Reflection on practice using Gibbs (1988) model

Based on the care of a client/patient.

Guidelines:

- Identify a client/patient

- Use the Roper et al (1996)activities of living

- Discribe how you may have communicated with this client/patient

The reflection must follow the guidelines for confidentiality and should be on
one aspect of care.You need to demonstrate communication skills with your
patient/client. The reflection should also demonstrate analysis (linking theory
to practice) by using appropriate references including those for
communication skills

Reflection

Throughout this reflection, the clients name and nursing home will not be
disclosed as this would breach confidentiality (NMC code of professional
conduct 2004).

In this reflection I will be covering the care given to a male client, aged 26,
who suffers from cerebral palsy and quadriplegic spacsicity epilepsy.

Due to client-x's severe learning disability, he is only able to communicate

non-verbally (i.e. hand gestures and body language). As the client is very
dependant on his carers, interpreting what he needs is essential to provide
him with what he requires.

I assessed the client and formatted a care plan. I noticed his serve learning
disability restricted him from fulfilling the activities of living.

I analysed twelve different activities of living generated by Roper et al (1996)

and placed them under five different categories which resemble all aspects of
client-x's lifestyle . The headings include biological, psychological, socio-
cultural, environmental and politico-economic. These elements are vital in
giving effective care to a client (Roper et al 1996) as it assesses the clients
lifestyle and the activities of living needed to survive,' Living is a complex
process which we undertake using a number of activities to ensure our
survival' (Roper et al 1996).

Roper (1996) generated twelve activities of living in which seven client-x can
not fully fulfil without assistance. These activities of living include maintaining
a safe environment, communication, eating and drinking, eliminating, personal
cleansing and dressing, mobilising and working and playing.

I will be concentrating on one of the seven aspects of care mentioned above

which client-x can not fulfil himself and explain the care given to him.

I will use the Gibbs reflective cycle (1988) to describe the procedure
undertaken when trying to feed client-x, thus fulfilling the eating and drinking
proportion of the activities of living. The care is extremely important in his
survival and therefore will be conducted with the up most respect and dignity
(NMC 2004).

Due to client-x suffering from cerebral palsy, he finds it very difficult to eat and
drink. Client-x suffers with spastic cerebral palsy which causes stiffness and
movement difficulties and therefore has difficulties eating and drinking
(Bachrach 2006). Cerebral palsy is a disorder which affects motor skills,
muscle tone and movement (Neil Izenburg 2006). Client-x can begin to choke
while eating due to his poor jaw control while chewing (Smith SW,et al.1999),
which could lead to him having breathing problems or pneumonia if food is
inhaled into the lungs (Raller 2006) . Due to this I had to ensure I was
extremely careful when feeding him.

The best practice I found was to talk to the patient while feeding him. Although
he could only communicate non-verbally I would talk to client-x, making him
feel more relaxed and less intimidated by my presence. Talking to client-x
enabled me to form a trusting bond with him which I gained satisfaction from.
Knapp (1978) suggests that non-verbal communication influences our
interpersonal relations.

Therefore I decided to use my empathetic skills (Egan 1998) to communicate

with client-x non-verbally. Argyle (1982) claims non-verbal communication is
four times more effective than verbal communication. Non-verbal
communication was vital to ensure the client was fully comfortable.

Before I sat beside him to feed him, I ensure I was comfortable distance from
client-x, Egan (1998) states five feet apart from the client ensures the client
does not feel intimidated. I positioned myself at a slight angle so he could
chose whether to have eye contact with me but not feel threatened as to how
he may do if I sat/stood opposite him. I also sat at a lower height than him to
reduce the risk of him feeling powerless or inferior (Egan 1998).

Other ways I communicated with client-x was by expression my feelings using

facial expression. Mehrabian (1971) suggested facial expressions make the
greatest impact. I smiled at him appropriately and gave him my full attention
by keeping constant eye contact.

While talking to client-x I was very nervous. Reading through his care plan I
noticed he has a tendency to kick out and therefore was unsure how to
approach him. I sat beside him and greeted him by shaking his hand and
introducing myself. I began to feel confident after I had introduced myself and
began building a friendly bond with him, thus reduce any anxieties he may
have.

I discussed the procedure I would be conducting with him and observed his
body language and facial expression for any signs. He smiled in response
which represented consent for him to be fed (NMC 2004).

I showed him two dishes with prepared food which he could choose to eat. By
observing eye movement I was able to distinguish which dish he wanted.

I began by washing my hands thoroughly to reduce the risk of infection

(Jeanes 2005). I placed client-x in a secure position for eating, as he was
sitting with an arch back and head backwards could cause him difficulties in
eating and swallowing. (Smith SW, et al 1999).

Due to client-x's difficulties in chewing food, his food has to be blended into a
smooth paste, to allow easy swallowing and to lower the risk of choking due to
his inability to chew food effectively.

I began by describing the food to him and keeping it at eye level so he could
see the colour and texture. I made this experience as normal as possible by
using normal table wear and cutlery (Roper 1996)

I had be careful to ensure the he was given a small spoon full as swallowing a
large amount could cause a blockage in the upper airway (Miller 2003).

Throughout this process I was worried client-x may begin to choke and
observed his facial expression and body movements to ensure he was
swallowing effectively.

I allowed him to chew his food to the best of his ability and advised him to
take his time and not to rush eating. I waited patiently while he consumed his
food safely.

Observing his facial expressions I could see he was hungry and opened his
mouth widely when he required another spoonful which gave me a cue to feed
him. When assisting client-x with drinking, I had to ensure I only allowed him
to take small sips as this can cause him to choke.

After feeding him 8 spoonfuls he was becoming agitated and moved his head
left to right to refuse food. I stop feeding him and encouraged him to eat by
communicating with him and explaining the importance of eating. This in turn
led him to finish his meal.

Feeding client-x was an extremely important procedure as he came into the

nursing home 6 months ago weighing 65.8 kg and currently weighed 56.5 kg.
This sudden lose in weight meant extra attention and encouragement had to
be given to ensure he eats fully.
Throughout this procedure I gave him encouragement by talking with him
while he was eating and asking him whether he wanted to drink. Cerebral
palsy can make it very difficult for an individual to chew and swallow (Miller
2003) which maybe one the reasons to his weight loss.

If client-x began to loss further weight he would be given nutritional

supplements or sip feeds. A dietician would need to asses his diet and give
appropriate treatment to reduce any risk of further weight loss.

If client-x refuses to eat, an enteral feeding tube can be used. This tube
involves passing a tube into the stomach through the nasal or oral route or
even through the gut (Roper 2004). This process would only be used in
extreme consequences and if client-x constantly refuses to eat.

If I were to come across this situation again I would asses the different ways
in which an individual may communicate both verbally and non-verbally and
therefore be able to gain a better understanding of what they need.

From this procedure I was able to learn how much client-x relies on others to
fulfil his eating and drinking activities of living. I used my empathy skills to give
him the highest standard of care and learnt the technique behind feeding a
client who maybe fully dependant on others to provide and guide them with
this activity of living.

References.

Argyle. M (1982), The psychology of interpersonal behaviour, 4th edn,

Penguin, Harmondsworth.

Bachrach. S 2006, What is cerebral palsy? [Online]

Available from: http://healthlink.mcw.edu/article/931226359.html

[Accessed: 2nd May 2006]

Egan.G (1986) The skilled Helper, 3rd edn, Brooks/Cole, California.

Gibbs.G 1998, Learning by doing. A guide to teaching and learning methods,

Oxford polytechnic, Oxford

Holland K, Jenkins.J, Solomon.J, Whittam.S, 2004 Applying the Roper-Logan-

Tierney model in practice, Churchill livingstone, United Kingdom

Jeanes A, 2005, Hand washing, nursing times, 101 (29):28-29

Knapp M.L (1978), Non- verbal communication in human interaction.2nd edn,

Rinehart and Winston, New York.

Miller 2003, Cerebral palsy program, Cerebral palsy; A guide for care.
Hopkins press [Online]
Available from:
http://gait.aidi.udel.edu/res695/homepage/pd_ortho/clinics/c_palsy/cpweb.htm

[Accessed: 1st May 2006]

Izenburg N 2006 Cerebral Palsy: Associated Problems [Online]

Nemours Foundation

Available from:

http://kidshealth.org/PageManager.jsp?
dn=KidsHealth&lic=1&article_set=22976&cat_id=135&

[Accessed: 2nd May 2006]

Nursing&midwifery council, 2004, NMC code of profession conduct, United

Kingdom

Raller. S 2006, Aspiration pneumonia [Online]

Bethesda

Available from:
http://www.healthtouch.com/bin/EContent_HT/cnoteShowLfts.asp?
fname=07190&title=ASPIRATION+PNEUMONIA+&cid=HTHLTH