Critical Analysis of Patient Care Utilising John’s Model of Structured Reflection

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The aim of this assignment is to reflect on the management of a patient with multiple organ dysfunction syndrome (MODS). Reflective practice is associated with learning from experience, (Johns & Freshwater 1998) and viewed as an important strategy for health professionals who embrace life long learning (Department of Health 2000). Engaging in reflective practice is associated with the improvement of the quality of care, stimulating personal and professional growth and closing the gap between theory and practice (Benner 1984; Johns & Freshwater 1998).

Central to Johns’ idea of reflective practice is the goal of accessing, understanding and learning through direct experience. It is this that enables the practitioner to
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Potassium levels were also increasing (6.8) and his urea and creatinine were markedly deranged. He also began to appear grossly oedematous.

Mr Cox’s sedation was stopped (Midazolam and Morphine) following the insertion of a tracheostomy. However, due to encephalopathy he never regained consciousness. Despite many attempts he was difficult to wean from the ventilator and eventually there was reduced base entry.

Mr Cox’s abdomen became increasingly distended and his jejunostomy feed was stopped and TPN was commenced. Due to an increase in sepsis he returned to theatre for a laparostomy washout, it was discovered that his bowel loops were necrotic.

An Endoscopy following a further GI bleed confirmed an arterial bleed, and it was deemed he was still unstable for any further surgical intervention. Mr Cox continued to deteriorate with sepsis and MODS, consequently at this point, it was decided to withhold and withdraw treatment. Renal replacement therapy (RRT) was withdrawn as he was still profoundly acidotic with no improvement, and surgical intervention withheld due to instability. All other treatment was continued, but he was ‘Not for resuscitation’ in the event of cardiopulmonary arrest. Mr Cox died after 30 days in ITU.

Aesthetical knowing is defined by Johns as the intuitive nature of grasping, interpreting, envisioning and responding (Johns 1995). Nurses’ aesthetic qualities are sometimes referred to as the ‘art of nursing’

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