NURS 3020 Acute Care Placement Reflection                                                                                                                                                                                    March 2017

 This past semester, I completed my acute care placement at the Peterborough Regional Health Centre on the orthopedic unit. I had the opportunity to learn more about acute illnesses and how to provide care for an acutely ill patient. This unit provided me with the opportunity to become familiar with hip and knee replacements, as most of my assigned patients were recovering from these surgeries. Additionally, I was able to care for patients following amputations, fractures, and a TURP. Each week, I was assigned to 1-2 patients whom I was able to provide care for, including a daily head to toe assessment. This semester I was able to build upon skills from previous clinical placements, such as maintaining a sterile field, dressing changes, Foley catheter insertion, and medication administration. This acute placement provided me with the opportunity to learn more about caring for a surgical incision by demonstrating dressings changes, wound cleansing and learning about vacs. Most weeks, I was able to complete a dressing change and a hemovac removal. As I enter my fourth year of nursing in September, I hope to continue to build upon my skills and become more comfortable performing skills accurately and independently.  

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3020 Reflection 2

              A recent new nursing practice situation I experienced at clinical was completing a packing dressing change for the first time. Demonstrating a packing wound dressing is a skill that we have learned and practiced in lab, but it was very different completing it on a real patient. In lab when we complete a dressing change on a mannequin, the wound does not look very real and the supplies that we use are different than what is used at the hospital. Initially, I was a little hesitant as I did not want to cause any pain or discomfort to the patient, and also I was unsure of what the wound would look like.

             Last Friday, there was a patient on the unit that had had his 5th toe amputated and a lot of tissue scraped out of his foot. This was not my assigned patient, so I did not know a lot of information about him or his condition. I had never seen a foot following a recent amputation of a toe, so I was initially worried about what the wound would look like. I had also never packed a wound before, so I was excited to be able to try this skill. My only previous experience with packing a wound was in lab on a mannequin, which is very different. To begin, I first removed the bandage, gauze and packing gauze that was already in the wound. It was slightly difficult to remove the gauze that was in the wound as it was stuck to his skin. I was able to observe the incision and the remaining tissue in his foot. I then organized my supplies and established my sterile field. Following this, I cleansed the wound with normal saline and packed the wound with gauze saturated in normal saline. I had some difficulty with holding all of the gauze while pushing it down into the wound without dropping the gauze and breaking sterility. I found that it was difficult to hold all of the supplies and pack the gauze in a back and forth pattern at the same time. I hope to improve my technique with practice. Once the wound was packed so that the gauze filled the entire wound, I placed dry sterile gauze on top and wrapped the foot with a gauze bandage.

            Throughout the dressing change, I was worried that the patient was in pain or uncomfortable as I had to push the gauze down to the bottom of the wound. When I asked him if he was experiencing any discomfort, he informed me that he could not feel anything in his foot due to his diabetes. This was reassuring as I then was able to be less hesitant when packing the wound. The literature outlines how diabetic neuropathy is a common complication of diabetes, and often results in the amputation of toes or limbs (Giurini & Lyons, 2005). When patients lose the ability to feel pain in their extremities, it puts them at an increased risk for foot problems and they should be educated about necessary precautions (Giurini & Lyons, 2005).   

            Moving forward, I need to continue to work on maintaining my sterile field as to decrease the risk of infection. Additionally, it would have been useful to know more about the patient before providing care, so in the future I will make sure to read the patient’s chart prior to providing care and I can ask the patient more about their experience. This experience provided me with the opportunity to practice a skill for the first time and gain knowledge regarding how to properly dress a foot following a toe amputation.   

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3020 Reflection 1 

             A recent new nursing practice situation I have experienced at clinical was caring for a patient who was post-op following a transurethral resection of the prostate. This was a new experience for me as I had never cared for a patient following this surgery, and I did not know much about the surgery itself. This experience taught me about how to care for someone following a TURP and I was able to learn more about the procedure.

            On Thursday, I arrived at clinical ready to care for my assigned patient with my pre-clinical questions answered and my priority assessments determined. I had been assigned a patient who was post-op day two from a Unicompartmental Oxford knee replacement. I had cared for a few patients before with the same diagnosis following the same surgery, so I knew what to expect and what care I needed to provide. When I entered my patient’s room, I found out that my previously assigned patient had been discharged and instead was a patient who had just returned from a TURP surgery 20 minutes before. At first, I was hesitant to care for this patient since I was not familiar with the surgery. I did not know what assessments would be considered a priority or what care he required. I considered caring for a different patient who was post-op from a knee replacement, but in the end I decided that this would be a good learning experience. The nurse that was assigned to this patient briefly explained to me what a TURP was and what care I needed to do that day. She explained how he was on continuous bladder irrigation and that I needed to monitor it frequently. After further discussing with my clinical instructor and peers about what a TURP was, I felt more comfortable with what was expected of me.

             I spent the shift monitoring the normal saline that was hung to infuse through the catheter, as well as checking and emptying the catheter bag when necessary. I made sure that there was always normal saline flowing through and hung another bag when necessary. Also, I had to keep track of the input and output. Each time I emptied the bag I made sure to measure the drainage and record my findings. This got a bit confusing, as the way the nurse explained to me how to record the ins and outs was not very straightforward. When I finally got it sorted out how to properly record the input and output, it became easier. Since I had to go into my patient’s room so frequently, I got to know him and learn about his experience with this surgery. He expressed that he was glad he had the surgery and felt relieved that it was over. This is consistent with the literature as a common finding is that patients often feel relieved as they have overcome something that has been a problem for an extended period of time (Vailee, Kalhor & Nayeri, 2013). Patients who require a TURP often have problems with their bladder and urination for a lengthy period of time, so having the surgery provides the patient with some degree of comfort (Vailee, Kalhor & Nayeri, 2013). 

             Moving forward, I will make sure to do research on the computer of conditions and surgeries that I am unfamiliar with when I get some spare time during the shift. Also, this experience taught me the importance of managing my time in order to maximize the time I have. I had to make sure I was charting and completing my other assessments in between changing the bags and emptying the catheter. I got to see how CBI can take up a lot of a nurse’s time and must be monitored frequently.     

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NURS 3021 Chronic Care Placement Reflection                                                                                                                                                                       December 2016

My chronic care placement at the Peterborough Regional Health Centre on the rehabilitation unit provided me the opportunity to expand my knowledge and understanding regarding chronic conditions and how to best manage them. I got to see how chronic illness affects patients differently and how I as a nursing student can provide care and support. Often, I was able to see not only the physical impact of chronic illness, but also the psychosocial aspects. On our unit, most of my experience was caring for patients who had been diagnosed with a CVA. I became familiar with signs and symptoms, treatment and expected outcomes. Working with the same patients for two days in a row allowed me to get to know my patients and establish a therapeutic relationship.

Upon completion of my chronic care placement, I feel that I have learned many new skills as well as enhanced previously learned skills. This semester gave me the opportunity to demonstrate skills for the first time such as catheter insertion, wound care, and medication administration. Before clinical, the only experience I had with these skills was in lab and simulation. Having the opportunity to practice these skills at clinical was very beneficial. Furthermore, I gained confidence in my assessment skills as I conducted full head to toe assessments each day. I became better at recognizing abnormal results and the related necessary interventions. In addition, I was able to see how the entire healthcare team works together in collaboration to provide patient care. I was able to observe other disciples such as occupational and physical therapy, and see how they contribute to providing holistic care. Moving forward, I plan to continue to expand my knowledge through maximizing my time at clinical practice and providing patient centered care. 

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3021 Reflection 2

            A meaningful nursing practice situation I have recently had the opportunity of experiencing at clinical is medication administration. Administering medication is something we have practiced during lab and simulations, but administering medication to my patient at clinical was more realistic and a much bigger responsibility. This experience taught me the importance of checking all of the rights to medication administration before giving the medication to the patient. Through this experience, I became aware of how easy it could be to make a mistake as well as practices to make sure I am completing all of my checks as to avoid error.  

          A few weeks ago at clinical I had the opportunity to administer medication to my assigned patient for the first time with the help of my instructor. Administering medication using the automated dispensing unit was a new experience for me as I have not used an ADU before. I got to learn how the system works and how to use it properly. While consulting my patients MAR, I was able to successfully withdraw the appropriate medication from the ADU. Throughout the process, I made sure to check all of my rights to ensure I did not make a mistake. Each time I removed a medication from the ADU, I made a note of it on the MAR as to keep track of what I had already withdrawn. I consistently referenced the order as to make sure I did not make any errors. Dispensing medication showed me how easy it could be to make an error, such as giving the patient the wrong dose, if you are not paying close attention. I learned that I have to pay attention to the dose that is ordered and the dose that the medication is dispensed in. For example, my patient had a pill that needed to be split in half, so this taught me the importance of paying close attention to what is ordered versus what is supplied. Following giving the ordered medications to my patient, I made sure to document and sign off in the MAR.

         Since medication errors can have serious implications on patient safety, doing all of your checks before administering medication is of utmost importance. The multitude of consequences associated with medication administration is extensively outlined in the literature, and includes repercussions such as prolonged hospital stays, financial implications to the healthcare system, and patient death (Adhikari, Tocher, Smith, Corcoran, & MacArthur, 2014). The literature suggests that medication errors are preventable and can be avoided (Adhikari et al., 2014). I learned measures to eliminate the possibility of making an error such as keeping track of what I had dispensed on the MAR as well as minimizing distractions. Interruptions to medication administration has been cited as a leading cause of error and can lead to both errors in dosage as well as procedural errors such as not checking patient identification (Hayes, Jackson, Davidson, & Power, 2015).  Furthermore, the literature cites reasons such as time constraints as making medication errors more likely (Jeongeun & Bates, 2012). I can relate to this as I felt that I was taking a long time to dispense my medication. Even though I felt like I had other things I needed to do, I understand the importance of taking my time to properly complete all of my checks.

Administering medication has taught me the importance of always checking your rights and being accountable for your actions.

         Based on my analysis, I have learned the importance of completing all of the rights of medication administrator and the consequences of making a medication error. Even though I felt like it took me a long time to dispense and check all of the medication, I understand the importance doing all of my checks and taking my time. I will continue to avoid distractions while I am dispensing and administering medication as to reduce the chances of making a mistake. When you lose your focus, you are more prone to making a mistake or forgetting what you have already done.  

Moving forward, I am glad I had the opportunity to administer medication to my patient, as medication administration is something that I will continue to do throughout my career. Learning the importance of completing all checks has benefited my learning and has contributed to my development as a nurse. As I continue to give medication, I will make sure to give my full attention to what I am doing as to prevent error. 

 

3021 Reflection 1

           A recent significant nursing experience that I have encountered in my clinical placement thus far was inserting a Foley catheter for the first time. Before beginning clinical, the only experience I have had with Foley catheterization was my lab experience, which is much different than in the clinical setting. In lab, female catheter insertion on the mannequin is very straight forward, whereas it is more difficult on an actual patient. This practical experience taught me new things about the patient’s experience of catheterization, such as how it can cause discomfort, as well as ways to try to ease the patient’s discomfort. I was originally feeling nervous but I was excited to have the opportunity to try a new skill. This experiencing taught me techniques to make catheterization go smoothly and accurately.  

          During my first week of clinical, the patient I was assigned to had an order in her chart from the doctor to have a Foley catheter inserted. Since she was my patient and catheter insertion is in our scope of practice, I was able to do the insertion myself with the help of my clinical instructor. I had learned throughout the day that my patient preferred to be left alone and did not enjoy being disturbed by the nurses. This made me a bit nervous as I had never done a female catheter insertion before and I was unsure about how cooperative she would be. When I informed my patient of what I needed to do, she was feeling apprehensive and hesitant. After explaining the indication for the catheter and reassuring her the best I could, she agreed to allow me to proceed. I began setting up the supplies I needed and brought two catheter tubes incase I did not get it on my first try. I made sure I had everything I needed and took my time to ensure I did not break sterile technique. I experienced some difficulty inserting the catheter, as the urethra was not completely visible and I did not want to put it in the wrong place. Once I had the catheter inserted and the balloon inflated, I was unsure if I had it in the correct place as no urine was coming out of the tube. When this happened, my instructor stepped in to try to move the catheter in further in hopes of getting urine outflow. During this, my patient started to feel discomfort and did not want us to continue with the catheter. When the patient started expressing her distress I was unsure how to alleviate the pain she was feeling while continuing with the insertion. My instructor was able to comfort her by talking to her about other things to take her mind off of the discomfort she was feeling. Once my instructor felt the catheter was in the correct place, we attached the tubing to the bag and hung it to her bed. I had successfully inserted the catheter but urine was not coming out because she had just recently emptied her bladder. My patient was relieved that we were finished and her discomfort stopped once we were done.   

        When comparing my experience to the literature, I have found similarities between my patient’s experience, as well as the difficulties I experienced and obstacles stated in the literature. In a study conducted regarding female catheterization, it is stated that catheter insertion in female patients can cause discomfort and stress, even when inserted correctly (Heaney, 2011). Furthermore, catheterization has been associated with patient feelings of loss of dignity as it is can be considered invasive (Heaney, 2011). In regards to difficulty locating the urethral opening, the literature coincides with my experience as it is outlined that this is a common occurrence due to variations in anatomy that cause the urethra to be hidden (Pelter & Stephens, 2008). It is stated that insertion of catheters in female patients poses a “greater technical challenge” than with male patients (Pelter & Stephens, 2008, p. 19).

Based on my analysis, I feel that my first catheterization was overall successful and I will continue with many methods I used, as well as make some changes. I will continue to take my time and not rush in order to maintain sterility as to reduce the risk of spreading bacteria and reduce the chance of infection. Something I would change about my experience would be trying to talk to the patient more while I was completing the procedure. I was mostly focused on whether I was doing it correctly rather than communicating with the patient to ensure comfort. Relieving any stress the patient may be experiencing will assist with making the process go smoother.

            Moving forward, I am glad I had the experience of female catheter insertion as I feel that it is a basic skill that I will need throughout my nursing career. Although it can be a little different each time, the basic techniques will remain the same. From observing my clinical instructor, I have learned strategies to help keep the patient’s mind off of any discomfort they may be feeling. Further experience with catheterization will enhance my learning and improve my skills.  

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March 14, 2016

Mat/Child Placement

Overall, my maternity clinical experience went very well and I really enjoyed it. My maternity placement at the Peterborough Regional Health Center provided me with the opportunity to learn and practice many new skills. Compared to my last placement, this placement was much more hands-on and I was able to be much more involved in patient care. I was able to practice practical skills such as vital signs, baby baths, assessments, and injections. I feel that my confidence and competence has grown throughout this placement as I have had the chance to practice these skills many times. I was able to make use of therapeutic communication skills and establish a therapeutic relationship with my patient and her family each week. I am looking forward to continuing my development in my next clinical rotation.   

 

 

March 7, 2016

              A meaningful nursing practice situation I recently experienced was having the responsibility of caring for two patients that needed my attention at the same time. Up until Saturday February 27, we have each been assigned to care for one mother and one baby at clinical. With only one patient to care for, I have not experienced having conflicting responsibilities and I have been able to focus exclusively on my one patient. On Saturday, we were assigned two patients to care for and complete assessments on.

             On Saturday afternoon around 3:15pm, I had completed taking one of my patient’s vitals and assessment, and was beginning to start my assessment on the baby and take his vitals. As I was taking the baby’s temperature, I heard that my other patient was going to start being discharged by my co-assigned nurse in a few minutes. This made me feel like I needed to hurry and finish with this patient so I could get to my other patient in time to see her being discharged. I think I was feeling this way because I wanted to be there for both of my patients and I did not want to miss anything. When I realized that I was feeling this way, instead of rushing and compromising the accuracy of my assessment, I decided that completing this assessment accurately was more important than observing the beginning of the discharge. This patient deserved my full attention, so I stayed engaged and completed the assessment. I was able to finish with the patient I was with and then go to my other patient to see the end of her discharge and end my therapeutic relationship with her.  

             Although we only had two patients, this situation gave me a sense of what it will be like to have multiple patients that require your attention at the same time. It provided me with insight into how a nurse must prioritize and manage their time effectively in order to provide the same level of care they would if they only had one patient. The literature emphasizes the importance of nurses using time management skills, especially in the case of a high workload or understaffing. Research by Twigg, Gelder and Myers (2015) outlines how understaffing and a lack of successful prioritizing can have a variety of negative effects on a patient’s outcome. Studies show that when a nurse’s caseload increases, there is a higher prevalence of adverse patient outcomes, such as infection, pressure ulcers, and hospital acquired pneumonia (Twigg et al., 2015). Since nurses directly contribute to a patient’s safety and the quality of care they receive, it is important for nurses to decide what takes precedence and act accordingly. In the hospital setting, conflicting responsibilities can affect clinical judgment and decision making (Patterson, Ebright, & Saleem, 2009). This data accentuates the importance of attention to detail and commitment to your patient even when you are very busy.     

Based on my analysis, I have learned the importance of time management and efficiency. Having the assignment of two patients taught me that in order to get everything accomplished in time, I must prioritize my tasks. In this experience, finishing my assessment on the patient I was with took priority over seeing the whole discharge process of my other patient. I have learned that if I devote my full attention to one task, I can complete it to my best ability then move onto something else. I was able to focus solely on completing my assessment before going to my other patient to observe her being discharged.

             In a similar situation, I will make sure to remind myself not to compromise patient care to save time or complete a task faster. Going forward, if I have some spare time when my patients do not need my attention, I will use that time to prepare for what I need to do next. I can use the time to gather supplies so that I am prepared to complete an assessment or a baby bath on time. I can also use this time to conduct research. I can research conditions that relate to my patients that I am not educated on in order to improve the care I provide my patient. In the future, I can also start completing a task a bit early, such as taking vitals, so I am not rushed.

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February 1, 2016

             A meaningful nursing experience that I have encountered in my placement thus far was when my previous assumptions regarding breastfeeding were challenged and changed. Before starting my maternity clinical placement, I had the assumption that most often, breastfeeding was something that happened easily for both the mother and the baby. I have learned about the many benefits of breastfeeding for both the mother and the baby in lab and other courses, so I assumed that all babies were able to easily latch onto the mother’s breast to retrieve breast milk that way.

I was unaware of the difficulty some mothers have trying to get their baby to latch properly and furthermore feed for an adequate amount of time. Even though I have read instructions on how to assist a mother with breastfeeding, I was unaware of how much time it could take and how much assistance a mother could need.

             On Sunday morning, I observed a mother trying to breastfeed her baby for the first time that morning since the baby’s birth the night before. It was her second time trying to breastfeed her baby. When I entered the patient’s room with the nurse, the mother was already trying to get the baby to latch on her own. When the nurse noticed that the baby was not latching, she tried to assist the patient with achieving a latch. During my time in the patient’s room, I was able to see first hand the different obstacles that can arise when trying to get a baby to latch properly. In this situation, factors such as the baby’s position, the baby’s willingness and the mother’s anatomy were posing a challenged to a proper feed.  After observing the nurse trying to help the mother for several minutes without any success, I felt surprised that it was taking so long. Since I had never seen someone try to breastfeed with so much difficulty before, I was unaware that this could occur. I could tell that the mother wanted to breastfeed and was concerned about the baby’s nutritional needs if the baby did not latch and start sucking. This influenced the situation as instead of giving up and trying again later, the nurse got a nipple shield to try to help get the baby to latch. When this did not work, the nurse instead expressed some breast milk by hand to feed to the baby from a syringe. Watching the different measures the nurse took in order to get milk for the baby taught me how difficult breastfeeding can be and changed my previous assumption. 

             When comparing my experience to the literature, I have found many similarities between the obstacles that arose at clinical and barriers stated in the literature. In a study conducted in the United Kingdom, it was expressed that many mothers have difficulty breastfeeding the first few days post-partum (Williamson, Leeming, Lyttle & Johnson, 2012). Mothers stated that some of the main reasons why they could not feed were due to difficulty finding a comfortable feeding position that worked and also the baby’s own disinterest (Williamson et al., 2012). These findings coincide with what I observed and learned about the patient at clinical.

             From this experience and reflection, I have learned that breastfeeding does not always occur naturally and easily to all mothers. I understand that many factors contribute to whether the mother will be able to breastfeed or not. I will no longer assume that all mothers are able to breastfeed on their own. I have also learned that even when a nurse does everything they can to help the mother and the baby, it still does not work sometimes and the situation must be reassessed and other measures must be taken. Additionally, as a nursing student this experience also taught me how perseverance and dedication to the patient is very important. In this situation, the nurse could have stopped helping the mother and tried again later, but instead she continued to use different resources to help the mother and the baby. 

             Moving forward, I feel more prepared to help a mother who is having difficulty breastfeeding her baby. From observing the nurses assist the patient, I have learned different strategies that can be used to try to make breastfeeding easier on the mother and the baby. I will be sensitive towards the mother’s needs when she cannot breastfeed without assistance. I can apply this knowledge to other situations, as I should never enter a situation with previous assumptions. A strategy to enhance my learning is to do more background research and be open to learning new things. 

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November 23, 2014

Nursing is a profession that requires dedication and preparation in order to be successful. You must commit time and effort into the profession if you want to flourish and grow. An event that represents my transition into nursing was preparing for my first midterm at the beginning of October. My first midterm was on October 6th for Introductory Life Sciences. During my preparation for this midterm, I had to use my time wisely and stay focused on what I was doing. I had to make sure that I studied all the material and understood the concepts of the course. I was feeling nervous and anxious, as this was my first time studying for a midterm examination. Also, it was my first time preparing for a test away from home without my parents there to remind me to study, and to make sure that I did not get distracted. I had to be self-disciplined and independent without my usual support system. Additionally, I had four other midterms to prepare for at the same time. This required me to prioritize my time and plan out how much time I was going to spend on each subject. The unfamiliarity of this experience made me feel uncertain and nervous about the results I would receive.   

 

My experience studying for my first midterm corresponds with what is illustrated in the literature. The literature suggests that preparing for an exam is an emotional time since the results are very important to your success in your program (Reeve, Silvia, & Winford, 2014). Emotions such as anxiety, stress, and apprehension are often felt leading up to an exam (Simic & Manenica, 2011). This relates to how I was feeling, as exams are a lot of pressure to succeed, which made me feel anxious. I felt overwhelmed and on edge with everything that I had to accomplish because I wanted to succeed. Furthermore, the literature addresses the aspect of self-regulation since there is no one to track the progress of your studying when you are away at school (Berger & Freund, 2012). This relates to how I was feeling since I did not have my parents to monitor my studying. These similarities show the connection between my own experience and what is demonstrated in the literature.

 

Studying for a midterm was something that was completely new to me, just as nursing is a brand new experience to me. In order to be successful on my midterm, I had to adequately prepare myself by dedicating time to studying. Similarly, by attending Trent, going to all my lectures, completing my assignments and soon taking part in clinical placement, I am preparing myself to become a nurse. To succeed on my midterm, I had to make sure that I understood the concepts relating to the course. This corresponds to my transition into nursing as I am learning the major concepts and theories of nursing in order to increase my chance of success in this profession. Another similarity between preparing for a midterm and my transition is working on multiple tasks at once. I had to prepare for multiple midterms, which required me plan and prioritize my time. This relates to my transition into nursing, as I will often have more than one task to complete at any given time. The skill of prioritizing your time is very important to nursing, as you must balance your time between multiple patients.

 

Additionally, my feelings and emotions associated with preparing for my midterm relate to how I feel about coming into nursing to some extent. Since nursing is so new it me, it can be overwhelming and stressful at times. It is something that I have to adjust to and become more familiar with over time.

This reflection gives me insight into the dedication involved in the transition to becoming a nurse. It is not something that happens immediately, but it is instead a process that takes time, just as preparing for a midterm does. Going forward, I have learned that I must learn to prioritize my time and try to cope with any stress that I am feeling. Some strategies to cope with stress are going for a walk, doing yoga, or reading a book. Additionally, building a new support system is an effective way to relieve stress since it would provide me with companionship. I need to assure myself that if I effectively prepare myself and focus on what I am doing, I can succeed.