Student reflection on an episode of care
Within your reflection describe the episode of care and how you assessed, planned, delivered and evaluated person-centred care.
On 12/10/22, I looked after patient RC M F. RC is a 88 years male with no known allergies, admitted due to unwitnessed fall with a medical history of atrial fibrillation, Chronic kidney disease, congestive heart failure, Dementia, HTN, Hyperparathyroidism, pacemaker, stoma. RC is on fluid restriction due to fluid overload . It is important to closely monitor and record his fluid input and output as he is on diuretic named Furosemide which help the patient to get rid of the extra fluid in the body. This is crucial to monitor the effectiveness of the treatment, his weight is taken daily.
At the start of my shift, I went to greet him and introduced myself by name and my quality as student nurse and gained consent for nursing care. I explained that I needed to take his weight and why. I explained that he will need to transfer from bed to chair. I then went to get the weight. I also explained to him why it was paramount that he sat out on the chair for some time in a bid to promote the healing of his pressure sore and bruises that he has all over the body .
On return, I closed the curtain, explained again that I was going to assist him with moving from his bed to the chair. I asked him if he could move by himself or needed assistance. I replied that he needed assistance. I then needed to assess what he could do by himself. After I out the chair on sitting position, I ask him to hold on the bed rail for support and shuffle himself a the edge of the bed what he did. However, he was reluctant to stand and I felt he was nervous. I then explained to him that I was going to support him. He finally stood and I guided him to the chair that used to check the weigh and from that chair to the bedside chair for sitting. Before I leave, I checked with him if he was comfortable and sitting well back in the chair. After his breakfast, we had a chat about his medication and if he understood why he was on fluid restriction.
I ensure during my shift I monitor all his fluid intakes such as water, Thea, juices and record it as well as urine collected in the urine bottle. I ensure all his fluid intake was recorded.
During my shift, I have noticed that he was always on his back despite the fact that he could turn independently. I had a conversation with him about the importance of turning regularly so that he does not developpe new pressure sores. I offered him assistance in case he found it difficult which he agreed to
What did you do well?
I value people and show them they are respected and that they count by introducing myself. Telling them this is who I am and asking them if they are happy for me to provide care show them their opinion matter and that their in control of the care they are receiving
I prioritise needs. After hand over, I consulted with the RN I was working with and we agreed that in term of priorities I was going to introduce myself to my patient and check if they were comfortable . Ensure their bedside was clean and clutter. I hade a brief chat to gather information on how they felt and checked their medical history, their drug chart to ensure I understand their care plan. e I was going to check and record RC weight.
Provide safe, evidence based person centred care
Before I initiate the transfer , I ensure I assess patient’s abilities by using waterlow score assessment . He was at risk of fall and care was needed for transfer. I also ask him what he could do ad what he could not. I also assess his motor abilities by asking him to raise his leg , arm and check of he could flex both limbs. During the transfer I kept talking to him. giving him clear and simple direction and also reassuring him that he was doing well. Afterwards, I checked if he was well sited with his bum not on the edge of the chair as he could slip down and fall. I understood that that because he previously fell, he was nervous to move from his bed and needed lots of reassurance. I acknowledged patients specific needs for reassurance and guidance .
I ensure the weigh was safe and break on to prevent fall.
I was able to communicate effectively with the patient by giving him simple instruction and checking if he understood before we make the move.
Promoting health and preventing ill health
Promotion of pressure sore healing and prevention of development of new by ensuring I check on the patient regularly to assist with repositioning and transfer
Muscle will waste and become short if not used and can also become shortened (Lister and al.. 2021). Optimal positioning and mobilizing is very beneficial as it reduce the risk of [pressure ulcers, falls, deep vein thrombosis, chest infection and increase length of hospital stay. During the moving and repositioning of the patient, I was all the time mindful to avoid pulling on the pump he was attached to which could have resulted in pain or even injury
Working in team
I closely work with the RN and HCA to deliver .As the patient was reluctant to walk, I thought that seeing two people instead of one will give him confidence that he was in safe hands . Later on I was asked to help out in another bay and ensure before I leave to delegate the fluid balance chart to the HCA to ensure continuity of care even in my absence and I informed the RN I was working with as she was the only one able to voucher on the competency of the HCA to perform the task .
All the care was provided in partnership with the patient. He was involved all the way by asking him his preferences and how he wanted things to be done for him or with him.
I feel that I am making slow but steady progress in providing person centred care. I feel so proud when see the positive result s of my nursing intervention such as managing to convince my patient to have a wash, get out the bed and if possible make some move if if it only around the bed side.
Assessing needs and planning patient centred care
I was able to assess patient mobility and most importantly understand his emotional state in regard with his fear of falling which is linked to his previous fall. For this reason, he needed more reassurance to come out the bed. I was able to move the patient from the bed to chair and from chair to bed and because I was talking to him all the time I felt he was more relaxed.
As he was on fluid restriction, I ensure I kept an eye on all his fluid intake. Good nutrition and adequate fluid intake is an important component of health and poor nutrition contribute to ill health and for those in acute care setting it can contribute to prolonged recovery from illness. To obtain ( Lister et al.,2021)
To obtain optimal hydration, fluid intake should equal output ( Maried and Hoehn 2018). Bodily water /fluid is crucial for controlling body temperature, delivery of nutrients and gases to cells, the removal of waste, acid base balance and the maintenance of cellular shape. Some patient are on fluid restriction due to fluid overload resulting for example from Acute Kidney injury or heart failure as for patient A .
What would you have done differently?
When recording the in put and output, I forgot to add the medication he had. He was on Furosomide 2 ml/hours. This is something I learned on that day.
Next time, if I have to look a patient on fluid restriction, I will ensure that all intake not only oral intake is recorded.
Describe how you have begun to work more independently in the provision of care and the decision making process.
At this point, I am more familiar with my surroundings and routine. As soon as the allocation is done and hand over finish. I discuss with the RN I am working with about the plan of my learning. I normally take the lead in outlining what I would like to learn depending on the patients and their nursing needs.
I know that after greeting patients and introducing myself to them. I ensure safety check are done , the board updated and bedside environment is clean and clutter free and update the safety check list .
I then check if there red tray on patient’s table to ensure those who need assistance with feeding are attended to when food is served without delay.
my patient was on the red tray but instead of assuming that he needed to be fed, I checked with him and it turned out he just needed the food to be made accessible to him, The bedside table to be pushed across the bed and the bed adjusted accordingly to prevent chocking.
I can independently monitor and record the fluid balance chart .
I can assess mobility and decide which course of action to take or if a patient need a specialist assessment for bed bound patient for example
What learning from this episode of care could be transferred to other areas of practice?
Communication is important while talking to patient, it is important that there is no misunderstanding. This skill is crucial in every aspect of human interaction hence it is my focus on this placement but also for following placement as I understand a good nurse is a nurse who is able to convey his message, his love and dedication in a way that the recipient can understand.
Being a team player is an attitude that is paramount in healthcare system which employs a workforce that is diverse and mostly work in team to deliver a coordinated care to patient. When working for a common goal, it is important to collaborate with colleagues and partners . I take feedback positively and see it as an opportunity to developpe. I understand that not doing my job properly could have an impact on the overall performance of the ward.