HNB3141 Nursing And Complex Care

Task Instructions:

1. You should provide a brief introduction outlining the clinical teaching experience you are using as a basis for this reflection.
2. Then you should use the following stages of Gibbs’ reflective cycle to discuss this experience:

Description- Describe what happened.

Feelings – Analyse your thoughts and feelings during and after the experience. Relate these to relevant literature.

Evaluation – What were the positive and negative outcomes in the situation?

Analysis – Highlight the factors involved in the situation

Conclusion – Discuss what else you and/or others could have done

Action Plan – Discuss what would you do if the situation arose again

In my clinical profession, helping people to live a happy, healthy and fulfilling life has been my mission. Having grown taking care of my diabetic mother, taking her to clinics for regular check-ups, and coping with the sudden complication that stole her happiness and deteriorated her health. Most of the time she could not see properly, her body could be numb, frequent constipation and episodes of hyper and hypoglycemia that forced me to always be with her to help and console her. Through this time, I learned many people lack enough knowledge about diseases and the management strategies to promote health and prolong life (Dwarswaard, Bakker, Van Staa, and Boeije, 2016). This lack of knowledge prompted me to enroll in the clinical profession to create the awareness and to change people’s lives. One day during my practice, I was to facilitate clinical teaching for newly diagnosed patients with chronic diseases. The teaching session took place in the hospital meeting room. The newly diagnosed patients sat silently,and I could tell from the look of their faces that they were frightened by their condition that they knew nothing about but have heard of the diseases being silent killers (Sawicka et al., 2011). As a teacher they expected me to change their perceptions and to pass information that could change the “death sentence” imposed on them. As suggested by Brookfield (2015), for active and fruitful teaching sessions, both the teacher and the student ought to know their roles. As the principle of learning which includes readiness, exercise, and effect, the patients were eager to learn and gain knowledge on how to deal with the threat of their lives.

Our ability to learn what we need for tomorrow is more important than what we know today (Siemens, 2014).Using the behaviorism theory that states that through conditioning behaviors are acquired, I extensively covered the effects of lifestyle to causing the chronic diseases (Sassi and Hurst, 2008). Though convincing the patients that habits such as cigarettes smoking, alcohol drinking and poor choice of diet highly contribute to acquiring diabetes and cardiovascular diseases faced a lot of resistance, the visualization model used in teaching played a crucial role in imparting this information to them. The projected images and videos on how these habits affect the body enabled the patients to come to terms with the reality. As Siemens stated that we wouldn’t know what is running in one’s mind, I applied the collaborative principle by ensuring that all students participate in giving a history of their lifestyle for them to assess the underlying cause of their respective diseases. The participation helped me to determine their understanding level and to spot areas that need more emphasize.  Teaching has been my passion. Therefore, it was easy to control and condition their thinking and learn new behaviors. From the teaching session, several patients decided to quit smoking while other changes their choice of diet.  It was shocking to confirm that many lacked information on the significant factors contributing to the diseases.

During the session, some of the patients opened up that they had the wrong information about the disease. They had the misconception that chronic diseases are communicable and spread through intercourse, others claimed it was a curse while others stated they acquired from their parents. As according to Kristinson et al. (2015), lack of information is a limitation to proper management of the diseases. The application of the significant learning principle that focuses on supporting the students to evaluate their assumptions and experiences in order to make a change, I gave a sense of relief to the patients by assuring them that proper management of the diseases enables a person to leave a normal life, delay the complications and promote good health (Ricardo et al., 2015). Fortunately, I had a video of two patients who had diabetes and hypertension respectively. Their history about their lifestyle before and after diagnosis helped the patients to relate to theirs and decide on choosing a better and healthy lifestyle. That is, through constructivism theory that implies that reflecting on experiences enhance understanding. To assess their knowledge, I pose some life-related questions which required critical think but were related to what I had taught. Through behavior management model I controlled their answering criteria by ensuring there was a systematic responding procedure rather than mass response. The behavior management helped me to determine those who understood the lesson concept and those who had already changed what they believed and chose for a better life. At this juncture, the patients asked questions for clarification. Feedback on the right diet for management of these diseases, how to use drugs and adherence to regular medical check-ups and counseling gave a treatment regime. Through the self-management principle that implies that learning empowers a person to make informed decisions and actions, the patients were in a position to accept their condition and decide to adhere to the appropriate treatment regime.

As a clinical teacher, having taught several groups of patients I have learned there is a significant information gap that need instant reaction. In the teaching session I felt the society is suffering and as clinicians we ought to save our people (Lambrix, Settersten, Mcgowan, Fishman and Juengst, 2014). The expression of anxiety and confusion from the patients created a feeling of discouragement and unknown future which made me think that the government has a role to play in creating awareness to the public and promote community outreaches where the health workers can reach to people and offer services. I wished I had this information the days I used to take care of my mother. Probably it could have saved or prolonged her life. However, the patients who participated in the session developed a positive attitude on the management of the diseases and confirmed that they should pass the knowledge to others in the society. As stated by Tozzi, Carloni, Gesualdo, Russo, and Raponi (2015) positive attitude of patients and families indicates strong set towards patients and social empowerment. However, some confessed their inability to stop some of their lifestyles and could not see the essence of regular visits to the clinics but instead shall be visiting once in a while. I could not withstand the negativity after such a long teaching session.

The challenge provoked me to seek for intervention to facilitate the creation of awareness in the society. As found by Hornik (2018), reaching the people repeatedly for health education succeeded in promoting health and improving people’s life. Contacting the hospital management team,led to funding provision and team selection to initiate the awareness program. Further analysis and researching on teaching methods enlightened me on new techniques of approaching difficult patients and helping to change their perception of good health and longer life.  The structured educational technology reduces barriers and difficulties in learning (Babineaux et al., 2015).

Finally, I decided to do a follow up on my patients after a month. As a loss of follow up of patients with chronic diseases highly determines the outcome (Machine et al., 2015). Some of them had adopted to change while a group of them were struggling to catch up with the new lifestyle. However, the follow up was like a propelling factor since the patients’ energy to acquire a new lifestyle became rejuvenated and promised to adhere to the teachings. Behavioral and motivational counseling are approaches that promote adherence to a healthy lifestyle and reduces resistance to altering the unhealthy habits (Stonerock and Blumentahl, 2017). Therefore, health service managers, policymakers and the government should ensure that there are many outreaches programs and provide enough clinical teachers to pass the information to the community. Moreover, the clinical teachers should focus on developing their professional skills to provide quality services to the community.

Conclusively, clinical teaching is core in providing health education to patients who in most cases, barely know nothing about diseases management. Both the teacher and the student have a role to play during the learning session. The facilitator ought to clear doubts and clarify issues for the patient to adequately adhere to the counseling. Various educational theories such as behaviorism and constructivism effectively enable the patient to make an informed decision on the actions to take to promote health. Since learning approaches differ from one person to another, educational models and principles are essential in ensuring the targeted patient understand the management strategies. Patients barriers and resistance to change reduce by behavioral and motivational counseling. Anxiety and confusion caused by the “death sentence” passed on the patients through chronic disease diagnosis, leads to despair with life and can negatively affect the health status of the patient. Monitoring through follow-ups motivates and facilitates lifestyle modification and consequently better life. Health service managers and the relevant bodies should engage in promoting community awareness about disease management to reduce the information gap. The clinical teachers should seek professional development to enhance their services, and the government should facilitate the programs and provide sufficient clinical teachers to provide the necessary services.

References

Babineaux, S. M., Toaima, D., Boye, K. S., Zagar, A., Tahbaz, A., Jabbar, A., &Hassanein, M. (2015). Multi?country retrospective observational study of the management and outcomes of patients with Type 2 diabetes during Ramadan in 2010 (CREED). Diabetic Medicine, 32(6), 819-828.

Brookfield, S. D. (2015). The skillful teacher: On technique, trust, and responsiveness in the classroom. John Wiley &Sons.Sawicka, K., Szczyrek, M., Jastrzebska, I., Prasal, M., Zwolak, A. and Daniluk, J., 2011. Hypertension–The silent killer. Journal of Pre-Clinical and Clinical Research, 5(2).

Dwarswaard, J., Bakker, E. J., van Staa, A., &Boeije, H. R. (2016). Self?management support from the perspective of patients with a chronic condition: a thematic synthesis of qualitative studies. Health Expectations, 19(2), 194-208.

Hornik, R. (2018). Public health education and communication as policy instruments for bringing about changes in behavior. In Social marketing (pp. 45-58). Psychology Press.

Kristinsson, S. Y., Gao, Y., Björkholm, M., Lund, S. H., Sjöberg, J., Caporaso, N., … & Landgren, O. (2015). Hodgkin lymphoma risk following infectious and chronic inflammatory diseases: a large population-based case–control study from Sweden. International journal of hematology, 101(6), 563-568.

Lambrix, M. A., Settersten Jr, R. A., McGowan, M. L., Fishman, J. R., &Juengst, E. T. (2014). Gatekeepers or Intermediaries? The Role of Clinicians in Commercial Genomic Testing.

Machine, E. M., Gillespie, S. L., Homedes, N., Selwyn, B., Ross, M. W., Anabwani, G., … & Kline, M. (2015). P17. 21 Failure to engage as key factor of loss to follow-up from care and treatment among hiv-infected children in botswana: a case-control study.

Ricardo, A. C., Anderson, C. A., Yang, W., Zhang, X., Fischer, M. J., Dember, L. M., … & Nessel, L. C. (2015). Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. American Journal of Kidney Diseases, 65(3), 412-424.

Sassi, F., & Hurst, J. (2008). The prevention of lifestyle-related chronic diseases: an economic framework.

Siemens, G. (2014). Connectivism: A learning theory for the digital age.

Stonerock, G. L., & Blumenthal, J. A. (2017). Role of counseling to promote adherence in healthy lifestyle medicine: strategies to improve exercise adherence and enhance physical activity. Progress in cardiovascular diseases, 59(5), 455-462.

Tozzi, A. E., Carloni, E., Gesualdo, F., Russo, L., &Raponi, M. (2015). Attitude of families of patients with genetic diseases to use m-health technologies. Telemedicine and e- Health, 21(2), 86-89.