Description of the Clinical Situation/Encounter
The purpose of the case study reflection is to review my experience and skills gained during the two weeks of hospital placement as a first-year nursing student. I have encountered positive and negative scenario which has challenged me as a student nurse. During the placement, I learned the most valuable lesson to think critically to identify problems or issues in nursing practice that may be investigated through research. For improving my practice in future and developing strategies to achieve a patient outcome, which explains about the standard of nursing and midwifery board accreditation (NMBA). I have chosen Driscoll’s model of reflection to reflect my experience on the headings: what? so what? and now what?
What? Description of the clinical situation/encounter that was confronted on the professional and individual level while undertaking the initial PEP
During my two-weeks placement, in the morning shift, all Registered Nurses (RN) were caught up with attending to Activities of Daily Life (ADL), administrating medicine, taking vital signs and blood sugar level (BSL) of their patients. I was confident in attending to a patient with ADL. My roles were bed making and taking of vital signs (manual blood pressure, temperature, pulse, heart rate) as I have some experience as a health services provider in an aged care facility. Nevertheless, at the end of the first week, I had the chance to administer oral medication under the supervision of RN (Chia-Wei 2016, p. 10). My supervising RN asked me to take the vital signs including BSL from one patient who was 62-years-old presented to the healing facility after falling in her garden resulting in a cracked right shoulder. My challenge was taking BSL on a patient under the supervision of RN. It was my first patient so I was feeling little nervous and excited about the opportunity. I went to patient’s bedside and without taking consent prepared myself for taking vital signs. I greeted the patient and manual started taking the blood pressure, temperature, pulse, heart rate and BSL. My supervising RN reminded me to take consent before each procedure (Islam 2016, p. 36). It was the first time in my life I was taking a BSL on a patient in a real scenario. The NSQHSS included decision making, development of care models, and measurement and evaluation of services. Other roles were the responsibility for safety and quality, education and individual performance of duties. The standard 7 on blood and its products directed me in following the implemented system of efficient, effective, safe and appropriate use. My role was mostly in procedure matching and patient identification (Safety and Quality 2017, p. 4). At a time, I pricked the patient’s finger but could not get out the blood and a repeat of the procedure on another finger was still unsuccessful. After several attempts, the patient seemed agitated and I could not reassure her. My poor communication skills necessitated the seeking of help from my supervising RN. As I was taking the BSL, I forgot to record the patient’s vital sign. Documentation is most important in nursing practice and for this reason, my supervising RN had to redo the procedure again. The supervising RN questioned my placement asking me if I was still sure I wanted to become an RN. I took this event as a learning curve. According to Nursing standard 2, I needed to maintain a therapeutic relationship with both colleague RN and patient, but I was unsuccessful to maintain effective communication. When messages are received, they are interpreted to give a response between the practitioner and the patient (Ferris-Taylor, 2017).
Analysis of the Event
Event analysis: The feelings at the time of practice, feelings after the event, things are done well and those that could be done better, and the effects of what was done and what was not done. What was done well and what could have been done better and the effects of what was done and those of what was not done.
On the earliest time, I became nervous and was occupied by doubt, fear, and panic. This situation filled the entirety of my first week in hospital placement. Most of the RNs and educators were helpful and positive; however, they were too busy but did not hesitate to answer all my questions. This way, my placement was a relief. On the first week, my roles were bed making, showering the patient, grooming of the patient, feeding the patient, communicating with the patient and serving the family with advisory services (Islam 2016, p. 36). All the care roles were in line with my learning objectives (NMBA). I was glad and did every task thoroughly. On my second week, I got opportunities to take a vital sign using Manual Blood Pressure conducting of urinalysis, wound dressing and oral medication. Observation and inserting cannula were great experiences and gave me the “nurse” feeling. While taking vital signs, I was tasked to take Blood Sugar level (BSL). According to National Safety and Quality Health Standard, the clinical workforce will record patients’ blood and its products, document the transfusion history and the indications for use (NSAQHS and standard 7). At times, I was helpless and unable to reassure myself on my confidence level and I even forgot to document the assessment. I should have written it down on my notepad to enhance my memory and provide the information to the RN (Islam 2016, p. 36).
According to Registered Nurses Standards for Practice, RN’s conduct systematic and comprehensive assessments in analyzing information and data and communication of the outcomes as a basis for practice. Practice and behavior are defined by the professional standards and are the guidelines to professional boundaries, ethics codes, conduct codes and competency standards. (Nursing Midwifery Board 2017, p. 1). My worst mistake was forgetting to get documentation done for the clinical BSL, which means pretty much have to prove I have actually done the intervention. The consequence of non-documentation is the creation of a barrier to effective and safe transitions (NCBI 2017, p. 1). Anytime I noted a new abnormal condition on assessment of the patient’s situation, I properly documented the information about the deteriorating patient. I could have written it down on my notepad so that RN does not have to go and reassess the BSL.
Main Learning and Implications for Future Clinical Practice
My other challenge was with communication. Where I realized that I failed to communicate with a 62-year-old patient who was diabetic for 10 years. While taking BSL, the supervising RN reminded me the need to get the consent of the patient because I had not done so. Informed consent is directly related to enhanced observance to medication, prevention of errors, improved health outcomes, improved communication and realistic expectations, and fewer claims of malpractices (NCBI 2017, p. 1). Actually, I was nervous at the situation and forgot to get the patient’s consent. I started pricking her finger to get a drop of blood but failed. Patient consent is important in any nursing profession. It is required that the patients must be informed of the purpose of the evaluation.
Communication is the process through which a meaningful exchange takes place between at least two people to convey needs, thoughts, facts, opinions, information, and feelings through verbal and non-verbal means and includes face to face interaction and the written words (DH, 2003).
The reflection on my practice helped me to evaluate my confidence, challenges and develop a proactive approach in seeking for higher professional assistance to develop self-reliance in my skills. A flaw was also present in maintaining confidence in new and challenging circumstances and recognizing the factors that posed to influence this situation as a student (Chia-Wei 2016, p. 10).
Main learning is taken from reflecting on the practice and the implications for the clinical practice in the future
In my future career taking BSL, I will be careful to get consent from the patient for respect and dignity. Reflection provided the opportunity to think and act professionally enabling the refreshing and update in skills, knowledge, and framing and creation of solutions to complex healthcare problems (Citeseerx 2017, p. 19). I encountered challenges while taking BSL without patient consent and during documentation, which I must improve in next placement by being careful. I improved my confidence while doing bedsides and ADLs in this placement. I will review my weaknesses in communication to improve my skills by listening to professional handovers from practicing ISBAR /ISOBAR for future placement.
I would strengthen my skills in taking care of the patient and exercise critical thinking while attending to the patient. I have realized that I need to identify strategies to improve my practice by thinking critically about future placement (Penny, 2006). I have learned new perspectives from this placement for my present and future courses of action will be that I need to document the patient’s vital sign which because of its importance in assessment. In the future, I must be carrying a notepad to keep every important note needed to be recorded.
My other key area of improvement in my future placement is therapeutic communication. I found it frustrating that I was unable to form relationships with both the supervising RN and the patient as required.
Research evidence indicates that willingness to listen and explain is considered by patients to be one of the essential attributes of health professionals. It is therefore vital that health professionals communicate effectively with the patients and peer professionals during a transition, assistance, and advice.
Finally, the IRM specifies the six communication modes which form the basis of a therapist’s interpersonal approach, that is, collaborating, encouraging, problem-solving, advocating and empathizing and instructing. For this reason, I have felt the importance of developing assessments that would provide a measure for these modes (Chia-Wei 2016, p. 10).
Conclusion
In summing up, my clinical nursing experience presented the opportunity to practically work on patients and gain experience about the work environment. Whenever I will encounter a fresh challenge, it will be an opportunity to develop new skills that require the development of practice through reflection on knowledge experiences, beliefs, actions and feeling to review my abilities and confidence (Standard 1.2, NMBA). As a health service professional, I have to ensure that each principle of legal and ethical practice is followed to the latter so that I perform my professional duty with more effectiveness. I have to develop and improve my reporting and on the ethical issues that may arise in my area of practice.
References
Islam, R 2016, ‘My non-verbal communication skills made a big difference’, Nursing Standard, vol. 30, no. 46, pp. 36.
Penny, H 2006, ‘Fundamental nursing skills’, 2 ed. New Jersey: John Wiley & Sons.
Taylor, F 2016, ‘Assessing therapeutic communication during rehabilitation: the clinical assessment of modes’, American Journal of Occupational Therapy, vol. 70. no. 4, pp. 10.
Citeseerx, 2017. www.citeseerx.ist.psu.edu, viewed 4 October 2017 <
https://citeseerx.ist.psu.edu/viewdoc/download;jsessionid=30A8552A48978AC533D950D77AC6CAB2?doi=10.1.1.473.8763&rep=rep1&type=pdf>.
Ncbi, 2017. www.ncbi.nlm.nih.gov, viewed 4 October 2017, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714367/>
Ncbi, 2017. www.ncbi.nlm.nih.gov, viewed 4 October 2017, <https://www.ncbi.nlm.nih.gov/books/NBK133402/>
Nursing midwifery board, 2017. www.nursingmidwiferyboard.gov.au, viewed 4 October 2017, <
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx>
Safety and quality, 2017. www.safetyandquality.gov.au, viewed 4 October 2017, <https://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard7_Oct_2012_WEB.pdf>
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