Assignment
Introduction
This reflective portfolio is based on my workplace experience placement (WPE) at Oncology and INC ward for 4 weeks, I am using Gibbs Reflective Model (1988). I have outlined my whole experience which involves Nursing and Midwifery Board of Australia standard 3 and person-centred practice framework 2018. This is my reflection on how I transitioned throughout the placement.
In my creative representation I have drawn picture of holistic and person-centred care provided by a nurse for the patient’s wellbeing. in this year 2 WPE placement, I applied my values/virtues such as respect, empathy and effective communication to provide person centred care following the guidelines from Registered Nurses, standards for practice (NMBA, 2016).
In compliance with the Nursing and Midwifery Board of Australia (NMBA), (2016) I will use the pseudonym Mr. Hanley to maintain the patient’s right to autonomy and confidentiality.
I was working the afternoon shift at Oncology and infection ward at St. George Hospital, Kogarah, a patient was transferred from emergency department (ED). Mr. Hanley was from a non-English-speaking background and therefore he only responded to us with smile and short answers. My shift was going well until when I was taking observation of Mr. Hanley, he started to have low oxygen saturation level of 89%. I was sceptical about the level, so I brought another machine and performed the observation again, but the result was the same. I quickly checked the electronic medical record (EMR), and it was always over 95%. That was when I decided to inform my buddy RN (Berman et al., 2020). She repeated the process, but the oxygen level did not improve. Therefore, my buddy RN initiated nasal prong of 2 litres, and she also alerted rapid response team (RRT). Until the team arrived, we monitored Mr. Hanley’s vitals every 5 minutes. RRT arrived within 15 minutes and put him in close monitoring and after couple hours Mr. Hanley’s condition started to stabilize and improve. The same night Mr. Hanley also had head strike fall in the bathroom again and suffered injuries to the brain. Mr. Hanley was non-compliance with the buzzer and wouldn’t seek any help from the staff.
I was very nervous and stressed about Mr. Hanley’s condition. His family hadn’t come to visit him in the hospital since his arrival. I was heartbroken to hear such a story. Somehow, I gathered my emotion and pushed myself into assisting Mr. Hanley as much I could. I was very attentive and provided all the appropriate care needed which align with my scope of practice NBMA, standard 3.5, (NMBA, 2016, p4). Mr. Hanley was recovering well but after the injuries from fall, his condition became more critical. Mr. Hanley was unable to urinate voluntarily therefore as per nursing team had to perform catherization.
Buddy RN asked me to closely monitor Mr. Hanley as the ward was very busy. I checked and recorded the vital signs every 10 minutes and also performed neurological assessment (Berman et al., 2020). I also updated the fluid balance in the chart input/output of fluid and bowel movements in EMR. When the medication was due buddy RN would supervise me while administering medication to Mr. Hanley except drug S4 & S8, which conjunction with NMBA, standard 3.4, (NMBA, 2016, p4). The positive part of the experience was it helped me gain more confidence in monitoring patients. The negative aspect of the experience was that Mr. Hanley was bed bound and suffered head injuries due to the fall.
When I informed my buddy RN about low oxygen saturation level of Mr. Hanley, she quickly responded and reassessed vitals and alerted RRT. The team arrived quickly and assessed the patient and provided the required treatment to bring the condition back to normal. This whole process went very efficiently since all the allied health professionals operated and communicated effectively together as a team. This was a positive experience as I was able to witness the process and now have the knowledge of what can be done in situation like this. By closely monitoring the patient’s vitals I was quickly able to inform my RN about the patient’s deteriorating condition and therefore required treatment was provided on time. By responding in a timely manner for the wellbeing of the patient, I believe I met the Nursing and Midwifery Board of Australia (NMBA) standard 3.1 and 3.2, (NMBA, 2016, p4).
My negative aspect towards the situation was the head strike fall that could have been avoided if the overnight staff on duty were more vigilant. The patient wouldn’t have been bed bound or suffered brain injury.
I have learned that quick reaction and close observation is very important for patient’s wellbeing and effective communication and working in a team is essential to provide holistic care to the patient.
I was able to gain knowledge and experience from the situation and it has also provided me more confidence to deal with any similar situation in the future. I would apply this experience in my future placement and lifelong learning. I will research how to prevent falls and learn to apply extra precautions in situation like this. And also inform and share my knowledge with my co-workers.
Reflection 2
Introduction
This reflective portfolio is based on my experience from my 2nd year, 4 weeks of placement at Oncology and INC ward using Gibb’s Model (1998) I have outlined my experience on the incident which involved and linked to providing patient centred care practice framework (2018).
The reflection involves 86 years old male Mr Pit (pseudonym), who came into intensive care unit (ICU) having respiratory rate (RR) of 30 per minutes. Mr Pit was in the ICU for a week and was transferred to our ward in my second week of placement. During my shift I was looking after Mr. Pit while suddenly he started breathing fast. I performed RR of 28 per minute and immediately informed RN and also by looking at Mr. Pit I was able to tell that his condition was deteriorating (Berman et al., 2020). The RN reassessed and informed met call and while we were waiting for met call to arrive my buddy RN tried to calm and relax the patient and made sure the patient was in a comfortable position. We tried to communicate and engage authentically with Mr. Pit at the same time.
My initial feeling towards the whole situation was completely stressful. However, I realised that I took control over situation very well. My buddy RN thanked me for the support and care I provided when the patient’s health was deteriorating. I was relieved that I took right steps by respecting patient autonomy (McCormack & McCance, 2018). When met call arrived my buddy RN asked me to explain the whole situation and handover the patient.
The positive aspect of the incident was that the patient’s condition was stabilized, and we were able to prevent from further deterioration. The whole team was working together and continuously monitored and communicated well throughout the entire process. My buddy RN and doctors team thanked me for witnessing the incident and taking immediate and appropriate action on timely manner (McCormack & McCance, 2018).
Reflecting on the incident I realised that I didn’t panic to be in the situation and while taking care of Mr. Pit I took correct action on time and avoided further deterioration. My priorities at the time were providing patient a holistic care by ensuring that my patient got treatment on time. Mr. Pit’s blood pressure was on above 100/60 bpm, heart rate was 80 beats per minute. Mr. Pit’s blood pressure was bit low comparing to previous records therefore RN started on 250 ml of saline. Mr. Pit had midline inserted the day before the incident and IV access was on place which was helpful for the process. The team had informed family member and Mr. Pit’s wife arrived. She was taken to the meeting room and the doctor team provided the information on the whole situation (NMC, 2018). she took it very positively and thanked all entire team for looking after him and stayed with the patient to provide comfort and emotional support. Reflecting on the whole experience it was very comforting and satisfying to know that I was able to help the patients by taking immediate action on time.
The outcome of whole situation was very good in the aspect that I provided the holistic care to the patient in my care and along the way I was able to apply my learning from the autumn session in my workplace experience placement. The tutorials and lab session has given me vision what to do in any situation and I also gained more confidence throughout the process.
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