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Posted on May 4th, 2014, by

The essay describes my experience in a NHS podiatric clinic as an observer. In my essay I rely on Gibb’s reflective model integrating the models of critical reflection described in Delany and Molloy (2009: 6) which include reflecting-in-action and reflection-on-action and others. I would like to mention that this clinic is busier than the clinic we have at our school. Thus, our time with the patients was limited. The purpose of the practice was learning about podiatry, how the organizations of health service are managed and gaining more skills in private practice. While preparing for my deplacement experience I learnt protocols on how to prepare foot care or surgery for patients. I hoped it would help me in my experience in the clinic. During my practice I tried to make notes and to consider carefully all the situations I could observe using the example of reflective diary (Example of a reflective practice tool). On the first day of my deplacement I tried to know more about the clinic and its staff, how the institution is organized and managed. Then I started getting more information about the patients, diagnosing and the process of treatment.

During my practice I had an opportunity to spend time with patients and communicate with the practitioners. I took part in ward round and watched the practitioner’s examining and interviewing the patients. I was an observer at a routing examination of 65 year old male patient who had been suffering Type 2 diabetes for 12 years. His case was rather interesting and hard as he has also suffered paranoid schizophrenia. I tried to study the history of his disease. The practitioner then explained to me that it was not his first attendance of the clinic. He was receiving treatment for his ulceration first. But later the examination showed that he had also had a swelling over the right toe. But not so long ago he came for a routine examination and was found to have deteriorated. He appeared to have osteomyelitis of his right toe. He had a collection of pus which was localised. The practitioner explained me that he had a fever and C-reactive protein of 151.6 mg/l. After the diagnosing he was advised to stay at hospital for admission and to have the first toe amputation. The patient refused. He was suggested to be treated with ciprofloxacin as an outpatient. So, he was receiving that kind of treatment. He was attending the clinic for daily dressing change from Monday to Friday and at the weekends the nurses came to him. Two weeks later after the deterioration he returned to the clinic and agreed to be admitted to the hospital as his state was quite poor and he had a high temperature. At the hospital he started being treated with piperacillin-tazobactam. However, Methicillin-resistant Staphylococcus aureus (MRSA) was found in his blood. Thus, piperacillin-tazobactam treatment was stopped and Vancomycin IV 1 g statim was appointed. The patient was isolated in accordance with the hospital MRSA control policy. The patient still refused amputation but accepted the treatment. When we came into the ward the practitioner greeted the patient, sat down near the bed and showed him his hands. He repeated several times that he was not going to take him anywhere; he had no medical tools with him and he just wanted to examine him and to know how he felt. The patient showed a kind of anxiety but still turned to the practitioner and looked at him and his hands. After that he was ready to allow examining him. It was rather hard to communicate with him as he ignored the practitioner’s questions several times. The practitioner had to ask about the same things in different ways and using different words again and again. From time to time the patient’s reaction was quite adequate and he replied the questions at once. After standard procedures and questions, the practitioner had to examine the toe. He warned the patient that he wanted to examine his toe. But again he had to repeat several times that he only wanted to examine it and to be sure that the treatment went well. The patient ignored the request. So, the practitioner had to explain his intentions again. It should be noted that the practitioner spoke in a very calm and friendly tone. Finally, the patient agreed to show the toe. The practitioner examined it, made some notes, thanked the patient, warned him that he would come to examine him the next day and we left the ward.

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