Reflection On Reflection In Nursing

Reflection

Reflection is turning experience into Learning. Reflection is a conscious, dynamic process of thinking about, analysing, and learning from an experience that gives insight into self and practice.

As part of a six week clinical placement I was posted in Aged care. During my clinical placement, I had an opportunity to enhance my knowledge about the ageing process. I had learned to apply advanced knowledge to plan appropriate care for an older person with complex health needs, analyse the principles underpinning best nursing care of an older person, integrate legal and ethical considerations into nursing care, including documentation and develop practice in relation to the care of a person with dementia.

I am reflecting on my experience

through this paper that encourages insight and complex learning involving gathering information, synthesizing and evaluating. The learning goal I have chosen is Pain assessment in Non-verbal and dementia residents. I chose this particular goal as I feel that without regular and systematic pain assessment, pain problems will often go undetected in this population. It is an area of clinical practice in which one should be competent because residents with dementia most frequently present with musculoskeletal and mobility concerns therefore valid pain assessment is necessary.
During my initial clinical experience in Dementia ward, I observed that pain assessment and documenting pain profile is a vital practice as the residents have serious inability to communicate their pain as a result of cognitive impairments that accompany dementias.

I was asked by NUM to do some of the assessments for a new resident that came in during my duty hours. All assessments (nutritional profile, skin integrity profile, mobility profile) went well but I got struck with pain assessment tool (PAINAD) which they use for pain assessment as I was not able to comprehend the tool. I approached NUM for seeking clarification regarding pain assessment

tool.
As per the second stage of Gibbs (1988) model of reflection, I was confronted with a wide range of feelings and emotions during the learning process. Not capable of performing accurate assessment left me with frustration and unsure of my skill level and this turn to affect my confidence, as I was not able to understand the domains in PAINAD tool. I was much concerned and anxious about it because appropriate pain management depends on accurate pain assessment. Understanding the importance of pain assessment in dementia residents for appropriate treatment, I identified it as my learning goal so that I can learn valid pain assessment without under reporting pain in them.
During the third stage of Gibbs (1988) cycle, I evaluated my experience, It was clear that I was not able to perform accurate pain assessment which makes me not yet competent in comprehensive and systematic nursing assessment(standard-5), leading to under treatment of pain. But the good thing about my experience is that I initiated a self -directed plan for it. As part of my self- directed learning, I researched online various publications regarding the practice guidelines for pain assessment among older persons with dementia. Most recent research done by Thomas (2010) regarding the practice guidelines for assessing pain in older persons with dementia shows how to use the different tools and how to look for the behaviours associated with dementia while using the tool for valid assessment. Moreover I came across a number of tools tested for their validity and reliability. Result indicates that PACSLAC (Pain Assessment Checklist for Senior with Limited Ability to Communicate) and PAINAD (Pain Assessment in Advanced Dementia) has very good psychometric properties and clinical utility. However PACSLAC was rated by nurses as the most clinically useful tool for assessing pain in seniors. I also approached NUM who demonstrated an assessment in front of me. Both of these aided me in understanding domains and how to perform accurate assessment. In addition to this, I had recommended the use of PACSLAC to the NUM as it covers all six of the AGS- recommended pain- assessment domains and Fuchs-Lacelle et al (2010) found that nurses who regularly used the PACSLAC to assess patient’s pain demonstrated reduced stress and burnout levels relative to nurses completing an irrelevant checklist. Through this understanding I found myself expertise in observing pain associated non- verbal behaviours.
The fourth stage of the Gibbs (1988) model requires an analysis of the event, at this stage of the cycle, I found that researching made me able to perform pain assessment accurately.

Afterwards I had done number of pain assessments on residents to analyse the effectiveness of their ongoing pain management program.

As per the National Competency Standards for the Registered Nurse, I was able to practice within an evidence-based framework (standard-3), participates in ongoing professional development (standard-4), and conducts a comprehensive and systematic assessment (standard-5)

Conclusion is the fifth stage of Gibbs (1988) cycle which acknowledges the learning and achievement of my goal of accurate pain assessment. I am now able to achieve my competency of collaborative and therapeutic practice and comprehensive assessment(Unit 5, 9, 10) as outlined in National Competency Standards for the Registered Nurse. I feel confident enough to assess the pain in non-verbal and dementia residents accurately and validly as the pain assessment done by me was counter assessed by NUM. She found it valid assessment. Moreover I was assessed by my assessor on my findings of pain assessment on three

residents.
The final stage of Gibbs (1988) cycle is the action plan which includes expanding my knowledge in behaviours associated with dementia and cognitively impaired residents. I would like to attend seminars, workshops and in-services in the future regarding understanding cognitively impaired clients. In conclusion, this assignment has allowed me to reflect on my knowledge and understanding of the specified clinical skill of accurate pain assessment in cognitively impaired residents.