Reflective Report On Experiences Working As A Midwife

Reflective Report On Experiences Working As A Midwife While I was on my first placement in semester one as a student midwife, I met many pregnant women, both within the community and in the hospital with different cultural backgrounds. For this essay which is a reflective essay, I have chosen to write about a pregnant lady and, in order to protect her confidentiality, according to the Nursing and Midwiferys Code of Conduct (NMC 2008), I will refer to her as Zara. In this reflection, I am going to use Gibbs (1988) reflective cycle. This encourages a clear description of the situation, analysis of feelings, evaluation of the experience, and analysis to make sense of the experience and an action plan to examine what to be done if the situation arose again. Description of the event: My placement at the time was on the midwifery led unit in the hospital of my Trust, and on the day in question, I was on an early shift and, when I arrived, my mentor and I went in to Zaras room and introduced ourselves. Zara was in pain and her husband was also present in the room. My mentor tried to placate her down by talking to her but, because Zara did not understand English, she looked more worried and was looking at her husband to explain it to her. Her husband did not understand much either so my mentor suggested a translator but they refused it. We took her notes away, went in to the office and read through them so that we could plan her care according to her needs. Zara was in her early thirties and unemployed. This was her twelfth pregnancy, she has had six miscarriages, two stillbirths and three live children. All of her births were done by caesarean section including this one .This was because Zara was unable to give birth naturally due to her being a victim of female ge nital mutilation (FGM). They were also requesting female only care providers and doctors due to them being Muslims. Zara had also not attended many of her antenatal appointments because according to Currer (1991) antenatal care among Muslim mothers was not seeing important they view pregnancy as a normal condition. Prior taking Zara into the theatre to have her caesarean, my mentor explained the procedure to the husband and he translated to the wife. They signed all the relevant papers but Zara looked worried. I could tell they did not understand everything but to my surprise, they did not ask any questions, but they did not want a translator. After a while the anaesthetist came to give Zara the epidural, and it was a male. As soon as Zaras husband saw that, he placed his hand on Zaras shoulder and did not want it to let go. The staff was becoming very annoyed and frustrated because they kept telling him do not put your hand there, the procedure of the epidural has to be 100% sterile but he did not understand that. I stepped in because I still remembered when I had to learn English and I knew the word choice was difficult for them and it has to be relevant to their knowledge of English. I said to Zaras husband no hand, bacteria, no good for Zara and I was also demonstrated it with my hands and face. He understood and said ok but I could still see that he was not comfortable. Finally the anaesthetist got the epidural in and we took Zara to theatre to deliver her baby along with her husband. When arriving to theatre, I tried to catheterise Zara but could not do it due to her genital area being completely sawn up, so the doctor had to intervene. Zaras husband was standing by her legs and the staff tried to move him to top of the bed but said that he wanted to see what we were doing to Zara and that he was going to stay there. After a long discussion and explanations, he finally moved. Zara and baby were being monitored and by this time the babys heart was not picking up and we had to act fast. The doctor then cut Zaras abdominal to deliver the baby but meconium was gushing out instead. I run to call the paediatrician. The baby was floppy and there were no sign of life. Zara was asking why the baby was not crying and the husband looked very worried. Reassured them and explain ed that, when babies are born in meconium, they will need extra care and attention. The baby was now on the resuscitaire and the doctors was doing all they could to take out the meconium from the babys mouth and nose, and rubbing the baby to promote. After a little while, the baby started to cry and we all let a relieved breath out. I took the baby and showed it to the parents and explained that the baby had to go to special care unit to ensure that everything was fine. Zara was doing well, and after a couple hours we transferred her and her husband to the postnatal ward. Feelings: In this paragraph, I will discuss my feelings and thinking surrounding Zaras situation and the care she received from the medical staff. I empathized with Zara and her husband because they could not speak English, Zara endured many pregnancies and which of some had ended up in miscarriages and stillbirths and was naturally worried about the wellbeing of this baby. Because of Zaras and her husbands limited English and their cultural background, caring for them was more difficult and the medical staff was getting very impatient and irritated with them. I knew I could help both the staff and Zara and her husband. I tried to build up a good relationship with them by doing a proper introduction of myself, where I was from and to try to put them at ease. I still remember how difficult it was being in a new country with different cultures. My first attempt was to ask if necessary, whether it will be acceptable if the doctor were male and I explained the procedure in a way they could underst and, I was acting as an intermediary between them and the medical staff throughout. I did not speak their language but because I was explaining as simply as possible, they became very comfortable with me and trusted me. I really felt useful and helpful as they responded to me as I put myself in their shoes and remembered how it was when I was new in this country. According to Wold (2004) the empathetic listening is in relation to the willingness to know the other individual not just judging the persons statement. I then stood by Zaras bed and when needed, I used some facial expressions and hand gestures which could be translated to if she were still feeling pain in her tummy and if felt sensation in her legs. I was also using simple words. She looked at me and smiled and point where she could still feel. I was unsure whether to continue or not because I felt the medical staff might think I was not being professional, but according to Funnell et al, (2005) body gestures and facial ex pressions are referred as a non-verbal communicating. So I continued because I knew that would help Zaras family. The language and cultural barrier affected the care Zara was receiving because the staff was not communicating with them and did not appreciate that good explanation were essential for this family with their particular circumstances of limited English and understanding. During the procedure, I stayed by Zara and kept my eye contact with her because according to Wilma (1999) direct eye contact could express a sense of interest in the other person. Zara was holding my hands and I was updating her whenever she was asking for it. Evaluation: I feel I made the right decision to accompany Zara. Furthermore, I could develop my caring role for clients by understanding that they all will have different needs and will require different care. I think my approach with Zara and her husband was a good approach. The staff and Zara did benefit from my effort. It was also my responsibility to care for her so that she was getting the best care and understood what was done to her. I was able to improve my non-verbal communication skills in my conversation with Zara and her husband during my time with them and I know they were now getting the necessary information that they wanted and needed in this challenging situation. According to OHagan (2001) issues such as cultural diversity, cultural sensitivity and cultural competence had no place in the training of care professionals. To enable this vision to be implemented, it is significant that health care professionals have the adequate educational preparation to provide culturally sensitive care to those who have a diversity of health beliefs and practices (Aziz et al. 2000). Promoting cultural awareness among health care professionals is believed to improve their confidence and skills in providing holistic care for patients with different cultural backgrounds Also, culturally sensitive attitudes and practices, rather than simple knowledge, are likely to contribute much toward achieving the ultimate goal of providing quality care to the patients and their families. (Murphy Clark, 1993, cited Zafir 2002). There are many implications that should be well thought-out when caring for Muslim patients. All procedures, decisions and judgments must to be family orientated and culturally derived. Religious and cultural frameworks give the most complete and holistic perspective for caring and understanding the patient population of Muslim denomination. Practices need to take into account the care constructs of presence, participation and support. In addition, the policies and philosophies of the hospitals and other institutions needs to reflect the cultural practices related the specific care, communication and spirituality. Also, where language is a problem, it is important to have access to interpreters in order to provide culturally competent care for Muslims. Secondly, there are differences in the cultural and psychosocial forms of expression of the Muslim patients and their families and those of the caress. The process of reflection and clinical supervision could assist care givers in identifying their own cultural barriers, stereotyping, and ethnocentricity, thus, ultimately impr oving care. Finally, the management should continually assess whether the staff have the appropriate knowledge and skills to handle the particular ethical situations involved in caring for the patient and his/her family of Muslim denomination and, with the aim of reducing emotional labour, provide a mechanism, which would assist the staff in becoming more competent. Halligan (2005) Zara was also a victim of FGM which is defined by the World Health Organization (WHO 2006) as procedures that involve partial or total removal of the female external genitalia and or injury to the female genital organs for cultural or any other non-therapeutic reasons. Zara had Type IV which includes pricking, incising or piercing of the external genitalia, stretching of the clitoris and or labia, cauterization by burning of the clitoris and surrounding tissue or any other procedure that is performed to cause vaginal narrowing or tightening, and this was why she could not give birth naturally. According to the National Institute of Clinical Excellence (NICE 2008) guidelines suggest that women who have experienced FGM should be identified early in the antenatal period through sensitive enquiry. I read through Zaras note but it was not recorded that she was a victim of FGM and the special care that she needed was not given. Analysis: My communication skills were very important when I was providing care for Zara. I noticed that my non-verbal communication skills helped enormously while caring for Zara. She could understand a few words when I was asking her questions but the lack of language hindered good communication. As the patient was not using her first or second language, I tried to communicate in a way she could understand. I still could manage to communicate in a way the other staff members could not because they had not the knowledge how to communicate with someone that does not speak English. White (2005) recommended that a care provider should learn a few words or phrases in the predominant second language to put a patient at ease for better understanding. Although, it was quite difficult to demonstrate certain things, Zara managed to understand and she was answering me by nodding her head when she was understood and also by her body gestures and her eye movement. Zaras husband was also asking me questio ns that I had to make the staff aware of According to Zafir et al (2000), Muslim patients should have a healthcare provider of the same sex. Exposure of the patients body parts should be limited to the minimum necessary, and permission should be asked before gently uncovering any part of the body. Even more care should be taken when exposing private parts, and attempts should be made to avoid such exposures unless absolutely nec ­essary. Zaras husband did ask for a female doctor but his request was declined because the ward was very busy and it was not possible. I think if this had been included her birth plan, it would have been arranged for them Zara and her husband may have felt discriminated .If communication is a problem for one or both parties in an exchange, they will have an interest in improving it In Zaras case, the lack of time, did not permitted this. Discrimination is usually due to miscommunication however this should be lower in hospitals especially when the relationship between the medical staff and patien ts has been sustained for a longer period. Furthermore, the gap will be even more difficult to bridge since learning and communication are can be more costly for the hospital such as when providing a translator. Balsa et al (2003) Conclusion: Writing this reflection has made me aware of my approach to car for clients who have language difficulties and have a different cultural background. Zara needed a lot of support and personalised care. It was vital to deliver this baby in a good condition due to her previous stillbirths and also, it was important to recognise that Zara and her husband came form a different culture and their values and belief were different to us. The beliefs and practices of Islamic patients may have an effect on the patients health care in ways that are not apparent to many health-care professionals and policy makers internationally. Intercultural misconceptions and misunderstandings of many healthcare professionals have potential consequences. Therefore, health-care professionals need to be better equipped to meet the needs of their patients and Interpreter should always be available when knowing the patient does not understand. Halligan (2005). Action Plan: My plan for my future role as a midwife, if I ever come across a client like Zara who was not speaking English, had dramatic birth experience and had different cultural background, I would know how to deal with it. I would prepare my self better, I would try to learn some word in her language and doing some reading regarding her culture and write down her expectations. I know that communication is a very important part to build up a good relationship. According to Payne (2007) communication and information provision play key roles in determining whether people engage in recommended health behaviors and whether the behaviors have a positive outcome. Health communicators may want to achieve any of a number of goals, including providing information, instruction or reassurance, influencing opinions and attitudes, and changing behavior. So an excellent communication is necessary in order to identify the patients wellbeing. I should not pre-judge my client by first assumption and impressio ns but I have to make her feel appreciated as an individual. I have also learned the importance of listening because when I was listening to Zara, I was watching her gestures as the same time, even though I did not understand when she was talking, I could read her gestures. I should also able to respect their basic principles, beliefs, culture and individual means of communication. In conclusion: I have used Gibbs (1998) Reflective Cycle as my support for this essay and I was able to discuss every stage in the Gibbs (1998) Reflective Cycle. REFRENCES: Ana I. Balsa a, Thomas G. McGuireb. (2003). Prejudice, clinical uncertainty and stereotyping. Journal of Health Economics. 22, 89-116. Aziz S. Abdul R. G. (2000). Caring for Muslim Patients. Radcliffe Medical Press Limited, Oxford. Currer, C (1991). Understanding the mothers viewpoint. Buckingham, Open University Press. Funnel, R Koutoukidis, G and Lawrence, K (2005) Tabbners Nursing Care 4E: Theory Practice, Australia: Churchill Livingstone. Gibbs G. (1988). Learning by Doing: A Guide to Teaching and Learning Methods. Oxford Further Education Unit, Oxford Polytechnic. Halligan, Phil, (July 2005) Caring for patients of Islamic denomination School of Nursing Midwifery and Health Sciences, College of Life Sciences, University College Dublin National Institute for Health and Clinical Excellence (NICE, August, 2008) FGM, F Nursing Midwifery Council (2008) the Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives OHagan, Kieran. (2001). Cultural competence in the caring professions. London: Jessica Kingsley Publisher Payne, S (2007) Psychology for Nurses and the Caring Professions 3rd Ed. McGraw-Hill White, L (2005) Foundation of Basic Nursing 2nd ed. USA: Thomson Delmar Learning. Wilma M.C.M. Kerkstra, Ada Bensing, Jozien M, Caris-Verhallen. (1999) Non-verbal behavior in nurse-elderly patient communication. Journal of Advanced Nursing 29(4), 808-818 Wold, G.H. (2005) Foundation of Basic Nursing. 3rd ed. USA: Mosby. World Health organization ( WHO2006) New study shows female genital mutilation exposes women and babies to significant risk at childbirth, Published in The Lancet Zafir al-Shahri. (2002). Culturally Sensitive Caring, Journal of Transcultural Nursing. 13, 133.

Book Paper Brave New World

His character is an outsider, even more so than Bernard Marx. However, with clear understanding and analyses of Shakespeare arena works and themes, John is able to put his complicated feelings into words. The values he takes from it also gives him a solid foundation on which to base his criticisms of the World State.It also enables him to ask good questions and SST ND his ground during his deep discussion of God with Mustache Mood (Huxley 2 02). ; John rejects the society values. He acts boldly in calling the Deltas to rebellion n and in throwing out the soma (Huxley 204). Finally, he faces the powerful Mustache Mood deliberately and intelligently and sets out on his own to create life for himself, which ends in tragedy (Huxley 286). John is held back by his o destructive tendencies toward violence and selenologist. Although John despise conditioning, Huxley reveals that John has been conditioned, too.Because of t he reverie conditions of his life in Mammals, John associates sex with humiliation a ND pain and character with suffering, and this destructive view gains further pop John's response to the poetry of Shakespeare. John's conditioning limits his a ability to act freely, making him a deeply flawed potential hero. His death is the result t of his own imperfect understanding as well as the inhuman forces of the brave n ewe world. The scene that best exemplifies this character is likely the taking of his own life (Huxley 310).This was ultimately a breaking point. Because of who John is, an he â€Å"nature† of his own personality and beliefs and feelings, suicide is the cacti on he was finally reduced to taking. 3. Mustache Mood Only Mood's extraordinary power keeps him safe from whispers of his dangerous knowledge and collection of unorthodox books. He is untouched able but not unreachable. With Hellholes and John, Mood discusses the unspoken assume options of the society they find so constricting, even confessing his own youthful experiment s In cha llenging authority (Huxley 169).Mood knows the nature Of the malcontent (he once was one of them) but he is committed to keeping the society stable. He uses his power for others' happiness, he explains, not his own. During his lectures, Mood express sees his unique views on the themes of freedom, happiness, civilization, and heroism. His dry delivery contributes not only to the satiric tone of the novel, but to John and h is thought processes through their intellectual discussions. 4.The central conflict lies between John the Savage whom Bernard Marx brings from the savages' Reservation and the New World. As a representative of humans as t hey once were before babies were â€Å"decanted,† John does not understand the lack of lit ratter and he arts; nor, does he understand that â€Å"everyone belongs to everyone else†the promiscuity of the New World. In general, the demutualization of the resided TTS of the New World who engage in gratuitous sex and who are repulsed by death and who escape any troubling feelings by using soma troubles him.This conflict of John the Savage with the New World represents the larger conflict of humanity vs.. Scientific techno struggle which man appears to be losing. John the Savage fights to retain his f redeem to feel emotions, to suffer, to age, to fail; in short, he struggles to remain human. For,he realizes that he will no longer be a real man if he becomes socially stable in the e New World because this stability depends upon soma, and regression, and his relinquishing of individual thought. 5.The year is OAF 632. (OAF means After Ford, or after the Model T). After doing the e math, We conclude that the setting Of this novel is 2540 A. D. In London, England and New Mexico, USA. 6. Theme: The government of Brave New World retains control by making its cit sense so happy and superficially fulfilled that they don't care about their personal free doom. In Brave New World, ONE theme is that the consequences of state co ntrol are a I joss of dignity, morals, values, and emotions-?in short, a loss of humanity. . Symbol: The drug soma is a symbol of the use of instant gratification to control the Woo RL State's populace. It is also a symbol of the powerful influence of science and techno gay on society.

Hamlet and Gatsby Comparison

Love is an essential part of life. Every individual wants to be loved, and needs someone to love. It is an element that is fundamental to the well-being of all human kind; it is that magic that can heal wounds. However love also has the capacity to traumatize a person if it is extracted from their life. While we all wish to experience love, many of us tend to find the often inevitable detachment to be quite painful. In the novel The Great Gatsby, Jay Gatsby's longing for Daisy Buchanan leads him to his own downfall. Similarly in the novel Hamlet, Hamlet's extreme love for his father and his hatred towards his mother play a major role in his tragedy. In these works, there are a number of motivating factors that contribute to the downfall of the main characters- obsession, hatred, and the wanting to be accepted – but ultimately it is love that leads to the demise of Gatsby and Hamlet. Hamlet loved his father, King Hamlet, and it was his death that broke young Hamlet's heart. It is the love he had for his father that brought him to his doom. After King Hamlet's death he appeared as a ghost moving through the castle at one o'clock every morning. When the guards and Horatio, Hamlet's best friend, noticed this ghostly figure, Horatio quite intelligently believed that he could get the ghost to speak with Hamlet. The next day the two guards, Horatio, and young Hamlet were present to speak to the ghost of King Hamlet. The ghost told Hamlet that he was murdered by Claudius, his brother, who had been sworn in as the new king and married his wife, Hamlet’s mother, Gertrude. After hearing this, young Hamlet was asked to avenge his father’s death, but in doing so his mother was to remain unharmed. Hamlet, being the loving and devoted son he was, and unable to accept Claudius as the leader to replace his father, accepted King Hamlet’s request. After this encounter, young Hamlet refused to tell the guardsman and Horatio what happened but made it known that he would act like a madman and they were not to say why. Claudius soon became suspicious of young Hamlet's moodiness and began to spy on him through Guildenstern and Rosencrantz. They believe it is because Ophelia, his former lover, left upon words of her father. Hamlet procrastinated in the killing of Claudius as he waited for his confession. Hoping to inspire a confession, Young Hamlet puts on a play that resembles what truly happened to King Hamlet to catch the conscious of Claudius. But more truthfully, Hamlet sought to prove to his mother that she was wrong in her actions after her husband’s death. Hamlet later sees Claudius alone praying, and although he would have been an easy target, Hamlet refrains from killing him then because he believed that Claudius should be able to make peace with God and go to heaven upon his death. In reality, Claudius was not indeed praying, and thus Hamlet missed his only opportunity to avenge his father’s death. This event ultimately led to Hamlet's own death when Claudius realized Hamlet's motives and wanted to get rid of him. Hamlet’s love for his father drove him to lose his love, Ophelia, his friends, and his life. Hamlet and Gatsby are similar in that they are willing to go through so much to the point where it leads to their death, so as to bring happiness to those whom they love. Being accepted by â€Å"old money† was very important to Jay Gatsby. He thought that if he was accepted by this elite group he will be able to win over Daisy, the woman he had come to love. Yet his unwillingness to trust himself and to be proud of who he was lead to his downfall. Despite his efforts to fit in, the elites knew that he was nothing more than a bootlegger. They would make mock him behind his back, talk about how he did not actually attend Oxford, and laugh at how he really became rich. Gatsby would try to impress them with his luxurious weekly parties, which he hoped would help him fit in while attracting Daisy. Gatsby shows off his wealth to demonstrate his influence and luxurious lifestyle, while demonstrating that he has plenty of money to spend on Daisy. All the while, he does not see what other truly think of him. For example, Tom once stopped by Gatsby’s house with his friends for some drinks at which Gatsby became nervous and agitated. He tells Tom awkwardly that he knows Daisy, and invites Tom and the Sloan’s to dinner. Rejecting his invitation, they ask insincerely if he would like to join them to which Gatsby unknowingly accepts, not realizing that they have no interest in him at all. Gatsby is so eager to be with them, fixated on his goal to be a part of the â€Å"old money† group of East Egg in order to show Daisy that he is worthy of her and able to support her. He is so in love with Daisy that it is blinds his judgement. If Gatsby had focused on being himself instead of trying to be accepted he would have made fewer enemies, and perhaps won over Daisy. Gatsby was driven by his love for Daisy, and was single-minded about how to get her. He did not realize that loving Daisy is all that he became concerned with and that it consumed him. Gatsby truly believed that if the â€Å"old money† of East Egg accepted him he would win her over but it was this unhealthy single focus, and his inability to trust that he could simply be himself, which caused his downfall. Meanwhile, Hamlet loved his father and when he found out he died it hurt him deeply. But moreover, it hurt young Hamlet’s heart more when he found out his mom married Claudius. It his Hamlet’s undying love for his father and his lost love for his mother that brought about his madness, and ultimately his death. In conclusion, Hamlet and Jay Gatsby are very similar to one another in that they both let their emotions control them. They have no sense of self control and die because of it. Tragically, they could have gotten what they wanted if they just were themselves and if they were able to not let their emotions get the best of them.

Evidence Tracking - 1528 Words

Evidence Tracking Properly handling evidence is critical to crime solving, improper deviations to the handling can make it impossible to prosecute using the evidence collected. This paper will outline will track the evidence from a chosen crime scene through all the proper handling processes. This paper will describe the chosen crime scene scenario, describe the collected evidence and proper collection, recording of the evidence, chain of evidence, processing, interpretation methods, preservation of the evidence, proper presentation methods for different types of evidence, and the consequences of mishandling the evidence collected. The Crime and Processing Protocols The chosen crime scene scenario is a sexual assault; the first†¦show more content†¦Wet evidence should be air-dried to prevent molding. Packages must be sealed with evidence tape, not staples; someone could cut themselves on the staples and contaminate the evidence (National Institute of Justice, n.d.). Evidence can be lost be storing it in the wrong materials or exposed to too much light, heat, or bacteria (Osterburg Ward, 2010). Evidence should only be stored in clean and leak-proof containers and kept in a cool place. Evidence should be delivered to an evidence facility as soon as possible (Osterburg Ward, 2010). Keeping evidence too long can be harmful for prosecution (Osterburg Ward, 2010). Chain of Evidence According to the National Institute of Justice, the fewer people handling the evidence, the better; there is less chance of contamination and a shorter chain of custody for court admissibility hearings (n.d.). The chain of custody of the evidence should include a list of all persons who have had physical possession of the evidence as well as the time period they carried the evidence, starting with the responding officer who was in charge up to this point. The evidence should be tracked from the responding officer’s hands or medical examiner, whoever recovers the evidence, to the processing and examination and preservation, to the presentation in court. Recording Evidence It can be beneficial for investigators to use a tape or digital recorder for the observations of the crime scene,Show MoreRelatedNCFE EVIDENCE TRACKING SHEET5458 Words   |  22 Pages(600/0054/5) Evidence Tracking Sheet Learner name: NCFE Level 5 NVQ Diploma in Occupational Health and Safety Practice (600/0054/5) Evidence Tracking Sheets Tracking your evidence During your course your Assessor will ask you to carry out work either in the classroom, in your workplace or at home which you’ll keep as evidence of your learning. The work you produce (evidence) will be assessed by your Assessor to make sure you’ve covered everything in sufficient detail. 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