Reflective Nursing Practice: Learning From Care Incidents, An Essay.

Reflection One

The activity that has been chosen from the first year of my practice is the incident when I escorted a patient for the electroconvulsive therapy (ECT) session. The staff nurses were there to support the patient alongside me. I had played the supportive role of helping the nursing staff properly provide the ECT intervention and helping the patient relax after the ECT session. I provided the patient with a tea and biscuit after the end of the intervention so that the patient feels relaxed.

From the ECT session, I learned the process by which the ECT process is carried out, how the intravenous injections are used in the ECT process, the manner in which the electric shock works, the moment of convulsion and unconsciousness. I also witnessed how the patient’s respect, dignity, and privacy of the patient is preserved. Additionally, I was able to understand the steps of the ECT process as the doctor verbally explained the same to me through a stepwise demonstration.

This experience helped me understand and incorporate the techniques like repeatedly checking the patient’s vital signs every time 15 minutes the patient is awake on four occasions.  This incident helped me enhance my professional skills in preserving patient safety, equality, and dignity (Poorchangizi et al. 2019).

On one clinical occasion, I was attending a 45-year-old British patient with the diagnosis of schizoaffective disorder. She had been diagnosed with Bipolar Affective Disorder in her twenties. `She had a long history of challenging behaviour. As she had a history of illicit drug abuse. Therefore, there are a number of risk factors associated with her (Archibald et al. 2019). I collaborated with the patient in developing an intervention plan for her. Furthermore, my role was to prompt her for her medications and ensured that she complied with the intervention. I checked her vital signs, physical health needs like food and fluid needs, monitored her bowel movement and did her urine test, and analyzed the urine test report. Additionally, I monitored medicine impacts and their side effects (Ielapi et al. 2020).

Through this clinical experience, I learned techniques to offer advocacy to the patient, reminding her of the medicines, and providing information about medicines.      I could learn and sharpen my collaborative skills through patient management.

It is relevant to the code of collaborative care to ensure patient safety and positive outcomes in the patient. This experience helped me exercise the code of promoting patient empowerment and trust by advocating and encouraging the patient to take care of herself (Nmc.org.uk. 2019).

Reflection Two

I was attending a female patient who was diagnosed with schizoaffective disorder with a co-morbidity of type 2 diabetes. The patient was on antipsychotic medication, metformin, NoVo-rapid pen, and insulin injection, alongside her antipsychotic medication (Archibald et al. 2020)

I regularly monitored her blood-sugar levels by using a glucometer. I reported the same to the other nursing staff including the nurse manager about the results in the electro e-observation and also developed a handover according to the result through which I directed the nursing students about the focus area of care for the patient. I ensured offering the patient her daily meals, created a healthy diet excluding excessive sugar and fizzy drinks. I encouraged the patient to comply with the prescribed medicine and the healthy diet by focusing on the positive outcomes of compliance.

Through this experience, I learned advocacy skills, skills to transfer care, and techniques to develop a handover and effectively communicate the care needs of the patient to the other members of the multidisciplinary team.

Through this experience, I was able to enhance my collaborative and communicative skills through handover creation.

The code of conduct that I exercised through this experience is the maintenance of patient safety and prioritizing the needs of the patient through the administration of a healthy diet to modulate diabetes (Nmc.org.uk. 2019).

To ensure that I maintain patient confidentiality, I always remember to work in accordance with to trust policy on patient confidentiality (Data Protection Act). This act states that every nurse should keep the patient’s record intact in the EPJS and not disclose the personal information related to the patient to any third person without the consent of the patient. Additionally. I made sure that the privacy screening system is covering the computer screens according to the Care Quality Commission recommendations. I ensured to log out of the computer, without exposing or sharing the passwords with a third party. I have never discussed patient issues or posted patients’ details on social media.

Through this experience, I understand the importance of patient privacy, choice, and wishes regarding personal information and treatment intervention.

The code of conduct that I could exercise and enhance through this experience was the importance of patient choice, wishes regarding personal information, and treatment intervention. I have learned the skill of destroying documents that are no more in use.

Through this experience, I learned the importance of working closely with other team members and supervising them to implement professional skills in order to practice effectively (Driscoll et al. 2019).

Reflection Three

Through this clinical practice, I preserved the right of the patient to freedom of choice. 

In another experience, I learned the importance of the use of communicative skills in supervising clinical nursing staff and working under the supervision of the nursing manager to engage in therapeutic conversation and gaining consent from the patient in order to reduce anxiety, confusion and promote the ethics of informed consent (Pebriyana 2018).

Through this experience, I learned how to assess, address and treat patients by prioritising  the patients at all costs. On return to the ward after the assessment and the report of the assessment is evaluated, I learned to reassure the patient and the patient family to emotionally and psychologically support the patient.

I will implement the skills of writing a discharge letter that I learned from the senior nurses and emotionally supporting the patient’s family.

The code of conduct that I exercised in this clinical practice is the establishment of a strong and understanding therapeutic relationship that promotes the right to be respected, supported, and empowered in healthcare settings (Gee 2022). 

Introduction

Reflective activities are an essentially transformative and pivotal part of efficient nursing practice. For professional development and the development of one’s leadership skills (Stanley and Stanley 2018), increasing the personal and professional resilience, understanding the gaps in one’s practice, and evaluation of one’s role and position in the multidisciplinary team (Bagheri et al. 2019). This essay is aimed at outlining one of the care incidents that I experienced in my final year and critically reflecting on the same based on the five essential learning outcomes that I have achieved through the care incident (Sensmeier et al. 2019). The reflective essay will conclude with a summary of the learning achieved and an action plan for future development. The action plan will incorporate all five learning outcomes. Gibbs’s reflective cycle will be used for completing the reflective activity. Gibb’s reflective cycle consists of five steps; they are description feelings, evaluation, and conclusion and action plan.

Discussion

The six stages that are used in Gibb’s reflective cycle are description, feelings, evaluation, analysis, conclusion, and action plan. The first five stages of Gibb’s reflective cycle would be clubbed together whereas the action plan will be developed separately. The five stages of the reflective cycle is described below (Adeani et al. 2020)

Description

In the last year of my practice, during my placement on the ward, I demonstrated knowledge and have practiced how to prepare the medication room before the medication administration process began. This process of learning involved me in the administration of prescribed medicines to the patients. In the preparation of the medicine room, it is essential for me to demonstrate and possess the ability to assess and identify risks related to errors of administering the wrong medicines to the wrong person in order to remove hazards and risks from the room, hence, ensuring the health and safety of the room environment (Jin et al. 2018). I maintained the room environment by calibrating the blood glucose monitoring machine (glucometer) and if the readings on the glucometer are documented correctly or not. I also check and recheck several times every 1 hour the room temperature and temperature of the fridge according to the organizational guidelines and policies (Koyama et al. 2020). The recordings of the fridge temperature and room temperature are documented by me according to the SLAM policy per shift basis.

Reflection Four

I also check whether the medicine labels are updated or not, along the way I certify that the medical equipment is intact and serial numbers on the medicine are embedded appropriately.

Furthermore, I ensure that the suction machine used in the nursing setting is working when switched on and full oxygen cylinder is at the right location by the green bag. In essence, I make sure all my checks are recorded in the appropriate sheet. I proceeded by ensuring that all patient medication charts are complete in the medication folder, signed by the responsible clinician and pharmacist. I ensure that I wash my hands following seven steps of hand washing to prevent medication contaminations. Under the supervision of my clinical supervisor, learned how to dish medication into the medication pot and hand it over to the patient by ensuring medication compliance, practicing, and putting into consideration the patient’s ten rights of medication administration. I have an adequate understanding of the locations of patient medication in the trolley, stored cupboards, control drugs, stock, and other patient personal medications. I learned how to give information to the patient about their medications should in-case the patient needs them. Also, I have acquired knowledge by familiarizing myself with the names, doses, and side effects of certain antipsychotic medications.

Feelings

As recording and documentation of the medicine maintenance and management are very crucial tasks, which basically form the foundation for the safe and secure administration of medicines to patients. I feel that my task plays a pivotal role in the establishment of patient safety, catalysing the process of patient safety, management, and positive patient outcomes. When I ensure the efficacy of the glucometer and document the temperature of the fridge in which the medicines are stored, feel both a sense of pride and a rush of anxiety as this task is essentially a huge responsibility on me. Sometimes, I am an issue trusting in my own ability to ensure that the machines and medicines are stored in the fridge. Therefore, I often engage in checking and rechecking actions to ensure that I am correct in determining the efficacy of the medicines that are stored. Oftentimes, I apprehend the worst outcomes of me making a mistake in determining the efficiency of the medicines. I ask myself, what if I level the medicines wrong? What if my documentation of the mistakes is wrong? These questions significantly decrease my self-confidence but I self-advice that the lack of self-confidence will increase the chances of committing mistakes in the responsibility I am entrusted with (Bolcato et al. 2019). The responsibility of the patient’s safety and chances of errors in medication administration is highly dependent on my ability to ensure that the medicines are labelled and documented correctly which if not ensured and promoted will cause a huge lot of guilt, shame, and professional ambivalence in me.

Reflection Five

Evaluation

The experience of taking care of the medicine room by documenting, determining, and managing the medicines that are administrated to the patients on a daily basis is both a work of pride and pressure. Every time I go to the medicine room, I feel a sense of power and control over my professional role. However, as soon as I start checking the medicines’ serial numbers, I am overcome with a subtle fear and anxiety that if I miss any digit in the serial number or mark the wrong medicine, I will be to blame for the side effects of the use of wrong medicine or outdated medicines. The safety of the patients is highly dependent on the administration of the correct medicine. The serial number categorization also assists the healthcare professionals to get access to the medicines as immediately as possible. The best part of being in medicine management is the feeling of being in a highly respectable position and healthcare, based on which the entire healthcare organization is dependent. The patient outcomes, patient satisfaction, safety, security, and healthcare organization’s ability to reduce patient readmission. These factors play a huge role in retaining the reputation of the healthcare organization and the health and wellbeing of the patients.

Analysis

The lack of confidence that I experience in the medicine management role might steam from the fact that my knowledge about medicine management is restricted and there is a provision to make improvements in this area of my professional endeavor (Yeoh et al. 2021). I believe that the best way to improve my confidence will be to interact with senior nurses and nursing managers, supervisors, and qualified nurses to gain knowledge about ways to improve my medicine management skills. The lack of confidence can manifest itself through a self-fulfilling prophecy and actually cause errors in my efficiency determination.  My metacognition plays a vital role in the understanding and recognition of one’s ability to perform effectively in any professional task that I am allocated (Jin and Ji 2021). For doing the same, I will require to improve my confidence in my ability to maintain the medicine (Bektas et al. 2019). Often times new medicines are added to the collection depending on the new patients who are admitted to the hospital. My anxiety increases in such a context as I believe that there are conflicting and inconsistent manners in which these medicines are managed in healthcare settings (Rhodes 2019).

Final Reflection

To ensure that I do not commit any mistake that can jeopardize my professional role and position alongside the health and safety of the patients, `I will have to improve my medicine management skills. Indirectly for the same, I will also have to ensure that I use appropriate communication, leadership, and supervising skills to entrust other colleagues and fellow student nurses to manage the medicine in my absence. For the same, I have been able to supervise the student nurses to manage the medicine room when I am absent. I provided formal training to the student nurses about the SLAM policy that ensures that the medicine management is followed by using the customer service policies that ensure consumer safety and health (Tsimane and Downing 2020). In the process, I learned ways to collaborate in a supported yet professional manner in engaging with the other professional members of the care team. Through this experience of medicine management, I have been able to understand the roles and responsibilities of the other members of the team in ensuring the safety of the patients by keeping the knowledge of medicine management to ensure that the correct medicines are administered and the medicines are stored and categorized in an appropriate manner. In this context, I have recognized the role of pharmacists in the safe management of medicines. For the same, the student nurses and my colleagues should be able to set a routine for every patient and be aware of the new medicines that are included in the medicine list. The nurses should remain well informed about each medicines’ side effects, drug interactions and its impacts on the health of the patients. The main aim of every healthcare organisation is to optimise heath outcomes for the patients, reduce patient readmissions and accidental deaths in patients. To ensure that I play my role effectively as a part of the collaborative team to ensure the aforementioned outcomes.

Action plan

The action plan will be constructed in the form of a SMART goal which stands for a goal that is Specific, measurable, achievable, relevant and time bound (Bagheri et al. 2019):

Specific –

The specific goal that I aim to achieve is to increase my knowledge of ethical and organisational guidelines that inform the medicine management process ( Bolcato et al. 2019) his is my specific goal as this will help me increase my self confidence and reduce my chances of errors in the medicine tracking processes.

Discussion

Measurable –

This goal is measurable as the success of my medicine management can be assessed and evaluated by documenting the number of errors that occurred, number of negative incidents with new drug interactions and incidents of medicine side effects. The number of medicine error cases, adverse impacts of drug interactions and adverse side effects cases will be documented six months before the intervention and six months after the intervention and the scores will be compared. By developing a power point presentation on the NMC code of conduct, I will evaluate my knowledge  of the NMC medicine management ethics and principles. I will acquire feedbacks of my senior colleagues, my manager, supervisor and fellow colleagues to provide feedback on my ability to teach them back the medicine  management relevant NMC guidelines.

Based on the feedback, the specific goal and intervention will be modified.

Achievable –

The goal developed is achievable by accessing the NMC guidelines of medicine management in United Kingdom and other peer reviewed articles on medicine management strategies and techniques. I will seek the advice of my senior colleagues on tips to improve my self-confidence in professional settings (Driscoll et al. 2019). I will discuss with them about other supporting policies that inform the medicine management procedure in the UK. I will also use relaxing and meditative techniques to reduce mental noise that might interfere with my ability to perform effectively in professional setting (Burgstahler et al. 2020). I will discuss my issues of self  confidence with social skill trainer who can suggest me strategies to deal with my low self confidence. Additionally, the goal is achievable by practicing relaxing techniques and yoga to manage my anxiety issues.

Relevant –

The goal is relevant as my level of knowledge about the techniques of medicine management will improve my self confidence and use of meditative techniques and yoga will improve my anxiety issues.

Time frame – The goal will be achieved within six months.

Conclusion

In nursing care, reflective process is very essential and the reflection helped me gain essential idea about my professional practice and provided me the opportunity to improve my weaknesses and build on my strengths.

I created an action plan that helped me achieve my goals of improving my medicine management skills by improving relevant knowledge and self confidence.

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