HELPFUL QUESTIONS IN MAKING A JOURNAL

I. Description
Here you have a chance to describe the situation in detail. The main points to
include here concern what happened. Your feelings and conclusions will come
later.
Helpful questions:
What happened?
When and where did it happen?
Who was present?
What did you and the other people do?
What was the outcome of the situation?
Why were you there?
What did you want to happen?
II. Feelings
Here you can explore any feelings or thoughts that you had during the
experience and how they may have impacted the experience.
Helpful questions:
What were you feeling during the situation?
What were you feeling before and after the situation?
What do you think other people were feeling about the situation?
What do you think other people feel about the situation now?
What were you thinking during the situation?
What do you think about the situation now?
III. Evaluation
Here you have a chance to evaluate what worked and what didn’t work in the
situation. Try to be as objective and honest as possible. To get the most out of
your reflection focus on both the positive and the negative aspects of the
situation, even if it was primarily one or the other.

Helpful questions:
What was good and bad about the experience?
What went well?
What didn’t go so well?
What did you and other people contribute to the situation (positively or
negatively)?
IV. Analysis
The analysis step is where you have a chance to make sense of what
happened. Up until now you have focused on details around what happened in
the situation. Now you have a chance to extract meaning from it. You want to
target the different aspects that went well or poorly and ask yourself why. If
you are looking to include academic literature, this is the natural place to
include it.
Helpful questions:
Why did things go well?
Why didn’t it go well?
What sense can I make of the situation?
What knowledge – my own or others (for example academic literature) can
help me understand the situation?
V. Conclusions
In this section, you can make conclusions about what happened. This is where
you summarise your learning and highlight what changes to your actions could
improve the outcome in the future. It should be a natural response to the
previous sections.
Helpful questions:
What did I learn from this situation?
How could this have been a more positive situation for everyone involved?
What skills do I need to develop for me to handle a situation like this better?
What else could I have done?
VI. Action plan
At this step you plan for what you would do differently in a similar or related
situation in the future. It can also be extremely helpful to think about how you
will help yourself to act differently – such that you don’t only plan what you
will do differently, but also how you will make sure it happens. Sometimes just
the realisation is enough, but other times reminders might be helpful.
Helpful questions:
If I had to do the same thing again, what would I do differently?
How will I develop the required skills I need?
How can I make sure that I can act differently next time?
Reference:
https://www.ed.ac.uk/reflection/reflectors-toolkit/reflecting-on-
experience/gibbs-reflective-cycle
Example:
I. Description
A young male patient aged 16 years came into the clinic around three days
ago. He complained of low self-esteem and is feeling fed up and depressed
because of pimples and spots on his face. The patient was worried that girls
would not be attracted to him because of the spots. The consultation took
place with just myself present, no other nurses were in the room at the time of
the appointment. The consultation lasted around half an hour, during which
time myself and the patient discussed the history of his problems with his skin
and the emotional distress that the spots were causing him. The patient
disclosed that he had begun to get spots at around age 14 when he had started
puberty and that it had begun to make him feel extremely self-conscious. The
patient described the negative effect that the acne was having. For example,
he has been bullied at school and is feeling apprehensive about starting sixth
form in September because he believes that he will be the only sixth former
with spots. Based on the reasonably lengthy history of the acne, the presence
of acne on the face and the negative emotional effect that the acne was
having, a three month dosage of oxytetracycline was prescribed for the
patient.
II. Feelings
During the consultation I had a number of feelings. Primarily I felt sympathy for
the client because his situation reminded me of my own time as a teenager. I
suffered from bad skin from the ages of 14 to about 20 and it severely affected
my own self-esteem. In a review of the literature, Dunn, O’Neill and Feldman
(2011) have found that patients suffering from acne are more at risk of
depression and other psychological disorders. However, the review also found
that acne treatment may lead to improvement of the psychological disorder
that are so often co-morbid. This made me feel re-assured that prescribing
oxytetracycline had been the right thing to do. My own experiences of acne
also meant that I was able to relate well to the patient. I also felt some anger
during the consultation. This anger was directed at the patient’s peers who had
been cruel enough to taunt and tease the patient because of his acne. I also
felt regret and guilt. I regretted not referring the patient onwards for
emotional support and for not exploring the psychological impact of the acne
in more detail. I also felt a sense of pride that this young man had the courage
to come to the clinic by himself to seek help for his acne. I remembered how
upsetting acne was as a teenager and I remembered that I would have been
too embarrassed to have ever gone to a clinic or to have sought help from an
adult. In turn, I also felt happiness. I felt happy that this young man had come
to the clinic and I felt happy that I was able to help him.
III. Evaluation
On evaluation, the event was good in a number of ways. Firstly it added to my
experience of dealing with young people and in dealing with the problems that
are unique to this population of patients. I have not had many young patients
during my nursing career and I welcome the opportunity to gain experience
with this group. Furthermore, it re-affirmed my career choice as a nurse.
During your career you always have doubts as to whether you have chosen the
correct path. However, there are points in your career when you feel sure that
you have made the right choice. However, there were also some negative
elements. Firstly, the appointment was quite short and I am worried that this
may have made the patient feel rushed and uncomfortable. After the
consultation I did some research into the effects of acne in young people.
Purvis et al. (2006) have found that young people with acne are at an increased
risk of suicide and that attention must be paid to their mental health. In
particular, the authors found that directly asking about suicidal thoughts
should be encouraged during consultations with young people. This
information only served to make me feel more anxious and I wished that I had
bought this up with the patient.
IV. Analysis
On reflection, being able to relate to the patient increased my ability to deal
more effectively with the situation. I feel that the patient was able to open up
more to me because he sensed my sympathy for him and his situation. Randall
and Hill (2012) interviewed children aged between 11 and 14 years about what
makes a ‘good’ nurse. It was found that the ability to connect to them was
extremely important and so I think this is why the patient felt comfortable
opening up to me. On reflection, I am also now convinced that the patient
coming to see me was a very positive event. The patient could have chosen to
go on suffering and could have chosen not to open up and talk about the
problems his acne was causing. In a review of the literature, Gulliver, Griffiths
and Christensen (2010) found that young people perceived embarrassment
and stigma as barriers to accessing healthcare. Therefore, it could have been
very easy for the patient to have avoided coming and seeking help. I felt a
range of both positive and negative emotions during the consultation, and I
think this re-affirmed for me that I enjoy nursing and enjoy helping others. It is
important to genuinely care about patients and to provide them with the best
care possible. This would be hard to do if you did not feel empathy for
patients. The experience also helped me realise that I need to actively search
out training and learning opportunities regarding working with young people
with mental health issues.
V. Conclusion
If the same situation was to arise again I think that I would approach it in a
slightly different way. In particular, I would have offered to refer the patient to
further support services. During the consultation the patient mentioned that
he felt that the spots on his face made him unattractive to the opposite sex. In
addition to providing medication to get to the biological and physiological
roots of the problem, on reflection I think it would have been beneficial to the
patient to have provided information about charities that offer self-esteem
and confidence building. Such charities that offer these services include Young
Minds (http://www.youngminds.org.uk/) and Mind
(http://www.mind.org.uk/). In retrospect, I also believe that I should have
given the patient a longer consultation time in order for us to have explored
the psychological impact of his acne in more detail. Coyne (2008) has found
that young people are rarely involved in the decision-making process when it
comes to their consultations. Therefore, giving the patient more time to
discuss his problems may have improved his sense of wellbeing as he felt more
involved in his care process.
VI. Action Plan
There are a number of elements to my action plan. Firstly, I will make sure that
in the future the consultation room has leaflets and information pertaining to
mental health problems in young people. This way, young people can access
the information if they perhaps feel too embarrassed to talk about it. Hayter
(2005) has found that young people accessing health clinics put a high value on
a non-judgemental approach by health staff. Therefore, in future I would be
sure to be aware of my attitude and make sure that either subconsciously or
consciously; I am not making any judgements about the patient. Hayter (2005)
also found that young people had serious concerns regarding confidentiality,
especially during busy times at the clinic. Therefore, in the future I would be
certain to reassure young people that their details and consultations are kept
completely confidential. To re-assure young patients, I may ask them to sign a
confidentiality form, which I will also sign in front of them. Furthermore, my
action plan will include improving my knowledge and awareness of working
with young people as a nursing professional. This will allow me to increase the
tools and skills I have for dealing with young people with complex needs.
During the consultation I felt anger toward the patient’s peers who had teased
him. In the future, I will focus on being more objective when dealing with a
patient who has been the victim of bullying.