Introduction

This is a reflective essay that will be focusing on my experience and feelings on

how I related with patients A and B during my care giving time. When I think of

“what” I do when providing care for my clients and patients; “how” a certain event

took place; and “why” I did the things that I had to do when I was doing my job.

This helps me follow my profession intelligently.

“Reflection” has become an important part of healthcare professional’s lives

(White, Laxton, & Brooke, 2010). Research shows that the processes involved in

the reflection process helps personnel think and analyze critically their daily

practices, facilitate problem solving, enhance practice, coping with feelings and

emotions and appreciating the results of following formal reflection (FInstCPD,

2005)

In the following essay, I write my experiences regarding two patients, one who is

autistic and the other who is suffering from lupus. I narrate my journey by

unfolding my personal experiences related to provision of care for individual

patients. I will further relate the shortfalls of care that I provide in relation to set

guidelines. Thus, my reflective essay would involve both “reflection-in-action” and

“reflection-on-action”. Through my experience, I have learned that some things

can be improved right at the spot (reflection-in-action), whereas, other things

need improvement as their happening was consequential (reflection-on-action)

(Ben-Jacob, Goldenfeld, Langer, & Schön, 1983; Hughes, 2001; "Types of

Reflection," ; White et al., 2010).

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Description

The diagnosis of patient A started when she was just 3 years old. At five, it was

concluded that she suffered from Autistic Spectrum Disorder (ASD), level 2. She

is now 27 years of age and is a part of supported living system that is helping her

to lead her life independently. The plan devised for Patient A follows the “NICE

guideline on recognition, referral, diagnosis and management of adults on the

autism spectrum” (Wilson et al., 2014).

Patient B suffers from a serious disorder called Systemic lupus erythematosus

(SLE). The disease has progressed for five years and patient B is now fully

dependent on professional care to fulfill his daily tasks. The disease has mainly

taken its toll on nervous system. Patient B is no longer in control of his body and

mind.

Both patients have lived with their conditions over years. In case of patient A, the

symptoms have improved. Unfortunately, in the case of patient B, symptoms

have worsened.

I visit Patient A regularly. Today, as always, I went to Patient A’s house where

she tries to manage her daily life but still need some assistance. I make sure that

I am available for her when she needs me. It is necessary for all autistic

individuals to follow a set schedule and not waver from their plans (Health, 2012).

So;

We begin our morning by making breakfast. I help my patient to choose her

ingredients. Today she plans to make eggs with tomatoes. I guide her to not cut

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herself while she cuts tomatoes into bite sizes. Later on, I aid her in frying her

eggs and guide her how to control heat while cooking. The most important lesson

that I want her to memorize is how she can protect herself while she performs

her daily chores. In kitchen work, there is risk for everyone, but, most people

know how to cope when something unexpected happens. In the case of my

patient, it is crucial for me that I guide and help her to protect herself from fire

hazards, cutting herself up, or minor burns that may occur when frying. I try my

best to explain to her all the precautionary measures she needs to take to ensure

smooth running of her daily schedule. And of course, she has shown vast

amount of improvement. As when she lived with her parents who were also her

caregivers, she did not have enough motivation to do even small level house

cleaning. But now, through the daily encouragement that I provide, she does her

cleaning and laundry on her own.

Patient A completes her daily home schedule designed according to her needs

and then we out together to the nearby mart, as we have to do a little shopping. I

help her choose her vegetables, fruit and cereal. Later on in the day, I make sure

that Patient A visits her “skill development community”. Here she learns to

develop any skill she wants to learn or she is interested in. Patient A has chosen

the art of designing birthday cards. She gives it her full attention. Previously,

learned water color painting and sketching. So, as her mind allows her, she

moves on to other skills.

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In such a community, she learns to overcome her communication barriers as

volunteers and other support personnel help her to establish a conversation and

socialize with other people in the community.

The plan that Patient A follows is an elaborate form of Applied Behavior Analysis

(ABA) therapy ("ABA Therapy Examples, Definition, & Techniques,"). The autistic

person is asked to repeat the wanted behavior (in this case it is the daily routine)

and is then rewarded. I usually use encouragement inducing words or sharing

sweet snacks.

Next follows my journal of providing support to Patient B as I was full-time

attending health personnel for him;

I provided Patient B with full-time in-home personal and medical support. Lupus

has progressed to its severe form in his case and he needs support and help in

all his tasks.

My daily routine with patient B begins with taking him out of his bed and helping

him get a bath. I then help him dress and take breakfast. I then help him to get in

his wheelchair and take him out for a breath of fresh air.

It is also the part of my job to routinely monitor his blood pressure, temperature,

heart rate and breathing. I report it to my senior support practitioner. I also make

sure that my patient takes his medicines on time as these help in managing his

inflammatory flares, fever etc. I try my best to help my patient move in bed so

that he does not get bed sores.

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I try to do my job in the best possible way but just the other day, I had to rush to

my house to attend a family emergency. I could not make proper adjustments

and also did not report my senior due to which I had to face consequences. As I

told already that my patient requires regular monitoring of his vitals, I did not

even make sure that he was doing fine that day and left everything in a disarray.

Patient B had a fever that day which got worse due to my negligence and

improper handling of procedures that had been briefed to me, but my own

emotions overcame me and I was left unable to make proper arrangements.

I discovered patient B in high fever and rushed him to hospital. He stayed

hospitalized for two days.

Feelings

I feel confident in Patient A’s progress. I am amazed by the progress that my

patient has made. According to her parents, patient A suffered from stress and

fidgeting fits. But by the support of our organization and me helping her through

each and every step, she has become a more independent person who now has

the ability to contribute to housework and is learning new skills that could help

her support financially.

Patient A also feels confident in me. She appreciates my efforts for her and

shares her achievements and problems with me. I have developed a special

bond with her during this journey of her embarking on new roads of honing new

skills and making herself a successful person.

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With Patient B, I used to feel confident in the start. I felt myself getting used to

the daily tasks and had started to think that I would be successful at caring for my

patient. But unfortunately, I failed, which led to endangering of patient B’s life. I

learned an important lesson that in my profession, the health and care of my

patients comes before my own personal engagements and emergencies.

Patient B, himself, does not feel really confident in me from the beginning. I

perceived as such when the patient refused to take his medicines and food. No

matter how much I tried, it was all a fail. As a result, the patient had to be

hospitalized and a feeding tube had to be inserted. I thought that it was I who

failed to establish a good relationship with the patient. But various studies show

that patients who are fully dependent on medical personnel or any other health

care provider do not show much co-operation or the health providers are not able

to provide what is being asked (Shakespeare, Bright, & Kuper, 2018) (Michael,

2008). It leads to an elaborate debate regarding the control that medical

personnel or family care givers have over the persons with disabilities (Carter,

2016).

Evaluation

In the case of Patient A, the outcomes usually are positive. If I keep going on

according to the well thought plan and schedule, I think that I would be able to

continue working with my patient and help her improve even more. Because with

autistic patient therapies, it is seen that repetition of similar activities help in

imprinting of certain behavior and removal of unwanted activities.

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The negative outcome in the case of Patient B has pointed out my own

unprofessionalism and extreme negligence on my part. Also the prior in-co-

operation and lack of communication are important factors in discussion

regarding Patient B. Before this incident, I try to communicate with my patient in

a professional manner. But the patient does not want to communicate and

continues to reject any medical aid. The situation worsened when I could not

attend my patient due to a personal emergency. I think it really affected badly on

the bond of trust that I was trying to establish with my patient.

Analysis

There are variety of theories that I can review in order to evaluate the situation

that occurred in the case of Patient B. These theories can be used to relate back

to the “incident” that happened;

The first one is Kolb’s Experiential Learning Theory (ELT) (A. Y. Kolb & Kolb,

2009; McCarthy, 2010). This theory states that the best way to learn is through

experience. I did learn my mistake but the consequence frightens me. I would not

want to repeat the same mistake. And this is the point that I was able to

understand in the most powerful way. The experiential learning works in four

steps; concrete learning, reflective observation, abstract conceptualization and

active experimentation. The first two steps of the cycle involve gaining an

experience, the second two focus on transforming an experience. Kolb argues

that effective learning is seen as the learner goes through the cycle, and that

they can enter into the cycle at any time ("Experiential Learning Theory," ; D. A.

Kolb, Boyatzis, & Mainemelis, 2014).

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Concrete learning is when a learner gets a new experience, or interprets a past

experience in a new way. The “new experience” for me was the mistake that I

made in the flurry of the moment.

Reflective observation comes next, where the learner reflects on their experience

personally. They use their previous experience and understanding to reflect on

what this experience means. As a result of this reflection, I recognized my

mistake and did not negate it, but accepted it.

Abstract conceptualization happens as the learner forms new ideas or adjusts

their thinking and methods based on their reflection about it. In my case, I

needed to follow the standard protocol and apply for “compassionate leave”

("Time off for dependents (compassionate leave),"). According to UK government

guidelines , I can take off when a person who is dependent on me falls ill, is

being assaulted or is injured, is having a baby, or any other issues related to

children or if the dependent dies. I must inform my senior support practitioner and

ask for an immediate replacement.

Active experimentation is where the learner applies the new ideas to the world

around them, to see if there are any modifications to be made. This process can

happen over a short period of time, or over a long span of time.

The same learning cycle must be applied from Patient B’s point of view to

understand the reasons why the patient was not co-operating with care giver;

It is not new for the UK healthcare system to encounter lupus patients. In UK,

lupus patients die on average 25 years earlier as compared to the mean (Gordon

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et al., 2018). If the disease is not promptly diagnosed, treated appropriately or

regularly monitored, it can progress rapidly. Guidelines published on the basis of

National Health Service (NHS) practice and the European EULAR guidelines are

now considered as standards to follow in the management of SLE, specifically

neuropsychiatric lupus (Fanouriakis et al., 2019), which is the case with Patient

B. Here the steps of “concrete learning” and “reflective observation” are

completely understood. We understand the diagnosis and progression of the

disease and also the fact that nature of disease in various patients varies.

“Abstract conceptualization” is the step that must be used to bring change in our

methods and ways of learning to treat the patients. Methodologies of care giving

must also be revised.

May be at this step I should have taken the help of another reflective theory

called as “Social Learning Theory” (Bandura & Hall, 2018; Grusec, 1994). The

concept of this theory that I should have applied in my care giving practice was

that I should not have been so controlling. I should have observed the patient

and then design a plan for the provision of food, medicines or any other need.

May be I should not have been so eager to get the food and medicines down the

Patient B’s throat. May be I should have allowed the patient to guide me. Here

again, I was at mistake, as I thought the patient cannot think any more and I have

to decide everything for him. But in thinking in such an ignorant way, I made the

situation worse.

Another worse idea that comes to my mind is that if I had taken into account the

personal feelings and choices of Patient B into account, may be his disease

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would have gone into remission or had shown some signs of improvement. May

be my wrong methodologies have ended all possibilities of Patient B becoming a

healthy person.

Conclusion

In conclusion, I should have been more professional when dealing with Patient B.

My experience has educated me on the importance of learning. Also, I am very

disappointed by the result of my mistake. At one hand I am embarrassed, but on

the other hand, I realize that my mind could not have apprehended the

implications of such a mistake if it were not a real life situation. Overall, my

experience was not a good one and I would try my best to refrain from repeating

it.

Action plan

If a similar event happened in future, I will ensure that I am not overcome by my

emotions and follow the national and organizational guidelines. I was not happy

at my behavior which indicated lack of concentration, incomplete knowledge of

guidelines and of difficulties that could be caused to my patient (that later

happened) and extreme unprofessionalism that was reflected in my not even

informing any other of my colleagues. To prevent this from happening again I will

guarantee that I am focused at all times and have more determination to improve

the care provided to the patient.

References

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