reflective on practices

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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...
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