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Module name: Clinical Practice Education 1

Module number: 400416

Programme: BSc Paramedic Science

Student Number: 201709307

AST: Antony Rodgers

Hand in date: Tuesday 12th May 2020

Word count: 2573

Introduction

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Reflection is described by Reid (1993) as the process of reviewing and evaluating an experience in
order to produce a positive impact and improve practice. It is suggested by Jasper (2003) that
reflecting on personal experiences is more beneficial than classroom teaching and that it is the most
effective method of developing practice. This essay aims to reflect on a scenario encountered as a
student paramedic in a healthcare setting, where the reflection can be used to close the gap
between theory and practice, to implement an improvement in quality of care. This essay will focus
closely on a scenario which has provided an insight on dignity and respect as well as exploring
professional values, whilst adhering by Health and Care Professionals Council (HCPC) regulations on
confidentiality (HCPC, 2020). Dignity in care is discussed by The Royal College of Nursing (2008), it
suggests that the biggest resource of maintaining people’s dignity is yourself as a health care
professional by using three tools: attitude, manner and enthusiasm. The importance of using these
three tools to provide dignity in care will be highlighted in this essay along with the importance of
communication. During this reflective essay Gibbs (1998) reflective model will be utilized. The
rationale for using Gibbs’ framework is due to the 6 stages which clearly link experience to future
practice suggesting that experiences are repeated. Appose to Boud’s (1985) reflection model which
is a wider model with more flexibility within the stages (The Open University, 2020). This essay will
provide a foundation for future reflective practice and be part of my continuing professional
development as required by the HCPC (2014) who encourage reflection of both positive and negative
experiences in order to generate meaningful reflections (HCPC, 2020). This essay will contain up to
date literature and seminal pieces of work.

Description

My first-year placement involved working on a 27 bed Gastroenterology Ward. A patient on the

ward was in an isolated room to reduce the risk of spreading infection of an antibiotic resistant
bacteria to other patients and staff (University Hospitals Coventry and Warwickshire NHS Trust,
2014). Prior to entering the room, I was asked to place gloves, apron and a mask on in order to stay
protected as the patient had recently returned from abroad with Carbapenemase Producing
Enterobacteriaceae (CPE) which is a contagious disease (Hull University Teaching Hospitals NHS
Trust, 2019). Upon entering the room, I noticed the room was uncomfortably hot and the patient
was sat up with wires and bags from different parts of their body. I soon learnt that the patient had
an ileostomy, a urostomy and a Hickman line. I discussed with my practice educator about this
patient and learnt that because of the patient’s high ileostomy output above the normal range of
1500mL to 2000mL (CliniMed, 2020) the patient could not handle the upkeep of a stoma. This
resulted in the patient having a 2cm pipe from the abdomen for faeces which met a large bag on the
floor along with another pipe for the patient’s urine which also met a large bag on the floor and a

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third from the patient’s chest, a Hickman line; these were all permanent fixtures for this patient.
After one week of placement the patient was diagnosed negative for CPE and although remaining in
the isolated room, the patient could now have the door open and staff could enter the room without
protective clothing. At the nearest opportunity I spent forty-five minutes talking to this patient to
find out his story as well as give the patient some company. In my time communicating with the
patient they cried complaining they had felt so lonely, isolated and depressed during their hospital
stay. The patient explained that I was the only member of staff to spend time and communicate with
them during their stay and that they are now returning home after three weeks of isolation.

Feelings

As a first-year student to see a patient so poorly with such a poor quality of life due to illness was
unsettling. This was the first time I had experienced a patient openly admit to suffering with
depression and understandably I felt somewhat responsible to act upon this. I was quick to assume
that the patient’s confession of depression was due to their illness and did not consider the impact
of being in isolation. Once the patient complained about the lack of attention from staff members, I
felt disheartened and disappointed. Prior to my placement I had read many articles such as the
December 2017 Nursing Times stating ‘demoralised, overworked nursing staff’ (Nursing Times, 2020)
yet my knowledge was conflicted as I was greeted by calm staff who had adequate breaks with
surplus time to socialize with one another. Due to my experience of staffing within the ward I felt
that nurses spare time could have been spent going above and beyond their duties. Ensuring
patients felt individually cared for and respected by communicating with them to avoid patient’s
feeling lonely. At this time, I felt unsure of my position within the team and did not feel confident to
address this conversation with my practice educator meaning I felt a lot of pressure to be the person
to make a change to the patient’s experience. Although my time within the ward was minimal, the
little time I did spend on the ward I feel I made every patient feel dignified, respected and
maintained my professional values. I am thankful that on the patient’s final day in hospital I spent
the time to make the patient feel included. However, after this conversation I instinctively
questioned nurses spare time throughout the rest of my placement.

Evaluation

On evaluation there were both positive and negative elements during this scenario. Firstly, it added
to my experience of communicating one-to-one with a patient and guided me on how to deal with
the unique population of patient’s in isolation. This experience has given me an insight of mental
health within the hospital setting and will make me become a better health care professional by
taking patient’s mental health into consideration. The positive feedback received from this patient

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with regards to my time spent with them re-affirmed my career choice as a paramedic and certified
my good intentions. There were also some negative elements, the time spent with the patient in
isolation by staff members was minimal and this therefore had a detrimental effect of the patient’s
feelings and wellbeing. Furthermore, I lacked confidence confiding in my practice educator and
reporting the patient’s complaint, this was due to little time I spent with my practice educator along
with self-doubt.

Analysis

Dignity is a key concept for patient-centered care (Pringle et al., 2015), The Social Care Institute for
Excellence (SCIE) (2013) list eight elements of dignity that should be addressed for each patient
including social inclusion and communication. These eight elements relate closely to the Standards
of Proficiency in Paramedics where it is expected that paramedics respect and uphold dignity and
respect for service users. The Standards of Proficiency for Paramedics also state that the healthcare
professional should be able to communicate effectively (HCPC, 2020). In December 2012 the 6 C’s
values were introduced as a national strategy for healthcare values to encourage compassion in
practice and are recognized as commitment, courage, competence, care, compassion and
communication (NHS, 2013). It is emphasized by Hawes et al. (2016) that Paramedics should
integrate the concepts of the NHS 6 C’s into paramedic practice. The NHS Institute for Innovation
and Improvement (2009) states that dignity in care should provide a personal service, a service that
respects a person’s privacy and allows flexibility in the care provided. In review of the literature, the
importance of communication is emphasized and it is considered a vital element of dignity and
respect. It is key that health care professionals establish a good rapport with patients as positive
relationships between health care professionals and patients are evidenced to improve patient
outcomes (AMN Healthcare Inc, n.d.). Patient outcomes are defined by The World Health
Organization as a change of health in an individual or group of people, this evidence indicates that if
communication is effective between health care professionals and patient’s that hospital stays may
be reduced (Health Catalyst, 2020). With this taken into account it would suggest that the shorter
time spent in hospital the reduced chance of long-term isolation therefore reducing the chances of
depression through loneliness. A positive relationship can be achieved between a patient and health
care professional by communication including introductions, additionally mirroring their demeanor
and disposition which in turn allows the patient to gain a sense of trust (Royal College of Nursing,
2016). The latter for trust covers honesty, confidentiality and showing respect to a patient (Hall et
al.2001; Mechanic & Meyer 2000).

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Understanding the importance of teamwork is supported by the Canadian Health Services Research
Foundation (1996) which demonstrated that healthcare teams adapt more quickly and are more
responsive when they work together (Academy of Learning Career College, 2020). A positive
relationship between a practice educator and student is essential to become an effective healthcare
professional. Teatheredge (2010) specifies that reducing student anxiety is a key function to build a
relationship between practice educator and student. Similar to nursing, paramedic practice is a
practice-assessed profession so Darling’s (1984) approach of mentorship is relatable where it is
outlined that essential characteristics of a practice educator that enable learning are: feedback giver,
eye opener, challenger and role model. This means having a practice educator that continuously
provides best practice care and allows the student to think critically will provide the best outcomes
for the student. Daloz (1989) explored the effects of support and the effects of challenging the
student which concluded that high support from a practice educator and challenging a student
results in growth and achievement of vision whilst a lack of support can result is stasis and apathy. In
this scenario if my practice educator was more supportive, I would of felt comfortable to address the
patients complaint with them.

It is stated by Oldman (1998) that patients with an infectious disease in isolation are associated with
being dirty and unclean. Moreover Knowles (1993) further stated that isolation rooms are often
distanced from the nurse’s station, making it difficult to attract nurses attention which comes with a
delay if the call bell is alarmed (Nursing Times, 2020). Although Oldman (1998) and Knowles (1993)
can be considered outdated statements this evidence highlights the additional care required in
patients that are isolated and that their mental health needs to be considered and monitored
regularly and supports the findings in this scenario. Another reason that Knowles (1993) is a useful
source is because he explored the experiences of both patients in isolation and the nurses treating
them. The statement provided by Knowles (1993) explains as to why patient’s in isolation may feel
less addressed and how those patient’s in isolation may experience less attentive care increasing the
patient’s anxiety. Patients have reported that attentiveness is a crucial component of good care
(Johansson et al. 2002; Radwin 2000; McWilliam et al. 2000). In addition, psychological support and
reassurance are highlighted as an aim in the ‘Care of Patients in Isolation due to Infection or Disease’
handbook suggesting the importance of the required extra care for patients in isolation is recognised
and published for healthcare professional’s knowledge (Black Country Partnership NHS, 2019). It is
suggested that for patient’s psychological well-being it can be beneficial to mobilize outside of the
isolation room at quiet hospital periods (Royal Devon and Exeter NHS Foundation Trust, 2017). One
of the most widely recognised elements of disrespect by patients is healthcare professionals not
attending to their needs by leaving them unattended or ignored. The National Health Service (NHS)

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created ‘Dignity Challenges’ which had requirements to meet including acting to alleviate patient’s
loneliness when in isolation. Efforts are currently been made to ensure patient experience and
responsiveness is improved by nurses and physicians completing hourly rounding (Meade et
al.,2006).

Action Plan

An action plan allows a target for self-development. Based on the analysis and evaluation in this
essay, I recognize that I would benefit from developing a positive relationship with my future
practice educators and, build confidence in communicating with the surrounding team. Effective
teamwork is described as team members and patients communicating positively to optimize patient
care; it is globally recognized as a necessary tool for effective patient-centered health care (Babiker
et al., 2014). I plan to ensure I integrate with the team around me in future placements and
throughout my career as a paramedic. In addition, I plan to use reflective accounts as a way to
measure my progression as well as to review my experiences as a student paramedic. It is important
that students reflect and set goals in order to progress (Cottrell, 2015) therefore my action plan will
utilize George T.Doran (1981) S.M.A.R.T goals. S.M.A.R.T goals are a tool to improve chances of
achieving a goal, they provide a sense of direction and focus by setting an achievable target
(Smartsheet Inc, 2020). The action plan for my future career as a paramedic also as a student
paramedic is set by the S.M.A.R.T framework:
Specific – I want to be able to communicate more effectively with the surrounding team in order to
build relationships and feel comfortable within my role as a student paramedic.

Measureable – I am going to work on this over my first year of placements. I will recognize I have
accomplished this goal when I feel confident asking questions to the team.

Achievable – I will go outside of my comfort zone to achieve this confidence and build up
relationships. Over a six-month period remaining of first year I feel this is attainable.

Relevant – This will benefit me throughout the rest of University and throughout the rest of my
career as a student paramedic and qualified paramedic.

Time-related – This is a skill I will work on throughout the rest of my life however I aim to make a
noticeable improvement over my first year to help guide me through my second and third year of
University.

Conclusion

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The literature used throughout this reflection is relevant and supports the need for improved care
for patients who are isolated and consideration for their mental health needs to be taken into
account. After completing a reflective essay on a patient’s mental health in isolation it has come to
my attention how little research is available around this subject. Very little advice is provided on how
healthcare professionals should ensure dignity and respect is maintained for patients in isolation.
Although studies have been completed around the psychological well-being of patients in isolation,
they are dated with very little information produced in the past 10 years. More qualitative research
including conducting interviews with patients in isolation would be beneficial for patient’s well-being
and healthcare professional’s knowledge.

Being able to take into consideration my strengths and weaknesses using a reflective framework has
been helpful. It has brought to my attention the problems a service user may experience when in
hospital which I can now use as a learning curve and adapt this to pre-hospital care to avoid patients
in my care feeling anxious. I will ensure I am an attentive paramedic who will continuously develop
skills to maintain professionalism and provide the patient with respect and dignity.

Reference List

 Academy of Learning Career College (2020) 3 Reasons Why Teamwork is an Important Part
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 AMN Healthcare Inc (n.d.) How to Build Rapport with Patients: 7 Effective Tips for RNs.
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 Black Country Partnership NHS (2019) Care of Patients in Isolation due to Infection or
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 Cottrell, S. (2015) Skills for success: personal development and employability. First edition,
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