Reflective Journal of Clinical Experience - Essay Example

Reflective journal of clinical experience BY YOU YOUR ACADEMIC ORGANISATION HERE HERE HERE Reflective journal of clinical experience Description of experience During the course of my clinical placement, I encountered a patient, a middle aged man who had diagnosis of obstructive apnoeasresp arrest and a permanent trachea. As per the handover my patient was ambulating with 4WF *1 and was on pureed diet thick fluids feed. The nursing care required Suctioning Trachea Care, Oral Abs, IV Timentin QID. Patient assessment: Before beginning any care I ensured that the suctioning and oxygen is working, nebuliser equipment, suction and suction catheters, CPR equipment was on bedside. I looked for signs of hypoxia, infection and pain while establishing a quality rapport. I then checked out the trachea tube, any tubing and equipment connected to it, and the stoma site. I observed for redness, drainage and bleeding at the stoma site, then listened to breathing sounds with a stethoscope; and monitored O2 saturation level. These were the tangible treatment activities undertaken when assessing the patient’s condition. However, outside of the tangible activity being performed, issues of holistic patient care had to be considered in order to provide a more emotion-focused series of outcomes for the patient. Holistic patient care “is based on the idea that there should be a balance between body, mind and spirit” (Ellis and Narayanasamy, 2009, p.886). At the same time, having never performed this procedure before, there were personal issues with self-confidence about performing the tracheotomy for the first time. I realized during this patient intervention that my own performance and ability to project confidence would give the patient more confidence and trust in my ability to successfully complete the task of health care. Prior to approaching the patient at the interpersonal level, I had to become visibly-composed and provide body language which suggests that I am familiar with the procedure and am confident about its successful delivery. Patients who are undergoing complex treatment in an unfamiliar hospital environment are likely to have a wide variety of negative emotional adjustment issues, therefore nursing competence as a practice goal brought this patient better holistic care. I realized that if I had conducted the tracheotomy without careful analysis of my internal emotional condition, the patient could have picked up on many non-verbal cues and realised that his caregiver was mildly concerned about their own ability to successfully complete the procedure independently. Nursing competence and the outward reflection of personal competence and task mastery gave the patient a more relaxed and less-anxious experience during this patient intervention. This situation caused me to reflect on the viewpoint of several nursing experts who offer that “nurses have the moral responsibility to facilitate self-care, renewal and healing…to foster caring and trusting relationships” (Turkel and Ray, 2004, p.249). Personal emotions and patient considerations Helping patients with personal hygiene shows nurses have time for them and helps build up trust and aids the nurse-patient therapeutic relationship far more than countless drug rounds” (Bowers, 2009, p.9). This was one of the primary thoughts I experienced when approaching the patient initially, realising that hygiene and showering of the patient would be included in this particular patient intervention. The patient was already giving obvious non-verbal cues that he was anxious and frustrated with his physical condition in relation to being unable to speak and being forced to rely dependently on nursing expertise to expedite the healing process. When first considering the potential delivery of the holistic experience, reinforcing that I, as the practicing nurse, understood the emotional complications of dependency in patient hygiene created this instant connection. Patient approval of my reinforcement of discretion and understanding seemed to give the patient much more satisfaction at the emotional level. Patients also tend to appreciate when nurses and other medical staff get directly to the point of their condition and clearly explain a particular procedure and the potential health risks associated. Experts in health care delivery often forget that patients can be much more resilient than expected and handle the tangible truths of their health condition so long as the patient trusts the caregiver and the source of the information. This patient had a difficult patient history and was exposed to many different emotionally-difficult procedures during the course of total subscribed treatment. As yet another caregiver approaching the patient with new procedures and health examinations, I realised my role in holistic patient care was to build trust in my professionalism and in giving step-by-step procedural and risks breakdowns to alleviate these patient concerns. The goal of this activity was to make the patient trust in the knowledge of the organizational staff and the quality of support given. “A holistic nurse is non-judgmental and is with the patient in true presence. It is not an intellectual, know-it-all way of being that is always stiff and bound by rules” (Wu, 2008, p.5). This medical procedure required strict compliance to medical protocols regarding the process, all of which were considered and followed in order to ensure minimal risks to the patient. However, through my personal experiences with this patient and his interpersonal relationships with visiting family members, I observed that humour was commonplace in how members of this family hierarchy communicated to one another. Though with some patients, humour at a time when procedures are being performed which can further complicate emotional stability in the patient, I felt that using moderate humour during this intervention would appeal to his sociological needs and bridge any gaps the patient might feel about the support quality of his nurse. The patient’s wife and daughter were present during much of the procedure and the entire intervention and made special efforts to express their gratitude for the high quality of nursing competence given to the patient. I felt this was a tremendous accomplishment considering the difficult emotional history this patient had faced during his entire treatment programme. Self-assessment and improvements required “Meeting family needs can be challenging for staff nurses already overwhelmed with escalating patient acuity and ever-increasing technical and documentation burdens” (Nelson and Polst, 2008, p.110). Had the more holistic outcomes on patient care not been considered, such as the patient’s emotional history and his close interpersonal relationship with family members, the quality of the intervention could have been radically reduced. This patient clearly relied on his family support network and as a nurse dedicated to improving holistic patient care, involving family through innovative interactive discussions gave the patient a much more relaxed composure. It is very easy, when burdened by administrative obligations, to dismiss family members as an environmental distraction and hastily excuse members while the patient is being observed or a procedure being undertaken. However, long-term the family is integral in some patient’s recovery process and emotional healing, therefore I wanted to ensure they were included in a way that was meaningful to the patient at the cultural level. “It has been proven that mental stimulation improves a patient’s emotional state and recovery time” (Lee, 2005, p.2). When reflecting on the quality of this patient intervention, I realised that I could have given the patient more opportunities to ask questions about the procedure and their perceived role in treatment delivery. Even though limited in speech by the inserted tube, the patient was clearly animated non-verbally, showing he was interested and intelligent and wanted to be interactive during the procedure. I do not believe that I did enough during this intervention to mentally stimulate the patient and would incorporate this aspect in future interventions when the patient illustrates a strong desire to be more involved. Understanding the importance of family and trying to incorporate them as much as possible during this procedure and patient assessment was a key strength to my holistic strategy. Observing the interpersonal dimensions of patient and family members can quickly paint a cultural view of the family structure, from areas of spirituality to individualism versus collectivism. A nurse well-versed in holistic patient care understands culturalism and performs extended research into what drives the family dynamic in different social groups and works to use these principles when conducting face-to-face, interpersonal discussions. Being a constant observer of patient social needs in areas of belonging, self-esteem and even security are key strengths in my holistic approach and I believe that recognising these factors built a stronger trust in the patience in my personal competence as a nurse. Conclusion and reflection Clearly, the therapeutic benefits to the patient included a reduction in anxiety and frustration, improved confidence in the ability of the medical staff to perform their obligations related to the patient, and increased self-confidence coming from a nurse who recognised the difficult emotions surrounding dependency on the caregiver. My personal discretion regarding patient hygiene was clearly appreciated by the patient, generated by positive body language and other non-verbal cues, creating an instant emotional connection between nurse and patient. Through this scenario, I learned to trust my instincts when it comes to monitoring patient socialisation needs and also to trust myself in my own competence in performing patient-related treatment procedures. Exhibiting an air of confidence and self-knowledge is part of holistic patient care and very much seems to be part of breaking down potential barriers between nurse and patient. References Bowers, Ben. 2009. Students must not underestimate the value of giving personal care, Nursing Times, London. 105(43), p.9. Ellis, H. and Narayanasamy, A. 2009. An investigation into the role of spirituality in nursing, British Journal of Nursing, London. 18(14), p.886. Lee, C.R. 2005. The arts in healthcare: Past, present and future plans for the integration of the arts within medical facilities and treatment practices. University of Southern California, Dissertation. Viewed 18 Nov 2009 at www.proquest.com. Nelson, D. and Polst, G. 2008. An Interdisciplinary Team Approach to Evidence-Based Improvement in Family-Centered Care, Critical Care Nursing Quarterly, Frederick. 31(2), p.110. Turkel, M. and Ray, M. 2004. Creating a caring practice environment through self-renewal, Nursing Administration Quarterly, Frederick. 28(4), p.249. Wu, S.X. 2008. My Nursing Philosophy as Viewed Through Nursings Metaparadigm, Illuminations, Cobourg. 17(2), pp.5-8. Read More