– REFLECTION Monitoring and Ensuring Quality Care


The purpose of this paper is to reflect on a recent personal experience of patient care, which enabled me to achieve a module 9 competency, Actively seeks to extend own knowledge.

I will be critically analyzing one nursing practice incident using Boud, et al (1985) model of reflection, (please see appendix 1) which will enable me to monitor and ensure quality patient care in future practice. The nursing incident happened when I was looking after a patient requiring enteral tube feeding (ETF). It is important to note that all confidential information relating to patients, wards, hospitals and professional colleagues has not been included in this paper to ensure ethical practice and adherence to the NMC code of professional conduct, section 5 which affirms that I ‘must guard against breaches of confidentiality’ (NMC 2008).

Reflection is a useful tool for the continuation of professional development among nurses (Somerville and Keeling 2004). The word ‘reflection’ originates from the verb reflectere which means to bend or turn backwards (Hancock 1998). It is a tool, which unlike text books and videos, does not have a limited shelf-life, it is cost effective, is portable and can be used world wide.

Patient Profile

The aspect of nursing care I have chosen to reflect on is the care of a patient who required enteral tube feeding (ETF) due to dysphagia – a condition in which the action of swallowing is difficult to perform (Unison Health Care 1998). This nursing intervention was essential for a patient in my care, who I shall call John. Please see appendix 2 for John’s past medical history.

The Plan of Treatment for John

John was admitted to my area of practice six days ago following his CVA. He is receiving ETF via an NG tube as an immediate intervention and is being assessed to see if he is a suitable candidate for a percutaneous endoscopic gastrostomy (PEG) tube which are used as a more permanent form of enteral tube feeding (Holmes 2004). The nasogastric tube is about ’22 inches [55.9cm] in length’ (Holmes 2004) and was inserted into his left nostril down through the pharynx, through the oesophagus and through the cardiac sphincter muscle and into the stomach (Marieb 2001). Food can be administered through the tube directly into the stomach and the swallowing process does not need to take place. The food is administered by a pump that controls the amount of feed given in mls per hour. This description could sound as though ETF is always safe and effective and has no complications. Elia (2001) affirms that ETF is typically safe and easy to administer. However John did experience a number of difficulties that could have been rectified sooner than they were. On reflection of Johns care it is clear to see (with the benefit of hindsight) that if Johns care was managed differently and if complications were noticed and acted on promptly, his hospital experience could have been very different.

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