Clinical Reflection: National Competency Standards - Essay Example

Clinical Reflection: National Competency Standards Introduction Reflection is the process by which a person evaluates and examines ones own thoughts and actions. Reflective practice is very essential for nursing clinical practice because it helps the nurse to understand, assess and learn through the experiences during clinical practice (Burns and Grove 1997). Infact, reflection is a very important tool for development which challenges the practitioner to think in new ways, raise doubts about effective clinical practice and explore various new methods of solving problems encountered in day-to-day practice. “Reflection gives scope for better understanding of oneself so that existing strengths can be used to build-up for future actions "(Somerville and Keeling, 2004). Every nurse registered under the Australian Nursing and Midwives Council or the ANMC needs to exhibit a certain degree of competency guided by the standard frameworks of competency standards designed by the ANMC (ANMC, 2005). High standards of competence can be maintained by the nurses through appropriate evaluation and examinations of ones own activities and performance, through clinical reflection. There are basically four domains of competency standards in nursing practice. They are professional practice, critical thinking and analysis, provision and coordination of care and collaborative and therapeutic practice (ANMC, 2005). In this essay, clinical reflection pertaining to critical thinking and analysis and provision and coordination of care will be discussed with reference to care of a a patient with diabetic ketoacidosis in an emergency setting. While the domain of critical analysis and thinking refers to "self – appraisal, professional development, and the value of evidence and research for practice" (ANMC, 2005), the domain pertaining to coordination of care deals with "the coordination, organisation and provision of nursing care" (ANMC, 2005). Gibbs model of reflection will be used because the framework is straight forward and includes a cycle of clear description of the clinical situation, analysis of the feelings of the practitioner, evaluation of the actions during the situation, analysis of the various activities and experiences during the situation and a conclusion for lessons in future (Online learning, 2006). Description of the situation During my postings in the accident and emergency department, a 35 year old woman Mrs. X was brought to the emergency unit by her husband Mr.Y with history of fever since 2 days and abdominal pain and vomiting since few hours. The patient complained of easy fatiguibility and tiredness since 5 days. There was no history of cough, cold, rash or loose stools. On further inquiry, the patient revealed that she was urinating several times a day which made her very thirsty. On examination, the patient appeared pale with sunken eyes and dry lips. Skin turgor was decreased, but perfusion was normal. Temperature was normal. Pulses were bounding and the pulse rate was 100 per minute. Respiratory rate was 40 per minute. Blood pressure was 116/80mmHg. Systemic examination revealed normal chest and abdominal findings. Basic spot blood investigations in the emergency room revealed blood sugar of 320mg,dl, which prompted me to perform urine dip stick test. The test revealed 3 plus ketones, 3 plus glucose and mild traces of protein. Spot blood ketones strip revealed ketones of 5.8 mmol/l. Based on these initial examination and findings, I made of diagnosis of diabetic ketoacidosis. The patient appeared very sick and was in moderate dehydration. I wanted the patient to receive immediate care. However, the physician in charge of the emergency unit was busy resuscitating and accident case and could not pay immediate attention to Mrs. X. I did not have much experience in managing diabetic ketoacidosis patients because the condition is more common in children and seldom presents in adults. Based on the knowledge I had, I decided to provide initial rehydration therapy myself. I started an intravenous line, drew samples for complete blood picture, blood culture, serum electrolytes and random blood sugar. I then started the patient on normal saline bolus at 20ml per kg. After initiating rehydration therapy, I called the intensive care unit and informed them about the patient. I also called the chief endocrinologist and sought further advice on management and triage. The intensive care unit and the billing section refused to shift the patient to the intensive care unit without notes from the physician in-charge. I then called the intensive care unit in-charge and explained the crisis situation and sought permission to shift. I shifted the patient to the intensive care unit after completing the bolus and after recording the new vital signs and clinical findings. The physician in-charge of the emergency room came in after an hour by which time the patient already received initial resuscitation and was shifted to the ward. He reviewed my management and mentioned that though I did a good job, initial arterial blood gas analysis, which I forgot to do, played a major role in the management. Feelings Mrs. X was diagnosed with diabetic ketoacidosis or DKA. She was not a known diabetic and this is the first time presentation. DKA is mainly seen in children and since my postings were mainly in adult wards, I did not have much experience in managing DKA patients. I however was aware of the fact that DKA is an emergency and resuscitation needs to be initiated as soon as possible because of the increased risk of death. Reflecting on the situation and my acts, I feel that I have acted in the best interest of the patient. The fact that I made the diagnosis in the emergency room without instructions from my superior made me feel confident about my competency. The tests I made and the initial, but crucial management I provided was guided by the competency domain "critical analysis and thinking" and my coordination with the intensive care unit personnel, billing department and endocrinologist is guided by the domain "provision and coordination of care". Although, initially I was nervous to handle the situation on my own, successful resuscitation and coordination of care boosted my confidence as a nursing clinical practitioner. The casualty medical officer who returned after an hour was in full-praise for my critical thinking and coordination of care. Evaluation DKA is a medical emergency and may be defined as a state of relative or absolute insulin deficiency which is superimposed by hyperglycemia, significant dehydration and derangements in intermediary metabolism leading to acidosis (Rucker, 2006). The condition is diagnosed when blood sugars are above 300mg per/dl, serum bicarbonate is less than 15mEg per liter, pH of arterial blood is less than 7.3 and there is presence of ketone bodies in the serum and blood (Rucker, 2006). Significant dehydration associated with the condition, along with dyselectrolemia and acidosis, contributes to increased morbidity and mortality. Thus immediate attention must be paid for resuscitation. which I did. However, arterial blood gas analysis is an important measure for the amount of acidosis and estimation of serum bicarbonate levels. It also provides important informaton of blood gas status. Initial ECG is also worthwhile doing because it provides an estimate of the potassium status. This is important because, serum potassium levels as determined by tests are usually false (Lamb, 2006). The confidentiality and privacy of the patient was maintained throughout the care. Analysis There was tremendous stress involved in the care of Mrs. X because of the real emergency situation and the fact that no superior was there to supervise. As such nurses play an important role in the management of patients in emergency situations (Nettina, 2006). Their actions have an impact on the morbidity and mortality. According to the ANMC professional code of conduct, "nurses practise in a safe and competent manner." Throughout the care of the patient, I tried to avoid viewing things in an emotional angle and exercised my knowledge and education towards the care of the patient. While providing care towards patients, especially in an emergency setting, nurses are expected to identify problems, conduct research, evaluate activities pertaining to care and seek information from superiors and other colleagues. Coordination of care is very important in an emergency setting. The nurse is expected to determine priorities of nursing care based on initial assessment of the patient and also based on current knowledge. With regards to these matters, I think I have fulfilled by duties as a nurse. Clinical reflection is a core component for critical analysis and thinking and through reflection, quality improvement is possible. According to the ANMC Code of professional conduct, "nurses practise in accordance with the standards of the profession and broader health system." Conclusion The main competency standards which were explored in this reflection are "critical analysis and thinking" and "provision and coordination of care" which have been met with by me. This reflection infers the need to further improve in emergency care. This point was made because initial arterial blood gas analysis was not done which is critical in the management of DKA patients. However, in general, the experience with this particular situation was mainly good and dealing with such a life threatening condition made me a much stronger individual and a more responsible and confident staff person. Infact, this clinical experience instigated for further research and exploration of knowledge which are crucial to maintain high standards of competency in nursing. References Australian Nursing & Midwifery Council or ANMC (2006). National competency standards for the Registered Nurse. Dickson, ACT: ANMC. Retrieved on 12th September, 2010 from http://www.anmc.org.au/docs/Competency_standards_RN.pdf Australian Nursing & Midwifery Council or ANMC (20O8). Code of professional conduct for Nurses in Australia. Dickson, ACT: ANMC. Retrieved on 12th September, 2010 from http://www.anmc.org.au/docs/ Burns, N., and Grove, S. K.. (1997). The Practice of Nursing Research: Conduct, Critique and Utilisation, 3rd ed.. Philadelphia: W. B. Saunders Co. Lamb, W.H., 2006. Diabetic Ketoacidosis. eMedicine from WebMD. Retrieved on 12th September, 2010 from http://www.emedicine.com/ped/topic582.htm Somerville, D. and Keeling, J. (2004). A practical approach to promote reflective practice within nursing. Nursingtimes.net, 100(12), p.42. Retrieved on 12th September, 2010 from http://www.nursingtimes.net/nursing-practice-clinical-research/a-practical-approach-to-promote-reflective-practice-within-nursing/204502.article Nettina, S.M., 2006. Diabetes and related disorders. Lippincott Manual of Nursing Practice.,8th edn. Philadelphia: Kipincott Williams and Wilkins. Reflective Practice. Online learning and teaching. Retrieved on 12th September, 2010 from https://olt.qut.edu.au/it/REFLECT/gen/index.cfm?fa=displayPage&rNum=1663211 Rucker, D.W. (2006). Diabetic Ketoacidosis. eMedicine from webMD. Retrieved on 12th September, 2010 from http://www.emedicine.com/emerg/topic135.htm Read More