My Clinical Experiences at the Acute Rehabilitation Ward in Canberra Hospital - Assignment Example

Clinical Reasoning Assessment Name: Course: Tutor: Date: Clinical Reasoning Assessment Introduction Acute rehabilitation is a treatment method applied on patients in an effort to help them regain their psychological, physical, social and emotional well being (ACT Health, 2010). The purpose of this is to rehabilitate patients into persons who are independent, thereby making them capable of living normal and fulfilled lives after a medical condition. In this case study, I shed light into my clinical experiences at the Acute Rehabilitation Ward in Canberra Hospital. I also expound on the care the registered nurse (RN) and I provided for a particular patient using a clinical reasoning cycle. Clinical reflection exercise at the Acute Rehabilitation Ward in Canberra Hospital In my voluntary work at the Acute Rehabilitation Ward in Canberra Hospital, I had a chance to use the clinical reasoning reflection cycle that is synonymous with the nursing profession. The clinical reasoning reflection cycle is a process that when dissected ensures that health professionals are able to give their clients the desired attention in regard to their health concerns. According to Turner et al (1999, p. 87-88), referrals top the reflection cycle followed by information gathering and analysis. This is followed by the definition of the problem in regard to clinical reasoning after which the health care professional determines the priorities at hand. The next step is planning and preparing for intervention, which is followed soon after by the implementation of the intervention. If the implementation process is successful, the health care professional proceeds to evaluating the outcomes of the clinical reasoning reflection cycle. If the implementation was not successful, the health professional goes ahead to refer the client to another professional. Those that have responded well to the treatment are discharged and the same happens to all clients who seek these services (p.87). In my line of duty at the Canberra Acute Rehabilitation Ward, I came across a client, Roselyn, who had suffered a stroke. Using the clinical reasoning process and under the watchful eye of the RN, I was able to take care of her. The first step into the process was considering Roselyn’s situation and by doing so, I was able to list the facts about her condition. According to Wedro (1996, p.1), stroke refers to the disruption of blood flow to the brain and this results in the death of brain cells. In Roselyn’s case, her stroke was caused by a blocked artery due to an earlier experience she had had with high blood pressure (hypertension). I was also able to review her current information and that is what highlighted on her hypertension through the assessments that had been earlier. To further confirm this, we ran more tests on her and these confirmed what we had established earlier. This process also involved us asking Roselyn questions about her general health and this helped further to shed light on her current and former situation. After this, we were able to process the information through data interpretation and this helped us to further understand our client’s symptoms. We were finally able to identify our client’s health problems through the synthesis of the facts we had gathered. From here, we were better placed to establish the goals we had for our client in order to get a desired outcome. The next step was to take action from the available alternatives in the treatment of stroke. After effecting the rehabilitation process, we were able to conduct an evaluation to measure how effective the remedies we had employed were on our client as highlighted by Ellis and Kenworthy (2003). This was followed by a reflection on the process, which also acted as an eye-opener as we assessed the various things we could have done differently in such a scenario. The good thing was that our client responded well to the rehabilitation and was able to get her life back as we are just about to witness. Discussion on the care I provided for my client Bates (2005, p.1) in the journal touching on management of adult stroke rehabilitation gives us a sneak preview on the severity of stroke. According to various research studies, stroke is among the leading causes of death in the world today. Many of the stroke patients suffer from functional impairment and a bunch of them become severely disabled. Rehabilitation interventions feature strongly here since they can break or make the situation. They are the backbone of the recovery process and early implementation of the recovery process can minimise the disability effects on the client. Clinical outcomes ought to be functional if the clients are to regain their wellbeing and be able to perform their daily activities with ease. In this scenario, our primary goal was to ensure that our client, Roslyn, stayed clear of recurrent stroke complications and managed her comorbidities. Carter (2008, p.1) states that stroke patients are at a risk of cerebrovascular events and that is why rehabilitation must revolve around reducing these risk factors. The care we provided Roselyn included ensuring that her blood pressure levels were regulated as failure to do so would have worsened the condition and even led to a recurrent stroke. The fundamentals for rehabilitation nursing according to Hoeman (2010) revolve around communication, hygiene, mobility and urinary and bowel elimination. In this scenario, we are going to look at hygiene routine care and practices that I took for our client Roselyn in aid of her recovery from stroke. In my experience at the Acute Rehabilitation Ward in Canberra Hospital, I indulged in acute care for Roselyn who had suffered a stroke. She was unable to take care of her basic daily activities such as dressing, bathing, and eating. She was also unable to attend to her urine and bowel movements as she could not move the right side of her body. She was also unable to perform personal care that included oral hygiene among others. It was challenging but with the training and guidance from my RN, I was able to accomplish the care plan. Brady (2007, p. 1) focuses on people with stroke and their oral care. Stroke patients are not only physically weak but also poor in coordination and this inhibits their mobility, making them unable to take care of their oral hygiene. They also suffer from cognitive problems and this calls for assisted care from nurses to help them lead an almost normal life. Some of the main symptoms of poor oral care in stroke patients include a dry mouth, stomatitis and oral ulcers which all impact negatively on oral health. To help our client, we took her through oral hygiene which involved helping her brush her teeth after every meal and ensuring that she was checked by a dentist regularly to rule out any infections. We also trained her to use her left hand to brush her teeth, something that she learnt with time. Hock (2009), in his booklet, ‘Taking care of a stroke patient’ highlights the routine care that should be accorded to a patient who has suffered a stroke. Hygiene here includes giving the patient a diaper treatment since they are unable to get out of the bed and attend to the call of nature. Since she had lost control of her bladder and bowel control, I applied urine and bowel elimination skills through training which made it easier for her to remove waste from the body. I assisted in changing her soiled diapers to ensure that she was as comfortable as possible during her rehabilitation period at the Canberra Hospital. The hygiene practices involved here were cleaning her to ensure that she did not smell of urine or faeces, something that could make her uncomfortable. Bathing Roselyn was part of everyday hygiene procedure and the bathrooms at the Canberra Rehabilitation Ward are big enough to fit two. This made it easy for me to bath my client and ensure that she was in prime condition and that her skin was clean and free from infections. With time, we introduced Roselyn to a commode, which is a movable toilet to train her in using the toilet independently. This was part of the rehabilitation process and the comfort that comes with a commode made it so easy for her to adapt to the changes. To help Roselyn exercise, we introduced her to physiotherapy classes whereby I helped her exercise her legs and arms. When taking care of a person with stroke, it is important to understand the condition to be well prepared on how to handle the patient. In my case, and with the help of the RN, I came into terms with the fact that my patient had lost mobility as she was unable to move the whole of her right side. I had mobility sessions with her everyday as she had difficulties walking and many times I wheeled her around the hospital. I also helped her do some subtle walking exercises which she performed while holding onto a rail for balance. According to Hock (2009), a stroke patient’s skin becomes thin and this exposes him or her to constant tears and infections. It is therefore important to take good care of it through the application of creams that help in skin repair. In my case, I subjected Roselyn to a daily dry skin care treatment which helped heal her skin and prevent her from getting further infections through the tears and cracks. I also took her to the mall near the hospital occasionally since it is vital to expose stroke patients to a new environment. This gives them hope of a quick recovery to get back to the activities they loved doing before the ailment struck. Among my other duties was ensuring that the patient took her medication according to the prescription made by the RN. According to Robey et al (2001, p.1), hygiene is of paramount importance in nursing homes since they are highly exposed to germs. Personal services given to patients must be hygienic and the food prepared for patients must be clean. Proper hygiene must start from personal hygiene and extend to other people and the environment as well. There are many infections that result from poor hygiene and hospitals must meet certain requirements. They must be constructed in safe areas that are accessible. Additionally, the housekeeping department must be on its toes to provide well-sanitized laundry. Conclusion The Acute Rehabilitation Ward in Canberra Hospital was an eye opener for me on what to expect in my chosen career. The clinical experiences I encountered here developed my knowledge on how to handle patients in acute rehabilitation. The opportunity I got to take care of the patient gave me first-hand experience on the rehabilitation of people with stroke and further reinforced my skills in routine hygiene care for disabled people. References ACT Health. (2010). Acute Rehabilitation. Australian Capital Territory Department of Health ACT Government Health Information. Canberra, Australia. Bates, B. (2005). Clinical Practice guideline for the management of adult stroke rehabilitation care. American Heart Association. 36:2049. Brady, M.C. (2007). Improving oral hygiene in patients after stroke. American Heart Association. 38:1115. Carter, P. (2008). A humanistic approach to nursing. Lippincott’s textbook for nursing Assistants. Philadelphia: Lippincott Williams & Wilkins. Ellis, R. B, Gates, B., Kenworthy, N. (2003). Interpersonal communication in nursing: Theory and practice (2nd edition). New York: Elsevier Science Limited. Hoeman, P. S. (2010). Rehabilitation Nursing, intervention and outcomes (4th edition). New York: Elsevier Health Sciences. Hock, C.B. (2009). Caring for a stroke patient. A caregiver’s perspective. University Hospital, Kuala Lumpur. Robey, K.L, Gwiazda, J., Morse, J. (2001). Nursing students self attributions of skill, Comfort and approach when imagining themselves caring for persons with physical impairments due to developmental disability. Journal of Development and Physical Disabilities, 13(4). Turner, A., Foster, M. & Johnson, S.E. (1999). Occupational therapy and physical dysfunction: Principles, skills and practice (5th edition). Beijing: Elsevier Publishers Limited, China. Wedro, B.C. (1996). “All about stroke.” The Medicine Journal Medicine Net, USA. Retrieved 18th September, 2010, from http://www.medicinenet.com/stroke/index.htm. Read More