The purpose of this essay is to select an incident which occurred during clinical placement and to discuss and reflect on it in order to improve future practice. To do this, the framework of the Marks-Maran and Rose Model of Reflection (1997) will be used. Utilising the four stages of this model, I will describe the incident, give a reflective observation, discuss related theory and conclude with thoughts for any future actions. Any patient discussed will be given a pseudonym to ensure patient confidentiality as described by the Nursing and Midwifery Council (NMC) (2010). During a recent placement in an Endoscopy day unit, I met Mrs Smith who was attending to undergo a Gastroscopy. She had a history of acid reflux and had been referred for the procedure as an outpatient but had not attended her Pre-Admission Clinic appointment. Upon her arrival, myself and a staff nurse took baseline observations and spoke with the patient to ensure that she had fasted from midnight which was necessary for the procedure. On advising her on anaesthesia, I informed her that she had two options. The first was a throat spray to numb the local area and she could leave almost immediately afterwards. The second was sedation and analgesia in the form of Fentanyl and Midazolam which would be given through intravenous cannulation; however, she would have to remain with us for several hours post procedure. Mrs Smith began to panic and became quite irate. She stated that she had been under the impression that she would be given a general anaesthetic and would be asleep the entire time. I explained that the doctor required her to be awake for this procedure and that general anaesthetic was not an option. Mrs Smith then stated that she was withdrawing her consent and wished to leave. The staff nurse who had been observing me swiftly took over the conversation and attempted to calm down the patient. She advised me to escort Mrs Smith to the private seating area that was reserved for consultations but not to offer her anything to drink; just in case she changed her mind about the Gastroscopy going ahead. Once we were all in privacy, the nurse then sat down and asked Mrs Smith why she was so scared. Mrs Smith stated that she had heard of complications involved with Gastroscopies and she would rather not take the risk. The nurse explained that the risk of a serious incident was extremely rare and at worst, she may suffer from a sore throat and gastric bloating afterwards. Mrs Smith was supplied with an information booklet and we allowed her some time to digest all of the information that she had been given and assured her that any questions she wanted to pose would be answered. Afterwards, she stated that she still did not want to undergo the procedure and that she wanted to go home. At this point, the nurse advised that she should return to her doctor and inform him that she had not undergone the test. Mrs Smith was also advised that she could return at a later date if she so wished and then she left the clinic. During my explanation of the procedure, I felt capable enough to fully explain what it entailed. However, when Mrs Smith began to panic, I lost some of my confidence as this was something that I had not faced before. Therefore, I felt unable to calm Mrs Smith down as I was lacking experience in this scenario. I was pleased that the nurse accompanying me took over in an instant. I felt that she was right to do this as I was floundering and also felt it was perceptive of her to notice this. As I listened to the nurse, I noted the optimism displayed by the nurse when she instructed me not to provide refreshments for the patient. When I later questioned her on this matter, she told me that she had been in the same position many times before. Mrs Smith was competent enough to exercise her right to refuse treatment. This is the moral and ethical right of every patient so long as they are deemed to have the mental capacity to make such a choice...
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