Critical Reflection on One Nurse-Family Interaction

This paper describes a significant learning family interaction that occurred when I was working in a community placement as a student nurse. I would be reflecting on that family interaction and use the “One Question Question” approach and analyse how this would contribute to your learning needs and nursing practice. Critical or significant interactions can be defined as situations that make an impression or have a special meaning to an individual.

The analysis of such incidents, a useful reflective technique helps us to identify professional capabilities, increase knowledge of self and improve patient care outcomes (Lian, 2001) and lead to practice that is better informed than before the reflection (Usher et al, 2001).

Critical reflection on one nurse-family interaction and the impact I was in my community placement where I got an opportunity to interact with an adolescent who was Insulin Dependent Type 2 diabetes and his family.

The community nurse visited for the monitoring of the BGL tests and insulin administration as he had fluctuating BGLs and he had a history of not complying with the insulin.

He was admitted to hospital numerous times with episodes of hypoglycaemias and hyperglycaemias. The family were very concerned about him and were worried about his erratic lifestyle. I must say the interactions I had with this family had some impact on me and I realised my shortcomings and learning needs. I used John’s model of reflection to access, make sense of, and learn through this type of experience.

My reflection involved what was I trying to achieve, why I did act as I did, what were the consequences of my actions – for the patient and family, for myself, & for people I work with.

It also involved about how I felt about this experience when it was happening, how the patient felt about it, and how I know how the patient felt about it. (Johns’, 2004) This model was a guide for analysis of my critical incident family interaction or indeed general re?ection on my experience and was useful for more complex decision making.

Johns’ suggests that- The need for learners to be supported through their learning experience/guided re?ection and that students should maintain and re?ective diary. Sharing re?ections on learning experiences allows for greater understanding of those experiences can be achieved than by re?ection as a lone exercise. (Johns’, 2004) Identification of three key challenges of the family interaction From the interactions with the adolescent and the family, I learnt some of the things that I hadn’t come across and needed to improve on.

Some of these shortcomings were due to lack of knowledge and experience, and some were due to my emotions from the overwhelming situation. The challenges that I faced during the interaction with this family and the teenager were: * Challenge in educating the parents and adolescent about effective diabetes management due to knowledge gap. * Challenge in maintaining a therapeutic relationship with the teenager patient due to lack of exposure and their age * Unable to control my grief and acting professional thinking about the overwhelming situation of the parents.

One Question Question (OQQ) The “One Question Question” (OQQ) approach was first introduced by Dr. Lorraine M. Wright (Wright, 1989) as a tool to explore family member’s most important health care needs. The OQQ I would be asking to this family is: “What are you doing as a family including the son to control the diabetes effectively and how is the son going about it? ” By asking this question I am trying to gain an insight of the parents’ awareness of their roles and responsibilities in diabetes management of their child. Also read luma reflection paper

The answer to the OQQ will also reveal what measure they have been using to manage their son’s diabetes, and how the son is doing with his self-management of diabetes. The answer would also give some light into the compliance of the son with the diabetic management plan. (Duhamel et al, 2009) Importance of the OQQ to my learning and family nursing practice OQQ is a useful tool to collect the most pertinent information and concerns in a brief therapeutic conversation (Martinez, D’Artois, & Rennick, 2007; Wright & Leahey, 2005).

The OQQ provides tremendous opportunities for nurses to be aware of and understand the areas of families’ greatest anxiety, challenges, sufferings, and concerns. By simply asking the OQQ can give the message to the family that as a nurse I care about the family and want to be helpful. (Duhamel et al, 2009) In the case of my family interaction, the OQQ helps me as a student nurse to communicate with the parents about their son. Family is the constant in the adolescent’s life, hence; I must work with the family to develop the best plan of care for the adolescent.

The family is also the adolescent’s main source of support providing stability in what can be an otherwise traumatic period in the adolescent’s life. The most important task of the nurse is to provide support to the family. Nurses should not only establish rapport with the patient but also with the family. This allows for optimal collaboration and collaborating with the family maximizes each child’s growth and well- being. Working together parents and health care workers can make more personal and informed decisions regarding what the best treatment is for the child. Neal et al. , 2007) To be able to come up with the best nursing care plan, I need to know what is happening currently. I need have an understanding of how the family and the son are coping with the diabetes management, whether they have any questions regarding the diabetes management. If they need any social support or other kind of support from the government or other organisations. The findings generated from this question about families’ experiences would highlight my learning needs education, research, and practice in the nursing of families Best practice strategies

Challenge in educating the parents and adolescent about effective diabetes management due to knowledge gap. After reflecting on my challenge in educating the parents and the adolescent, I had a debriefing with my preceptor and she advised me to spend some time with the diabetes educator of the facility. The diabetes educator was very friendly in nature and helped me through the diabetes management education process and also gave me some research available regarding diabetes management.

I also attended an in-service provided to the staffs of the facility about diabetes management. I spent some time researching regarding the diabetes education of the adolescents’ parents and after researching evidence based literatures as well, I come up with some best practice strategies. Parents, along with their children, should be made aware about healthy eating habits, physical exercise, and dosage management of drugs/ insulin. Carroll and Marrero (2006) reported that focus groups for parents were helpful for families with adolescents.

Family counselling to improve communication may be helpful for some families, especially those with high levels of diabetes management conflict between parents and adolescents or those with poorer metabolic control. Wysocki and associates (2006) demonstrated that Behavioural Family Systems Therapy developed specifically for diabetes decreased family conflict for adolescents with HbA1c above 9. 0% and resulted in fewer declines in adherence.

However, they also found that multifamily educational support groups led by experienced diabetes nurses also resulted in improvements in metabolic control among adolescents who were in poor control at baseline. Challenge in maintaining a therapeutic relationship with the teenager patient due to lack of exposure and their age I researched on evidence-based literatures to gain some insight into overcoming challenge in maintaining a therapeutic relationship with the adolescent patient. I didn’t have any exposure with this patient group.

Hence, it was a good learning experience for me. The Family Approach to Diabetes Management (FADM) is a novel model that stresses patient and family self-management by identifying and exploring patterns of family communication that hinder or support positive clinical outcomes. It is a very effective strategy to maintain a therapeutic relationship with the adolescent patient and gain their trust. Clinical intervention strategies that include the entire family have been shown to be both cost-effective and easy to integrate into standard diabetes care.

They have also been shown to be capable of delivering favourable clinical outcomes related to general quality of life and test results. (Anderson, 2001) In order to be relevant and effective, management plans for children must take into consideration their age, growth and development issues, cognitive functioning, and family dynamics (ADA, 2003). It is particularly important and challenging to instill in adolescents a sense of confidence, competence, and independence about managing their disease, without losing sight of the fact that they are not yet adults. Hanna, 2003). It is also essential to make them feel good about themselves with short “bursts” of improved management, support groups, summer camps, lectures, and additional education. (Anderson, 2001)

Unable to control my grief and acting professional thinking about the overwhelming situation of the parents. Grief has been defined as the psychological distress associated with and the emotional response to loss. The intensity and duration of the grief response are relative to what is lost, and is often viewed as an adaptational response. Redinbaugh, 2001) I adopted some ineffective coping mechanisms such as withdrawal, psychological numbing, and avoidance of personal involvement with this family for first few visits. However, it was not working as I didn’t feel good about it and didn’t think it was professional. As a nurse, I should be able to provide compassionate care, sharing in the grief, loss, and fear experienced by ill patients and their families. I brought up this issue during a debriefing with my clinical preceptor. She was very understanding and helped me to overcome this issue and guided me through the strategies to implement in overwhelming situation.

She advised me that it was totally normal to feel sad about a situation but it was totally important to remember what our job is and the responsibilities are. The facility had established a bereavement program within work places to help staff members’ process grief. She also mentioned to me that it comes up with practice and experiences and it was always a good idea to some reflection about the experience and the learning. I felt a lot better as I had talked this with someone and it was like I removed a heavy stone off from my chest.

The bereavement program included peer support groups, whose members assist the nurse(s) with stress management and process other feelings related to a sudden or traumatic death. Group counselling that uses an intervention ‘team’ to solicit the health care providers’ interpretations of the patient’s death is also employed to give the providers ‘permission’ to grieve and bring a sense of closure. (Clements, 2005) I also talked about this issue to my colleagues and peers. They also had similar situations and we all were reflecting on each our learning experiences. While we were doing the reflection process we used the John’s model of reflection which was taught to us in our lectures (John, 2004). It was very helpful as it is a structured and step-wise process.


In conclusion, I can say that this family interaction has led me to reflection on my practice and exploration as a nursing student about to graduate and assisted me to identify my own learning needs in working effectively with families. It has led to a better practice as a graduating nurse, which is better informed and professional, that before the reflection.

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