Reflecting on the time my supervisor allowed me to be more autonomous and call my own patients in A&E triage.

I asked my supervisor if, with her supervision, I could call patients in and take secondary  assessments by myself after observing her do many.  She agreed as it was a great learning opportunity. At first I worked on my communication skills, as I wanted to get as much history from the patient as I could in the time frame I had. I found this challenging at times as the questions I would ask were too generalised. For instance, I would ask the patient if they had any pain right now and they would tell me about chronic back pain they have had for a year, however that is not what they came into the ED for. My supervisor gave me feedback and told me that I needed to simplify the question and ask questions such as “do you have any new pain or pain that has become worse over the last few weeks” so that they could understand what I was saying. This worked better as I would get direct answers. Another aspect that I worked on was what to prioritise. I was tasked to prioritise what I needed to do and in what order. At first I didn’t know what to prioritise. I would take bloods which would take some time and then take vital signs/ relevant assessments. However that would mean I spent longer than needed with the patient. Therefore, after a while I figured that I would take all relevant assessments and vital signs before taking bloods as that was the most time effective way. For example, when a patient comes in with chest pain I would prioritise getting their ECG and vital signs while doing an A-E assessment and taking their history first and then get the appropriate bloods. That way if I saw any anomalies in their ecg I would escalate it to the A&E doctors. 

I learnt a few things from this experience. The first thing I learnt was I have to communicate in a way my patients understand. This means I can’t use jargon nor can ask generalised questions that would not give the relevant information. I learnt to ask the appropriate simplified questions that would allow me to get accurate and relevant information for my documents. Another thing I learnt was to manage my time effectively. I learnt that I had to be organised to manage my time effectively. Effective time management is an important aspect of nursing, it means that we are able to give the patient the best care possible while also spending the appropriate time with them.

In the future, I will communicate in a simple way that my patients understand.  I will be more organised in the way I practise and I will manage my time well by prioritising the urgent aspect of a patient’s care first and then completing the minuscule tasks. For example, if a patient has urgent timed medication I will give that first before personal care.  

This reflection is relevant to the code as I learnt and now understand what it means to practise effectively. I now understand that I need to communicate clearly by using terms that are understood by the patient so that I can write clear and accurate documentation. I also was able to work well with the doctors by giving them the ECG/VBGs and giving them the presenting complaints of the patient.

My most recent placement was in A&E and I was able to further my knowledge in many ways. I’m reflecting on when I observed and played a role in the resuscitation of a patient while my supervisor was using the toilet. 

This patient was moved from majors B to resus after it was reported that she had a seizure. While I was connecting the patient on the monitor I realised that the patient had stopped breathing. I called out to the patient and did a trapeze squeeze; however the patient did not respond I checked their radial pulse but couldn’t feel anything. Feeling scared and uneasy, I pulled the emergency button, the nurse in charge and a consultant came in and I explained to them what happened. There was no bilateral lung movement or any sound and although there was activity shown on the cardiac monitor when the consultant checked both the femoral and carotid arteries but they felt no pulse. In resus each cubicle has their own red crash trolley and I managed to pass the consultant the defib pads and the equipment that she needed to intubate the patient (which was in the first draw)  while a nurse started CPR. After this I decided to step out and just observe the nurses, anesthesiologist, doctors and consultants work. I watched as the doctors I quickly bleeped the anesthesiologists who got to resus as quickly as they could and the nurses started to give the first dose of adrenaline. I observed a piece of equipment called LUCAS placed on the patient chest and started chest compression more effectively. This was really effective as after 2 rounds of adrenaline and chest compressions the patient was resuscitated. I was relieved. The anesthesiologists took over from the consultant to fully intubate the patient. Who was later taken to ICU. 

One aspect I learnt from this experience is that when you realise that som1ething is wrong with your patient it’s okay to feel scared and uneasy, it’s okay to call out for help even when you’re in shock and panic. I had to reassure myself that this patient was actually having a MI as all the signs were present and to get help even when the shock stopped me from thinking clearly.  Another aspect I learnt from this experience is that it’s normal for nurses and doctors to fade away into the background while and after the patient is resuscitated. This allows the consultants, the anesthesiologists and some nurses to work hand in hand getting medication ready and working to intubate the patient. Overall I learnt that in situations like resuscitation teamwork and good communication is essential as it allows everyone to work in harmony. 

This was the first time I had observed and played a role in the resuscitation of a patient. This experience allowed me to observe the signs of cardiac arrest and how to work well in a team. I now know to look for the pulse in the femoral and carotid arteries and not only the radial pulse. Moreover i realised that the cardiac monitors are not reliable and that i should actively feel for a pulse. 

This reflection links to practices effectively and prioritises people. I was able to communicate what I found effectively and assisted the consultant when needed. I observed how well the MDT worked cooperatively, maintaining effective communication and documentation of what was administered and what time. I saw how they respected each other’s expertise and contributions by taking a step back and allowing the other members of the MDT to work without disruption. I also observed how the MDT made sure to uphold the I patients dignity by covering the patients private parts as much as possible throughout the experience.

This reflection is on an incident that happened while I was doing medication administration. I prepared medication for bed one under supervision and I went to give it to the patient.  I looked at the name and date of birth of the patient on iclip however, I had forgotten by the time I made it to the patient. I then went to give the medication without supervision. When the patient double checked with me if the medication was correct I assured them that it was. But I had forgotten the layout of the bay. I made the mistake of forgetting that side rooms always count as beds. And in this case I forgot that side room was bed one. Hence why I administered the medication to the wrong patient. 

When I was first informed by the other student that I had administered the wrong medication I was shocked. I was in utter disbelief. I was quite confused as I thought I had administered the right medication to the right patient, until it dawned on me that the sideroom is bed one. My practice assor and I immediately let the patient know, who was quite understanding that errors can occur sometimes. I felt quite embarrassed and shaken. I work in healthcare and I have never made such a medication error before. I’m very careful and I always double check. I remember being tired and the pressure of doing medication administration with my practice assessor and another student making me feel stressed. Luckily the patient was fine and had been discharged the following day.

After this when administering medication I made sure to have my practice supervisor present and I took the computer with me, so that I can make sure I have the right person by asking them for their name, date of birth and if they had any allergies. I double checked it on the computer and made sure this was correct. I even counter checked it with my supervisor. I made sure that my supervisor was present when I was preparing simple medication like paracetamol and ibuprofen as I wasn’t allowed to prepare other medications. I then, with my supervisor present, gave the right medication to the right person. I have made sure to follow the 5 RIGHTS since I made the medication administration mistake.

The nmc states that a nurse should “take measures to reduce as far as possible, the likelihood of mistakes, near misses, harm and the effect of harm if it takes place” (NMC,2018) I plan to ensure that I uphold this statement from the NMC as I want to prevent any harm that could affect a patient in my care (within my ability). The NMC proficiencies for student nurses require us to “demonstrate appropriate listening skill” and “seek clarification where appropriate” which I didn’t do (Brown, 2018). I will ensure I listen to patients as they know more about their medications than we do. If they say the medication doesn’t seem right then I will double check with the nurse I’m with.

I have learnt a lot from this unfortunate experience. I know that I must always double check the name, date of birth, any known allergies and make sure it cooperates with the right bed.. I understand how serious this type of error can be with other potent medication. I could have seriously harmed someone. I will make sure to always use the 5 R’s before giving medication and prevent this type of error. Which are the right medication, right patient, right time, right dose and right route (Grissinger, 2010). Furthermore, I will ensure that if I’m ever hesitant about giving medication or feel as if I’m under pressure, then I will speak up because this prevents errors from happening. 

Brown, A. (2018). New standards of proficiency for registered nurses. British Journal of Community Nursing, [online] 22(Sup12), pp.S5–S5. doi:10.12968/bjcn.2017.22.sup12.s5

Grissinger, M. (2010). The Five Rights: A Destination Without a Map. Pharmacy and Therapeutics, [online] 35(10), p.542. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957754/ [Accessed 18 Oct. 2022].

NMC (2018). The Code: Professional Standards of Practice and Behaviour for nurses, Midwives and Nursing Associates. [online] Nmc.org.uk. Available at: https://www.nmc.org.uk/standards/code/ [Accessed 18 Oct. 2022].

Reflecting on my second year placement at a hyper acute stroke unit HASU as a student. At HASU I was able to observe how the stroke pathway was conducting. The main focus of my reflection is caring for a palliative patient who sadly passed away. 

This patient was admitted 1 weeks ago with a suspected TIA however he was discharged as he was able to pass his swallow assessment and could mobilise with his frame well, he was medically fit to go home.This was good news for him and his family who were eager to have him home. A few days later he was admitted back into HASU after having a stroke with left side weakness. Although I wasn’t able to interact with him before he was discharged, I was happy for him and his family and wished them well. Seeing that he had deteriorated a lot since his last visit made me more compassionate towards him.

At first he was in the ward with all the other patients, but after his NEWS score was continuously 9+ and due to the nature of his stroke medical intervention was of no use, it was decided by the doctor that the patient would be on palliative care and be moved into the sideroom for a dignified death. This was something that was,understandably, strongly disagreed by the family who wanted there to be medical intervention for their father no matter what. Although the doctors had already explained why that wasn’t possible, me and my supervisor were tasked with reiterating the fact that the patient sadly could not have any more medical intervention other than keeping him pain free and allowing him to have a peaceful and dignified death. For the family’s sake we slowly stopped monitoring the patient NEWS score although the family insisted. For me this was really hard as the nurse asked me to remove his monitoring as it wasnt not needed any more. Although I was able to take his ECG leads off, I was met with disapproval and questions. I kept my composure and with compassion I explained to the family that we had to remove the monitoring as the patient was declining. However, they negotiated with us to keep the SpO2 probe on and I left it on.

The Patient passed away the following few hours with his family present. I felt really sad for the family who were in tears, we gave the family some space and let them grieve. After this I was able to start the bereavement process, I got the death certificate and asked the doctor to sign it. I also got the bereavement pack for the family. me and my supervisor were able to  do the patient’s last offices and wash him. I made sure to maintain dignity and show compassion towards him. After doing all our checks we were able to wrap him in the white sheets which were requested by his family and placed him into the body bag. I found this really hard as this was the first time i had done the last office, i was emotional.

Throughout this experience I learnt that compassion isn’t hyper focused only on the patient, but it extends toward the family as well. In a way we have to vigalinat about their feelings and be mindful/aware of what we say and how we say it. I also learnt that it is important to still speak to the patient when they pass away as if they were alive and treat them with dignity, respect and compassion. I now make sure to be compassionate and respectful towards any patient’s family member regardless of the situation. This adheres to prioritising people in the NMC code. Not only did we treat the patient with kindness, respect, compassion and dignity, we listened to the family and responded to their preferences.