Reflective experience with a cerebellar stroke patient

Introduction

The assignment is a reflection of an experience with a cerebellar patient admitted in a medical ward. My patient is an old man suffering from a cerebellar stroke of the right hand. Previously he used to carry out self-care but at the moment his left side of the body has been weakened hence malfunctioning. He no longer can go home since he needs detailed care which can be available at a rest home. My experience with Mr. Andrew an old patient suffering from cerebellar stroke impacted my professional practice since it was possible to point out the disease impact on the patient, community and attitude, and feelings of the medical caregivers.

This reflection is narrated in accordance with different stages as explained by Graham Gibbs is his cycle of reflection (Gibbs 1988). Graham has given a well-structured suggestion to enable one to analyses a scenario through the use of various questions in each particular stage. This cycle is helpful only that it does not specify the required number of questions to be used or asked in every step during the scenario analysis. Six stages are used and they include the following; detailed description of the scenario, the particular emotions faced due to the scenario, a good evaluation of the scenario, a specific analysis of the scenario, the conclusion and the action plan to be taken in case of the recurrence of the scenario (Finlay, 2008).

Scenario Description

Attending a clinical rotation in a medical ward is part of my course requirements. My scenario is about a cerebellar patient who was admitted to a medical ward. He was an old man at an age of 86 years old. Before being admitted to the hospital, he used to live with his daughter and son-in-law.

His daughter prepared food for him and carried out cleanliness. At this time the old man could perform self-care. His condition got worse and hospitalization was necessary. While in the hospital, his left arm could not be used and at the same time weakness of the lower limb manifested. While nursing care was administered, Mr. Andrew displayed several signs and symptoms due to the cerebellar stroke. He had difficulties in reading since his eyes were affected hence cold not visualize normally. In several occasions, help could be offered in reading all the information directed to him that was in written form (Fisher, 2014). These included phone messages, medicine prescriptions and results from various tests done on the patient.

Problem-solving was another challenge. Mr. Andrew had memory issues since he could not remember most of the things that involved his life. He could only understand and remember a handful of self-information and events in his life. The medical team could depend on his family especially the daughter in planning for various activities. All the medical reports could also be well explained to the family members. This made me sympathize with my patient but the presence of his daughter enabled me to feel relieved about this. Carrying of objects was not possible by the left arm of the patient. We could assist in feeding, carrying out cleanliness and moving of any required objects.

In addition, Mr. Andrew could neglect people, objects and sounds that were on his left side of the field of vision (Fisher, 2014). This is because the left side of the body was entirely affected. We could handle this through giving of objects or medication while approaching him through the right side. Anybody who wanted to talk to him could do it while standing on his right side. Left sided weakness brought about difficulties in walking and grasping objects using the left arm. Assisted movements were offered to the patient through holding and supporting the patient while moving around the ward.

Other observable changes were changing in facial appearance and difficulties in chewing different foods and finally swallowing (Fisher, 2014). This brought about nutritional challenges but soft foods with other options for liquid foods were given. Through this swallowing was made efficient. A change in voice was observed in the patient had very weak muscles. Changes in mood, having fatigue and regular headaches were observed. The caregivers did their best in managing these through medications and counseling sessions to the patient.

Experienced Emotions

A positive attitude has been always worn on my face every time while visiting a medical ward. This started to change upon encountering Mr. Andrew. He required total nursing care since the cerebellar stroke had affected much of his bodily functions. Caring procedures done by the qualified nurses seemed right to me since they brought comfort to the patient (Wright, 2014). When it was my turn to help in various procedures, a feeling of guilt paved in since the patient could complain or try to ignore me. My fear was that the patient would fall when trying to help him walk around. Another fear was the patient could not buy my ideas since he was very old while my age was quite very small.

The feeling of anger could not be avoided. This was due to the patient having difficulties in communicating with me. In several occasions, the patient could repeatedly try to communicate with me all in vain. Due to lack of experience a feeling of being irritated rose up and the only solution was calling for a qualified nurse to help in communication with the patient (Hunter, 2016). Being resentful happened on a daily basis. My patient had been deprived the autonomy of carrying out self-care by his disease. The family also never fulfilled their roles like being at the hospital in time. Talking with family members enabled me to calm down since they too had a lot of activities to do.

Worrying about the condition of my patient regularly could hit my mind. This was because management of stroke could not cure the condition but bring comfort to the patient and enable copying with the daily routine (Wright, 2014). Loneliness affected my patient since he only had two family members. Imaginations of where other family members always ran through my mind.

Evaluation

The clinical experience had a good start only to experience changes as days went by. Different caregivers attended my patient in the medical ward. Their way of working was not the same making me try and cope up with their personalities. The patient complains while it was my turn to assist made me feel insufficient and unable to offer care. This was further challenged when the patient was satisfied with the care given by the qualified nurses and other caregivers. Sometimes moving out of the ward could happen to me in order to have my mind relaxed.

Analysis of the Scenario Activities

Inputs from different medical caregivers and family members of the patient brought comfort to Mr. Andrew. Although my role in that ward brought about very little positive changes, avoidance of deteriorating the condition of the patient made my conscious to be at peace. The various activities that involved me where not well done. Examples are feeding the patient, helping in moving around and cleaning the patient. A patient with a cerebellar stroke is in need of total nursing care and requires one to fully understand the various needs and wants to be offered. My knowledge on how to offer this needs and wants was limited since the patient satisfaction was not fully attained.

Scenario Conclusion

The scenario needed everyone’s effort in supporting patient care in the right way. Although my effort was very minimal, attitude and emotion control is compulsory in offering total nursing care to a stroke patient. Misunderstanding on how to handle the patient was unnecessary since prior preparations are needed before caring for a stroke patient. After the encounter with a cerebellar stroke patient, awareness of involving every individual in the hospital setting to manage the patient condition has been instilled in me (Hunter, 2016). If this was applied, a smooth caregiving and learning process could have taken place during my clinical study.

Action Plan

Future scenarios will receive maximum input from me since learning how to control my emotions and feelings has been effective. This will be through concentrating entirely on the needed procedures and making of decisions are required by the nursing professional ethics and policies. Involvement of all caregivers will take place to enable efficient patient care (Benet, 2016). Lastly is about proper preparations before handling a patient. This will be done in order to do the right procedures.

Conclusion

In conclusion, the above reflection plan about an experience with a cerebellar patient has been discussed in accordance with the Graham Gibb’s reflection cycle (1988). All the six stages have been highlighted and the required nursing care of a right side cerebellar stroke patient has been reviewed in detail.

References

Benet, A. & Lawton, M. (2016). Revascularization of the Posterior Inferior Cerebellar Artery       with Contralateral Reimplantation of Right Posterior Inferior Cerebellar Artery to Left Posterior Inferior Cerebellar Artery. Operative Neurosurgery, 12(3), 305. http://dx.doi.org/10.1227/neu.0000000000001143

Finlay, L. (2008). Reflecting on ‘Reflective practice’. PBLB paper, 52(0), 1-27

http://www.sencer.net/Symposia/SSI2015/documents/Finlay-re2008-Reflecting-on-  reflective-practice-PBPL-paper-52.pdf

Hunter, S., & Miller, C. (2016). Miller’s Nursing for wellness in older adults (2^nd Australia &         New Zealand Ed). North Ryde, Australia: Lippincott Williams & Wilkins.             http://trove.nla.gov.au/version/216912186

Fisher, M. (2014). Stroke. Journal of the American Heart Association, 46(1), 1-1. http://dx.doi.org/10.1161/01.str.0000459572.56231.25

Wright, J., Huang, C., Strbian, D., & Sundararajan, S. (2014). Diagnosis and Management of        Acute             Cerebellar Infarction. Stroke, 45(4), e56-e58. http://dx.doi.org/10.1161/strokeaha.114.004474