Reflection on Medical Practice - Essay Example

This is a reflective essay based on a situation encountered during my duty at the pediatric ward of a public hospital. In order that I could use this situation for my reflection and for confidentiality purposes, the patient will be referred to as “Patient X” and the staff nurse as “Nurse X”. According to Monash University scholars, critical incident is often an event which makes one stop and thinks over what happened. It has a significant impact on a professional that eventually creates a positive perspective toward the achievement of a goal. This reflective practice is associated with learning from experience, and is associated with the improvement of the quality of care, stimulating personal and professional growth and closing the gap between theory and practice. To facilitate me with my reflection, I have chosen GIBBS model 1988. This is a clear-cut approach wherein one can easily put into words the clinical experience that has been learned. It starts with the description of the incident, followed by the feelings, evaluation, analysis, conclusion and action plan. Discussion includes the importance of proper administration of medication and how it has touched me in order to grow personally and professionally. The first stage of Gibbs 1998 model of reflection is the description of events. It was one of those busy days of the hospital. I could not forget my first day of 11pm to 7am duty at the pediatric ward of that public hospital we were affiliated to. My classmates and I were asked by the chief nurse to observe a staff on how to administer medications to the patients. I was very excited about the task that I did not even want to miss a single minute. When it was time for us to proceed to the children’s rooms, I whispered a little prayer and grabbed my small notebook in case the nurse would do some lectures as the procedures were done. We were five in our group and most of us were tired because of the previous lectures we had during the day, but still managed to stay focused on the task. Nurse X went on with the administration of the medications. Then we reached the last patient of the ward, which was Patient X’s room. I was very eager to know the rationale of giving antibiotics to Patient X who was just one-month old at that time. He had staphylococcal infection on the right forearm which was full of pus. Due to mere curiosity, I asked Nurse X what antibiotic in particular she just introduced at the intravenous line of Patient X. She glanced at me with surprise, not expecting my question. She was speechless for a moment and then excused herself gracefully and did not answer my question. She ignored me as if she did not hear anything. Instead, she just said that the activity was through and that we could go back to the student’s area. My classmates looked at me with questioning stares but I just shrugged my shoulder. I, too, was not sure why Nurse X did not even say a word. I just noticed the frown on the patient’s mother who was then nursing him. Sure enough we headed on to our area. Not long after, each of us was given a break. I was on my way to the comfort room when instinctively I got a look at the nurse’s station. There was Nurse X with that sad look on her face while browsing over the medical records of the patients. I am now approaching the second stage of Gibbs model of reflection, which requires my thoughts and feelings about the incident. I was aware of that big negligent act of Nurse X and that look of apprehension seen on Patient X’s mother. I knew that one of the most basic skills that a nurse should master is the proper administration of drugs. No wonder why this has always been included in our curriculum as a nursing student. That was the reason why I got very interested in asking questions that night. I thought that it was also the best time for me to learn especially in the clinical setting. This left a significant mark on me because just early that day, we had a return demonstration quiz to one of our clinical instructors about the proper way of giving bedside medications to patients. I was taken aback with the fact that even skilled and knowledgeable nurses could commit a negligent act as that. I felt really bad the sight of the baby suffering from the infection, but even more bothered by the fact that nurses like Nurse X sometimes fail to take a good look at the medical records of the patients before they apply what they need to. Suddenly I was questioning the integrity of the nursing process. I was thinking that if nurses, as experienced as they are, would commit the same mistake, will there be people left to trust us? We will all become sick and be lying on a hospital bed, too. Who would want to hire a nurse that will introduce something on your body without knowing what he has done to you? Evaluation is the third stage of Gibbs 1998 model of reflection and this asks the reflector to state what was good and bad about the event. I knew that nursing is basically the care for others and that the major role of a nurse is to provide knowledge-based care that is aimed at helping others reach maximum health and quality of life (Taylor, 2005). Our school clinical instructors taught us that we must treat patients with concern and pure dedication so that we would gain their trust, as stated by the NMC code of conduct. Because of this, I would always review in mind what is to be done before actually seeing the patients and treating them with our instruments, gadgets or machines. Taylor (2005) even added that clinical ethics is literally concerned with ethical problems “at the bedside”, that is ethical concerns that arise within the context of caring for actual patients, wherever they are found, and a violation of this would mean negligence, which is an act that a reasonably prudent person under similar circumstances would not do, or failing to perform an act that a reasonably prudent person under similar circumstances would do. Nurse X surely knew about all these, but still did not adhere to what should be done. Moreover, the staff nurses were aware that student nurses were affiliating in the hospital where they work for us to learn more about practice, instead of just the usual theories studied within the four corners of the room. This meant treating on the outside and real world out there. That was why they would expect us to be asking a lot of questions that were new to our ears. This was also a part of their work as a staff nurse, to educate and orient us about what is practiced clinically. This holds true when Win Tadd said that one of the coordinating tasks of nurses is to design and implement individual nursing care plans. No matter how toxic a nurse could be, he or she must always conform to what is expected of her to do. It is a profession and a job at the same time. Stage four of Gibbs reflection is the analysis which requires one to make sense of the situation. Medication administration is a basic nursing function that involves skillful technique and consideration of the patient’s development and safety. The nurse administering medications needs a knowledge base about drugs, including drug names, preparations, classifications, adverse effects, and physiologic factors that affect drug action (Taylor, 2005). The patient, or the significant others may not know what was going on; but still nurses should do their tasks the best way that they can. According to Barbara Cherry, the most useful tool for the morally professional nurse is a set of principles or standards based on ethical actions. I did not know what went wrong with Nurse X that there was a time or times during her practice that made her forget her duties and responsibilities. I would not say that she might have done mistakes in the past but this incident crystal-clearly proved her wrong. It was a misconduct that needs to be corrected if we were to follow strictly our code of ethics. She might had problems that hindered her from committing to the dictates of her job, but Masters, Kathleen says prevention of any negligent act requires learning how to manage stress and still adhere to the current standards of care. Through evaluation of this event, I have become aware that in order to treat a patient well, it is but important to always hold fast to the promise of the nursing profession which is to serve patients and clients with utmost care so that they will reach their optimum health (Taylor). Provision of proper medications is tantamount to giving injections and vaccinations. This skill entails a lot of practice, but it is also important to know the rationale of what you are doing to the patients. Personally, this experience has taught me on how to turn out to be more responsible over my actions, that is, to always consider putting yourself into other’s shoes. Professionally, this incident made me realize that even experienced and skilled nurses do commit mistakes intentionally or unintentionally. A tough job like ours requires several duties and responsibilities that we need to meet. No wonder it is a very challenging profession. Furthermore, I have learned that in order to be effective and efficient, we should always have presence of mind and be active always, for we are not just dealing with any thing, but the most important being God has created, the human beings. And just like our patients, we too, most likely, want to have someone to treat us with utmost care and concern. I now move on to the fifth stage which is the conclusion. I am aware that although sometimes we cannot make it sure that we will not commit a mistake in our profession because there’s always a room for our improvement, we can always be cautious and take extra precautions in order for us to give the care patients we need from us. Reading and understanding the medical charts of patients once in a while, especially before treating is a major step to prevent a mistake. This will keep us more updated and will eventually cause us to really become a part of the integrated and holistic approach toward the patient’s recovery. My future practice will always go back to this experience where I have gained personal and professional growth- never to administer medications without fully understanding and memorizing well the procedure. Within my action plan is to research further on the other aspects of nursing care for me to become more sensitive towards attaining my clinical goals. I know I still have a lot of things to be more familiar with my chosen field of endeavor, but I believe I still have ample time to gather and absorb all the theoretical and clinical knowledge that I need to in order for me to become a fully responsible, mature and competent nurse. This incident opened my perspective to the world of critically analyzing practices in the hospitals and clinics which I will be able to use should the circumstances allow them to happen again. I am planning to talk to my clinical instructors more about efficient note taking, as well. In conclusion, my ability to reflect on certain situations like this has been enhanced. By utilizing the reflection model of Gibbs, I have learned how to put into writing my feelings and thoughts about a vital clinical experience that will be of great importance throughout the wise practice of my profession. Moreover, as a student nurse, I have attained a sense of maturity with regard to providing treatment to my present and future patients. Knowing this gives me security and the drive to achieve more and further develop my clinical skills. Resources: CALT Learning Support. ‘Language and Learning Online’.Monash University. February 21, 2007.www.monash.edu.au/lls/llonline/writing/medicine/reflective/5.xml Cherry, Barbara and Susan Jacob. Contemporary Nursing; Issues, Trends, and Management. 2nd edition. Missouri: Cosby Inc.,2002 Masters, Kathleen. Role Development in Professional Nursing Practice. Jones and Barlett Publishers: Canada, 2005 Tadd, Winn. Ethical and Professional Issues in Nursing. Palgrave MacMillan: New Y, 2004. Taylor, Carol, Carol Lillis, Priscilla Lemone. Fundamentals of Nursing. The Art and Science of Nursing Care. 5th ed. Lippincott: New York.2005 Read More