The purpose of this essay is to reflect on my internship with adults who have both physical and mental disabilities focusing on risk. During my first year of studying adult nursing, I was assigned to a residential home for adults with learning disabilities for a month. Ellis (2013) stated that the main purpose of reflecting on previous experiences is to develop future practices when working with people with different needs. Reflection helps develop evidence-based nursing practice, making it a valuable process for me when I become qualified. Initially I will talk about Ana (not her real name), (for confidentiality reasons (NMC,2002), an elderly lady with complex learning difficulties who does not communicate, is confined to a wheelchair with dementia, neck injuries, problems convulsive and with a nasogastric tube in place Secondly, I will discuss the risks that Ana is vulnerable to if staff are not trained or have no knowledge about feeding patients with swallowing problems as she has a high risk of choking and falling the importance of risk assessment and government guidelines associated with managing Ana and preventing the risk of accidents such as falls I will use Gibbs' 1988 reflection model, which was developed to help students engage in meaningful reflection and is often used. from nursing settings and I find it helpful in identifying my learning and addressing developing feelings about the incident. Say no to plagiarism Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get an original essay This reflective framework includes. of six phases which are: Description, Feelings, Evaluation, Analysis, conclusion and Action Plan. Confidentiality will be maintained on this reflection by not stating the actual names of any person or organization (NMC,2015). During my four-week experience in a residential home for residents with learning disabilities, I witnessed one of the residents choking. The incident occurred while I was caring for a resident who suffered from dementia and epilepsy named Ana. Ana is unable to communicate, is confined to a wheelchair and must be lifted to transfer from bed to chair and vice versa. He has a nasogastric tube because he is unable to swallow due to his illness. During the meal, the health worker continuously and carelessly gave Ana a dry, cut-up sandwich while talking to the rest of the staff, and Ana began coughing. Instead of asking the team leader to give Ana a drink through the tube, the assistant simply shouted at Ana to swallow and stop coughing. I went to reassure Ana and offered to feed her and informed the team leader that Ana was coughing badly. I stayed with Ana and the assistant who fed Ana went to another patient. I realized that Ana was choking and the team leader quickly flushed Ana through the enteral route. At the time of the accident, it was only the third day of my learning disability placement. I didn't feel confident enough to face these circumstances. Initially I felt very bad and my anxiety level increased, and I was afraid to intervene in the situation. Additionally, I could have helped breastfeed Ana earlier because I knew she had a nasogastric tube and I had a better understanding of anatomy and physiology. Instead of relying on the caregiver to feed Ana, the child appeared not to care and had limited knowledge of what was happening in Ana's response to choking due to coughing. I feltto be responsible for ensuring Ana's safety as she was vulnerable due to her complex needs and lacked the ability to communicate her feelings. The shift manager later asked the assistant who fed Ana to fill out an incident report. Then I documented it in the medical record countersigned by my mentor, highlighting the need to be careful in Ana's nutrition. Also, at every handover they mentioned what happened to Ana and how they went can prevent her from suffocating. NICE guidance (2015) advocates that everyone involved in the care of service users with learning disabilities must be aware of the risk involved and continually document issues that may increase the risk. My mentor showed me Ana's documentation of past choking incidents over the past year and a care plan that was put in place. A referral to the speech therapy team was made a long time ago. Ana's care plan included a multifactorial evaluation and treatment plan intended to address specific needs and some precautions that could help her swallow more safely and manage recurring choking. Various precautions include: making the patient sit upright while eating and drinking, taking small bites, taking time, and ensuring that food is cleared from the patient's mouth. According to PHE (2018) Guidance Dysphagia (Swallowing Disorder), people with learning disabilities are more likely to suffer from dysphagia than other people. The National Patient Safety Agency (NPSA) (2004) highlighted choking as a significant health risk for people with learning disabilities. Dysphagia can cause suffocation and lead to death. Ana is an elderly woman with swallowing problems, seizures and dementia, who is at high risk of choking due to her illness. She regularly takes painkillers such as liquid ibuprofen, which makes her nauseous, and carbamazepine, an anticonvulsant drug that has side effects of drowsiness and fatigue. These are administered via nasogastric tube (BNF, 2017). Ana also underwent a falls assessment, as she suffers from seizure issues and immobility. During my internship I observed that staff members apply some restrictions or limits to Ana, as she had a seat belt on her wheelchair, but I know that it is in her best interest to ensure her safety. According to the Mental Capacity Act 2015, the Deprivation of Liberty Act (DoLS) is an act which is a precise method containing a list of orders intended to safeguard the adult deprived of right and the course of action is equally suitable and, in best interest of the patient (Alzheimer's Society, 2016). The Department of Health (2015) guidance on DoLS argues that local authorities, healthcare professionals and learning disability psychiatric consultants can give the verdict on whether or not to make an application for DoLS. Ana requests, to avoid falling from the chair, due to the risk of falls and immobility, justifies the use of the seat belt. After the accident the shift supervisor asked me what had happened and I explained to him. I felt guilty that Ana had been carelessly fed by the caregiver and I should have recognized the signs of choking more quickly. The shift manager was very helpful and explained to me that accidents happen at any time and thanked me for staying and reassuring Ana. The shift supervisor also told me that I acted and reacted well to the incident and they also believed that I had done everything I could in this situation. This experience was positive because I learned from itaccident, as it taught me the importance of acting quickly in any emergency situation, in order to protect patient safety. The downside of this experience was that the staff did not seem to follow the assessment carried out by the speech therapy team by paying particular attention to Ana during breastfeeding. This is a risk as Ana has swallowing problems and she has a nasogastric tube. According to the Department of Health (2007), The importance of referral to adult speech and language therapy (SALT) is important because people using health and social care, healthcare workers, families, professionals or organizations see risk differently and as part of In risk assessment, it is crucial to recognize possible risks involved in patient care and a person-centred care plan should be considered. Support the individual and establish a critical understanding of how to work with individual colleagues to encourage risk assessment and exercise, recognize and examine possible measures that could cause harmful effects on service users with learning disabilities in the community and to respect the legal obligations under occupational health and safety it is important to document risk factors, correct handover and recognize person-centred care plans considered to reduce risks. Scarborough and Broussine, 2012) stated that health and social care staff need better training on how to support people with learning disabilities. During the time of the incident I will probably have postponed my response and tried to maintain and manage the circumstances personally. But I felt strongly that something more serious was happening and I needed help. Maybe I could ignore Ana and walk away, but for her best interest in well-being I thought Ana wouldn't want to be left alone. When the shift manager arrived, I could have walked away from her as other more experienced members of staff were present, but as Ana was my patient, I felt I had a role to play in her successful recovery. My four week placement in the learning disabilities field provides evidence and an opportunity to gain a concise understanding of different fields of practice. I gained background knowledge through this experience and learned about the policies and procedures, such as the DoLS in place to protect vulnerable adults and reduce the risk they perform, and I also recognized the local and national regulations obtainable online to which the entire staff can also access for the management of similar incidents. After learning about local and national regulations and management procedures, I have now learned how to respond professionally when an incident occurs. I now understand that I have learned: the importance of recording risk factors, communicating with the team about the incident, and resident care plans intended to reduce hazards. Overall, I did well for my first experience of seeing a resident suffocate and respond quickly to the incident, and now I feel that having thought critically and confidently, I am more improved with the situation that may arise in my future nursing career . I will retain all the knowledge I gained during my placement, for example on adult safeguarding, risk assessment and management, how to manage incidents, the importance of communication, record keeping and teamwork (Barnes and Jenkins, 2015). Any incidents must be reported and reported to the team. Any exploitation or abuse observed must be reported to the safeguarding team and appropriate documentation.