Introduction
Reflection is a process in which we go over the events that we have been through and think over what happened, what we have done, and what we could have done better if we had to find ourselves once again in that situation. Reflection can happen either as we are going through something, or afterwards when we stop and reflect. Reflection helps us to gain insight as to why we act the way that we do and so help us to understand better how we behave in certain circumstances. Reflection is a dynamic method whereby a specialised person can gain awareness and achieve an understanding of how shared, social and individual experiences have contributed to professional training and knowledge (Wilkinson, 1996). ‘We can regard it as having three elements: return to experience, attending to feelings and re-evaluation of experience’, (Boud 2001)., Reflection is a way of developing practical knowledge and students can start using reflection as their knowledge of nursing mounts up. There are two focal points of significance: unawareness and socio-political significance (Heath, 1998). Knowing is a self-motivated process and a product of individual thinking and changes as the person survives and interrelates in the world. Its qualifications are knowledge, cognizance and reflection. The results are to understand the behaviour and making sense and altering the behaviour, (Bonis, 2009).

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Reflection is being wary of what you do and say, either when you are experiencing something or afterwards, like when the person is looking through a window and sees himself within the perspective of a specific experience in order to challenge, comprehend and try to solve conflicts amid his own idea of what is right and what he actually practices, (Johns, 2005).
Account
Whilst on one of my placements at the Commcare I was asked to accompany one of the staff to the multiple daily assessment visits that they do.
Commcare is an assessment unit which delivers support to the community by assessing individual needs and then acting accordingly, while at the same time providing assistance and care plans for the individual needs. Assessment is done to calculate the essential needs, to develop care plans, watch for timely improvement, and design delivery of the needed services,(Gamble and Brennan, 2006). Commcare’s aim is help the individual maintain his or her freedom while still living in the comfort of own homes. Individuals are referred to other services if needed. Persons can also be referred to the Malta Memorial District Nursing Association, (M.M.D.N.A.), which is a non-paying organisation, offering nursing and midwifery services. Commcare also provides the services of a physiotherapist, social worker, an occupational therapist and carers. ‘The precise organization and content of health services will differ from one country to another, but in any well-functioning health system, the network of service delivery should have the following characteristics: comprehensiveness, accessibility, continuity, people-centeredness, coordination, accountability and efficiency’ ,(Global Health Observatory,2014) .
After visiting some clients who needed some sort of service or other, we visited the last client on the list for the morning. When we rang the door-bell, a lady, who looked like she was in her early sixties, opened the door for us. As soon as we stepped in we could tell that this was an educated family. The house smelled clean and the occupants looked educated. This could be seen by the way that the house was kept, by their verbal communication and through their body language. Non-verbal and verbal hints are smart signals for transmitting and getting information, (Galloway, 1968). A slightly elderly gentleman joined the lady, and since both of them looked healthy and both were over sixties, I was wondering why we were actually there. Both of them asked us to go up the stairs and then we were guided into another clean room where there was this very old gentleman, with oxygen nasal prongs and sitting in a comfortable chair. The room seemed well equipped to the needs of the patient and some structural to build a small bathroom in his bedroom. The nurse started to ask who was everyone and we found out that whilst the elderly gentleman was the father, the other two were his non-married children and that all lived in the same house. The son, who was a priest, was mostly out of the house especially during the day while the daughter took care of the house and her father. However she was finding it difficult to leave the house even to go shopping since her father had returned from hospital and he needed some supervision and so she could not leave him alone. The father, who was quiet a tall gentleman and who was 92 years old, wished to bathe instead of showering . However he needed some assistance to wash the lower part of his body especially his feet and he would not allow his daughter to bathe him. The nurse was interviewing the daughter regarding her father’s needs and the dad interrupted the nurse to tell him that he must be included in the conversation. I smiled silently to myself as I could see that he meant what he said. The nurse nodded and started to address the gentleman as well but somehow once again he ended up addressing the daughter. The gentleman stood on his feet and cleared his voice with all the highest pitch that he could muster told that nurse that he was still here, on this world and since it was him that they were talking about, he wanted to know what they were saying and to be included in the conversation. The opinions and observations of those that we take care of are necessary to allow us to carry out care compassionately, with pride and respect, (Hemmingway, 2012).
This home visit highly contrasted with a home to which we had been a few minutes before. The first thing that I noticed when the door was opened was the musty smell that came out and all that I saw at the time were a pair of very dirty shoeless feet even though the weather was very cold. The man who stood before us looked very old and he was by himself. His home was extremely dirty and poor-looking and I felt that I needed to get out as soon as possible. Conditions in which people live effect a person’s chance to be healthy and jeopardize their life expectancy, (World Health Organisation,2014). When the nurse started interviewing this client they found that he had no-one to help him, had no income and he had a multitude of health issues. Deprived people have more risk of developing disease due to their lower socio-economic status, (WHO, 2011). The man was only sixty-six years old and had been jobless his entire life. Although money was a problem he had been smoking and the nurse did ask him why did he spent the little money that he had on cigarettes and not use them to get food. But going through the only room which he occupied was a picture of him when he was much younger. In this picture he was smoking. People develop coping mechanisms to deal with problems and although this was not a good method to deal with his problems, and he had to be discouraged from using cigarettes, I felt that this issue could be handled later, after his more basic needs were met.
Feelings and Thoughts
The first thing that came to my mind when we visited this house was the difference in social class that exists on our island. Inequalities in health are not only connected to accessibility to health care services; there are other determining factors linked to the conditions in which we work and live (Whitehead et al., 2014). Barely twenty minutes before had we been to another house just a few minutes away, and the difference was tremendous. I could not help the feeling of the great injustices around us. Here was this educated, well dressed gentleman, warm in his house, being well cared for and looked after, while in the other house, the gentleman lived by himself, alone and dirty, with nothing in the house to eat except a piece of a stale loaf and some dried up tomato paste. Unconsciously I was comparing the gentlemen’s houses and way of living. The first house that we had visited was dirty, had no furniture except a bed in a corner and some very spare items, whilst the second house was very well attended to. I could never have imagined that there was so much difference in the way people lived. I was not blaming anyone but I did think about the inequities in health and social detriments
I loved the way that the gentleman kept interrupting the conversation. He was very assertive in the way that he said that he had to be involved in the decisions which were being taken regarding his issues. It is true, some of us, me included, sometimes tend to decide about someone’s well-being without including and taking the opinion of the person about whom we are talking. Although the gentleman was very old, he was still very lucid and aware of what was going on and I felt that we were somehow taking away his dignity because we were treating him as if he was not there and we were taking decisions for him until he stopped us. It is by being conscious of individual actions that the health care professional may change his views and actions to develop more corrective measures in the nurse/client therapeutic relationship, (Maude,2012). Both of his children cared for him in their family home. The son spent a lot of time out of home, but the daughter spent all the time at home with her father and did not seem to have any time for herself. She was also not very young and seemed like she could profit from some help. Her father did seem a little demanding and I thought that she needed a break from her routine. I was glad to note that Commcare could offer the services of a carer for a few hours per week, an offer which she gladly agreed to.
Something which I admire in the service is that it looks holistically at the needs of the person and the situation as a whole. Whoever goes to assess the individuals does this with an open mind and help is offered holistically. Holistic needs assessment is a procedure of collecting data from the patients and carer to discuss and improve the client’s requirements and ideals with the person as a whole by ‘integrating their physical, emotional, spiritual, social, and environmental well-being’, (National Cancer Survivorship Initiative,2011). Help is offered at all levels and I was impressed by the way that they follow their clients to see that they are getting what they need.
ANALYSES
During these placements I noted that most people do not know about the services that are provided and even if they know about them, they do not know how to access them. Maybe the local councils can help in this area by providing lists and telephone numbers to a number of government and non-government services and agencies that are available. Another thing that I noted is that we do our best to see that if possible care is provided in the homes and that is a very good thing, however we do not seem to offer a lot of support for those people who care for their elderly. Emotional illness affects both the way that carers provide the care as well as their private lives. Two of the most common disorders of the carers are anxiety and exhaustion, (Penson et al., 2000). I think that even in this area, local councils can help. They can create groups of local volunteers who could offer their services for a few hours to these people who in return would be able to take care of themselves for a few hours.
These placements have reinforced my beliefs that being is nurse is not just helping with the medical and nursing advice. Assessing the patients in their own environment is also important if we are to treat the patients holistically. We are the patients advocate and as that we have to make sure that the treatment that they are getting is adequate. It is also essential to be empathic and supportive. Sometimes we need to put ourselves in that patient’s shoes or maybe ask the question ‘How would I treat this patient if she or he were my mum or dad?’ Practising empathy helps us feel stronger and less stressed because we will understand that we are somehow connected, (Dinkins, 2011).
Going through some sites to research for this assignment, I came through an article which really had an impact on me. The article by Rhonda Nay,(2013), is about how our modern civilization has put apart our senior citizens and how this is our problem and that we should value senior citizens ‘and make care of older people and people with dementia an issue of high importance’.
Most times we tend to think that old people cannot think for themselves, that they are no longer useful to the community. While it is true that they might not be as agile as they once were, it is also true that they can still contribute to society. ‘ The economic and social contribution offered by older people – in employment, volunteering, or caring for partners, children and other family members– is rarely acknowledged’, (Commission on Dignity in Care for Older People, 2012).
Working with helpless people has helped me to improve my skills in handling delicate issues. They have helped me become aware of certain problems which I had not been aware of before, like poverty and like how important it is to look at the clients in a holistic way and without any prejudice. In other words, both the staff and the clients have helped me comprehend the concept of holistic care and the importance of looking at a client’s lifestyle as well as his history and not just focus on his medical condition. We are there to see past the illnesses and we are there to teach patients on how to adopt better lifestyle choices which can positively affect their health. I am sure that having more insight will help me to continue to offer the best service to our clients.
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