Reflective practice allows health care professionals to assess how they use their clinical knowledge in realistic situations. After getting my clinical placement, my role as a student nurse was associated with many challenges, however these challenges gave me the opportunity to learn and develop as a registered nurse. This reflective essay describes my experience related to a clinical scenario that I faced in my clinical placement. The reflection will be done using the Taylor’s reflect model to describe the case scenario and the challenges that I faced while caring for the patient. Taylor’s model of reflections will help me as a nurse to critically reflect on the challenges I faced, how I overcame them and what I learnt from the experience that helped me to develop as Registered nurse. The practical reflection approach is selected to describe what happened and how my role affected the patient. Evidence also suggests that reflective learning related to delivery of nursing care enhances the knowledge and skills of registered nurse. It makes them aware of their own values in nursing and develop nursing plan accordingly in the future to deliver patient-centered care (Vikstr?m et al., 2015).
Taylor’s REFLECT model of reflection is based on the following aspects- Readiness, Exercising thought, Following systematic processes, Leaving oneself open to answer, Enfolding insight, Changing awareness and Tenacity in reflection. My readiness to reflect comes from my commitment to continuously learn and enhance my nursing competencies by reflecting on past experiences and taking lessons from them. I am going to exercise my thought by describing lived experience of a clinical situation that I faced in my clinical placement (Taylor, 2014).
By the process of practical reflection, re-experiencing questions describes my clinical scenario. During my clinical placement, I came across a deteriorating patient who had been admitted to the emergency department with an overdose. At that time I was newly placed in the hospital as a student nurse and my role was to be with the preceptor who had the responsibility for maintaining the airway of the patients. I was informed by my preceptor that such patients with drug overdose develops seizures, circulatory collapse and they also have the risk of dying. Acute intoxication also leads to respiratory depression, slurred speech, pulmonary edema, coma and death (Zhang et al., 2016). Hence, the first immediate step for the nurse in this situation was to insert the endotracheal tube as precautionary measures and use assisted ventilation to stabilize the patients (Bolen, 2016). My preceptor ordered me to go to the resuscitation area and assist the senior nurse. As I had never been to the resuscitation area before, I was very nervous. I had no idea about how the patients are incubated and what equipments are needed for the process. When I was put into this situation, I realized my lack of nursing skills in the area of maintaining airway potency. I was not aware of the equipments required for intubation and I knew that I will have a hard time assisting the senior nurse.
Based on reinterpretation of the situation where I encountered the deteriorating patients in the resuscitation room, my hope was that I will try my best to assist the nurse and make no delay in my actions to prevent any harm to patients. I was aware of my nursing values of being accountable and fair to the patients and use my expertise to safe guard health and well-being of patients (Iacobucci et al., 2013). In the resuscitation rooms, a physician was overseeing the patient and asked the senior nurse to arrange the equipments for intubation quickly. The patient’s condition was deteriorating and intubation either with endotracheal tube or tracheostomy might solve airway complications in the patient. I was given a checklist of intubation equipment which I had to provide to the nurse as fast as possible. It mainly included equipments like endotracheal tube, laryngoscope, face mask, bag valve mask, oxygen source, cardiac monitor, IV kit, stethoscope, lubricating gel, syringes and batteries (Bean et al., 2016). I was familiar with some of the equipments and the airway trolley. Finally I decided to communicate this to my senior nurse as for me patient’s safety was my first priority and did not wanted to cause any harm to patients because of my lack of knowledge. I told her that I am not familiar with many of the equipment. She immediately understood and told me this is normal at this stage as I had just been newly placed at the hospital. Hence, I at least managed to achieve my communicative role and avoided any confusion or risky situation in the clinical setting (Williams et al., 2016).
I was highly relieved by the nurse comment; however I resolved that I will ask about the equipments and its use from my preceptor after my end of shift. Earlier I had the perception that physicians only play a role in the intubation process, however after assisting the nurse, came to learn that nurses also play a vital role in management of patient’s in the resuscitation room (Schneiderhahn & Fish, 2014). I observed the senior nurse and stepwise process she performed as part of preparation for intubation. She oxygenated the patient using the bag valve mask and attached the patient to a pulse oximeter (Hatch et al., 2016). Another observation by me was that professional nurses and other health care staffs delegate task efficiently so that everyone is aware of their role in the process and the medical intervention takes place at a rapid rate (Valentine, Nembhard, & Edmondson, 2015). The senior nurse instructed me to position the patient. However this was not simple, the patient had to position according the height of the bed so the physicians get a comfortable position to insert the tube. Other responsibilities were to prepare and administer sedative medications which I did and I had no problem in this because I had done this earlier during my nursing education.
During the preparation for the intubation process, I was clueless most of the time regarding why certain equipments are being prepared. I wanted to get back to my preceptor to learn about the equipment as soon as possible (Prekker et al., 2014). At this stage, all the preparation related laryngoscope and battery check was done. Finally the physicians placed the endotracheal tube accurately and the senior nurses attached the patient to ventilator as per physcian’s order. I thought this is the end of the process and my responsibility. However, the senior nurse interrupted me and told me that nursing management after the patient is intubated is very crucial. She was constantly giving me new knowledge and I was feeling empowered after being aware of different nursing responsibilities to manage airway problems.
The reflection about the above scenario and my experience at the resuscitation room taught me many lessons. It was a form of relearning for me even after my completion of nursing education. I realized that whatever knowledge so far I have garnered as part of my nursing education is not enough and my real learning and professional development will start when I will face real patients in clinical setting. I was at least confident after this experience that next time I will not struggle during the intubation process. I learnt that even after inserting the tube, nurses need to constantly monitor the patients. For example they need to assess the client’s respirator status every 2 hours and assess their nasal mucosa for any redness or irritation. Secondly, they need to close monitor the cuff pressure of patients to minimize any risk of tracheal necrosis. Patients under intubation also have risk of oral infection, so nurse has the responsibility to provide oral care after every 4 hours (Sole & Bennett, 2014).
Another most important lesson that I learnt about airway management and care of such patient was that we should communicate frequently with such patient. As they cannot speak, they should be given communication aids such as white board so that we can understand their issues and build a therapeutic relation with them. Furthermore, after my shift time, I cleared all my doubts regarding the use of different equipment and airway trolley tube from my preceptor. Now I was confident that this knowledge will come in handy during the airway management of patients coming in the emergency room in the future. As part of my ethical responsibility, I will also ensure that I will perform all my nursing responsibility in accordance with the current standard of nursing practice and hospital’s protocol. Hence, airway management is a skill dependent on knowledge of airway anatomy, equipments for airway manipulation and judicious use of pharmacological agents. I am also sure that my nursing skills will improve by experience and more time spent in clinical setting (Lewis et al., 2015).
The essay on practical reflection on the challenges faced in clinical practice summarized the problems encountered by a nursing student while dealing with a patient admitted to the hospital after medication overdose. The use of Taylor’s REFLECT model helped in setting the stage for reflection and describing the detailed process regarding the challenges faced in practice and the manner in which the problem was resolved. It finally gave detail on the key lessons learnt from reinterpreting the situation and using it to develop in professional nursing career.
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