The Operating Theatre Journal - Flipbook - Page 24
A re昀氀ection on my learning as an individual and as part of a team
during my second-year anaesthetic placement
Re昀氀ective practice is de昀椀ned by Jasper (2003) as a fundamental way of learning from what happens to us to be able to broaden our understanding
and come up with an action plan for future experiences. It helps an individual comprehend their competencies and limitations and develop their
judgement skills and ability to make decisions, which is only possible from re昀氀ecting on good and bad experiences out in practice. Joyce (2014) is
con昀椀dent that re昀氀ection is a vital aspect for any health care professional to see improvement of their practice and is an essential characteristic
of a good practitioner.
Section 7 of the Operating Department Practitioners (ODPs) Standards of pro昀椀ciency (Health and Care Professions Council, 2014) states that an
ODP must comprehend the signi昀椀cance of con昀椀dentiality and must be able to maintain it inside and outside of practice. In this essay con昀椀dentiality
of trusts, places and staff were all maintained using pseudonyms such as local trust, the anaesthetists, doctors, ward nurses, and the patient.
To re昀氀ect on my experiences in practice I will be combining two re昀氀ective models to create one which allows me to re昀氀ect and analyse my
experiences. I will be combining Gibbs (1998) re昀氀ective cycle cited by the University of Edinburgh (2020), with the re昀氀ection-in-action and
re昀氀ection-on-action model by Schön (1991), cited by The University of Hull (2022). My reasoning for combining these two models, is because
Gibbs’ model is simple to understand and eases the 昀氀ow of writing up the re昀氀ection, while Schön’s model helps me vocalise how I re昀氀ected in
the moment and then further re昀氀ected after the event happened to analyse and assist with what to do if a similar situation arises in the future.
Compared to the other models, the combination of these two is what allows me to re昀氀ect on my practice the best way for me as an individual.
Description
I am going to be re昀氀ecting about my experience on a night shift during my anaesthetic placement where I did Cardiopulmonary Recusation (CPR)
on a patient. We were called to a ward where there was a patient who had already had a cardiac arrest and was suffering from a Peri-arrest.
There were many anaesthetists, one of which was a consultant, a few junior doctors, the ward staff, two quali昀椀ed ODPs and me. Initially I stood
there scared, while I tried to absorb everything. An ODP asked me to step in and do a 2-minute cycle of CPR. I was hesitant but did not have much
time to think, so I got a stool to use my full body weight. I broke some of the patient’s ribs which was a horrible sound and feeling. I completed
my cycle and we stopped to check his pulse and the patient had stabilised. I had to step away from everyone as I became quite emotional, and
an ODP came over to praise me and to check I was okay. After a few minutes, I volunteered to do another round of CPR. The Patient did stabilise
again, however they would not stay that way and kept falling into Peri-arrests. The consultant anaesthetist decided that we would stop CPR and
make the patient comfortable and leave them to pass away peacefully.
Re昀氀ection-in-action + Feelings
Using Schön’s (1991) method, cited by the University of Hull (2022), I was undergoing some re昀氀ection-in-action by processing how I was feeling
while the situation was unfolding. It was initially chaotic with people standing around, until the consultant anaesthetist took the lead and directed
people, then it became much calmer and productive. I assumed due to my lack of experience that I was there to observe so stayed well out of the
way. I was shocked when my Practice Educator hinted to me to get involved in the CPR and I froze. After some encouragement, I got involved. The
adrenaline rushing through me meant I could hear my own heartbeat. I was tired after 1 minute, but the anaesthetists and ODPs were giving me
lots of motivation and I completed a whole 2-minute cycle of compressions. During the CPR I could feel and hear myself breaking the patient’s ribs,
it was the most awful sound and it really scared me, but then I remembered from Basic Life Support training that this is good thing, as it means I
was compressing hard and deep enough. I stepped back and felt emotional. An ODP noticed this and took me out into the corridor and encouraged
me to let it out and reassured me that I did a great job. This was kind of them, I felt proud of myself but also overwhelmed, and so grateful for
having such a supportive team to work with. They suggested to go and have a break and let my emotions out. I motivated myself to go back into
the situation and try again, and was welcomed back, which made me feel respected and recognised as an essential member of the team, which is
so important for team dynamics (Royal College of Physicians, 2017). I went back in and did a few more cycles of CPR before the patient became
unrevivable. This made me feel de昀氀ated, as I had worked so hard, but we all did the best we possibly could.
Evaluation
This experience is a good example of interprofessional working. There was an array of different professions, who did not always regularly work
together. I had never worked with any Junior doctors nor ward nurses in that environment before. Due to there being so many people, it could have
been a recipe for disaster, but because of good task management and brilliant interprofessional working of all the staff this helped to make an
ideal expert team. Engel and Gursky (2003) de昀椀ne interprofessional working as the importance of each profession’s ability to be independent and
interdependent of each other and the need for the balance of both, by identifying each individual profession’s skills and to amplify these through
combining the skills of other professionals. This scenario is a perfect representation of this de昀椀nition, as everybody in the team all utilised each
other’s strengths, allowing them to collaborate ef昀椀ciently and care for the patient the best they could.
Another aspect that was good about this experience, is the use of closed loop communication. Peyre (2014) de昀椀nes closed loop communication as
the swapping of information clearly and concisely between people, and for there to be recognition from the person receiving the information that
they have heard and understood the knowledge given to them. This ensures that both the person telling the information and the person listening
to it had a mutual interpretation through veri昀椀cation of communication. Salik (2022) suggests that most failures in interprofessional teams are
due to miscommunication or misunderstandings, and that strategies such as closed loop communication, are key to successful collaboration and
teamwork. This scenario was an amazing example of teamwork, due to the impeccable communication skills, including the clear leadership from
the anaesthetist and his use of delegating tasks to other members of the team. One of the reasons this worked well was due to people verifying
that they understood what was asked of them. This allowed the anaesthetist to understand who was doing what, and the next action, with the
reassurance his team knew what they needed to do and what he was expecting from them.
Re昀氀ection-on-action
An anaesthetist kindly offered to debrief with me (Vickers, 2011), as they knew it was my 昀椀rst-time doing CPR and knew it would be upsetting
for me, by talking to them I could re昀氀ect-on-action. Frequent debrie昀椀ng in healthcare is vital as it improves a practitioner’s ability to process
dif昀椀cult situations and decreases risk of mental harm by talking through and re昀氀ecting on what happened. Debrie昀椀ng allows people to discuss
things in a non-threatening environment without fear of being judged (Royal college of Nursing, 2021). A key aspect of debrie昀椀ng is establishing
what the person who is re昀氀ecting has learned for personal growth through experienced-based learning (Pearson and Smith, 1985). By discussing
what happened I was able to fully understand it and was given positive feedback which boosted my con昀椀dence. I was given advice for the future,
which will allow me to apply this new knowledge and con昀椀dence to similar situations in future practice.
Analysis
One of the reasons that everyone managed to work so well together was the use of non-technical skills such as teamwork and communication. For
example, the positive behaviours of verbally acknowledging orders from the team leader and from other colleagues (University of Aberdeen, 2015).
Other professionals within the team were also showing these non-technical skills which again contributed to excellent teamwork. The anaesthetist
was showing good task management, a non-technical skill required of them (University of Aberdeen, 2012),
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