Reflection of Scenario

A Reflection on Scenario One

This is a reflective essay, aims to discuss how I have managed to achieve the learning outcomes of scenario one in module two. The first part introduces the concepts I have learnt in this scenario and indicates how I have utilised the tutorials for learning, followed by a description of my practical and theoretical formative assessments. Thereafter this paper will reflect on my positive and negative learning experiences from scenario one including the details of the rest of the resources assisted me in achieving the learning outcomes. The final paragraphs bring my action plans for the future developments as well as a brief conclusion.

In this scenario, we focused on a 72 year old patient called Mrs. George, who had been recently diagnosed with diabetes. This is a disease when patients have a high level of glucose in the blood, due to the lack of insulin in the body (Jane et al.2005). Mrs George also suffers from arthritis, which is an illness that causes pain and swelling in joints (Warrall, 2006). Our learning targets were to assist Mrs. George with moving, assessing vital signs, urinalysis and guide her to a healthy diet in this scenario.

At the start we were introduced to a market day, which provided us with the opportunity to meet health professionals from Diabetes, Age concern, and children’s health sections, where I learned that a diabetic diet needs to contain less sugar, salt and fat and some alternative options found in choosing diets for diabetes such as using wholemeal bread for white bread, this information is supported by Dunning (2003), which was useful to maintain the nutrition level for Mrs George. We also received information of health visitor’s roles that they promote breast feeding and assist in children’s growth as Fawler (2006) mentioned. Furthermore, protected mealtimes and red tray systems are strongly recommended by Age Concern (2006) in order to ensure the nutrient intake of elderly at hospitals.

When starting the simulation learning, our tutor showed us the technique of hand washing before contacting Mrs. George, because using protective clothing when handling patients’ body fluids and hand decontamination before every patient’s contact are to protect the patients and health professionals from microorganisms (Kennamer, 2002). As these microorganisms develop health care associated infections, we also need to ensure the cleanliness of health care environment (Wenzel et al. 2002). Working at the hospital during attachment days provided me with a good opportunity to apply these infection control methods I learnt into practice.

In order to explain moving and handling methods, our tutor showed us a demonstration of walking Mrs. George from the bed to her chair by holding her hands to support. I was carefully observing the tutor’s posture, techniques and the communication skills she used, in order to learn. Because, effective communication gives a better understanding and enables nurses to promote empowerment as Dewit (2009) agreed. Furthermore, Mallik et al. (2004) alert nurses that poor manual handling techniques and the poor posture will bring long term back pains and will also affect patients’ safety.

In learning about observations, our respiratory organs inhale oxygen from the air and exhale carbon dioxide. The oxygen inhaled is passed into our blood when the alveoli in the lungs exchange oxygen for carbon dioxide from the blood, which is then exhaled out. One inhaling and exhaling process counts as one respiration (Andrew, 2000). According to Simonds (2001) the normal respiratory rates are, for adults 12-20, children 15-25, and infants 20-40 and for new born it is 30-80. Michel and Albert (2001) say breathing patterns should be assessed as it varies on patient’s health condition, such as blocked air ways, less oxygen in blood, brain injuries, heart failure, renal failure, overdose of medication.

The oxygenated blood from the lungs reaches our heart’s left ventricles to be pumped into our body cells through the aorta. The maximum force used to pump the blood into the circulation system against arterial walls by left ventricles is measured as the systolic pressure. The minimum force, while heart relaxes measured as diastolic pressure (Bassett, 2003). In addition, Coni et al. (2003) inform that the normal blood pressure measurements are on adults 120/80, on children 90/57 and on newborns 73/55. They also state that assessing these measurements helps to evaluate the risks of heart diseases, because when the arteries are blocked, the heart uses more force to push the blood into our body cells and this leads to a high blood pressure. A low blood pressure level will indicate the less blood flow through the aorta which is caused by bleeding.

When the heart’s left ventricles contracts to push the blood out to the body cells via aorta, a wave can be felt in arteries, which we count as heart rates. The normal pulse rates are on adults 60-100, on children 75 -120 and on infants 80-180. It is commonly accessed on wrists. Weaker pulse may indicate a decreased amount of blood pumped via the aorta because of conditions such as bleeding, shock or reduced cardiac function. Bouncing pulse may indicate large amount blood being pumped, absent of pulse may indicate the signs of blocked or injured arteries or cardiac arrest (Elkin et al. 2007).

Our normal body temperature level is 37 degrees Celsius, and it is commonly assessed in mouth rectum and armpit. The internal balance of temperature is controlled by an endocrine organ, the hypothalamus, when there are abnormal signs in the body such as infections, it will raise our body temperature. But in conditions such as shock or stress, body temperature drops because of the lack of blood flow to the skin and tissues. Therefore measuring body temperature helps to evaluate patient’s abnormalities (Jamieson 2007).

In learning about urinalysis, the nephrons in our kidney filter the blood to produce urine and excrete the waste materials such as urea, creatine, drugs and chemicals (Lote, 2000). Urinalysis helps in identifying abnormalities by detecting the level of substances such as bilirubin, ketones, glucose, protein, blood, nitrite, pH and specific gravity leukocytes in urine (Thomas, 2002).

We learnt the observations by assessing our colleagues and charting them on TPR chart and learnt urinalysis by using regent strips and recorded the findings. The blood pressure measurement was hard to learn. As a result I regularly visited the simulation centre and practiced more, I also bought a sphygmomanometer in order to practice more at home too. The physiology tutorials were a useful guide in receiving understanding of patient’s assessment. However I became more fluent at assessing vital signs and urinalysis, while I worked at hospital during the attachment days. .

In completion of scenario one, we had our formative assessments. In the practical assessment we worked as pairs in assisting Mrs. George from the bed to a chair and assess the vital signs including urinalysis. I achieved the hand decontamination and manual handling as my colleague and I worked together up to that point. But next, I had to complete the vital signs, while my colleague was sent to complete the urinalysis. Even though I had a good knowledge on vital signs, I could not measure them on my own within the time limit. The feed back from my tutor said that I had good communication skills, but I was very nervous and did not achieve the targets.

I felt more comfortable sitting next to my colleagues on theory assessment. However, four out of twenty questions were hard to answer, particularly about nephrons in the kidney, DNA in cells also about health and safety legislations. My score on this MCQ was 90% as I did some educational guesses.

In my opinion, I enjoyed most sessions of scenario one, as the simulation centre gave me an impression of working at a hospital environment. Every tutor was very approachable and willing to help any time I needed. My colleagues encouraged me whenever I had difficulties and shared their knowledge with me, especially the techniques in blood pressure measurement. The learning activities were useful; particularly essence of care benchmarks guided me to gain better information on care. The online learning (Intuition, 2009), taught me that effective hygiene can prevent everyone from infections, applying good postures while heavy lifting can avoid injuries, and nutrient screening and providing sufficient assistance whilst serving meals decreases nutrient problems among patients. The lecture notes on blackboard (Simulation Centre, 2007) supported me in remembering the tutorials from the class. I could also utilise the txt books from library.

However, the formative assessments did not go as well as I thought, especially the practical side. The possible reasons for this could be that I was not used to work under pressure nor in new situations. This nature would not suit me in the future while I work at hospital environments, as I may meet new patients and new colleagues quite frequently. Moreover, although I am good at reading and remembering the literatures, I seem to miss out revising a few important bits, which makes me incompetent on the theoretical side as well.

However these experiences have helped me to highlight the issues on which I need to develop. My future aims are now to be braver when interacting with new people and to act quicker whilst working under pressure. As well as continuing with revising the theory side of learning, I aim to brush up on the knowledge and also to apply the skills I gained in this scenario into practice wherever I work, such as hospital placements and in the future, as a nursing professional to ensure safe and effective patient care all the time.

To conclude, the tutorials, learning resources, support of tutors and colleagues all assisted me in achieving the learning outcomes on scenario one, where I have been taught to take care of diabetes patients and to maintain; nutritional balance, infection control, appropriate methods manual handling, effective communication while working with patients. I also received knowledge on assessing vital signs and urinalysis in finding patients’ abnormalities. However I have problems with time management and also with relaxing in new situations. My future plan is to improve on these issues and to brush up on and apply the knowledge that I received from scenario one into practice.

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