A REFLECTIVE ACCOUNT OF AN EXPERIENCE IN PRACTICE

by Alicia Healy, Third-year student, BNSc (Intellectual Disability), St Angela’s College, Lough Gill, Sligo.

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Introduction

Christopher John (1995) wrote that reflection enables nurses to be critical of their performance, facilitating the identification of strengths and weaknesses. The author is a third year Bachelor of Nursing Science (Intellectual Disability) student in the Republic of Ireland. This reflective essay describes an incident that occurred while the author, a student in the third-year of the Bachelor of Nursing Science (Intellectual Disability) was on a placement in a childcare setting. The reflective process has assisted the author to identify an issue that wasn’t known to her before the placement.

The Incident

In my second year in college, I was on a childcare placement, working in a school with children who had an intellectual disability. The children were brought once a week to a mainstream school, to mix and play in the school hall with the children of that school. There were 5 staff and 8 children who enjoyed this outing every week.

On our arrival I was told that our role was to observe the interaction of the children, and to assist if necessary. The children of the mainstream school would play with the visiting children and keep them occupied, and generally the staff would not be involved too much. The day we arrived, the school had on display, in one corner of the hall, art made by the students. This would not normally have been there. As the art was breakable and the children would be playing near it, some staff and I stood in front of it. The children started to play the moment they came in.

One child from our school, who had communication difficulties, took a great interest in the art; he wanted to look at it and touch it. My reaction was to stop him and try to distract him, as I believed he would damage it. I proceeded to stand in front of him to block him from the art. I also tried to interest him in a ballgame with other children. This made the child more anxious to get near the art and he became very annoyed with me. He tried to push himself past me and run around me.

After a few minutes I was asked to assist another nurse. While I was away a teacher’s assistant attended to the boy I had been with. When I came back, the teacher’s assistant had brought the boy to the art and was showing him a doll house made out of cardboard. The boy showed a great interest in it, he opened the doors and put a model person sitting on a chair. The teacher’s assistant explained throughout the importance of being careful as well as how nice the art was. I felt embarrassed for not giving the child a chance to play and said this to the teacher’s assistant. She said I wasn’t to know how well the boy was going to react, but that in future that I might give a child the chance to experience things.

Aesthetics

The first step in John’s Model is to look at one’s aesthetic response to a situation, i.e., what one was trying to achieve and the consequences of that. When blocking the child from the art I was thinking about the art, not about the child. I was thinking I needed to keep the boy away in case he might break it. I tried to distract the child with the ball and the other children, believing that this would keep his interest. The child, however, was becoming more irritated by me blocking him. It made him want the art more that ever and meant that I was making the situation worse.

The other children watching felt they had to assist me and also tried to get him to play with them. The reaction I showed was not the best way to show other children how to interact with a person with a learning disability. I felt unsure of what to do and reacted in an inappropriate way by physically blocking him.

I also decided that it would be better for him to play with a ball than to do what he wanted—again presuming that I knew best, rather than acknowledging his choice. Bailey (2002) wrote that services should incorporate innovative ways to assist those with significant communication difficulties to make choices and influence decisions. The child showed his irritation by trying to push past me; he became upset by my actions. The child did not understand why I wouldn’t let him near the art and I did not explain it to him. I was assuming the child would automatically break the piece of art. I did not give him the benefit of the doubt.

Personal factors

The next step in John’s Model is to look at the personal factors that influenced me, and how I felt during this incident. I felt unable to handle the situation and lost as to what to do. The child was upset, which made me feel bad for him and about what I was doing, yet I still felt he should not go near the art. At the time I wanted someone to come up and tell me what to do, but the other children were watching me and I felt I should be able to deal with the situation. Many things were influencing me, such as the protection of the art and the influence my actions were having on the other children. I was not concentrating on the child, who I was meant to be assisting. Arnold and Boggs (1995) stated that if denied an opportunity to practise independent behaviour or to express legitimate feelings freely without fear of reprisal, a child might develop a sense of vulnerability and shame. I did not stop and think about what the child wanted, I just reacted. I decided for him that he could not look at the art. It was wrong of me to take away his choice.

Ethics

In John’s Model the next thing to be considered is the ethics of one’s actions. On reflection, my actions where completely incongruent with what I believe. I have always thought of myself as quite good at communicating with children, however, I handled this situation very badly. I thought that I did not have a negative attitude to any child or person with an intellectual disability, nor did I think that I would make a presumption about what was best for them. Yet in this situation I showed that this could indeed be the case. Brown (1997) wrote that it is critical that the frontline worker is a supporter and enabler of an individual with a disability. If a child without a learning disability had showed a similar interest in the art, I believe I would have behaved differently. I would have encouraged the child, while ensuring that he/she was careful. I believe I acted in the way I did because the child had a learning disability. In the back of my mind I presumed that this meant that the child could have had the cognitive age of a one/two-year-old, and therefore he would not be able to handle the fragile artwork. I did not know him, as he was not from the class I had worked with before; I did not know his personality and should not have made such a presumption. It is hard to admit this, yet I think it is true. I did not think that the child would intentionally break anything, but that he might do so accidentally.

Another factor influencing me was the people around me. I believed at the time that I should be able to handle this situation myself- I did not look for help, which goes against what I know and believe I should do. I let the pressure from myself to deal with this situation on my own stop me from seeking help. The consequence of this was that the child became upset and annoyed due to my actions.

Empirics

John’s Model then goes on to deal with the knowledge that should have informed me. I have, since starting this course, learned a lot about the attitudes (negative and positive) that people carry with them. I learnt how these attitudes could influence the practice of nursing and the people with learning disabilities who experience the attitudes. People can be unaware of their own negative attitudes; I now have a new understanding of this, a more personal one. During my training I have also learnt about, and believe in, the individuality of a person with an intellectual disability. Gates (1986) stated that each individual is greater that just his/her cognitive functioning, and many other life events and habits contribute to the evolution of a particular personality. Yet I assumed that the child in this situation would respond in a particular way. I did not give the child a chance to examine the art; I assumed he wouldn’t be able to do so without breaking it. This negative attitude influenced me. Other knowledge that should have informed me was the availability of help and direction from the other staff. I did not request assistance even though I did not know how to handle this situation. Had I sought help, the child would not have been upset.

Reflectivity

The final step in John’s Model is reflectivity—looking at an experience to see if you could have handled it better and, if so, the consequences of doing that. The way I handled this experience was completely wrong. First, I was uncertain what to do, therefore, I should have asked the staff whether or not it would be alright to let the boy see the art. Then I should have brought the child with me, explaining to him how gentle he would have to be when touching it. Finally I should have encouraged his interest in it, as art can be beneficial to everyone. Sundeen et al (1989) stated that the negative attitude to or judgment of a client is likely to hinder the development of a caring relationship built on respect, trust and empathy. I would have enjoyed the interaction with the boy if I encouraged him, and maybe it would have increased the child’s enjoyment of the trip. The child would not have been angry or annoyed. If I had handled this situation better, it would also be of benefit to the other children from the mainstream school who were watching. It would have displayed a positive way to interact with a person with a learning disability. While reflecting on this experience I feel annoyed with myself and sorry for the child. I feel I was wrong and that I should have known better. I am annoyed, embarrassed and surprised that I assumed the child would damage the art, and that this assumption came from his having an intellectual disability.

Conclusion

I have learned a lot from this experience. I have learned to question the way I interact with a person with a intellectual disability, to be aware that I might be treating a person with an intellectual disability differently to a person without one. I believe this experience has been a valuable one for me. Arnold and Bogg (1995) wrote that knowing personal motivations, prejudices, strengths and limitations helps nurses connect with clients in a straightforward manner. It has been hard for me to admit that I treated someone with an intellectual disability differently. However, it has made me aware of it; in the future I will know not to allow negative attitudes or judgments to influence me. I believe that this can assist me in being a better nurse in the future.

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