¬Ã‚ ¢ Asking what, why and how other people do things. à ¢Ã¢â€š ¬Ã‚ ¢ Generating choices, options and possibilities. à ¢Ã¢â€š ¬Ã‚ ¢ Comparing and contrasting results. à ¢Ã¢â€š ¬Ã‚ ¢ Seeking to understand underlying mechanisms and rationales. à ¢Ã¢â€š ¬Ã‚ ¢ Viewing our activities and results from various perspectives. à ¢Ã¢â€š ¬Ã‚ ¢ Asking What if à ¢Ã¢â€š ¬Ã‚ ¦..? à ¢Ã¢â€š ¬Ã‚ ¢ Seeking feedback and other peoples ideas and viewpoints. à ¢Ã¢â€š ¬Ã‚ ¢ Using prescriptive (advice) models only when carefully adapted to the individual situation. à ¢Ã¢â€š ¬Ã‚ ¢ Analysing, synthesising and testing. à ¢Ã¢â€š ¬Ã‚ ¢ Searching for, identifying and resolving problems and result limitation. As a guide to its essential nature, reflection can be viewed as ten Cs of reflection. Johns.C (2000b) à ¢Ã¢â€š ¬Ã‚ ¢ Commitment believing that self and practice matter; accepting responsibility for self; the openness, curiosity and willingness to challenge normative ways of responding to situations. à ¢Ã¢â€š ¬Ã‚ ¢ Contradiction exposing and understanding the contradiction between what is desirable and actual practice. à ¢Ã¢â€š ¬Ã‚ ¢ Conflict harnessing the energy of conflict within contradiction to become empowered to take appropriate action. à ¢Ã¢â€š ¬Ã‚ ¢ Challenge and Support confronting the practitioners normative attitudes, beliefs and actions in ways that do not threaten the practitioner. à ¢Ã¢â€š ¬Ã‚ ¢ Catharsis working through negative feelings. à ¢Ã¢â€š ¬Ã‚ ¢ Creation moving beyond self to see and understand new ways of viewing and responding to practice. à ¢Ã¢â€š ¬Ã‚ ¢ Connection connecting new insight within the real world of practice; appreciating the temporality over reality. à ¢Ã¢â€š ¬Ã‚ ¢ Caring realising desirable practice as everyday reality. à ¢Ã¢â€š ¬Ã‚ ¢ Congruence reflection as a mirror for caring. à ¢Ã¢â€š ¬Ã‚ ¢ Constructing Personal Knowing in practice weaving personal knowing with relevant extant theory in constructing knowledge. Reflections can vary in their details and their complexity. Two main levels of reflective enquiry have been identified; either practitioners engage in deep and potentially meaningful inquiry, or they opt for superficial problem solving according to tradition or pressure of work. Burnard P. Chapman C.M. (1988) Reflection can be facilitated in a number of various ways. In the narrative, through reflective writing, this may be in the form of analysis of a significant incident from the writers area of practice, through poetry and journal or diary entries and in the context of a portfolio. In clinical supervision, this has been described as an exchange between practising professionals to enable the development of professional skills. B Procter (1989) pg. 23, it can be expressed through dialogue and it has a vital part to play in sustaining and developing professional practice. Reflection can also be expressed using creative strategies such as music, poetry, modelling, art and collage. There is a danger that personal reflection can focus on the negatives of a given incident, where it should involve balanced critical evaluation, focused on abilities and potential for growth. In order to provide a framework for methods, practices and processes for building knowledge from practice there are several models of reflection available. All can help to direct individual reflection. Some may be particularly useful for superficial problem solving, and other better when a deeper reflective process is required. Reflective models however are not meant to be used as a rigid set of questions to be answered but to give some structure and encourage making a record of the activity. The model I have chosen is Driscolls What? model. The reason being that though it has a format of three simple questions what? , so what?, now what? the added trigger questions give a deeper and meaningful reflective process by stimulating a more in depth enquiry leading to the formulation of an action plan for the future. It may be argued that reflective practice in my own area of clinical practice in the ambulance service has always been deployed whether through debriefing after a serious incident or the informal discussion in the cab of the vehicle. I and my crewmate, an ambulance technician, received an emergency call from ambulance control just after midnight to respond to a road traffic collision between a pedestrian and a car. The location was given as a semi-rural area some 6 miles distance from our Ambulance Station, and we were quickly on the scene. As we arrived on scene we first saw the car that had been involved in the incident and l made a quick mental note of the damage to the bonnet, windscreen and roof to assess the mechanism of injury to the pedestrian. The driver was still sitting in the drivers seat and although obviously distressed had no apparent injuries and was being comforted by a passer-by. This situation was left as it was; the primary concern was the pedestrian. The pedestrian, a male in his early forties, was lying on the road some distance from the damaged car. There were three passers-by with him; one of them stated that the casualty was unconscious but breathing. I carried out a patient assessment with a primary survey a rapid in-depth survey of airway, breathing, circulation, disability, taking 60- 90 seconds. (Joint Royal Colleges Ambulance Liaison Committee. Pre-hospital Clinical Guidelines Manual.) I immobilised the patients cervical spine using a semi-rigid cervical collar and opened his airway using the jaw thrust technique. (Institute of Health and Care Development Ambulance Service Paramedic Training Manual). On assessing the airway I observed the patients mouth and upper airway for air movement. There was obstruction due to blood and I removed this by aspirating with suction equipment, and then inserted an oropharyngeal airway in the patients mouth. Moving onto breathing assessment I exposed the patients chest to observe chest wall movement and assess for chest trauma as a cause of breathing problems. Breathing was absent so l proceeded with resuscitation guidelines. Administering basic life support with cardiac pulmonary resuscitat ion I asked my crewmate to fetch the trolley and the spinal board and we positioned the patient on to the spinal board ensuring that cervical spine immobilisation was maintained by using head blocks and straps. Once secured safely to the spinal board, placed on the trolley and transferred to the ambulance, whilst continuing Basic Life Support. The patient was attached to the cardiac monitor which showed Asystole (no cardiac output) and advanced life support was commenced. Intubating the patient was difficult, and it took several attempts to achieve, but eventually the endotracheal tube was in position and connected to the oxygen driven mechanical ventilator to allow artificial ventilation of the patient. The next task was to gain intravenous access for the administration of drugs and fluids, and full advanced life support was commenced. Whilst on The Reflective Practitioner Course I chose to reflect on this incident by writing a piece of poetry entitled Final-Cup Final based on Gibb s model of reflection (see appendix 1). The feelings I had then was that I had done everything possible to save the patients life given the circumstances. But when using Driscolls model (see appendix 2) , with the added trigger questions, a deeper and more meaningful reflection process occurred making me question my actions and leading to the formulation of an action plan for the future. Final Cup Final I remember that warm summers night so clearly, the football cup final. Most people would have watched it just the same as you. Our shift started at seven, by the time we returned to base at midnight five emergencies already, I felt ready for a break. I must have nodded off, suddenly awoke with the ringing of the phone Emergency between A and B Pedestrian versus car.. Off we set all sorts of things racing through my mind. Soon arrived on scene and first saw the damage to the car Crumpled bonnet, broken windscreen, dented roof. The driver sat there shaking, terribly distraught. Passers-by were with you, not sure how to help. Myself and my crew-mate did all we could, used all the skills we knew, Intubation, cannulation, full drugs protocol Nothing we did could save you and my helpless feelings grew. And now as l pass by the scene several times each week I often stop to wonder is there more we could have done? On careful reflection theres nothing more we could. And now I have to realise nothing could have changed. Negative thoughts turn positive look to the future and learn from what has been. Using The What ? Model of structured reflection suggested by Driscoll (2000) the incident can be analysed in the following way. The purpose of returning to this situation is to review and reflect upon my experiences of this particular incident, and help make sense of what was a stressful, complicated and messy situation. I need to question if l made the correct decision as a paramedic to continue with resuscitation of this patient or if l should have certified fact of death at the scene. The casualty was in respiratory and cardiac arrest and so cardiopulmonary resuscitation, basic, and advanced life support was commenced and the patient rushed to the nearest hospital with an accident and emergency department. My crewmate helped with clinical procedures on scene, i.e. cardiopulmonary resuscitation, assisting with intubation and cannulation and drawing up drugs. The casualtys friend and passers-by, although in an emotional state of shock helped as much as they could by fetching and carrying when asked to and I think this helper them in the situation they found themselves in by giving some purpose of being useful. At the time of the incident there was a reflection in action, where do we go from here? tuning in and going with the flow approach from both myself and my crewmate. There were two options available, either continue with resuscitation with full advanced life support or certify fact of death. The best approach at the time, and the one that l chose, even though his injuries were not compatible with life, was to continue with resuscitation. The main factor for this decision was by assessing the situation as a whole and considering the feelings of others. If resuscitation was not attempted the casualtys friend and bystanders would have thought that we were not giving him the best possible chance of survival, even though this chance was very remote. This had to be weighed up against the consequences of commencing resuscitation when it could be both futile and distressing for relatives, friends and health care personnel. Time and resources could be wasted in undertaking such measures. Through reflection on action I have recognised that no guidelines can cover every situation that may arise. They are intended to provide adequate guidance for the great majority of circumstances. Not everything is black and white, there will be grey areas, and it is the individuals responsibility to act as he thinks appropriate at that particular time. The implications for me and others when facing a similar situation again, are to recognise that there is sometimes a grey area when considering if to attempt resuscitation or not. This has to be assessed taking in to consideration the particular situation and using professional judgement based on best evidence and up to date knowledge, and at times thinking beyond the guidelines, whilst remaining professionally accountable to the Heath Professions Council. I can use this learning experience when working with and mentoring trainee ambulance staff and discussing my feelings with them and how they may react and feel in a similar situation. I can get more information and support to face a similar situation from my Clinical Support Manager, Ambulance Service Education department, Joint Royal Colleges Ambulance Liaison Committee Clinical Practice Guidelines manual and the Institute of Health and Care Development manual. Conclusion Reflection can range from deep and potentially meaningful inquiry, to superficial problem solving. The care that patients receive has the direct potential to improve through reflective practice. Structured reflective practice also has the potential to develop staff and improve the implementation of professional standards. It has the following advantages to offer the health care professional; helps to make sense of complicated and difficult situations, a medium to learn from experiences and therefore improve performance and patient care, identify educational needs, identify workload stressors, highlight barriers to development and ways of identifying improvements, and provide evidence of continual professional development and lifelong learning. In addition staff could become increasingly more motivated and empowered.

Creative Toys Company

The role of social system in the case was highly important because in the organization, The Creative Toys Company, all the people in it and their relationships to one another are mutually interdependent. This was evident in the case wherein in the transportation department, the eight members divided their work among themselves in order produce more toys. Thus, at the beginning, their department surpassed all other departments in production for 12 months. The impact on productivity is that the employees had a dysfunctional effect on the organization because they were unwilling to use their talents and were resistant to to organizational changes. This was based on the case wherein the physical layout of the department did not facilitate efficient traffic flow to and from the other departments hence the plant manager decided to call in consultants to determine a way production could be increased without physical expansion and the suggestion was for the rearrangement of the work areas in the transportation department. Two months after the change was implemented, the department’s productivity was declining hence it seemed they didn’t want to do good with their job because they were unsatisfied with the organizational change. In terms of the organization’s communication, it seems that the organization was not able to convey the key elements of the firm’s culture and vividly reinforce the values of the organization. This was based on the case wherein the plant manager tried to convey to Mr. Wilson the problem of the department but instead of keeping an open mind and listening to the needs of his employees, he just disregarded it. By not listening to his employees, Mr. Wilson did not give them the chance to have individualization which led the employees to rebel since they didn’t have a strong impact or influence on the organization. An informal organization is defined as a network of personal and social relationships (alliances, cliques, friendships) that arise as p eople associate with other people in a work environment. In the case, this informal organization caused the issue that Mr. Wilson was trying to figure out. A system could be considered as the heart of an organization that makes its different departments function well just like organs, but it should never be forgotten that it is still the humans that run the system. Without humans, the system of a company or an organization, no matter how technologically advanced it is, will be useless. As shown in the case, Mr. Wilson even hired special consultants to analyse and change the business process but in the end, they found out that the problem they were looking for was not in the system but actually in the people running the system, which were the employees. This is because the employees had an informal organization brought about by a single reason which is salary related. The informal organization is their way of voicing out their concern to the management and making their presence felt. Their somehow rebellious act caused a dysfunctional effect to the company that forced the management to look for the current issue affecting the company’s performance. There are a lot of factors that motivate people. Some motivations are just because of a deadline, some because of the rewards they get for doing a great job, or just the self fulfilment involved in the whole process of doing the job. Motivation also contributes a lot in the quality of output or work and plays a good role in maximizing a person’s potential. Making a person feel important, and giving him the proper respect and value as a person will make him feel motivated to do better and maintain this image that you have of him especially if you are the boss. Although, giving a person a reason not to get motivated can have its toll on you as a leader and as part of an organization that is output oriented. Lack of motivation will transform a person’s point of view towards work, lack of motivation will turn every task into a burden instead of an opportunity to strive and do better. In the case, Mr. Wilson probably was a nice boss due to the fact that his workers has stayed with him for at least 2 years. The problem comes in when there is an issue involving all workers that affect their motivation to work, which is their low salary. No matter how much changes to the system Mr. Wilson does, the results stayed the same because this one issue has caused the workers to not strive to do better anymore. They lacked the motivation to prove their worth to Mr. Wilson by actually trying to do more than what is expected of them.

Marcos’ family Essay

Unlike the Antagonist, the protagonist is introduced from the first scene, Eddie Carbone. At first we don’t see him as the mean and vicious person he later turns out to be. From this we get an understanding as to what kind of ‘hero’ he is. During the course of the play Eddie becomes an evil ‘hero’. Making the protagonist an evil person makes the play more effective. At no point does Eddie actually break the law, but instead breaks the rules of society. The society in which Eddie lives, (full of Italian immigrants) has made it a golden rule not to snitch, not to tell on anyone that may be doing something wrong in the governments eyes but not in theirs. Eddie makes this the first thing that Catherine and Beatrice have to know before the arrivals of the cousins. He tells them a true story about Vinnie B, how he betrayed his family by snitching to the authorities about the illegal immigrants his family was hiding. As a result Vinnie gets treated like a foreigner in his own family, and gets thrown down the stairs and has to leave the house despite being the youngest. In this play there is unity of time, place and action, all the action appears to be continuous in one place. Miller brings unity into the play, everything happens over a period of time there are no gaps except the gap between Acts 1& 2 allowing time for Catherine and Rodolfo’s relationship to grow; the unity in this play brings all the action, betray and romance in one place so it gives the audience a better understanding as what is happening. Whereas if one thing was happening in Jersey and another thing in New York it wouldn’t keep the audience interested. Miller creates a sense of pity and sorrow over the audience at the very end of the drama. Eddie ringing the Immigration Bureau brings us to the catastrophe. It is Marco who breaks the law. We, as the viewers, believe that Marco has done nothing wrong but to defend his beliefs, which is to protect his name and by doing so protecting his family. Eddies manliness was challenged when Marco confronted him to a chair lifting contest; this warned Eddie to stay away from Rodolfo. Mixing the pathos and misery with the catastrophe of Eddie’s death makes the drama much more effective. After taking a traumatic journey through Eddies mind, the audience is left to think that he will never love Beatrice again because he has been showing all his emotions, especially ‘lust’ the feeling that is usually associated with couples, towards her niece, but Miller surprises us because Eddie reclaims his love for his wife Beatrice, this is a very tear-jerking scene. He turns what the law says is right into a moral wrong, by having Eddie obey the law and telling the authorities that there are illegal immigrants in the community, but by doing so he is also put the lives of Marcos’ family in Sicily in jeopardy. Miller has borrowed many elements from the Greek Tragedy; he has used the prologue to set the basis of the play, which gave a strong sense of fate from the beginning that something awful is going to come out of Eddie taking in the two cousins. Miller has used Eddie as the Protagonist and also an evil hero. The unity of time and place has been used through out the whole play to give the audience understanding; having things done within 24 hours was significant as to what happened the next day. To have many scenes in separate places may have confused the audience. Miller made the chorus more effective by using the narrator (Alfieri) as the voice behind the story, he expressed the traditional morals and the social attitudes that the audience relate to. The pathos has been used several times in this piece of drama, one example being, when Eddie reclaims his love for Beatrice. This was a tear-jerking scene in the drama, not just making the play dramatic but allowing the audience to feel pity and sorrow for Eddie. Miller borrowing such elements has made the play more effective.

Irelands Repeal Movement

The Repeal Movement was a political campaign spearheaded by Irish statesman Daniel OConnell in the early 1840s. The goal was to break political ties with Britain by repealing the Act of Union, legislation passed in 1800. The campaign to repeal the Act of Union was considerably different than OConnells earlier great political movement, the Catholic Emancipation movement of the 1820s. In the intervening decades, the literacy rate of the Irish people had increased, and an influx of new newspapers and magazines helped to communicate OConnells message and mobilize the populace. OConnells repeal campaign ultimately failed, and Ireland would not break free from British rule until the 20th century. But the movement was remarkable as it enlisted millions of Irish people in a political cause, and some aspects of it, such as the famed Monster Meetings, demonstrated that the majority of Irelands population could gather behind the cause. Background of the Repeal Movement The Irish people had been opposed to the Act of Union since its passage in 1800, but it wasnt until the late 1830s that the beginnings of an organized effort to repeal it took shape. The goal, of course, was to strive for self-government for Ireland and a break with Britain. Daniel OConnell organized the Loyal National Repeal Association in 1840. The association was well-organized with various departments, and members paid dues and were issued membership cards. When a Tory (conservative) government came into power in 1841, it appeared obvious that the Repeal Association would not be able to achieve its goals through traditional parliamentary votes. OConnell and his followers began to think of other methods, and the idea of holding enormous meetings and involving as many people as possible seemed like the best approach. The Mass Movement During a period of about six months in 1843, the Repeal Association held a series of enormous gatherings in the east, west, and south of Ireland (support for repeal was not popular in the northern province of Ulster). There had been large meetings in Ireland before, such as anti-temperance rallies led by the Irish priest Father Theobald Matthew. But Ireland, and probably the world, had never seen anything like OConnells Monster Meetings.   It is unclear exactly how many people attended the various rallies, as partisans on both sides of the political divide claimed different totals. But its clear that tens of thousands attended some of the meetings. It was even claimed that some crowds numbered a million people, though that number has always been viewed skeptically. More than 30 large Repeal Association meetings were held, often at sites associated with Irish history and mythology. One idea was so instilled in the common people a connection to Irelands romantic past. It can be argued that the goal of connecting people to the past was accomplished, and the large meetings were worthwhile achievements for that alone. The Meetings In the Press As the meetings began to be held across Ireland in the summer of 1843 news reports circulated describing the remarkable events. The star speaker of the day, of course, would be OConnell. And his arrival in a locality would generally consist of a large procession. The enormous gathering at racecourse in Ennis, in County Clare, in the west of Ireland, on June 15, 1843, was described in a news report which was carried across the ocean by the steamship Caledonia. The Baltimore Sun published the account on its front page of July 20, 1843. The crowd at Ennis was described: Mr. OConnell had a demonstration at Ennis, for the county of Clare, on Thursday, the 15th ult., and the meeting is described as more numerous than any that preceded it—the numbers are stated at 700,000! including about 6,000 horsemen; the cavalcade of cars extended from Ennis to Newmarket—six miles. The preparations for his reception were most elaborate; at the entrance to the town whole trees were plants, with triumphal arches across the road, mottoes, and devices. The Baltimore Sun article also referred to a large meeting held on a Sunday which featured an outdoor mass held before OConnell and others spoke of political matters: A meeting was held at Athlone on Sunday—from 50,000 to 400,000, many of them women—and one writer says that 100 priests were on the ground. The gathering took place at Summerhill. Before it, mass was said in the open air, for the benefit of those who had left their distant homes too soon to attend morning service. News reports appearing in American newspapers noted that 25,000 British troops had been stationed in Ireland in expectation of an uprising. And to American readers, at least, Ireland appeared on the verge of a rebellion. The End of Repeal Despite the popularity of the large meetings, which mean the majority of Irish people may have been directly touched by OConnells message, the Repeal Association eventually faded away. In large part, the goal was simply unattainable as the British population, and British politicians, were not sympathetic to Irish freedom. And, Daniel OConnell, in the 1840s, was elderly. As his health faded the movement faltered, and his death seemed to mark the end of the push for repeal. OConnells son tried to keep the movement going, but he did not have the political skills or magnetic personality of his father. The legacy of the Repeal Movement is mixed. Though the movement itself failed, it kept alive the quest for Irish self-government. It was the last great political movement to affect Ireland before the horrific years of the Great Famine. And it inspired younger revolutionaries, who would go on to be involved with Young Ireland and the Fenian Movement.