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Samantha Larvin CPY 3. 1 â€“ Understanding child and young personâ€™s development. Explain the sequence and rate of each aspect of development from birth to 19 years. NEW BORN BABY Physical â€“ The first few days of a babyâ€™s life are usually composed of long periods of sleep interspersed with short periods when the baby is awake. The duration of wakefulness lengthens gradually and includes periods of fretfulness, crying and calmness. The responsiveness of the baby depends on the state of sleep or wakefulness (Brazelton and Nugent 1995). At birth the arms and legs are characterisitically stiff (hypertonia) and the trunk and neck floppy (hypotonia). Lying on the back (supine) the arms and legs are kept semiflexed and the posture is symmetrical. Babies born after breech presentation usually keep their legs extended. Pulled to sitting, marked head lag is present. Held in a sitting position, the back is curved and the head falls forward. Placed on the abdonmen (prone) the head is promptly turned sideways. The buttocks are humped up, with the knees tucked under the abdonmen. The arms are close to the chest with the elbows fully flexed. Moro Reflex â€“ Is in born, not learnt. It is normally present in new born babyâ€™s to the age of 3 months. When the baby feels it is falling, the arms are flung back with the hands open, the arms are then together as if to clutch hold of something. Palmer grasp â€“ A reflex in new born babyâ€™s to 6 months. If you touch the palm of a babyâ€™s hand, itâ€™s reaction is to curl itâ€™s fingers around your finger and cling to it. Planter â€“ The reflex in the foot, when you stroke the sole of the babyâ€™s foot. Toes spread out and foot turns inwards, up to the age of 12 months. Communication â€“ Within a few days of birth, infants establish interaction with their carers through eye contact, spontaneous or imitative facial gestures and modulation of their sleep-wakefulness state. Intellectual/Cognitive â€“ Babies are sensitive to light and sound at birth through visual responsiveness varies at birth. From birth onwards, or within a few days, infants turn their eyes towards a large and diffuse source of light and close their eyes to sudden bright light. An object or face must be brought to a distance of 30 centimetres to obtain interest and fixation. Infants usually turn their eyes to slowly follow a face. Social, emotional and behavioural â€“ Patterns of interaction and subtle indications of individuality shown by babies from birth onwards strengthen the emotional ties between infants and their carers. 3 MONTH OLD Physical â€“ Lying on back, prefers to lie with head in midline. Limbs more pliable, movements smoother and more continuous. Waves arms symmetrically, hands loosely open. Brings hands together in midline over chest or chin. Kicks vigorously, legs alternating or occasionally together. When pulled to sit, little or no head lag. Held sitting, back is straight except in lumbar region. Head held erect and steady for several seconds before bobbing forwards. Needs support at shoulders when being bathed and dressed. Lying on abdomen, lifts head and upper chest well up in midline, using forearms to support and often actively scratching at surface with hands, with buttocks flat. Held standing with feet on hard surface, sags at knees. Visually very alert, particularly looking at nearby human face. Moves head deliberately to gaze attentively around. Follows adults movements within their visual outlook. Follows dangling toy at 15-25 centimeters from face through half circle horizontally from side to side and usually also vertically from chest to brow. When lying supine watches movements of own hands before face and engages in finger play, opening and closing hands and pressing palms of hands together. Reaches out to grasp with both hands by 16-18 weeks of age. May move head from side to side as if searching for sound source. Quietens to sound of rattle or small bell rung gently out of sight. Communication â€“ Cries when uncomfortable or annoyed. Often sucks or licks lips in response to sounds of preparation for feeding. Shows excitement at sound of approaching voices, footsteps, running bathwater etc. Vocalises delightedly when spoken to or pleased, also when alone. Vocalisations are integrated with smiles, eye contact and hand gestures during turn taking exchanges or â€˜protoconversationsâ€™. Intellectual/Cognitive â€“ Holds rattle for a few movements when placed in hand, may move towards face, sometimes bashing chin. Babies are starting to learn how to distinguish between faces and show obvious pleasure when they see a familiar face. Social, emotional and behavioural â€“ Fixes eyes unblinkingly on parentâ€™s or carerâ€™s face when feeding, with contented purposeful gaze. Eager anticipation of breast or bottle feed. Beginning to show reactions to familiar situations by smiling, cooing and excited movements. Enjoys bathing and caring routines. Responds with obvious pleasure to friendly handling, especially when accompanied by playful tickling, child-friendly speech and singing. 6 MONTH OLD Physical â€“Lying on back, raises head up and moves arms up to be lifted. When hands grasped, braces shoulders and pulls self to sitting. Sits with support with head and back straight and turns head from side to side to look around. Can roll over from front to back (prone to supine) around 5 â€“ 6 months and usually from back to front (supine to prone) a little later at around 6-7 months (Bly 1994). Placed on abdomen, lifts head and chest well up, supporting self on extended arms and flattened palms. Bears weight on feet and bounces up and down actively when held in supported standing with feet touching hard surface. Eye colour is established. Teeth may appear. Moves head and eyes eagerly in every direction when attention is distracted. Eyes move in unison. Follows peoples activities across room with purposeful alertness Communication â€“ Vocalises tunefully to self and others, using sing song vowel sounds or single and double syllables i. e â€˜a-aâ€™ â€˜gooâ€™. Laughs, chuckles and squeals aloud in play. Screams with annoyance. Shows recognition of carerâ€™s facial expressions such as happy or fearful and responds selectively to emotional tones of voice. Intellectual/Cognitive â€“ Immediately stares at interesting small objects or toys within 15 â€“ 30 centimetres. Shows awareness of depth. Stretches out both hands simultaneously to grasp, adjusts arm and hand posture to orientation of the object. Uses whole hand to palmer grasp and passes toy from one hand to another. Drops one object if another is on offer. Listens to voice, even if adult not in view. Turns to source when hears sound at ear level. Social, emotional and behavioural â€“ Shows a happy response to rough and tumble play. Reacts enthusiastically to often repeated games. Shows anticipation responses if carer pauses before high points in nursery rhymes and other action songs. When offered a rattle, reaches for it immediately and shakes deliberately to make a sound, often regarding it closely at the same time. Still friendly with strangers but sometimes shows some shyness or even slight anxiety when approached too nearly or abruptly, especially if familiar adult is out of sight. Moral â€“ 9 MONTH OLD Physical â€“ Pulls self to sitting position. Sits unsupported on the floor and can adjust body posture when leaning forward to pick up and manipulate a toy without losing balance. Can turn body to look sideways while stretching out to pick up toy from floor. Progresses on floor by rolling, wriggling on abdomen or crawling. Pulls to standing, holding on to support for a few moments but cannot lower self and falls backwards with a bump. Held standing, steps purposefully on alternate feet. Only needs a bit of support when sitting on parentâ€™s or carers lap and being dressed. When being carried by an adult supports self in upright position and turns head to look around. Can reach and grab a moving object by moving towards the anticipated position of the moving object. Picks up small object between finger and thumb with â€˜inferiorâ€™ pincer grasp. Enjoys casting objects over the side of cot or chair. Communication â€“ Shouts to attract attention, listens then shouts again. Babbles loudly and tunefully in long repetitive strings of syllables e. â€˜dad-dad â€˜mum-mumâ€™. Responds when name is called. Understands â€˜noâ€™ and â€˜bye byeâ€™. Reacts to whereâ€™s mummy/daddy? by looking around. Intellectual/Cognitive â€“ Shows understanding of things that are usually connected, e. g plays with cause and effect toys and pulls on a string to get the connected toy (casual understanding). Looks in correct direction for falling or fallen toys (permanence of object) â€“ the understanding that objects continue to exist even when they cannot be seen, heard or touched. Jean Piaget argued that this was one of an infantâ€™s most important accomplishments. At 9 months the baby forms multiple attachments as they become increasingly independent, becoming clingy and look for their primary carer. Bowlby (1969) believed attachment is characterised by specific behaviours in children, such as seeking proximity with the attachment figure when upset or threatened. Rudolph Schaffer and Peggy Emmerson (1964) discovered that babyâ€™s attachments develop in stages. Social, emotional and behavioural â€“ Throws body back and stiffens in annoyance or resistance, usually protesting vocally at same time. Clearly distinguishers strangers from familiars and requires reassurances before accepting their advances, lings to known person and hides face. Still takes everything to mouth. Plays â€˜peek-a-booâ€™ and imitates hand clapping. Offers food to familiar people and animals. Grasps toys in hand and offers to adult but cannot yet give into adultâ€™s hand. Puts hands on breast or around bottle or cup when drinking, tries to grasp spoon when being fed, enjoys babbling with a mouthful of food. AGE 12 MONTHS Physical â€“ Sits on floor for indefinite time. Can rise to sitting position from lying down with ease. Crawls on hands and knees, shuffles on buttocks or â€˜bearwalksâ€™ rapidly about the floor. May crawl upstairs. Pulls to standing and sits down again, holding onto furniture. Walks around furniture lifting one foot and stepping sideways. May stand alone for a few moments. Walks forwards and sideways with one or both hands held. May walk alone. Fine Motor skills â€“ has a mature grasp, picks up small objects with neat pincer grasp between thumb and tip of index finger. By 13 months reaching and grasping become co-ordinated into one smooth action e. g closing of hand starts during approach and well before touching the object. Communication â€“ Babbles loudly and incessantly in â€˜jargonâ€™. Shows by behaviour that some words are understood in usual context i. e car, drink, cat. Understands simple instructions with a gesture, such as â€˜come to mummyâ€™. Will follow the gaze of an adult (joint visual attention). Points to objects and then looks back to the adult for a reaction, for the purposes of requesting or eliciting a comment from the adult (Tomasello 1995). Intellectual/Cognitive â€“ Drops and throws toys forwards deliberately and watches them fall to ground. Looks in correct place for toys which fall out of sight. Points with index finger at objects of interest. Uses both hands freely but may show preference for one. Holds two toy bricks, one in each hand with tripod grasp, and bangs together to make noise. Locates sounds from any direction well. Immediately responds to own name. Will put objects in and out of cup or box when shown. Plays â€˜pat-a-cakeâ€™ and waves â€˜good-byeâ€™. Demonstrates understanding by use of objects, e. g hair brush (definition by use). Social, emotional and behavioural â€“ Takes objects to mouth less often. Very little, if any, drooling of saliva. Likes to be insight and hearing of familiar people. Demonostrates affection to familiars. Enjoys joint play with adults, actively switching attention between objects and adult (co-ordinated joint attention). Shows recognition of familiar tunes by trying to join in. 18 MONTHS Physical â€“ Walks well with feet only slightly apart, starts and stops safely. Runs carefully, head held erect in midline, eyes fixed on ground 1-2 metres ahead but finds difficulty in negotiating obstacles. Pushes and pulls large toys or boxes along the floor. Enjoys climbing and will climb forwards into adults chair, then turn around and sit. Walks upstairs with helping hand and sometimes downstairs. Kneels upright on flat surface without support. Flexes knees and hips in squatting position to pick up toy from floor and rises to feet using hands as support. Communication â€“ Chatters continually to self during play, with conversational intonation and emotional inflections. Listens and responds to spoken communications addressed directly to self. Uses between six and twenty recognisable words and understands many more. Echoes prominent or last word in short sentences addressed to self. Hands familiar objects to adult when requested (even if more than one option available). Obeys simple instructions, i. shut the door, get your shoes. Beginning to give notice of urgent toilet needs by restlessness and vocalisation. Bowel control may be attained but very variable, may indicate wet or soiled pants. Intellectual/Cognitive â€“ Picks up small objects immediately on sight with delicate pincer grasp. Recognises familiar people at a distance and points to distant interesting objects when outdoors. Enjoys simple picture books, often recognising and putting index finger on boldly cooured items on page. Turns several pages at a time. Holds pencil in mid or upper shaft in whole hand in a pronated grip. Spontaneous to and fro scribble and dots, using either hand alone or sometimes with pencils in both hands. Builds tower of three cubes after demonstration and sometimes spontaneously. Enjoys putting small objects in and out of containers and learning the relative size of objects. Beginning to show preference for using one hand. Assists with dressing and undressing, taking off shoes, socks and hat. Social, emotional and behavioural â€“ Explores environment energetically and with increasing understanding, no sense of danger. No longer takes toys to mouth. Treats dolls and teddies as babyâ€™s, ie hugging, feeding etc. Still casts objects to floor in play or anger, but less often and seldom troubles visually to verify arrival on target. Exchanges toys, both co-operatively and in conflict with peers. 2 YEAR OLD Physical â€“ Runs safely on whole foot, stopping and starting with ease and avoiding obstacles. Squats with complete steadiness to rest or to play with an object on the ground and rises to feet without using hands. Pushes and pulls large wheeled toys easily forward and usually able to walk backwards pulling handle. Pulls small wheeled toy by chord with obvious appreciation of direction. Climbs on furniture to look out of window or to open doors and can get down again. Walks upstairs and downstairs holding onto rail or wall, two feet to a step. Communication â€“ Uses fifty or more recognisable words appropriately and understands many more. Puts two or more words together to form simple sentences. Can understand verbal instructions and react to them and begins to listen with obvious interest to general conversation. Knows and uses their own name and talks to self continually during play but may be not understood to others. Constantly asks names of objects and people, joins in nursery rhymes and action songs. Can carry out simple instructions i. e â€˜go and get your teddy and put it in the bagâ€™. Intellectual/Cognitive â€“ Shows increasing understanding of size of self in relation to size and position of objects in the environment and to enclosed spaces such as a cupboard or cardboard box. Good manipulative skills; picks up tiny objects accurately and quickly and places down neatly with increasing skill. Can match square, circular and triangular shapes in a simple jigsaw. Holds a pencil down near towards the point, using thumb and first two fingers, mostly uses preferred hand. Builds tower of six or seven cubes. Enjoys picture books, recognising fine details in favourite pictures. Turns pages singly. Can name and match pictures with toys or with other pictures. Social, emotional and behaviour â€“ Follows parent/carer around the house and copies domestic activities in simultaneous play i. e hoovering. Extremely curious about environment, turns door handles and often runs outside without thought of common dangers. Constantly demanding parent/carerâ€™s attention. Clings tightly in affection, fatigue or fear although resistive and rebellious when stopping them doing something they enjoy. Tantrums when frustrated or in trying to make self understood, but attention is usually readily distracted. Defends own possessions with determination. Resentful of attention shown to other children particularly by own familiars. Moral â€“ May take turns but as yet little idea of sharing either toys or attention. AGE 3 â€“ 7 YEARS Physical â€“ At this stage, children will be able to carry out more co-ordinated movements e. g walking up and down stairs, moves rhythmically to music, grips strongly with either hand, throws and catches a ball well. They will be refining their skills developed so far and will have more control over fine motor skills such as writing, cutting and drawing. Children will be more confident in activities such as running, hopping and kicking a ball and using larger equipment. Throughout this time children should be out of nappies and toilet trained for both day and night. Communication â€“ Speech becomes fluent, loves to be read and told stories. Gives full name, age and birthday. Delights in reciting or singing rhymes and jingles, enjoys jokes and riddles. As children become more social and have wider experiences, they start to use an increasing number of familiar phrases and expressions. They will also ask large numbers of questions and will be able to talk about things in the past and future tenses with greater confidence. Defines concrete nouns by use. Shows sense of humour in talk and social activities. Intellectual/Cognitive â€“ This will be a period of development in which children are becoming skilled at aspects of number and writing, as well as continuing to learn about their world, they will still be looking for adult approval and learning to read. Throws and catches a ball well, plays all varieties of ball games with considerable ability, including those requiring appropriate placement or scoring according to accepted rules. Builds elaborate models when shown, holds cubes with the ulnar fingers tucked in and the hand diagonal to get a better view. Can cut a strip of paper neatly using scissors, can colour pictures neatly, staying within outlines. Can use knife and fork competently. Becomes competent in riding first a tricycle, pushing the feet along the floor and then moving onto a bike with stabilisers, and finally learning to ride a bike without stabilisers. Social, emotional and behavioural â€“ Children will be developing their own identities and will be starting to play with their peers and socialise using imaginative play. This will help them to develop their concept of different roles in their lives. It is important that they are able to learn the importance of boundaries and why they are necessary. They will also respond well to being given responsibility i. e class helpers, dinner money monitors and fruit monitors and will need adult approval. Chooses own friends, can play co-operatively with peers most of the time and understands the need for rules and fair play. Appreciates meaning of time in relation to daily programme. Moral â€“ Shows concern for younger siblings and sympathy for playmates in distress. Understands taking turns as well as sharing. Children should have understanding of respecting each other and adults alike and understand boundaries and rules. AGE 7 TO 11 Physical â€“ Children between this age group enjoy participating in many sports, i. e playing football, being part of a football team in and out of school, going swimming, dancing, gymnastics etc. Communication â€“ By this stage most children will be fluent speakers of a language and will be developing and refining their skills of reading and writing. Their language skills will enable them to think about and discuss their ideas and learning in more abstract terms. Intellectual/Cognitive â€“ Children start to develop ideas about activities they enjoy, they will still be influenced by adults and are becoming fluent in reading and writing skills. They will be developing their own thoughts and preferences and will be able to transfer information and think in a more abstract way. Social, emotional and behavioural â€“ Childrenâ€™s friendships will become more settled and they will have groups of friends. There is some evidence to suggest that boys friendships are likely to be group based while girls prefer closer but fewer friendships. They will need to have the chance to solve problems and carry out activities which require more independence. They will still need praise and encouragement and will become more aware of what others may think of them. Moral â€“ AGE 12 TO 16 YEARS Physical â€“ Behaviour in this age range is complex. Children physically are changing and hormones might be affecting their moods. In addition, young people will be making the transition from dependence on family to independence. Communication â€“ Young people should be encouraged to talk and negotiate their own boundaries, and be encouraged to be independent. Intellectual/Cognitive â€“ Young people will usually now have a clear idea about their favourite subjects or activities and will usually be motivated in these areas. They will be reflecting on their achievements and choosing their learning pathway. They may lack confidence or avoid situations in which they have to do less popular subjects, to the extent they may truant. Social, emotional and behavioural â€“ At this stage the self esteem of children and young people can be very vulnerable, their bodies will be taking on the outer signs of adulthood but they will still need guidance in many different ways, they will want to be independent of adults and spend more time with friends of their own age, but can continue to display childish behaviour. It is particularly important to teenagers that they feel good about themselves and want to belong. Moral â€“ They can find that they are under the pressures of growing up and have increasing expectations and may be unsure on how to behave in different situations. Young people can find themselves caught between wanting to remain in a group but not wanting to adopt the groupâ€™s values and behaviour. AGE 16 TO 19 YEARS Physical â€“ Communication â€“ Intellectual/cognitive â€“ By the time they come to leave school young people will be thinking about career choices based on the pathway and subjects they have selected they will be able to focus on their areas of strength and look forward to continue to develop these as they move on. Social, emotional and behavioural â€“ Children enter adulthood will still sometimes need advice and guidance from other adults. They will lack experience and individuals will vary in emotional maturity and the way in which they interact with others. Moral â€“ B. Explain the difference between: The sequence of and the rate of development: Each child is unique and will develop at their own rate, while they usually follow the same pattern of development the ages at which they reach them may vary. Milestones of development are given as a broad average of when children may be expected to attain a particular stage. You may notice in particular classes or year groups, some children may stand out as they have reached milestones earlier or later than other children. Sometimes if childrenâ€™s growth patterns are very different from their peers this may have an effect on their behaviour. For example children in the last two years of primary school may become taller and develop some of the first signs of puberty. Girls in particular can become much taller than boys and this can put pressure on them to behave differently. There may need to be additional provision made in these cases for example when getting changed to PE there may also be pupils who are very tall or very small for their age and this can sometimes affect how they are treated by their peers. It can also affect social and emotional development. The patterns of development discussed here should therefore be seen as a guide to help you draw up an overall idea of these different stages. Why is it important to understand this difference:
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Support and Caring for a Person with Dementia Essay
The patient presents with dementia, poor posture (her chin close to her chest) and dislikes solids, there for has to be assisted to feed and chooses only to consume liquids. Her communication skills are also poor and doesnâ€™t have the capacity to engage in a flowing conversation but has the ability to answer a question using the words â€˜yesâ€™ or â€˜noâ€™ or by saying individual words. I was given the task of feeding the patient at lunch time as she requires one to one support at meal times due to her lack of willingness to consume solids and fluids.
It is extremely important to maintain good fluid intake to reduce the chance of dehydration which could contribute to increased confusion in a dementia patient. To prevent this, patient H has a daily fluid chart which is filled in every time fluids are consumed as a way of effectively monitoring her intake of fluids. I informed patient H it was meal time and directed her to her chair by her bedside, supporting her to sit and positioned a bedside table over her chair.
H expresses distress and agitation when sitting in the dining room at meal times with the other patients therefor patients Hâ€™s preferences are respected by supporting her to feed at her bed area. I put a plastic green apron on her to protect her clothes and maintain her dignity, washed my hands and put a green apron over my own clothing for hygiene purposes in accordance with my wards food hygiene policy. As the patient only consumes fluids I got a Fortisip drink from the fridge, poured it into a handled plastic cup and added a straw.
Fortisip drinks have a high nutritional and energy value and are used as meal replacement in cases such as this patient. I communicated with the patient verbally in an encouraging manner and held the cup and directed the straw to her mouth. I did this at several intervals, making sure I left a sufficient time in between sips to enable her to swallow the contents of the liquid, encouraging conversation throughout. After drinking three quarters of the cup the patient refused to open her mouth to take the straw and shouted â€˜noâ€™ and got up out of her chair which at this point I praised the patient and relocated the cup on the table.
I chatted in general conversation with her to give her sufficient time to digest her intake then offered her further fluids to which she stated â€˜no moreâ€™. Satisfied she had had enough, I removed her apron and directed her to the lounge area and then discussed the task with my mentor. Feelings/thoughts Before I started this task I felt slightly anxious as it was the first time I had supported this patient on a one to one basis.
I was unsure of how she would react to me as I was an unfamiliar face to her in relation to her feeding and I had previously witnessed her being very verbally aggressive, trying to leave her chair and showing signs of frustration during meal times with other trained, experienced staff on the ward. Throughout the task I felt my confidence increased as the patient was fairly compliant with what I was trying to achieve, this made me become more relaxed and less anxious which I feel eased the mood of the whole experience.
After completing the task I felt satisfied that I had achieved what was required whilst undertaking a person-centred personalised approach to meet the needs of the patient. Evaluation I felt that I achieved the desired outcome which was to ensure the patient consumed an adequate volume of fluids during meal time whilst promoting a person â€“ centred approach to their care as I ensured the patient enjoyed and consumed her meal through liquid form with a suitable aid which is her preference to enable easier consumption.
In order to meet patientâ€™s needs I required a straw, cup, appropriate meal supplement and syringe which are all aids I used during the task. If I hadnâ€™t prepared her meal in liquid form then the patient would have been unable to consume her meal which would result in dehydration, hunger and lack of sufficient nutrients absorbed into her body to enable her to function normally.
I felt I could have been more organised with the task as I felt I interrupted the flow of the task by leaving the table on a couple of occasions to retrieve required items. I should have had the meal supplement already poured in the cup with straw to hand at the table along with the oral syringe before directing the patient to get seated in her chair. If I had done this I feel I would have been much more focused on the patient which would have been a more positive experience for the patient. Analysis
In order to reduce my anxiety of the task I feel it would have been beneficial to have spent more time interacting with the patient on a general basis before supporting her with feeding. This would have provided a more natural transition into the task effectively creating a more relaxed experience for the patient. This would enabled me to have an even better person centred approach as I would have known what works well and what doesnâ€™t work so well in regards to feeding the patient concerned. Conclusion
I feel that the patient received a good standard of person centred care in regards to her mealtime. It is important that the patient feels included and valued within the ward and I feel this is met by ensuring she has one to one support during mealtimes in an area where she feels most comfortable. However, it is also important to note that there may be occasions where the patient would rather not be situated at her bed area and her behaviour of standing up and removing herself from the chair may indicate this.
I understood this behaviour was the patientâ€™s way of expressing that she didnâ€™t want any more intake, where in reflection it could have been an indication that she was unhappy with the current surroundings or the temperature for example. My mentor was satisfied that I had taken a person-centred personalised approach to the task as I had met and taken into account the patient emotional, metal and physical needs by tailoring her meal time experience using appropriate aids and the environment to create a positive experience which took her preferences into consideration.
Action plan In future I will aim to forward plan more and ensure I have all required resources to hand to enable me to dedicate my time and use my time with the patient more effectively. This will ensure that I make the best use of my time which will allow me to support my team effectively and also ensure that the patient feels completely valued and display to them that I am competent and focused on the task I am supporting them with.
It would also be beneficial for me to interact with the patient if possible before undertaking a task which would relax the patient and help them feel at ease. I have had previous experience of this skill as I have worked in the social care sector for many years but have found having this opportunity to reflect on my practice through the use of the Gibbâ€™s model of reflection valuable and given me awareness of how I can develop this skill further to benefit the patient.
Write something about yourself. No need to be fancy, just an overview.