Reflective writing is a useful approach for nurses to learn from experience.In nursing, self reflection is essential to acknowledge own strength and limitation and to initiate necessary changes in future to improve the situation and for professional development (Ushe,Foster& Stewart,2012). I have selected Gibb’s reflective cycle to reflect the incident as it helps to express both events and feelings generated by experience (Andre&Heartfield,2011,pp.62-63).
On placement, I was assigned to take complete care of 4 patients in a surgical ward of the Hospital Umum Sarawak under the supervision of senior nurse. The night shift new graduate registered nurse handed over to us that one of our post operative patients had an indwelling catheter(IDC) which was taken out a night before and patient voided after removal of IDC.The nurse reported that the patient’s incontinent aid was moderately wet at night,however the patient was still complaining of not being able to void which made the nurse think that the patient was confused.
Upon receiving a handover, I went to check my patients and I found that particular patient was restless and when asked she stated she had a lot of pain in her lower abdomen.A quick physical examination revealed distended lower abdomen.After reviewing her clinical notes I noticed patient received PRN (as needed) analgesia for abdominal pain early that morning however no further investigation and intervention were done for pain. Furthermore, I assessed the patient and found she was well orientated to time,place and person as there was no significant history of confusion or delirium in her clinical notes.
At that time, I felt the situation wasn’t correct and I reported immediately to my mentor. She appreciated my initiation and instructed me to perform an ultrasound bladder scan.
Bladder scan revealed a residual volume of 998 mls of urine in bladder.I immidiately noticed my mentor and the junior medical officer working on the floor who reviewed the patient and ordered for immediate insertion of IDC.While I was inserting IDC under supervision of my mentor I delegated the assistant in nursing staff (PPK) staff working on the floor to keep on close eye on my rest of the patients and answer their needs.Upon insertion of IDC a urine output was 1650mls within a couple of minutes and patient stated she felt much more comfortable. Patient thanked us for not ignoring her complaint of pain and not considering her as confused and undertaking prompt action to make her comfortable.
In my opinion, the night shift nurse changed her incontinent aid which was fairly wet thought the patient was confused when patient stated she can’t void. The patient might have incomplete bladder emptying or overflow incontinence which the night nurse might have assumed as patient voiding normally. Later, my mentor spoke to the night duty nurse about the incident and asked her either she attended bladder scan or informed any of the senior nurses or treating team about the situation. The nurse said she was really busy and she didn’t think about it. My mentor explained to her how important is to attend comprehensive and accurate assessment of patient rather than making an own judgement.My mentor discussed about legal requirement of nurses to fulfill the duty of care and how negligence can lead to harm to the patient.The night shift nurse assured my mentor that she will never ignore patient’s needs and always fulfill her duty of care in future.
Australian Nursing and Midwifery Council (ANMC) have outlined the competencies for nurses to provide safe and competent nursing practice adhering to the legal and ethical framework(Davidson &Everett,2012). ANMC competency for registered nurse requires nurses to perform a comprehensive and accurate assessment of the patient before performing any interventions (NMBA,2006).In this scenario,the night duty nurse should have performed comprehensive assessment (physical assessment and bladder scanning) when the patient was complaining of abdominal pain and discomfort.It is the responsibility of nurses to fulfill the duty of care for their patients. Based on ANMC competency standards, reflecting on this incidence has enhanced my understanding of the importance of duty of care,nurses role to advocate for their patient, critical thinking and analysis, comprehensive and systematic nursing assessment to identify actual and potential health problem and need of effective communication and care coordination with multidisciplinary team to achieve optimal level of health.Furthermore, with this incidence I have also learned that whilst providing care to the patient nurse must understand their own personal value and attitudes should never impose the care they provide to their patients(NMBA,2006).
Reflection on this incident in feel i performed fairly well however,I should have acted much sooner to alleviate my patient suffering. I now realize if I would have ignored the incident thinking the patient is confused I would have put my patient’s well being at risk. Retention of more than 800mls of urine in bladder increases the risk of bladder over distention injury (Nguyen et al,2016). Similarly, there are many other complications associated with acute or chronic retention of urine which may include infection, flaccid bladder, renal damage due to reflux and development of bladder diverticulum or pouching (Casey,2011). Hence,if the relevant action wasn’t initiated in time the situation might have been worst. Looking back on this incident,apart from fulfilling duty of care I realize nurses are legally obligated to recognize and respond promptly to unsafe and compromised care.Therefore, keeping patient well being at the forefront i also learn to challenge the practice of colleagues if their practice put patient’s health at risk(NMBA,2006).Furthermore,this incident helped me to understand the importance of comprehensive patient assessment in identifying actual and potential health issue. By conducting through patient assessment the exact cause of the problem was able to notify and with the involvement of multidisciplinary team the issue was easily resolved. This incidence provides me an insight of the importance of patient centred holistic care,effective communication and teamwork skills for smoother transition as a beginning level registered nurse(Walker et al,2013).
Nurses are accountable to provide safe and competent nursing care (NMBA,2008). The national competency standards for registered nurses to fulfill duty of care and recognize and respond to unprofessional and unsafe practice(NMBA,2006).With this incidence I have learned to fulfill the duty of care carefully and to significantly improve the assertive skills. Similarly, effective communication is an essential attribute a new graduate nurse should have. Taking time to listen to the patient,recognize their unique need and involving them n their own care promotes patient centered care(Stein- Parbury,2012). Relating back to the incident,due to lack of effective communication a client needs was neglected therefore,in order to successfully transit into beginning level registered nurse i should develop competent communication skill.
The transition from a student into the professional graduate is often confronting and requires a wide range of knowledge and professional skills (Williams,Richard&A Sayah,2015).In order to successfully adopt into the professional role, a new graduate nurses are expected to prioritize care,manage workloads,make an appropriate clinical decision,exert leadership skills and work within the interdisciplinary team(Williams et al,2015). The other key competencies required for a new graduate nurse are practicing within the evidence based framework,mentoring,regularly monitoring patient progress,care coordinating and advocating for patient (Davidson& Everett,2012). Apart from other skills,a novice practitioner is also expected to have skills like leading, mentoring and delegating the task to other staffs based on their competence and scope of practice(NMBA,2006).
Leadership skill is one the essential in the nursing profession. Upon completion of graduation,a new graduate nurse is also expected to lead a team depending upon the organization policy and protocols. The new graduate nurse can demonstrate and built leadership capability by working within a small group of staff who has different competencies and skills such as enrolled nurse and assistants in nursing in order to achieve a common goal (Thoms & Duffield,2012). Leadership skill requires a nurse to clearly delegate tasks to other,provide recurrent feedback,communicate effectively within a team and involve in the professional development of self and others(Thoms & Duffield,2012). Delegating a task to others is often a challenging job for a new graduate nurse.Before delegating a task to others it is essential to have a sound knowledge of skills and capabilities of other team members (Thoms & Duffield,2012). In addition ,consistent supervision , support and mentoring are essential to ensure delegated task has been performed safely and accurate (NMBA,2006). Meantime, as a leader providing appropriate feedback is also important to motivate team members.
Hence,reflecting on this incident has helped me to get insight into my clinical practice, understand the importance of comprehensive assessment, assertiveness, holistic patient centered care,interdisciplinary team work,leading mentoring and delegating within the team for a successful transition into the role of registered nurse.