This assignment will reflect on the effectiveness of my clinical and interpersonal skills in relation to my position as a nurse in a busy critical care unit. It will primarily focus on one particular patient and the care they received by myself in their immediate post operative period. In accordance with the NMC’s code of professional conduct names will not be used to protect the patient’s confidentiality. NMC (2008).
Reflection is an important tool for all health care practitioners. It can improve our skills and help us understand the choices we make while in practice. Williams (2001) states that “Reflective learning involves assessment and re-assessment of assumptions and critical reflection occurs whenever underlying premises are being questioned”. Critically reflecting on events we experience will continually add to our understanding and knowledge base. “Reflection makes the practitioner mindful of their practice, encouraging analysis and increasing self-awareness in relation to our own skills, knowledge and emotions”. Price, (2005).
There are many different models of reflection available but for the purpose of this assignment I shall be using Gibbs (1988). Gibbs reflective cycle is a simple analytical approach to reflection which encourages a clear description of the event. It also analyses the feelings felt at the time and includes an evaluation of the event and tries to make sense of it. Finally Gibbs examines what you would do if the situation arose again.
A 89 year old woman was admitted to the recovery ward for monitoring after a dynamic hip screw procedure of the right hip. The patient was received by myself and I immediately began the ABCDE approach to caring for the patient while the anaesthetist began his verbal handover of the patients medical history, intra operative care and instructions for post operative care including iv fluids and analgesia. The anaesthetist explained the patient had advanced dementia and prior to surgery had extremely poor cognitive function. He had given the patient a femoral nerve block to reduce post operative pain and the patient had also had analgesia given intra operatively. The anaesthetist explained he had prescribed 5mg of morphine sulphate to be given slowly, post operatively due to the patients age and cognitive impairment. He stated the nerve block should be sufficient and the morphine should not really be needed.
The patient’s clinical observations were at first stable. As I was unable to initiate a verbal response to assess the patient’s pain I was relying on non verbal signs and clinical observations to assess pain levels. During the first 30 minutes the patient seemed comfortable showing no signs of discomfort or distress, while remaining sleepy due to the anaesthetic. After around 45 minutes the patient seemed more alert, her heart rate and systolic blood pressure has increased significantly. This was elevated from her pre-operative observations which had been recorded on the ward earlier on the day. At this point I tried to assess patient’s non-verbal signs for any sign of pain or distress. The patient seemed to be grimacing and appeared extremely tense. I decide to give 2.5mg of morphine and assess again in 15 minutes. After 15 minutes the patient’s heart rate and blood pressure remained elevated. Her non-verbal signs still indicated to me that she was in extreme discomfort so I gave a further 2.5mg of morphine. After a further 15 minutes I felt the patient was still in a high level of discomfort. I asked my colleagues to help me reposition and check the patient’s skin. While repositioning the patient it was clear she was very distressed and she also began groaning in pain.
When the change of position had not helped I decided to consult the anaesthetist. I explained to him that I felt the nerve block may not be wholly effective and that I had given the morphine prescribed and repositioned the...