Reflective writing on clinical experience

Reflection is an important and powerful strategy for the use of development in professional skills; as it enables the link between the practice and theoretical aspect of learning to help moving from a beginner to a skilled practitioner. Reflection should enhance self-awareness, identifying personal strengths and weakness as well as help in the improvement.

From the first term of my Diagnostic Radiography degree at Glasgow Caledonian University, I attended clinical placement for a total of 32 days until write this essay to gain experience and practice my imaging techniques that I learned in various imaging departments. The placement module provided me with a learning experience in a radiology department and helped to broaden my clinical skills in a variety of clinical environments. These 32 days was diverse between 3 different hospitals also in different imaging departments general x-ray, CT scan, ultra sound and MRI. I kept a reflective diary from the first day of my placement to help me record my feelings and thoughts on the examinations I was asked to perform, the varying patients I examined, the outcomes of these examinations and any problems or achievements I felt important in my time there. The most significant reflection, however, was in respect to my clinical staged assessments. I will be using this diary as a means to help me reflect on my experiences on this placement and on how I have developed both professionally and personally.

what is the reflective? {{21 Johns,Christopher 2005;}} state that "reflection is an active process that will enable me and other health care professionals to gain a deeper understanding of any experience with patients.

Why the reflective is important for radiographer student? Reflective learning is an important feature of many radiography courses. Writing tasks are used both to promote and monitor student reflective learning {{20 Hamilton,John 2010;}}

Before I start writing my reflective I found that there are several models have been developed to guide the process of reflection.. But I choose Johns Model of Reflection: This model has 5 stopping points which are:

• Description of the experience: describe the experience and what were the significant factors?

• Refection: what was I trying to achieve and what are the consequences?

• Influencing factors: what things like internal/external/knowledge affected my decision making?

• Could I have dealt with it better: what other choices did I have and what were those consequences?

• Learning: what will change because of this experience and how did I feel about the experience / how has this experience changed my ways of knowing

I feel this cycle allows analysis to make sense of the experience, it takes into account a sequence of feelings and emotions which play a part in a particular event and leads you to a conclusion where you can reflect upon the experience and what steps you would take if the situation happened again. I am asked to describe one staged assessments that I completed and my recollection of thoughts and feelings before, during and after the process.

Description of the experience

Because I was spending some days on the General Department where I would be performing this type of assessment that encourage me to do my assessment and also helped me to know the procedure and the protocol for each position.it was required to do three Assessment which are 2 form Shoulder, Vertebral column, Pelvis and Skull So I decide to do the C-spine so I kept watching the radiographer what they do exactly for more than 3 days just to make sure that I follow the hospital protocol. Also I thought it best to be after I had performed the examination many times and would be feeling confident.

So after three days I felt confident that I would be ready for this assessment and when I arrived to the hospital on my fourth day I told the member staff who is work in radiology department reception told me for any c-spine patient. after the lunch break one patient came to department. So, the radiographer calls me and asked me if I can do this exam for this patient. I hold the request and read it carefully. It was C-Spine and both hand from the first time I found it interesting because the patient was male and his age was 45 years only. This gives me more confidant because it was the first assessment for me and patient condition and movement looks good .

However, when I started the examination, I give the radiographer my assessment sheet the situation looks like an exam for me due to the radiographer stand in silent and keeping eye on me this took away some of my confidant.

• Refection: what was I trying to achieve and what are the consequences

Before I called the patient I checked the request card and the patient's history on the hospital information system (HIS) to check for any previous history and corresponding images, I washed my hands and I prepared the machines when I call the patient I introduce myself for him as international student radiographer and today I will do the x-ray for him and I am supervised all the time by the radiographer who is with us on the room the patient agreed after that I ask him to confirm his name, date of birth and address next, while I am looking for his information on the request card then, I explained to him what I am going to do during the examination. fortunately, the patient was very kind and co-operative with me .so I started to ask him to change his clothes in changing room just on the top and wear a hospital gone just to make sure there is no anything can affect the image quality such as necklace or anything in his clothes. The C-Spine x-ray procedure was carried out routinely as an, antero-posterior and Lateral views, Next, the patient came out and orientated him to stand facing the tube and his nick touching the cassette and his chin slightly up his shoulder relaxed down without movement the distance between the tube and the cassette was 100 cm I used factors 63 KV and 2.8 mAs then I forget to clean the cassette after used it . for the lateral view the patient stand his left side and his nick from his left side touching the cassette and his chin up his shoulder relaxed down as possible as he can without movement the distance between the tube and the cassette was 180 cm I used factors 77 KV and 2.8 mAs. The resulting image for AP and Lateral was an acceptable diagnostic image. the patient was very co-operative and aware of the situation around him which made it easier for him to understand and carry out the instructions I was giving him. Everything went smoothly The radiographer was pleased with my technique and anatomy knowledge and I received an excellent feedback for assessment mark from the radiographer with small minor and although I was relieved that it was over I still felt pleased with myself that I had carried out the C-Spine x-ray to a high level. I am thankful however that I kept my reflective diary on this occasion as everything happened so quickly and not to the plan that I anticipated that I benefit from reading my emotional conflicts that I experienced at a later date. This feeling is reinforced by Schön (1987) who argued that reflection is not a simple process and that practitioners need coaching and require the use of reflective diaries as tools for dealing with practice problems.

Boud et al (1985) suggest that 'In reflective practice, it is necessary to gain an appropriate balance between the analysis of knowledge and thoughts, and the analysis of feelings. It is also important to focus on positive feelings as well as trying to deal with negative feelings, in order for the process to be constructive.' Bulman & Schutz. As I follow Gibbs (1988) cycle to explore my emotions and feelings I am aware that this step in Boud et al's (1985) framework becomes appropriate. He advises to 'acknowledge negative feelings but also to not let them develop a barrier. I did experience negative feelings, more so in the first staged assessment. This has been an emotion that has surfaced from the start of my training and continued until this point, although the fear factor has reduced significantly. I sometimes do let my nerves get the better of me but as I have come through this degree my worrying has lessened and my confidence has grown. Wondrack (2001) acknowledges that fear and feelings of guilt often accompany emotions which spring from a lack of confidence in how to resolve situations. On reflecting in past modules I have highlighted my nervousness and so I do not find it a barrier but a test of my determination now. With regards to my first staged assessment I was nervous and anxious as I was 'put on the spot' and not as fully prepared mentally as I would have liked. I think I coped as well as I did due to the fact that I have been learning how to adapt to changing circumstances since my first year placement. I know that I can deal with what is thrown at me now and ask questions if I am in any doubt of my actions. My general clinical placements have all required for me to think on my feet, in the case of the patient who was hard of hearing, the main problem was communication. Schön (1993, 1987 cited Moon 2001, p. 3) focuses on reflection in professional knowledge and its development. He identified two types of reflection which are 'reflection in action' and 'reflection on action'. Schön proposes that these types of reflections are used in unique situations, where the practitioner is unable to apply 'theories or techniques previously learnt through formal education' (Moon 2001). It would therefore seem that 'reflection in action' and 'reflection on action' are highly beneficial to the healthcare environment as practitioners are working with individuals who are more often than not, text book examples. Reflection is a fundamental part of my radiography practice and future career, as all patients are unique this means that every time I image a patient I may have to approach it differently as I will need to consider the individual needs of the patient. The outcomes of both my staged assessments were very good and a positive result did come after my initial negative feelings.

Following both the reflective frameworks, I began to analyse what made me feel the way I did. As I considered the pros and cons as suggested by Gibbs (1988) I found that it was reasonable to feel the way I did and that it is all part of being a student. Every other student that I had spoken to felt nervous when both completing the staged assessments and facing new situations with patients. It was to be expected in the lead up to potentially becoming a radiographer. The cons were that I showed my weakness to the radiographer and maybe came across as less confident as I should have, the pros were that I used these feelings to push myself forward and it made me want to do my best to prove that I was capable of producing good diagnostic images.

Reflection is more than just thinking about something, it should be an active process, which should result in learning, changing behaviours, perspectives or practices (Boud et al, 1985). By reflecting I have certainly changed my perspectives and behaviours on clinical placement. I am a more positive student and person due to the challenging situations and people that I have encountered. Where I previously became flustered I now take a deep breath and think through the situation and take my time. I have the knowledge to back up my skills and vice versa now so it is my application of these tools that can move me forward. Gibbs (1988) cycle concludes by asking what could I have done differently, both staged assessments were not extreme cases and I was lucky to examine co-operative patients. I would not have done anything differently in the practical aspect. Experience will help me to become more confident in my own skills and capabilities and will help me in adapting to change quickly. This is where I prefer Boud et al's (1985) framework as it encourages you to reflect on how you feel about the experience and what you have learned. Gibbs (1988) is slightly more negative and asks 'what would you change and do differently'. I was unable to turn my nerves and emotions off and on but I could learn to control them and make them work for me.

. These experiences have been immensely helpful in evaluating my emotional reactions and professional limitations in the clinical setting. Therefore, my diary has been an essential tool in my development. According to Maggs & Biley (2000) evaluating practice through reflection can bring advantages. The challenge is to recognize and use these advantages, together with the knowledge they generate.