L.E.A.R.N ASSIGNMENT GUIDELINES Reflection is a deliberate & conscious activity that permits learners to contemplate events & responses to these events that facilitate future action (Patterson, 1995). You will use your lab interview, peer evaluation & patient interview to self-evaluate, reflect & analyze your effectiveness with therapeutic communication skills (during a health history interview). Reflecting can help you make connections among theory, research & practice. Think of reflecting as critical thinking about your unique experience. As you reflect, you will encounter new insights, ideas & concepts. The LEARN assignment encourages you to reflect on your current practice of therapeutic communication with increased understanding not just of the situation but on how you are in your personal & professional self. You will use the CNO?s ?LEARN? process. L – Look Back E – Elaborate & describe A ? Analyze R – Revise approach N – New trial Guidelines: Look back at the lab interview & patient interview. Review it in your mind as if you were watching a video. Elaborate & describe what happened during the situation. How did you feel & how do you think others felt? What were the outcomes? Were you surprised by what happened during the event or did it turn out as you expected? Analyze the outcomes. Review why the situation turned out the way it did. Why did you feel or react the way you did & why did others feel/ react that way? If the situation or outcomes were not what you expected, consider how you could improve on them next time. This is an opportunity to really question your beliefs & assumptions & ask yourself what you value. It is also an opportunity to integrate, compare & understand the knowledge you have gained from your nursing practice in relation to nursing theory. Utilize the feedback from others. Revise your approach based on your review of the situation & relevant literature decide how or if you will change your approach. This might involve asking others for ideas for dealing with the situation next time, or how to work on a learning need. With your new learning, you may decide to try a new approach, learn more about the subject, or decide that you handled the situation very well. New Trial: Discuss how you would incorporate your new learning into action. This may require anticipating or creating a situation in which you can then try out your new approach. In the Practicum Handbook (p.25) you will find the following sample of the L.E.A.R.N format applied to a patient situation. This is not an interview analysis but provides a guide to the five components required for the assignment. Issues Surrounding Bathing & Cognitively Impaired Clients (from Practicum Manual) Look Back When I reflect upon my two clinical experiences on this Continuing Care Unit, one issue continues to present itself over & over. I am surprised by the number of clients who become agitated & uncooperative when confronted with the idea of taking a bath or shower. Initially, I placed much of the blame on the staff, but on a second thought I decided to explore the issue further. Elaborate Most of the clients on my unit suffer from some form of cognitive impairment due to Alzheimers disease, Parkinsons or some form of brain damage. There were three incidents that brought the issue regarding bathing to my attention. On my first clinical day I was asked to assist one of the staff members to dress a client who had just finished showering. When I arrived in the room, the client was partially dressed & sitting in a chair. I introduced myself to the client, explained what I was there to do, & asked if I could help him with putting his socks on. The client said ?yes?, he appeared tense & had an angry expression on his face. While putting on one of his socks the client cried out claiming that I had hurt him. I immediately apologized, & told him that I would be gentler. I was surprised by the gentleman?s response because I was very careful & felt that his response was exaggerated. The nurse tried to comfort me by telling me that this man does not like showering & often yells while he is being showered. Later in the recreation room I overheard another staff member asking one of the other clients if she would like a shower before lunch. The client said ?NO?. The third incident occurred on my second clinical day while I was assisting my client with her morning routine. When I asked her if she would like me to wash her face she replied, ?Not really?. I was a little taken a back by how her demeanor seemed to change so quickly with the mention of merely washing her face. I noticed some lipstick in her side table draw, so I suggested that if she washed her face we could put on some lipstick & go to breakfast together. I was so pleased that she said ?OK? & we continued without any noticeable tension. To say the least I found it surprising that so many of the clients respond negatively to being bathed & wondered why it was occurring. Analyze While in post conference I shared my experience with my group & asked if it could be because clients feel vulnerable during the bathing experience. My professor mentioned that vulnerability may very well be one of the issues, & that there is a lot of literature regarding what I witnessed. I thought the bathing experience would be therapeutic for clients, & that the warm water & their skin being massaged would be refreshing. It also upsets me when I think of the emotional stress these clients are experiencing on a daily basis. I wondered why this was happening & what could be done to make this a more pleasant experience for both the clients & the care givers. I decided to review some literature about Dementia & I soon realized that I was not adequately informed about the effects of dementia & aging. From the research, I was reminded that Dementia affects a person?s memory, concentration, language, visual/spatial skills & ability to reason (Barrick & Rasin, 2004). Also, another article stated older adults resist assistance with bathing for reasons such as physical pain, fatigue, weakness, confusion, embarrassment, & loss of autonomy (Rader, Barrick, Hoeffer, Sloane, McKenzie, Talerico, & Glover, 2006). I did not consider the possibility that bathing may cause fear & pain in the elderly, which can result from increased sensitivity to temperature changes, arthritis, & fear of falling (Barrick & Rasin, 2004). One recommendation included shifting the ?focus from the task of bathing to the needs & abilities of the person being bathed, with an emphasis on comfort, safety, autonomy, & self-esteem? (Barrick & Rasin, 2004, p. 30). Some other tips for decreasing agitation during the bathing process are: bathing according to preference (bed/tub/shower), promoting flexibility regarding bath times, promoting a warm environment, eliminating excessive noice, promoting autonomy, moving limbs carefully, utilizing the unhurried approach, & assessing the need for routine analgesia or nonpharmacologic approaches (Rader, Barrick, Hoeffer, Sloane, McKenzie, Talerico, & Glover, 2006). Revise In this situation, there are very few things for me to preserve. I should try to underst& the reasons behind client behaviours & find ways to accommodate their needs to gain their cooperation. I should use the different strategies suggested in the articles to make bathing a more pleasurable experience for both the client & the staff member. (LIKE WHAT?? Provide examples) I now realize that what these clients are experiencing is real to them & is not unusual. I learned from the articles that there are common problems associated with bathing of cognitively impaired clients & there are ways to address these problems to reduce fear & discomfort in clients. I believe that it is possible to bathe clients in a therapeutic manner, & view a client?s behaviour as their perception of the situation as a threat. When caring for cognitively impaired clients, I will be able to accommodate the clients? feelings/needs & find solutions which fit the clients? needs. New Perspective What could I do in the future in similar situations? I will get as much information as I can about my client?s health state & related nursing care using the available resources before I pass any judgment about the client?s behaviour or reinforce my clients to do something he/she does not want to do. I would encourage my client to participate in his/her care to gain their cooperation to help them maintain their independence & dignity. (You mention other excellent strategies above, in your Revise section. Will you try them?) Finally, I will share my knowledge with my colleagues so that they can see that a number of tips I researched are feasible & will fit into a tight schedule. This will help to make the bathing experience less stressful for both clients & staff members.