INTRODUCTION

This assignment is an analysis of a critical incident about sponge bath of a neonate that took place during a clinical placement at the Central Regional Hospital of Cape Coast on an Obstetric and Gaenacology ward. A brief description of the incident will be given. Theoretical models and self-care principles will be incorporated in the analysis. I will apply Gibbs (1988) reflective model to identify my own strengths and weaknesses noted in the analysis and how they may be enhanced to create further strength. In conclusion, I will state how much I have gained from the actual experience and the structured reflection. Pseudonyms shall be used to maintain confidentiality (NMC, 2000). Heller (1984) suggests that people learn by reflecting upon what they do and may also learn from observing other people in terms of both successful and unsuccessful activities. Burnard (1988) defines knowledge as propositional, practical and experiential. Experiential knowledge is knowledge gained through direct encounter with a person, object or place. Experimental learning is a process in which a particular experience on reflection translated into concepts which in turn become guidelines of new experiences. Experiential learning always begins with the experience and is followed by reflection, analysis and evaluation of the experience. For this reasons there is a growing interest in the role of writing in learning, where by students use writing as a tool to foster reflection on specific experiences (Walker 1985). Critical incident analysis involves both writing about and reflecting on, an experience/incident which occurred in the practice setting. It is therefore suggested that critical incident analysis can be used effectively as an educational tool to assist nursing and midwifery students to learn from their experiences, thus providing the opportunity to develop new skills, knowledge and attitudes.

Flanagans original (1954) definition of a critical incident is an observable human activity that is sufficiently complete in itself to permit inferences and predictions to be made about the person performing the act. Critical incident analysis requires the student to recall the experience, identify feelings and then to learn through the process of writings and/or role playing the critical incident for analysis. As a result the student may demonstrate outcomes of the experience within any of the educational domains as identified by Watson (1991): affective (emotions or attitudes), cognitive (knowledge), or psychomotor (skills). In the analysis, the experience or incident is translated into concepts which in turn illuminate future experiences.

BODY Self-assessment of this clinical self-care procedure was done through the use of Gibbs (1988) reflective model to question what could have been done to such incident should it occur in the future. Gibbs described six steps of reflection: description, feelings, evaluation, analysis, and conclusion and action plan. This model is based upon the idea that the reflective process is most appropriately described as a circle and that deepening awareness, increase in knowledge and skillfulness arise from repeated clockwise movements (palmer et al, 1991). Description of the event The account occurred on an obstetric and gaenacology (O&G) ward. The client in question is a neonate who had been delivered only some several hours ago through elective caesarian section. The neonate was brought to the O&G ward while the mother was recovering at the recovery unit of the surgical suite. And as protocol demanded on the ward, these babies are given a bath before they are given to their mothers when they come on the ward. And so when it was

time to bath this baby, I volunteered to give the bath. I appeared nervous and lacked confidence initially in my abilities to undertake this procedure even though I had the knowledge about bathing neonates. The said knowledge I had gained was as a result of observing the health aid do the bating in previous days. My first time of observing the incident can equally be classified as a critical incident as I was amazed at the whole procedure. And so observing the procedure for several times, I decided on this particularly day to perform this procedure myself. For my performance to be effective, it required preparation and planning. Therefore a learning plan was constructed to provide direction to the bathing session. This involved initially identifying learning needs and planning how these could be met in a systematic way. Learning plans increase confidence and ensures that optimum use is made of available procedure time and greater job satisfaction (ODonnell, 1995). It also minimizes the omitting vital parts of the procedure, and ensures that all necessary factors have been considered. For this reason, I read a procedure manual on self-care: bathing (NMC, 2000), nursing theorys relating to self-care. The resources used for the procedure were; olive oil, towels and blankets, a soft clear washcloth, cotton balls, basin, baby shampoo and baby soup (non-irritating), clean diaper and clothing. I then commenced by pouring some of the olive oil into my palm and then starting from the babys head rubbed it on his hair and skin. This was done because it has been found out that the oil helps to effectively remove or melt down all the vernix caseosa- a fatty substance found on neonates and which protects the baby by preventing heat loss for the baby to maintain an optimum temperature. Vaseline is also a preferable product to use. As a result of this, I made sure the room was warm, without drafts about (75 degrees F). After about 5 minutes, when all the vernix caseosa had been removed, I then proceeded to give the sponge bath.

I had gathered all equipment and supplies in advance, so I poured warm water into a clean basin (between 90-100 degrees F). I then placed the baby on thick towels on a flat surface that was waist high, because of the delicate nature of their thermoregulation, I kept the baby covered with a towel. At this point, the supervising health aid who was supervising the sponge bath asked me to calm down as she had observed that I was a little bit nervous. The assurance came in handy; as it went on to alleviate the anxiety. Starting with the babys face, a moistened clean cotton ball was used to wipe each eye, starting at the bridge of the nose then wiping out to the corner of the eye. The rest of the babys face was washed with a soft moist wash cloth without soap. The outside folds of the ears were also cleaned without inserting cotton swab into the babys ear canal because of the risk of damage to the ear drum. From this point I had gained the desired level of confidence I had wished for as I had begun performing the procedure with ease and graciousness as evident by the supervisor verbalizing it. I added a small amount of baby soap to the water and then gently bathed the rest of the baby from the neck down uncovering only one area at a time. I then rinsed the part with small amount of water making sure to avoid getting the umbilical cord wet as this can cause sepsis. The baby head was the last part I washed with a shampoo which I rinsed carefully in order not to let water run over the babys face. I then put his diaper on and wrapped him up in one of his core sheets and placed him in his cradle.

My feelings having experienced the incident I believe that I achieved the second phase of the reflective cycle, as I felt unsure of being able to perform this procedure, hence the reason why I keenly observed the procedure anytime it was done. Using the second phase of Gibbs (1988) reflective cycle, what I anticipated to be a total

nerve racking experience rather turned out to be enjoyable one. However, I was concerned about my positive feeling and perhaps some negative aspects as well, which I thought have been overlooked. Actors views (evaluation) of the situation Using the third phase of the cycle, the experience gave me confidence in caring for neonates, applying theoretical elements of self-care, as well as satisfying my curiosity about how the procedure felt. Evaluation of the procedure was done verbally. My ward-in-charge told me it was a good procedure even though she didnt fully supervise me; she just popped in to see how I was getting on, and then went back to the ward. I think I could have got more effective feedback from her if she had supervised me fully. Analysis of the incident

OREMS SELF-CARE THEORY

On reflection, I used appropriate strategies, self-care theories and principles to provide effective care. Orem (1980), said nursing has as its special concern the individuals need for selfcare action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with its effect. Also infant, children, the aged, the ill, and the disabled require complete care and assistance with self-care activities. She described self-care as a deliberate action that has a pattern and sequence. It is developed in dayto-day living, aided by intellectual curiosity, by instruction, by supervision from others, and by experience in performing self-care measures. Since this baby cannot perform his needed self-care

activities i.e. bathing because he doesnt have the necessary strength, will and knowledge (Henderson, 1995) it took me the self- care agent to provide that care. Conclusion and action plan Using the fifth and sixth phase of the cycle, Gibbs (1988) asks the question, what else could you have done? in the conclusion phase of his reflective cycle. I felt I could have evaluated the procedure by making the ward-in-charge supervise and evaluate me by using the NMCs component tasks or any other evaluation tool to assess my performance. I realized that I should have applied some spirit to the cord to help with caring for it and also I should have done a headto-toe examination to look out for any abnormalities. This I would definitely do in future procedures as part of my action plan if the situation arose again.

CONCLUSION In conclusion, there is much to be gained from the experience and the structure of reflection. This critical incidence on sponge bathing has given me the basic knowledge and the necessary skills to understand the role of the nurse as a care giver and has enabled me to acquire skills in the clinical area with greater insight and effectiveness. Carefully planning and the structured procedure resulted in increased confidence and improved performance for me and maintained health for the baby. Having being given the opportunity to examine, explore and expand my knowledge in regard to the nature of observing and performing self care needs, I now feel more confident in my ability to perform in the clinical area.

REFERENCES Bernard, P., 1988, Building on experience. Senior Nurse 8(5): 12-13. Flanagan, J., 1954, The critical incident technique, Psychological Bulletin 51(4): 327-358. Gibbs (1988) in: RCN Realizing Clinical effectiveness and Clinical Governance through Clinical Supervision Practitioner book 1, RCN Institute, Radcliffe Medical Press, Oxford.

Heller, 1984. In: Parker L.D., Webb, J., & DSouza, B., 1995, Nurse Education Today, Pearson Professional Ltd, 15:111-116. Henderson V., Textbook of the principles and practice of nursing, 5th ed. New York: MacMillan Publishing Co., Inc.,1995, p.4. ODonnell, J., 1995, Learning Power Nursing Times volume 91. Orem, E.D., 1980, Nursing: Concepts of Practice (New York: McGraw-Hill Book Company, 1980). Page 35. Nurses and Midwives Council of Ghana, 2000. Procedure manual. Palmer, A. et al (ed.), 1991, Reflection practice in nursing: The growth of the professional practitioner: Blackwell Scientific, Oxford. Walker, D., 1985, Writing and reflection. In : Boud, D., Keogh, R., Walker, D.,(eds) Reflection: turning experience into writing. Kogan Page, London. Watson, S.J., 1991. An analysis of the concept of experience. Journal of Advanced Nursing. 14(16): 1117-1121.