Reflection On A Brain Injury Clinic

Reflective Piece.

Reflection refers to the process of learning from experience. In order to learn effectively we need to address our experiences and tailor them to our needs. Spalding (1998) stated that reflection has three main learning phases. The learning opportunity, the gathering and analysis stage and the changed perspective.

Boyd et al (1985) suggest reflection to be an: Ð''...important human activity whereby people recapture their experiences, consider them and evaluate them'. Reflection has been strongly advocated by the UKCC (1996) and a wealth of nursing literature during the last decade, with the aim of improving practice via a structured means of identifying, reviewing and making sense of relevant practice knowledge (Conway 1994, Jarvis 1992, Palmer et al 1994).

Gibbs's (1988) cyclical model contains six stopping points as shown in the diagram below, each point on the cycle being associated with a key question. This reflective essay will use the Gibb's (1998) model to understand a learning experience from my time on placement within a rehabilitation ward as part of my common foundation year

The ward environment I was working on was a very relaxed, small and intimate ward for individuals needing intense rehabilitation due to or following a traumatic brain injury (TBI). The ward consisted of an eight bedded in patient facility with a 200+ out patient facility. Based on the ward was a full multi-discipline team consisting of nursing staff, occupational therapists, speech and language therapists, psychologists and psychiatrists, social workers and community out reach nurses along with physiotherapists.

Prior to attending my placement I was both intrigued and apprehensive with regards to the purpose of the unit and the work carried out there. I had previously never experienced this kind of environment so was eager to familiarise myself with the purpose and philosophy of the setting. The situation gave me an opportunity to be able to learn about how and why brain injuries occur and how this affects both the patients and their families whilst also giving me the experience of working with a close knit multi-disciplinary team (MDT) in a small milieu.

DESCRIPTION

The reflection undertaken in this essay is structured using Gibbs (1998) and is structured using the six key stages and, therefore, begins with a description of the recorded event.

As part of my learning experience I was attending an out patient/screening assessment with the community out reach nurse. The patient in question had been referred to the service by their general practioner. For the purposes of confidentiality and in accordance with the Nursing & Midwifery Council (NMC) Code of Professional Conduct (2004) the patient will be referred to as Ms X. Ms X had been sent appointment letters and had not attended on two occasions, prior to the letter an occupational therapist had tried to do a home visit but had been denied access to Ms X's home.

At the weeks MDT meeting it had been argued whether or not to refer Ms X back to the GP because of the non-attendance. The thought was that Ms X wasn't ready for or accepting of rehabilitation at this time. The community out reach nurse however argued that it may have been due to unforeseen circumstances that Ms X had not attended and another attempt should be made to establish contact with Ms X.

At first I was sceptical as to the purpose of this as all previous attempts had been unsuccessful and as with other members of the team I questioned whether Ms X was actually in need of the service. The community outreach nurse explained to me that people suffering from a TBI often develop good masking and avoidance skills connected with their altered body image, and to the onlooker this is displayed as an effective coping skill but the deeper causes are neglected and it can have effects on the sufferer's health.

For example a person will appear to be cooking and coping with the house work, but upon further questioning, because the sufferer is in fear of leaving cookers and pans unattended as they forget why they are on they don't eat hot meals, or will eat convenience food which long term will affect the physical health of the patient.

FEELINGS

After the discussion with the other members of the team, I was shocked to both my own views and stunned to realise the effects that a TBI has on individuals whom appear to be coping. When a patient has to have a long stay in hospital then the after effects are easier to see but when patients are discharged and appear to be coping these are less visible, and can lead to them being discharged when they are in need of help.

EVALUATION

The situation made me address these attitudes that I had and made me think about the seriousness of symptoms that individuals mask. When we visited Ms X it turned out that the reason Ms X had not attended was that she