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

The event that stood out the most to me during my clinical experience this month was when my assigned patient and her family began asking questions about the care the patient was receiving and other non-medical related questions.

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.

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.

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.

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.

S: How was your clinical experience this week? This week was an okay week. I spent most of my time trying to get back into the swing of things. I was a little rusty at the beginning of the week but it got better as the week went on.

The client for this paper is a twenty-seven-year-old single mother to a six-year-old son. The client was raised in a hardworking middle class family in which her father built a successful business. Her parents divorced when she was ten years old, and she reports she never heard them argue before they announced to the family they were separating. The client describes the divorce as “ugly.” She started smoking marijuana with her friends at the age of fourteen which led to her opioid intravenous addiction by the age of eighteen. The client’s drug of choice is hydrocodone. She admits she has never tried to abstain from her drug use and has been arrested over twelve times as a result of her addiction. Her last drug charge resulted in a six-year prison sentence at the age of twenty-three. The client is currently court ordered to successfully complete an in-patient drug treatment program for up to eighteen months. If she successfully completes the program, she will be released two years early from her sentence. The client has been diagnosed with 304.00 (F11.20) Opioid Use Disorder – Severe which continues to make her eligible for treatment. Client is Hepatitis C positive.

There were multiply factors that contributed to the above scenario; Larkin and Burton writes that “after this near-miss, failure to rescue incident” (p. 394) a task force consisting of management, clinical nurse specialist (CNS) and unit educator convened to discuss the event. The task force concluded that the nursing staff members were ineffectual in critically evaluating the patient’s signs and symptoms. The CNS chose a framework that utilized “Bloom’s Taxonomy of Educational Objectives”, that provided measurable outcomes to the educational activity and enabled the nursing team to optimize their critical skill levels. A workshop to assist staff to navigate through the case study in a realistic manner was implemented (Larkin & Burton, 2008, p.395).

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.

Several of the roles which I observed this morning were expected: the nurses took vitals for incoming patients, performed focused assessments, and were the main communicators between family, the patient, and the physician. I realized when the first patient came in around 10:00 am, the RN’s role in assessments, gathering blood work, and carrying out all the necessary steps to situate and stabilize the patient as soon as possible. It was incredible seeing the nurses work together, in sync, in those first moments when the patient was brought in. And though expected, I appreciated seeing just how much communication was held and information was gathered from the patient or family members by the nurse. Jessica asked the right questions from both parties, while still showing incredible empathy and not making the whole situation seem rushed and flustering. I understood this as another essential role of the nurse in the ED; he or she must maintain even in such a fast-paced environment empathy and focus in each interaction.

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.