Reflection On Clinical Practice

I always feel slightly off when returning to clinical practice after a break, whether that is one week due to SIM or a whole month for Christmas break. I felt like my sense of direction was disheveled this week. My first morning with a client I found myself lost on were to even start with her care. I forgot to introduce myself during my first morning and I found myself relying on the outline sheet for a head to toe. Even finding my way around the unit made things take slightly longer than I would have liked. As the day progressed I began to get back into the groove of things. Going into the second shift my morning was much smoother and I didn’t have to look at my head to toe guide as I preformed my assessments. I felt more comfortable with my charting and was able

My first clinical experience for this nursing program was completed at New England Rehab Hospital. I walked in with some clinical experience but no experience in the realm of nursing or certified nursing assistants (CNA). During that first semester we followed CNAs to understand their job and gain basic nursing skills like bathing patients, bed making and other daily tasks. It was useful and I’m still happy we were able to have that experience. A situation that made me uncomfortable during that semester that one particular CNA never sanitized his hands when entering and exiting a patient’s room. In most hospitals and nursing facilities there is a “pump in, pump out” rule to abide by when entering and exiting a patients room rule to ensure health care workers are not spreading bacteria to themselves and other patients. This particular CNA admitted to me that he pretends to push the hand sanitizer and rub his hands together without actually getting any sanitizer in his hands. His reasoning was that he found it overly drying to use the sanitizer so frequently despite the hospital providing lotion as well.

During my first day of clinical, I encountered an issue that I believe is very significant. As a student nurse, our duty for this day was to follow our health care aide around the ward and assist in completing resident care. The resident required assistance in many of her daily tasks. The health care aide asked if I would perform one of those and do perineal care for her. I turned down her offer because I did not feel comfortable with my skill level. The resident had a bowel movement during the night. There was a significant odour in the room that overwhelmed me. I really wanted to leave the room because it was so unpleasant, but I stayed in the room so that the resident would not be embarrassed. This feeling of embarrassment, I assume,

Throughout my clinical experiences, there have been quite a few circumstances I have been placed in that have remained with me whether good or bad. All of them have been learning experiences for me whether it is how to improve and to do better next time from a mistake, for me to learn that this is or is not how a patient should be treated, how to handle family situations, and many others. One experience that I was able to participate in that will remain with me because I had not experienced this before was during my critical care rotation in the fall of 2015. This patient was dying and we were implementing comfort care for him.

Narrative therapy is way in which a therapist can help externalize sensitive issues, by allowing the client to take the reigns by talking through it outload with the therapist as the active listener. This objectification dissolves struggle and resistances and allows the client to address this issue in a more productive manner.

Pressure ulcers occur over bony prominences when skin is compressed for long periods of time, affecting the blood supply to certain areas, leading to ischaemia development (Waugh and Grant, 2001). Compression of skin is caused by pressure, shearing and friction, but can also occur due to pressure exerted by medical equipment (Randle, Coffey and Bradbury, 2009). NICE (2014) states that the prevalence of pressure ulcers in different healthcare settings in December 2013 was 4.7%, taken from data available for 186,000 patients. The cost of treating ulcers can vary depending on severity from £43 up to £374 (NICE, 2014). Evidence based practice skills are essential in nursing as it allows the best available evidence to be used to improve practice and patient care, while improving decision-making (Holland and Rees, 2010). I will be critiquing two research papers; qualitative and quantitative, using a framework set out by Holland and Rees (2010), and will explore the impact on practice. Using a framework provides a standardised method of assessing quality and reduces subjectivity.

When narrative therapy first came into my life, I was not able to realize its brilliance. I had the misconception that the modality found where problems stemmed from and then showed clients how to cope with problems when they reoccur. Then I saw narrative therapy in action during a session with clients of my colleagues. The idea of problems being outsiders intruding on the system was fascinating and co-authoring a new narrative with a client sounded fulfilling. When all of a client’s knowledge is considered socially constructed rather than learned, it helps the therapist to see the client and the client’s problems as separate entities. Meaning becomes attributed to these problems through the client’s interactions with their social environment.

My clinical day of week 3 started pretty much with the same routine. I had to shadow a CNA preceptor and helped her throughout her assignment. By late morning, I have encountered a patient that at first refused to have a conversation with me despite my efforts of searching the right therapeutic questions that will make her open up to me. I founded the situation to be a little bit frustrated and made me feel unsuccessful that I was not be able to form a relationship with the patient. I did not know what to do or what to say. She just kept staring outside the window without saying anything. At lunch time, she surprised me when she approached me and expressed her apology for her earlier behavior.

The following case study is a critical analysis of patient’s experience within clinical practice. Through the use of a process map, the patient’s journey will be evaluated and ways of which it could be improved suggested. In accordance with the NMC code of conduct (2016), section 5 will be adhered to with consent being obtained. Furthermore, a pseudonym will be used throughout the text. The patient from here on within will now be referred to as Maureen. Maintaining confidentiality is an ethical duty, it is part of good medical and nursing practice. Moreover, it is a condition of registration that we, as health professionals abide by our ‘registering bodies ' guidance on this issue (Lowth, 2013).

My reflective clinical practice experience was based on my eight weeks placement in an acute mental health ward in a hospital. I was not sure of what to expect because I have never worked or placed in an acute ward and this was my second placement. Before starting my placement, I visited the ward and was inducted around the ward. This gave me a bit of confidence and reassurance about working in an acute ward.

Beneficence entails an obligation to protect persons from harm by maximizing anticipated benefits and minimizing possible risks of harm.

O'Hanlon (1994) summarized the narrative approach into seven steps, which are outlined below. However, I feel that before these steps can be implemented, the story needs to be heard. While the client is telling their story, the counselor needs to be on the lookout for contradictions or "gaps" in the story. It is helpful to ask specific questions to elicit information about the client's experience that does not fit their telling of the dominant, problem-saturated story (Zimmerman & Dickerson, 1996). Remember any contradictions that you notice so that they can be brought to the attention of the client. Problem-saturated stories exert a powerful influence on people's lives. These stories act as restraints by limiting choices and even responsibility. Narrative therapist views these problem-saturated stories as standing in the way of the clients.

Looking back to the first day of clinical to the last day I have changed a lot during this time. During the whole clinical experience I had to use a lot of the growth mindset in-order to get fully through the whole process. My clinical teacher and I didn’t quite have the same opinion on certain things. While we did struggle through are different mindsets, it was a great learning experience. I will have people I work with that I don’t always agree with and I will have to find a way to compromise with them. This was something we talked about with each other and worked through. So, Im grateful in that aspect in learning how to deal with those situations. I also changed in that I’m more confident in giving my lessons to my students, along with I tried to not be as scared in-front of them.

There is no better teacher than experience itself. This statement holds true with regards to acquiring knowledge and necessary skills in the nursing profession. Clinical rotation is when theories are actually put in to practice and competencies acquired. Indeed, during this clinical rotation I felt like I gained a whole lot of understanding about the nursing process, the legal and ethical matters surrounding the practice, and the public health nursing as a profession.

Also, the objective is to find patient’s document finding and correlate it with chronic disease process of elderly adults. With this reflection, I will discuss what I’ve learned, and my strengths and weakness in my clinical experience.