Genre analysis: language practice 1

A(n) ____?____ of a decision made in practice incorporating critical analysis of the evidence that was/could have been used to inform the decision.

I will reflect on a decision made in practice and incorporate critical analysis of the evidence that was and could have been used to inform it, using the Gibbs reflective cycle (1988 cited in: Palmer et al, 1994 p39) (Appendix b) as a guide. Decision-making processes and theories will be discussed and information I feel relevant to my decision and the context in which it occurred will be included. I will reflect on my methodology for gathering evidence (Appendix a), and critically review two pieces of evidence I feel are of relevance based on the criteria of the Critical Appraisal Skills Programme (CASP) (Milton Keynes Primary Care Trust, 2005a; Milton Keynes Primary Care Trust, 2005b). I will also discuss the implications of my learning on future practice. Pseudonyms will be used to respect anonymity.

Whilst on placement at a stroke unit I was caring for 39 year old Mark, who was 6 days post stroke and had right-sided hemiplegia. Mark was a consultant surgeon from Africa who had travelled to give a lecture and had a stroke on his second day in the country. Together with the worries caused by having a stroke and by being in a different country away from his family, he was finding it very difficult to accept that he had to rely on others and, because of his cultural beliefs, found it particularly difficult to allow others to wash and dress him. I had spent time with Mark but was not directly involved in his care. On his sixth day post stroke I was assigned his care with one of my responsibilities being to assist him with his washing and dressing. I knew that up until now the nurses caring for Mark had been washing him at the bedside and that rather than expose himself he had chosen to neglect his hygiene needs. I thought he would find it hard to let me wash him so after discussion with my mentor and Mark, and based on my knowledge of his ability, I decided to try and enable him to shower himself. In deciding this I had to make assessments of the risks posed and needed to balance what Mark wanted against his safety. I spoke with colleagues to see if they felt Mark was able to manage, asked Mark what he felt, and looked at all the shower rooms to see if it would be feasible and which would offer the safest environment. I hoped that by adapting to the environment and making continued assessment, I would be able to minimise the potential risks. I felt that as Mark was finding it so difficult to allow others to wash him, and as he understood the risks and was managing well despite his hemiplegia, helping him to shower himself would be a risk worth taking and if successful would benefit his overall wellbeing.