Nursing Care Activities in Queen Elizabeth Hospital - Essay Example

Assignment 2 Part B Introduction My placement was at the Queen Elizabeth Hospital in the Upper GI/Colorectal ward. This ward was involved with various medical care aspects such as; stomach problems/cancer of stomach, esophagus problems/cancer of esophagus, duodenal ulcer as well as surgical treatment for upper GI cancer. This report presents evidence of my progress and achievement of my placement goals. Additionally, the report will identify strategies to meet clinical goals that were not fully achieved during placement and also link the goals with the NMBA national competency standards for the registered nurse. Goals and Strategies During my placement, I was able to participate in various nursing care activities. I performed pre-procedural assessment of vitals as well as documentation to make sure that patients complied with bowel cleanses which is necessary before an endoscopy is performed. Before an endoscopy is performed, the patient is placed on a clear liquid diet (Eskicioglu & Forbes, 2010). In regard to this, I would request patients to withhold solid foods apart from clear liquids for 2 days prior to the planned procedure and require withholding from all foods and liquids for at least 4 hours before the endoscopy procedure (Eskicioglu & Forbes, 2010). Additionally, I would ensure that on the preceding day patients use bowl cleansing solution to ensure the alimentary canal is cleared of residue. I would also advice patients to withhold particular drugs such as avoiding Coumadin for 7 days and Aspirin for 5 days before the endoscopy procedure (Eskicioglu & Forbes, 2010). I was also involved in transporting patients into the procure room where I would connect oxygen sources along with other monitoring devices. I would also move the patients as required whenever the anaesthesiologist or the gastrointestinal doctor required repositioning of the patients. I also documented the number of times of insertion and removal of the scope. Even though the RN and anaesthesiologist also documented this data, the data I recorded would be valuable sometimes for instance when they missed the precise time. I also participated in various therapeutic communication techniques by being supportive to nervous patients as well as offering explanations to patients on follow up care plan. As Melanie (2010) explains, patients who undergo endoscopy are normally nervous and scared of the unknown and therefore reassuring and explaining the procedure to them assists the patients in combating their fears. It is also necessary to reassure patients of staff’s proficiency. As a nursing student, I was able to assist patients in this setting. In this regard, I would relay my observations in a tactful and suitable way and this often helped patient be at ease with the endoscopy process (Melanie, 2010). One endoscopy procedure I remember where I used therapeutic communication techniques was with a child who was undergoing endoscopy procedure. I walked the parents out of the room and I reassured and offered comforting words to the parents as I escorted them to the lobby. Afterwards, I learned that parents are requested to leave the operation room after the children are administered with general anaesthesia since past experiences indicate that parental presence is not conducive to a safe environment. As a result, parents are required to leave before intubation is done to prevent the parents from being devastated since several parents even faint on seeing their children being propped with clinical tools. In addition, I also took part in the recovery phase where I carried out assessments to establish patients’ level of consciousness as the effects of anaesthesia waded off and also monitored patients’ vital signs by observing the monitor as well as listening to body sounds using stethoscope (Verschuur et al, 2007). During the post-procedural phase, I would remove IVs. I observed various endoscopy procedures such as colonoscopy. A colonoscopy is an invasive procedure that enables the colon to be viewed as well as the nearby parts of the large intestine. During the colonoscopy, the scope would be inserted via the rectum and the colon would be visually projected on various monitors within the room (Blomberg, 2010). The transmitting video aid the clinician in observing the gastrointestinal tissues which displays any abnormalities like inflammation due to Crohn’s disease, pocketing from diverticulitis, intestinal obstructions, and even polyps. Discovery of polyps lead to obtaining of tissue sample for biopsy. The polyps are then sent in the lab for evaluation and they are categorized either as malignant or benign (Blomberg, 2010). When an obstruction is detected, the patient is referred for a barium swallow. This determines the exact location and characteristics of the detected obstruction (Blomberg, 2010). I gained more knowledge on techniques utilized during endoscopy. Distinguishing of the intestinal tissue is complex and hence landmarks are used to locate the scope. Particularly, the hepatic and splenic sphincters are utilized in pinpointing the progression. The scope can also measure the length of the gastrointestinal tract and this allows recording of the exact location of any abnormality for subsequent probing (Smale, 2013). I also observed sigmoidoscopy being performed although it was done less often when compared to the colonoscopy. Sigmoidoscopy would be used when it was necessary to view the intestinal tissue in order to examine any pathology within the GI system for instance, identifying microbes that induce diarrhea (Melanie, 2010. I observed that since the procedure is less invasive as compared to colonoscopy, most patient did not even require sedation if they believed they could handle the discomfort without having to be sedated. Lastly, I also had a chance to observe esophagogastroduodenoscopy. This is an endoscopy procedure where the observation of both the duodenum and stomach is done. The procedure is used in evaluating pathologies like gastroenteritis and cardiac sphincter function. Esophagogastroduodenoscopy is almost like colonoscopy through it is inserted on the other edge of the alimentary canal. Therefore, the beds of the patients undergoing this process are placed in the opposite direction and patients are sedated in the same way as lower endoscopy procedures (Melanie, 2010). However, I observed some noteworthy differences. In esophagogastroduodenoscopy, patients would develop hiccups and I learnt that hiccups are common side effects of fentonol (Smale, 2013. In one instance, I along with the RN had to rush and reposition the patient since hiccups caused the patient’s diaphragmatic contractions to jerk her body out of position. I also learned that the positioning of the patient’s head is equally important. In this event, the RN aided me to achieve the patient’s correct angle of the neck by calculated pillow placement. An interesting aspect that I noted is the image of the stomach during this process. On advancement, the wrinkles of the stomach are clearly evident but after the scope is on the duodenal boarder, insertion of air in the stomach is done in order to enlarge the tissue and this makes the wrinkles to vanish. The RN told me that the reason for this is to imitate how the stomach looks like and hence enables the healthcare provider to have more visual abilities during tissue observation (Melanie, 2010). Self-assessment There are some of endoscopy procedures that I did not have an opportunity to observe. One of them is bronchoscopy which is very crucial in Endoscopy department. There are various barriers that hindered me into observing this procedure even though a bronchoscopy was scheduled for me to observe. I was not allowed to observe the procedure because of the hospital policy for students on placement. The Queen Elizabeth Hospital policy does not permit students to visit bronchoscopy room. During the procedure, staff members are obligated to wear mask and other protective clothes during the whole procedure. Due to the safety and liability concerns, students are not permitted to be in the room or have any compacts with the patients undergoing bronchoscopy because some of the patients may be having active tuberculosis infections (Cohen & Benson, 2012). Similarly, I did not get a chance to administer sedatives to the patients. During endo procedures, administration of sedatives was done by the anesthesiologist, RN or physicians with anesthesiology credentials (Cohen & Benson, 2012). The law as well as the hospital policy does not allow student nurses to administer propofol which is the sedative that is commonly used during endoscopy procedures. According to the hospital policy, only healthcare providers with anesthesiology credentials and experience are allowed to administer propofol. Generally, I feel that the endoscopy department did not provide numerous opportunities to carry out nursing skills. This is because administration of all medications was done by the anesthesiologists or RN and physicians with the anesthesiology credentials and not nurses. In addition, the scope of exposure for student nurse is restricted to the GI tract. However, I feel that this was a valuable experience for me since there were numerous chances of learning regarding therapeutic communication, gastrointestinal pathologies, as well as the specifics of the procedures (Kelly & Ahern, 2009). Since endoscopy RNs with additional training in the endoscopy are deemed competent enough to carry out safe sedation procedures as well as discuss rationale for the endoscopy procedure, benefits, risks, complications as well as the clinical outcomes, it will be necessary for me to enrol in further training on endoscopy to acquire the required nursing skills in endoscopy (Kelly & Ahern, 20090. RNs are also responsible for carrying out detailed nursing assessments, ascertaining accurate and comprehensive information on patient’s medication and medical history in the endoscopy department (Blomberg, 2010). In this regard, RNs are required to make sure that all information is documented within the endoscopy care pathway documentation. RNs are also required to make sure that all pertinent documents are availed and that consent forms correspond with the referral documentation for the proposed procedure (Smale, 2013). The RN also has the responsibility of ensuring that the consent forms are filled precisely. The strategy I plan to use to gain these skills is by accessing the current evidence and reviewing journals specific to endoscopy and particularly upper GI/colorectal nursing and also by attending education workshops and programs that are specific to endoscopy and upper GI/colorectal nursing. I also plan to read widely on sedatives as well as medications utilised during bowel cleanse, intestinal pathologies and gastrointestinal anatomy (Blomberg, 2010). With this, I will gain the required knowledge and skills in endoscopy and upper GI/colorectal nursing. I will also review the common medications utilised during endoscopy preparation. All this will be important in filling the knowledge and skill gaps that were left during placement. Linking Goals to NMBA Competency Standards NMBA competency standards obligate RNs to take part in professional development in order to improve nursing practice. This is attained by the RNs seeking additional knowledge or support from colleagues when they face unfamiliar situations (Australian Nursing and Midwifery Council, 2010). I upheld this standard by always asking for help from the Registered Nurses whenever I encountered difficult situations and also consulting most recent evidence on the situations. For instance, during esophagogastroduodenoscopy, the patient developed hiccups during positing. I sought help from the RN who helped me reposition the patient’s head. Similarly, NMBA competency standards require RNs to exhibit professional responsibility and accountability during practice (Australian Nursing and Midwifery Council, 2010). I upheld this standard by ensuring that I always performed the duties I was assigned to. I was given the responsibility of performing assessments and transporting patients to the procedural rooms and I always ensured that I did this. I would also assist anesthesiologist, RNs and physicians wherever they needed my assistance as required. Additionally, NMBA competency standards require RNs to collaborate with interdisciplinary healthcare team to provide comprehensive nursing care (Australian Nursing and Midwifery Council, 2010). I upheld this standard by ensuring that documentation of information was done appropriately. I documented all procedures starting from pre-procedural assessments such as patients’ bowel cleanses even during the endoscopy procedures. For instance, I would document the number of times of insertion and removal of the scope and this would come in handy especially when the other healthcare providers missed the time. NMBA competency standards also oblige RNs to demonstrate collaborative and therapeutic practice. RNs achieve this by communicating effectively to facilitate provision of care by using the suitable communication skills and suitable language (Australian Nursing and Midwifery Council, 2010). I achieved this by communicating effectively with the patients. For instance, I would reassure patients whenever they got nervous and use my communication skills to conform and reassure them that the whole endoscopy procedure would be a success and that the healthcare team handling them was the best. This always relaxed the patients and they would end up being relaxed and ready for the procedure. Reference List Australian Nursing and Midwifery Council, 2010, code of professional conduct for nurses in Australia, Dickson ACT: Australian Nursing and Midwifery Council. Blomberg J, 2010, Aspects of Endoscopic Interventions of the Upper Gastrointestinal Tract, Stockholm: Karolinska Institute. Cohen, B & Benson A, 2012, Issues in endoscopic sedation, Gastroenterology and Hepatology, 5(8), 565-570. Eskicioglu C & Forbes, S, 2010, Preoperative bowel preparation for patients undergoing elective colorectal surgery: A clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons, Canadian Journal of Surgery, 56(3), 385-395. Kelly J & Ahern K, 2009, Preparing nurses for practice: A phenomenological study of the new graduate in Australia, Journal of Clinical Nursing, 18(6): 910–918. Melanie S, 2010, Patients requiring upper gastrointestinal surgery, Sydney: Elsevier. Smale S, 2013, Upper gastrointestinal endoscopy performed by nurses: scope for the future? Gut, 52(8): 1090–1094. Verschuur E, Kuipers E &Siersema P, 2007, Nurses working in GI and endoscopic practice: A review, Gastrointestinal Endoscopy, 65(3), 469-478. Read More