reflective on practices

Grief , Terminal illness

  • School: university teknologi mara
  • Course: reflective on practices
This is a reflective essay based on my experiences whilst on my six week medical placement on a haematology ward at a local hospital. The aim of this essay is to discuss the psychological and sociological impact on the family when a loved one dies, and then focus on how the nurse supported the husband and relatives through their loss. I chose this particular incident as I felt very strongly about the care given to this patient shortly before her death, and felt the need to reflect on it further. In order to help me with my reflection I have chosen Gibbs (1988), as the model to help guide my reflective process (see appendix 1). This model comprises of a process that helps the individual look at a situation and think about their thoughts and feelings at the time of the incident. Reflective skills help us to think about what could have been done, so that if a similar situation occurs again the experience gained can be used to deal with the situation in a professional manner (Palmer et al 1997). To enable me to use this situation for my reflection the patient will be referred to as “Ann”. This is in order that her real name is protected and that confidentially maintained in line with the NMC (2002) Code of Professional Conduct. Description

Ann was a 58 year old lady married to a very loving husband, she had been previously diagnosed withmultiple myeloma with secondary renal impairment, and had been receiving cycles of chemotherapy. My mentor and I were looking after Ann on the day concerned, her observations were within the normal limits but she continued to complain of shortness of breath. She became very anxious and I could tell by the look in her eyes she was frightened, and asked for me to “get someone quick” as she could not breathe properly. I called my mentor as he was nearby who came over and gave Ann some oxygen. Ann said to the nurse ” I can’t breathe” and seemed even more anxious and scared, she repeated several times that she could not breathe and each...
This is a reflective essay based on my experiences whilst on my six week medical placement on a haematology ward at a local
hospital. The aim of this essay is to discuss the psychological and sociological impact on the family when a loved one dies, and
then focus on how the nurse supported the husband and relatives through their loss. I chose this particular incident as I felt very
strongly about the care given to this patient shortly before her death, and felt the need to reflect on it further.
In order to help me with my reflection I have chosen Gibbs (1988), as the model to help guide my reflective process (see
appendix 1). This model comprises of a process that helps the individual look at a situation and think about their thoughts and
feelings at the time of the incident. Reflective skills help us to think about what could have been done, so that if a similar
situation occurs again the experience gained can be used to deal with the situation in a professional manner (Palmer et al
1997).
To enable me to use this situation for my reflection the patient will be referred to as “Ann”. This is in order that her real name is
protected and that confidentially maintained in line with the NMC (2002) Code of Professional Conduct.
Description
Ann was a 58 year old lady married to a very loving husband, she had been previously diagnosed withmultiple myeloma with
secondary renal impairment, and had been receiving cycles of chemotherapy. My mentor and I were looking after Ann on the
day concerned, her observations were within the normal limits but she continued to complain of shortness of breath. She
became very anxious and I could tell by the look in her eyes she was frightened, and asked for me to “get someone quick” as
she could not breathe properly. I called my mentor as he was nearby who came over and gave Ann some oxygen. Ann said to
the nurse ” I can’t breathe” and seemed even more anxious and scared, she repeated several times that she could not breathe
and each time the nurse replied very sternly and unsympathetically “you can breathe, you are talking to me.” Ann was by now
clutching at my hand and asking me not to leave her alone, I reassured her that I would stay with her as long as she wanted me
to. My mentor then summoned me to attend another patient nearby, so I explained to Ann and apologised that I had to go and
reluctantly did as I was asked by my mentor. On returning to Ann she was found to be tachycardic and having great difficulty in
breathing. The doctors then arrived and it was suggested that her husband be called as she was deteriorating. It was at this
time I had previous arrangements and so had to leave the ward for a short time.
On my return to the ward a nurse informed me that there had been a cardiac arrest on the ward whilst I had been gone, I
instinctively knew it was Ann. She had died alone, whist my mentor had been attending another patient. I was informed that an
attempt had been made to resuscitate her, without success, she was then pronounced dead.
Ann’s husband and family were already waiting in the relatives’ room, and so were informed that she had passed away. It was
the families wish to be left alone with Ann, to allow them to say their farewells, they were reassured by the nurse that someone
was available should they need company at this very emotional time. My mentor then spent a short time with the family
explaining the procedures and helping them with any information they wanted, including details on where to go for help and
support if they needed and where to obtain the death certificate.
Feelings
On reflection of the incident I felt that I did not act in the best interests of Ann, as the NMC (2002) (clause 1) states that I am
answerable for my actions and omissions, regardless of advice or directions from another professional. I felt angry that I was
made to leave a patient who was obviously very frightened and anxious, when there was no reason for me not to stay with her.
Scrutton (1995) reinforces this by stating that the support of a friendly nurse in stressful situations can greatly reduce the
anxiety and fear of the patient. I agree with this and felt that it was a shame that I was not there for her and feel she would have
appreciated my company.
I understand that nurses are busy and have to prioritise their work but at this present time there was no urgent situation that
required me to leave her.
I felt angry and annoyed that when the family came to view her body, the nurse involved actually started to show some concern
for Ann when only a short time earlier he had no time for her at all.
Evaluation
It was a shame that a professional nurse acted in the way that he did, ignoring how anxious and upset she was becoming at not
being able to breathe. The nurses` compassion and communication skillsseemed to be very much lacking, not listening to her
concerns and not showing any feelings towards her. Cooley (2000) acknowledges the requirement of all nurses to use basic
interpersonal skills, to appear warm and welcoming to patients whilst allocating time and attention to communication.
Fallowfield and Jenkins (1999) discuss how nurses can worry about not knowing what to say or saying the wrong thing when
communicating with dying patients and their relatives, which can create barriers in communication. It was this lack of
communication that led to a breakdown in the nurse-patient-relationship, with the patient being fearful of the nurses return to
the bedside, and begging me not to leave her alone. Which was also in contravention of the NMC Code of Professional
Conduct (2002) clauses, 1 – 2 – 5 and 7. By not listening, reassuring and comforting the patient, all of this added extra
stressors to Ann who was already anxious and extremely scared. I feel that I should have reacted differently in this situation and
been more confident and assertive and stand up to my mentor and say that I would stay with Ann, as she wanted me to.
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