This assignment aims to reflect an incident that happened during my short period volunteer work as a student nurse at a day center for elderly. Reflective writing help us to think deeper and learning from the event. Gibbs reflective cycle was used to organize and analysis the incident systemically.
In the past few months, I attended the volunteer work for 3 days with my groupmates, which was held in Caritas West Kowloon Day Care Centre for the Elderly. This center provides various care services for the older people who aged 60 years old or above, health condition from moderate to severe. Some of them have physical disability or dementia that required more specific care. There are different staffs in the center except the nurse, including occupational therapist, physiotherapist, health care assistance and cook. My role was as a nursing student in this event. On the first day, Ms. Wong, a center-in-charges introduced all information and operation about the center to us. However, Ms. Wong could not supervise us in the following days as she was quite busy. Therefore, we spent most of the time touring around.
The most unforgettable experience was the interaction between me and the old lady with dementia. One day, an old lady yelling loudly that she wanted to go to the toilet and asking the staff to free her from the geriatric chair. She claimed that she could go to the toilet by herself. However, no staff answered her request. I thought that no one came to help her as everyone was too busy. Thus, I prepared walking aids and tried to unlock the table from the chair. Luckily, a health care assistance stopped me instantly and explained that “This old lady has dementia and with physical disability. She always tells lies and cry, so we can ignore her.” After that, the old lady was losing her temper and crying because we did not fulfill her desire.
Initially, I felt scared and ignored the old lady every time I walked near her because I afraid of irritating her emotion. But then I realized that my action and attitude were incorrect, I keep asking myself that how could I ignore something or someone when I did not how to handle it. I felt very ashamed of myself for what I had done. Hence, in the next service time, I tried to comfort the old lady when she started yelling and distracting her focus by asking questions about her past life. Eventually, she did not reply me, but she stopped yelling for a while. I was pleased she was listening to me and I did not feel that the old lady was unapproachable anymore.
In this section, I identify the good and bad points from the whole experience. For the positive aspect, it added to my experience of dealing with older people, especially client who has dementia. For the negative side, the conversation time was quite short. I could not spend much time on talking to her because I had other tasks to complete, such as taking vital sign and meals distribution. Moreover, I found that it was difficult to start a conversation with the old lady as she could not reply me. I failed to understand her feelings and motivation.
My strength was that my confidence to approach the old lady. However, my weakness was that anxiety in handing the situation. Second, I had a preconception before approaching the client. At first, I agreed with the health care assistance that if we knew the old lady always tell lies and lose temper easily, it is not need to give respond and then pretended I cannot hear her. Third, I was not able to apply the therapeutic communication techniques, such as silence and active listening to encourage the expressions of feelings and ideas.
In the later stages of dementia, the person has higher chance miscommunication. They may not understand what is being said to them, and some of them may be unable to respond verbally because they may have limited or no speech. They may repeat the same phrase or sound, or may only be able to repeat a couple of words. Furthermore, people with dementia may encounter different behavior changes. When the patient shows distress or agitation, this may be due to the person is confused about where they are or who they are with (). We can assume that the old lady repeated shouting out loudly because she felt insecure and did not recognize where she was, according to herself. This makes me realize that the reason behind those behaviors. I should show more patience and empathy to dementia patient. Also, it is important to pay more attention on relieving the insecurity with the patient.
Furthermore, a critical element of person-centered care is that the caregiver attempts to establish a trustful relationship with the dementia patient (). To create and maintain relationships are important to the person with dementia’s sense of identity and feelings of personhood(). This inspired me that I should build good relationship with the client first. In additional, good communication skills that enhance the caregiver’s ability on handling troubling behavior of dementia patient(). This experience helped me realize that effective communication is an important element in caring the patient. When communicating with the person with dementia, we can use simple words and sentences with slow rate of speech and allow time for the client to respond. I should be more patience and sympathy to the patient.
The theory of human caring argued that human cannot be healed as an objective and love healing source. In the incident, the old lady experienced anxiety and distress. In order to promote love, it is important to develop a helping, trusting human caring relationship. For example, offering self and time for the patient. Furthermore, support and accept the client’s positive and negative feelings (). For instances, suggest the client to release negative emotion through crying out. All nursing practice that has healing the whole person as its goal (). As a nurse, caring should not just limited on the physical, but also the entire person.
After I reflected on the event, I establish three further goals for personal growth and development. First, I will examine my self-awareness regularly. The main element for forming therapeutic nurse-patient relationship is that having sense of self-awareness. The more the nurse will be self-aware the more a therapeutic environment for caring will be enhanced (). In order to understand myself better, I will collect the views and feedbacks from my friend and reduce the unknown area to self. Second, I will improve my knowledge psychology aspect. In most of the situation, patient’s motivation is misunderstanding by the health care professional. Motivation would be the key in solving the problem of changes in personality and behavior. Also, learning more background information of the illness, such as signs and symptoms may help in handing specific circumstances. Third, I will build good nurse-client relationship by communicating effectively and practice therapeutic communication skills in daily life.
The experience of service offered an opportunity for me in identifying the strength and weakness. Moreover, I learned to treat the patient with kindness, patience, empathy, respect and how to look at things from a different angle. If similar satiation happened again in the coming time, I would manage it with better way. I realized that learning to care and love is a lifelong lesson, each day is a learning experience. Therefore, I will strive to improve myself and accomplish my goals.