Task 1
Reflection/Reflective Practice
Ordinarily, reflection is a process of quite thought/meditation about something. In professional terms, however, reflection is a complex process whereby an individual deliberately thinks and interprets an experience with a view to learn from it. Atkins and Murphy observe that reflection in professional practice is not an automatic but conscious process that can take place either independently or in isolation. During reflective learning, an individual, always under the trigger of experience, examines and explores the finer meanings of self in relation to the experience and practice with the objective of changing perspective. Reflection clarifies the obscure and the ambiguous. As a professional practice, reflection is attributable to Dewey. The practice has undergone tremendous evolution to gain its present prominence. In this paper, reflection will be through the Atkins and Murphy model.
Critical Thought Processes Underpinning Reflection
Reflection commences once an experience triggers an uncomfortable feeling/thought. From this thought, a practitioner realizes his/her inability to explain a circumstance and therefore engages in critical analysis of the situation. Four processes underpin the reflection. The first, association, relates to drawing connection between original experience and the new thoughts stemming from reflection. The second, integration, establishes relationships between old and new information with a view to find meaning. The third, validation, entails determining the authenticity of ideas stemming from reflection. The fourth, appropriation, involves owning the new ideas and making them your own.
Reflection in Action and Reflection on Action
Schon provides the most lucid distinction between reflection in action and reflection on action. Reflective on action occurs after an action and is retrospective. A practitioner analysis and interprets practice with a view to establish the lessons he/she has learned from a certain situation. He or she may also speculate on alternative courses of action he/she might have taken in a certain situation. Reflection in action, on the other hand, occurs while still acting. As new situations arise, a practitioner recognizes and thinks about them. Next, he/she mixes the different responses and applies the ones that fit a situation well.
Gibbs Model of Reflection vs. Atkins and Murphy Model
Gibbs model of reflection differs significantly with Atkins and Murphy model. Gibbs model has six stages, the first one being description of what happened. The second stage is feelings and involves what one felt and thought after an occurrence. The third stage, evaluation, seeks to establish what was good or bad about the experience. Evaluation leads to analysis (the sense one makes from an experience), conclusion, and action plan. On the other hand, Atkins and Murphy model entails awareness of uncomfortable feelings, describing the situation, analysing feelings, evaluating relevance, identifying new knowledge, and action. I would prefer to use Atkins and Murphy model because I find it more comprehensive than Gibbs model. Atkins and Murphy model identifies the stimulant of reflection, which is the moment of discomfort/question, unlike the Gibbs model that glosses over the cause/stimulant of reflection in professional practice.
Reference
Atkins S, & Murphy K,1994, “Reflective practice”, Nursing standard 8 (39), 49-56, Nursing Standard. (0029-6570). [8 pages].
Task 2
Evidence-based Practice
Esther Duflo’s talk covers three evidence-based areas, arguing that in the 21st century, it is foolhardy to continue with the same old practices with little or no fruits. The first evidence-based area is immunization. The folly of human existence is that human beings continue to die from diseases preventable through immunization. Parents are reluctant to immunize their children for various reasons, but majorly because immunization centers are far from them, myths, and misconceptions, procrastination, and lack of incentive. Randomized tests in Udaipur District, Rajasthan, show that just by increasing immunization camps, immunization rose from 6 to 17%. With incentives, immunization rose to 38%.
The second evidence-based area in the video is use of mosquito nets to eradicate malaria. In Kenya, Esther Duflo argues, people are reluctant to acquire nets because, first, they have to purchase them and second, they do not appreciate their value. Randomized tests reveal that when the nets are free, many people are likely to have them. Moreover, people with nets are more likely to replace them in future. The third evidence-based area is education/awareness interventions. Educating people on the benefits of an undertaking, for instance, going to school, increases the number of years one spends at school.
Personal Reflection
The most surprising thing in the video is the fact that policy makers ignore the role of evidence while formulating and implementing policies. In the 21st century, one would hope that the government and private sector uses evidence to inform practice. One would for instance hope that the millions that WHO puts into health, especially in developing countries helps promote health issues and eradicate disease. This, however, is not the case. In the era of rapid scientific advancement, research should be at the center of all government and private policies.
Reference
Esther Duflo: Social Experiments to Fight Poverty, Film recording, TED
Task 3
Determinants of Health and Trends in Singapore
Singapore is a developed economy with an advanced health sector that rivals the best in Europe. Most people live well beyond poverty line, and the government has taken deliberate efforts to reduce infectious diseases. Singapore has therefore reduced child mortality and adult deaths. Consequently, the life expectancy has increased from 78 to 82 years from 2000 to 2013 (Haseltine, 2013, p. 54). The reduction in child and maternal mortality rates and adults death has translated into higher longevity. This means that Singapore has a very high population of older people. Coupled with the fact that Singapore has a very high population and the country lies between developing and poor countries, the country faces, and will faces, several health issues as this section of the paper will explore.
The first health concern for Singapore, and which will affect even the future, is the aging population. The Asian economic powerhouse faces, and is likely to face emerging health problems because an aging population is twice as likely to fall sick than a young population (Compton & Shim2015, p. 21). Chronic diseases, especially, are on the rise because of this age bracket. As one ages, immunity to diseases decreases and Singapore is grappling with this eventuality. In response to this threat, the government has created a Ministerial Committee on ageing to address the health concerns of aged people, among other issues.
The other health concern facing Singapore is its high-density population, the fact that it neighbors poor neighbors, and that it attracts and harbors high foreign population. If there is a disease outbreak within or from outside, it spreads very fast. A case in point is the 2003 outbreak of acute respiratory syndrome. In 2009, the H1N1 pandemic killed many people before the government and other agencies could put in place effective control measures (Okma, 2010, p. 32). The Singapore government reacted to the threat of infectious disease within the high population by enacting the Infectious Disease Act (WHO Commission on Social Determinants of Health, & World Health Organization, 2008, par 34). The law has given the ministry of health the access to disease surveillance, an aspect that has enhanced early detection and prevention. The move has drastically reduced the threat of infectious disease. However, the country’s poor neighbors coupled with the fact that diseases are evolving and mutating, poses a current and future concern for Singapore’s health sector.
The other most pressing health concern is the proliferation of chronic diseases. Being a developed country, the state of pollution poses a significant threat of respiratory infections such as Asthma and lungs infection. Hand, foot, and mouth disease continue to afflict Singapore and given that the disease is contagious, the threat is even bigger. Type 2 diabetes is on the rise with more than 10% of the adult population suffering from it (Lim, 2013, p. 43). The fact that type 2 diabetes is attributable to genes (some ethnic Malays suffer type 2 diabetes even on diet that does not cause such disease in other people) compounds the situation. Cases of cancer are on the rise because of lifestyle. The fact that the society is paying little attention to health living, pollution is increasing, and the population is becoming denser poses a current and future health concern.
References
WHO Commission On Social Determinants Of Health, & World Health Organization, 2008, Closing the gap in a generation: health equity through action on the social determinants of health : Commission on Social Determinants of Health final report. Geneva, Switzerland, World Health Organization, Commission on Social Determinants of Health.
Haseltine, W. A., 2013, Affordable excellence the Singapore healthcare story. Washington, D.C., Brookings Institution Press.
Compton, M. T., & Shim, R. S., 2015, The social determinants of mental health. Singapore Asian Publications.
Okma, K. G. H., 2010, Six countries, six reform models: the healthcare reform experience of Israel, the Netherlands, New Zealand, Singapore, Switzerland and Taiwan : healthcare reforms “under the radar screen”. Hackensack, N.J., World Scientific.
Lim, J., 2013, Myth or magic: the Singapore healthcare system. Singapore Asian Publications.
Task 4
School-Based Health Promotion
Vegetables and fruits are very important components of a diet. However, their consumption is very low prompting several interventions such as school-based vegetables and fruits programs. Australian schools adopted the program in 2005. However, little research has gone into understanding the prevalence, predictors, and barriers to the programs. It is therefore not very clear to what extent the programs realize their objective of having children consume fruits and vegetables. The study by Nathan et al (2011) has three main objectives. The first objective is to determine the school principals’ attitude towards the vegetables and fruits program in Australian schools, and barriers that they face while implementing fruit breaks in school. The second objective was to determine the prevalence of vegetable and fruit breaks in schools. The third objective was to determine the implementation strategies that schools use and recommended adoption.
After obtaining ethical approval, Nathan et al conducted a cross-sectional survey of primary and central schools. The New England state of Australia where Nathan et al conducted their study has 863,000 children, all aged 5-14 year. The researchers visited the websites of the Department of Education and Training and obtained a database for sampling. From this data, the researchers randomly selected 479 schools from both from government and non-government schools. The selected principals received invitation to the study. After 2 weeks, the researchers called the selected principals for a 20-min Computer-Assisted Telephone Interview. Principals answered interview questions for 5-12 years old students only. Of the 479 respondents, the research expunged 3 because their schools served special purposes that would have jeopardized the validity of tests.
On attitudes to vegetable and fruit break, 99.5% of respondents agreed/strongly agreed that the school has a responsibility to create an environment that fosters the habits of eating fruits and vegetables. On barriers to vegetable and fruit breaks, 41.1% of the respondents cited curriculum overload as the biggest barrier. On prevalence and characteristics of school vegetable and fruit breaks, 62.5% reported that their schools implement the program. 76.7% and 90.8% respectively reported to presence of vegetable and fruit breaks and their (programs) daily implementation. On program implementation strategies, 87.2% of respondents use lesson plans to explain benefits of fruits and vegetable. However, only 30.2% reported to having trained teachers on fruits and vegetable breaks. Smaller and rural schools reported to having fruits and vegetable breaks that are up to recommended levels. The key message is that fruit and vegetable breaks are prevalent up to 62%. Positive attitude towards the program exists despite only half of the schools implementing it to recommended levels. Enough evidence exists to support the article.
Reflection on Recommendations
Nathan et al (2011) recommends that parents provide fruits and vegetables for children, improved communication between parents, teachers, and students, and teacher training to boast the program. I agree with the recommendations to a certain extent. On parents providing fruits and vegetables, I agree largely. Schools in urban areas where fruits and vegetables are scarce and expensive have lower fruits and vegetables success and having parents support in that aspect, uptake would improve. On communication, I largely agree because communication improves success of any venture. On training teachers, however, I find it not as useful as the article suggests. Eating fruit and vegetables is as basic as eating any other food type and with the right programs and implementation, no training is necessary.
Reference
Nathan, et al, 2011, Vegetable and fruit breaks in Australian primary schools: prevalence, attitudes, barriers and implementation strategies, Health Education Research, Vol 26, 4, 1-10.
Task 5
Nurses’ Role in Smoking Cessation
Title: Nurses’ Opportunistic Interventions with Patients in Relation to Smoking
Author: Whyte Rosemary, Watson Hazel, and McIntosh Jean
Date: 2006
Aims: To assess nurses’ skills and knowledge on their health education role
What happened? The study is mainly qualitative. It selected 12 nurses in three Scotland hospitals in 2000. Data collection was mainly through observation, semi-structured interviews, and use of recording technology to capture patient-nurse interaction. The main areas of observation are elements of health education. These include oral communication, health information, learning readiness, and teachable moments.
Findings: Nurses have many opportunities to discuss with smoking patients about the danger of smoking and formulate a plan for cessation. However, poor communication and inadequate health information were barriers in the process of helping patients.
Conclusions: Need exists to train nurses on their health education role in order to equip them with skills and knowledge on the same.
Strengths/weaknesses: Methodological weakness exists in that close observation and recording of interactions may make the nurses in question nervous and unable to execute duties as they would in a natural environment.
Personal Reflection
The surprising element in the article is the glaring absence of skills and knowledge among the nurses on their health education role. A principle of medicine is that it is always cheaper and better to prevent than to cure diseases. It is therefore baffling that nurse’s lack in the area that would contribute greatly to prevention of ailments associated with smoking. My own experience in assessment of health education with patients is that smokers have knowledge to counter the clichéd dangers of smoking that nurses have been reciting for years. I therefore recommend a strong education curriculum on health education role for nurses. If you tell a smoker that smoking kills, he would certainly tell you that one could die from other causes too.
Reference
Whyte Rosemary, Watson Hazel, and McIntosh Jean, 2006, Nurses’ Opportunistic Interventions with Patients in Relation to Smoking, Issues and Innovations in Nursing Practice