paraphrases and rewriting with out paralogism

During the final term of my Diagnostic Radiography degree, I attended clinical placement for a total of 42 days to gain experience and practice my imaging techniques in various imaging departments. The placement module provided me with a learning experience in a hospital environment and helped to broaden my clinical skills in a variety of clinical environments. I was formally assessed by a member of the clinical staff on 3 different imaging procedures, knee x-ray, as part of the degree evaluation process. 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 reflection and why does reflection help me in my learning? Reflection is a process of gradual self-awareness, critical appraisal of the social world and how it transforms your thinking. (Johns et al. 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". One definition that is appropriate for student radiographers is "Reflection in the context of learning is a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations (Boud et al. 1985). The use of a reflective journal during my final placement helped me with my reflective development as it would have been difficult for me to remember all the numerous thoughts and feelings I experienced over a 42 days’ period. (Kennison 2006) sees the reflective clinical journal as a method in which a learner may write about clinical learning experiences and reflect on them. He considers this as a beneficial tool of reflection which not only improves the learner's writing skills but also essentially helps to "reflect on their practice, explore reactions, discover relationships and connect new meanings to past experiences". On the other hand, (Newell, 1992) states that any reflective practice is reliant on memory and interpretation of events - selective memory is a particular problem especially following a negative event. I can relate to this as I did find that a balance was required when recalling certain events, I was inclined to remember more negative situations than positive ones, these negative feelings and thoughts of particular events stayed with me longer and had a bigger impact on me.

If I am to approach this account of my clinical placement reflectively I must choose an appropriate model for reflection. (Sterman 2002) found that there are several models have been developed to guide the process of reflection. The first model I will use to aid my analysis and to explore my feelings is the Gibbs (1988) reflective cycle. This model has 6 stopping points which are - Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan. 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. This model can also be used through different levels of reflection from novice to advanced. The second model I am employing is (Boud et al. 1985). This model helps reflect before, during and after an action and will be ideal to explore my feelings and experiences through the whole of my placement. (Boud et al. 1985) identify reflection as "a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations". This reflective model is therefore appropriate for radiographers and other health professionals to adopt in critical reflection exercises. (Boud et al. 1985) & (Schon 1995) state that the development of the abilities to be reflective and critically reflective in practice can be perfected through active, repeated, guided practice.

Starting at the beginning of the Gibbs (1988) cycle and (Boud et al. 1985) framework, I am asked to describe the two different clinical staged assessments that I completed and my recollection of thoughts and feelings before, during and after the process.

My timetable actually dictated that I would perform knee x-ray assessment first. This was due to me spending the majority of my first few weeks on placement in the General Department where I would be performing this type of procedure regularly on ward patients. I thought it best to be assessed during the third week after I had performed the examination many times and would be feeling confident. At the start of the second week of my placement I felt confident that I would be ready for this assessment in week 3 and was looking forward to my 2 timetabled days in the Accident and Emergency (A&E) Department prior to working in the General Department again. On the first morning in A&E the radiographer in charge asked if I had any staged assessments to be evaluated on, I advised her that I had a knee x-ray to do but I was happy to do this in the General Department the next week once I had gained more practice. Unexpectedly, the radiographer suggested that she would assess me that morning and that I should carry out the examination on the next patient that required a knee x-ray.

My first instinct was to put this off and decline, as in my mind I had planned to be assessed on a ward patient the following week. I also felt panicked as I did not have much practice using the mobile x-ray machine in the resuscitation area at this point and the surprise of the request took away some of my confidence. This was a test of my mental strength and as a future health care worker I would have to get used to making quick decisions and rising to challenges on a daily basis. My response was to agree, which surprised myself, I accepted that I was going to be assessed that day. I did not have my assessment sheet and criteria to hand but I managed to find another student who had the information and photocopied it. The morning passed very quickly and I was worried every time a request card was passed through to the viewing area from the A&E staff as I thought it would my turn to carry out my assessment. When the request eventually arrived it was to image a 45-year-olda woman that came accident suffer from Pain in her chest and knee, maybe there is fracture in her knee because she cannot be moving the knee, she was sitting upright on a trolley in the resuscitation area of Accident & Emergency. A chest x-ray was required and so I checked the request card and the patient's history on the hospital information system (HIS) system to check for any previous history and corresponding images, I washed my hands, collected a cassette and proceeded to take the mobile unit into the required area. The radiographer accompanied me and asked the patient for her consent and her co-operation to have a student perform the x-ray, the patient agreed. She then observed the whole procedure to evaluate my performance. The knee x-ray procedure was antero-posterior and HBL view, the patient was very co-operative and aware of the situation around her which made it easier for her to understand I was giving her. The resulting image showed a fracture in proximal neck of knee and was an acceptable diagnostic image. I received an excellent assessment mark from the radiographer and although I was relieved that it was over I still felt pleased with myself that I had carried out the mobile 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 (Schon 1995) 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.

Following both the reflective frameworks, I began to analyses 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 behaviors, perspectives or practices (Boud et al. 1985). By reflecting I have certainly changed my perspectives and behaviors 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. 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.

From following both (Boud et al. 1985) and Gibbs (1988) models of reflection I have analyzed the situation in detail in a logical order. 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 et al. 2000) evaluating practice through reflection can bring advantages. The challenge is to recognize and use these advantages, together with the knowledge they generate.

References

BOUD, D., KEOGH, R. and WALKER, D., 1985. Reflection: turning experience into learning. London: Kogan Page.

Gibbs G (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.

JOHNS, C., FRESHWATER, D. and Dawsonera., 2005. Transforming nursing through reflective practice. 2nd ed.Blackwell Publishing.

KENNISON, M.M., 2006. The evaluation of students' reflective writing for evidence of critical thinking. Nursing Education Perspectives. 27(5), pp. 269.

MAGGS, C. and BILEY, A., 2000. Reflections on the role of the nursing development facilitator in clinical supervision and reflective practice. International Journal of Nursing Practice. 6(4), pp. 192-195.

Newell, R. (1992) Anxiety, accuracy and reflection: the limits of professional development. Journal of Advanced Nursing. Vol.17(11), pp.1326-1333.

Sandars, J. (2009) The use of reflection in medical education: AMEE Guide No. 44. Medical Teacher. Vol.31(8), pp.685-695.

SCHON, D.A., 1995. Educating the reflective legal practitioner. Clinical Law Review. 2(1), pp. 231.

STERMAN, J.D., 2002. All models are wrong: reflections on becoming a systems scientist. System Dynamics Review. 18(4), pp. 501-531.