Munja Shrestha

As an international student studying nursing in Australia I have gained a lot of different experience. I have been in a nursing profession for around a decade and during this time I have faced with many simple to complex incidents which have always assisted me in updating my knowledge, skills and evaluating my performance. From this particular incident, there were a lot of questions that I ask myself whether I handled the situation better by myself, was I initiative enough? Was I confident and competent enough? Did the patient received quality care? Was the patient family and relatives happy about the quality of care provided? From my study and placement I have gained a wide range of idea, knowledge and skills in the Australian health care setting. There are numerous things to be considered from the following incidents. Whether the organization may not provide staff satisfaction which result more agency staffs. Furthermore RN role was to supervise the new enrolled nurse but instead she gave her an extra job for orienting the agency staff .I wondered why? RN asked other person to orientate while she was responsible. These shows there are lack of team work and negligence.

Nurses are like a pillar of the hospital so they should know the importance of self care. To maintain self care nurses need to make sure that they are taking proper and balanced diet, drinking adequate amount of water or liquids, maintaining good physical and mental health through regular exercise, taking adequate sleep and rest, socialising and meditating. Everyday Nurses are responsible for taking care of many patients and in addition to taking care of themselves nurses also need to care for their work mates as well. Work satisfaction in nursing is vital like in any profession and without it no one can be mentally healthy and happy. To maintain healthy work life nurses need to actively participate in a team and focus on an effective team work. As sometimes nurses have to deal with difficult patient and their family there needs to be continuous support from the senior nurses and the management. To achieve a balanced work life nurses should be trained and educated in handling stress which is one of the common problem in nursing through different stress management strategies, debrief  and how to cope with difficult situations. Positive attitude or optimism in work also helps for self caring. In work place, infection control, OHS, hand washing and regular study also helpful for self care. In addition, work within scope of practice, rules and regulations, respect and discipline.

Journals are essential in nursing. It makes it easier to communicate within self and also helps for future refrences.It helps to keep knowledge’s upto date. Journaling help to think critically which essential character of nursing is. After starting journaling I found that my writing habit, analysis of situation has been completely changed. By the help of journal I am able to express and reflect back on things which are required for further developing my knowledge and skills. Journaling also help to relieve my emotional and mental pressure of the incident. Primarily journaling is helpful to remember things for long term. Secondarily it educates reflect on previous practice and stop making same mistake again. Furthermore, it helps to examine what happened and what we could have done better for next time. So in future it helps me to think critically so that we could avoid doing same mistake.

At the very end of the reflective journey, I found myself as a growing student nurse and a competent nurse. I have done well during the incident even though there were numerous limitations and restrictions. After the incident I feel more confident and comfortable to work independently and competently as a professional nurse. From the incident I had an opportunity to learn lot of new things in the real health setting and experience critical incidents that is part of the nursing profession. I am now more confident to deal with any complicated situations and handle them well. Reflection helped me to think differently and assist me to find out what could have done differently. I will also practice as evidence based practice. In any kind of situation, I would always follow the policy and procedures ensuring the quality care are provided to the patients. Apart from these I will continue learning process and training to further develop my knowledge and skills.

Reflective Journal - D

Different people have different view about the incidents according to their level of knowledge and level of effect on them. In that incident there was a significant impact on both the patient and their family. The patient might had a gut feeling of being unwell before he had a seizure attack as a result of late medication. He had suffered from difficulty to breathe due to unavailability of emergency equipment and also the fear of death. Patient had to wait for oxygenation and position which resulted death. From the family point of view, they were probably shocked and could have thought that nursing home and the nurses are not looking after the patient properly. The nurses may have realized about their negligence on duty of care as they failed to check emergency equipment at the beginning of the shift. Nurses might have frustrated due to not being able to handle emergency situation and save the patient’s life. Form the care staffs view as there was more agency staff in the ward than the regular staff and it seems like problem in staffing. Care staff witnessed delayed in oxygen administration. They could have viewed an inexperienced nurse around, lots of medications for one nurse.

As an international nurse and a first placement in a foreign country firstly I was a bit nervous and scared. I tried exploring my knowledge and experience. As student nurse I could not make any decision what to do nevertheless I did in emergency situation. From the nursing staff point of view they likely to perceived me as an initiative, enthusiastic and experienced student nurse. Being a student, I encourage myself for airway application. If I had not mentioned that the patient would have had more suffering. They may observe my performance such as assisted for positioning, brought oxygen cylinder quicker. They may not expect that I would be able to apply airway even the paramedics were surprised to see it. Care staff may also assume me as a confident and competent student nurse.

Perception is our sensory experience of the world around us. Perception not only creates our experience, it allows us to act within our environment. Every individual perceive things differently. From patient’s family view, delayed medication as the cause of patient death which have significant impact on them both personally and emotionally .It is because that the medications are most essential to control the disease which should be dispensed on timely manner. If there is alteration in the timing it may result a seizure and vise versa. As a family member they have great exception from the nursing home to provide good care for their loved ones. They might have perceived it as negligence from the nurses and the management. From the nursing home point of view there would be pressure on the management and the professional practice within the nurses. The institution could improve on their areas of weakness like pattern of staffing, emergency equipment check, nurse patient ratio, and proper supervision .In that way both parties may have perceived the incident differently.

Reflecting back to the above incident, it was both stressful and unforgettable day for me. I have learned a lot and I will apply all these experiences in future. I would ensure that I and all my team follow all the standards and guidelines set out by the Australian Healthcare Systems. As a nurse there would be situations where one has to handle some serious issues therefore I would be calm and try to make the best possible decision for the well being of the patient. I would also ensure that all the safety and equipments are available and are in good working conditions. From that day I have built strong foundation of confidence to handle the situation. I would also pay extra attention during medication. I will primarily focus on my task list first and wouldn’t carry out someone else job until I have completed my major task.As part of ongoing development I would participate in various training and education programs to continuously improve my knowledge and skills to become a good and competent nurse.

Reflective Journal Part C

In an aged care facility, residents are placing accountability for their care into the hands of the staffs. Therefore, it is fundamental that staffs take on a major responsibility. As the resident was diagnosed with Dementia, the staffs need to keep one step ahead and predict the problems that may arise.

The Registered Nurse tried to perform her duty of care in a smoother way. As previously mentioned that the nurse as a leader at times was good to handle the situation but at the same time she was also not able to fulfil her role as a leader nurse.

I think that the main conflicting issue in the whole incident was the nurse in-charge failure to provide proper information to the carer staff regarding the resident’s current health status. This would have obviously prevented from the occurring of that incident and the resident would not have been in that dreadful condition where she fractured her hip and ended up in the hospital bed. As an in-charge she has to deal with many other issues. A nurse in-charge in a nursing home facility has many responsibilities. She has the task of not only caring for the elderly residents, but also the in charge of other employees and have to make sure the nursing home runs smoothly which is indeed a very big responsibility in one’s head. I personally think that this might be one of the contributing factors for that incident.

As a student nurse I fulfilled my job that was assigned to me and reported the incident to the registered nurse but she didn’t go to the spot to assess her.  Previously when she assessed the resident, she didn’t notice any sign of pain or fracture on that resident, that could be why the RN didn’t bother to go and find what was wrong with the resident despite of my reporting. It might be the RN’s overconfidence on herself that her finding’s can never go wrong that’s why she didn’t trust my findings. On the other hand the nurse was not able to prioritize her work. She might have thought that informing to her family member and the doctor was more important than that issue.

The other conflicting issue is forgetting to do the documentation. I being a student nurse didn’t realize that how important the documentation is and thought that the in-charge nurse will do all the documentation. I didn’t realize that accurate documentation is essential to maintain continuity and inform health professionals of ongoing care and treatment and also provides legal evidence that I failed to do so. She was also assigned as the mentor and it was her responsibility to check whether the student nurse has done her job or not. This contributed to the fracture not being diagnosed earlier, thus causing more harm to the resident.

If the same kind of incident happened and I were the in-charge Registered Nurse, I will listen carefully what the student is trying to say and follow up whether her findings are correct or not. This will lead to know two different things: firstly how competent the student nurse is on her observation technique, and secondly I can assess the resident’s health status. I will not leave the student nurse on her own to do all the observation but instead supervise and guide at all times. The other most important thing is I will give the clear handover to the upcoming staffs about the current condition of the patient so that the similar incident doesn’t occur again. Therefore, next time if the similar incident happened, whether being a student nurse or the in-charge nurse I will be in opposition to handle the situation better through this reflection.

REFLECTIVE JOURNAL – PART B

         To begin with, the nurse did so well from the beginning of the shift. She priorities tasks right after handover. She gave thorough orientation to the agency staffs as well as guided them throught the day .Although she started medication later than normal time, went well until she got a call for seizure. Nurse stopped the medication round. Coincidentally, she was not in the middle of medication administration. Medication trolley taken back to the medication room.The incident informed to the RN about the RN. As patient was in supine position, my buddy nurse quickly turned patient to left lateral position with the help of care staff. At the same time, she asked me to get an oxygen cylinder from the nurse station. This shows efficiency in the performance. The duty nurses did not think about airway management. Nevertheless, they gave me an opportunity to apply guddle airway. There was clearly team work in between them. As a result patient was sent to hospital on time for betterment of treatment. At the second half of medication round, accidently, medication error occurred immediately reported to RN, medical officer. Then started to frequent observation monitoring of patient. As a result, though there was an error but still nurses were able to save patient from detoriated condition.

In the same way, there was a lot of agency staff in that particular       ward .The nurse in-charge they could have swapped the agency staff to other ward. So that the ratio of regular staff and agency staff would be equal. As a nurse the most important task in the beginning of the shift is to make sure all emergency equipments are in good working condition. For instance, oxygen cylinder, nasal tube, mask, suction tube. They meant to check Oxygen cylinder in each nurse station. The nurse didn’t realize to manage airway when patient was severe cyanosed. If the nurses were able to check airway on time patient would not be hypoxic for long period of time. During the morning shift, nurses were heavily disturbed from the out coming call such as from patients’ family, hairdresser, carer so this could be reported management. So that during the medication time the nurses will not get interrupted. Furthermore, Enrolled Nurse should rush with the medication round.

To the extent, the nurse shown excellent leading power over the both situation. Nurse was able to tackle the situation under control regardless short staff. Leadership power is the most important for nurses. Lack of leadership may affect in patient care. The nurse handled the situations well, although there was a lot of incident. The nurse also led over the multiple incoming phone calls, completed legal documentation, Observation monitor, Nurse also guided over the agency staff even she was busy in her own work. For the safety of everyone, the nurse brought medication trolley. Nurse becomes emotionally strong overall except the time of medication error. But she recovered with in short period of time.

As a student nurse, I truly pleased to be a member of that incident in Australian health care settings. I contributed to be a part of team and work to meet a single goal. I respect the way how they handled the situation. From that scenario i become confident. I have learnt to be ready for anything to be able to handle the consequence. From this time onwards, airway is my first prioritise. I felt great, got appreciation as well. I will never miss out to manage airway .In addition i will also be careful in medication administration.it was my first placement. I was nervous as patient’s condition detorated. That particular day is memorable in my life. In my view all staffs had done their own roles well. Moreover I got chances utilize my skill. I became worried and stressed by witnessed the symptoms of the patient and incident. Overall I felt it was a good experience for me during my placement, learnt to become emotionally and psychologically strong. From this time I will carefully perform as per duty of care.

For the fulfillment of my Bachelors in Nursing I was required to complete a clinical placement in the aged care setting. During my third week of placement I was on a buddy shift with one of the Enrolled nurse (EN) in a high care where there were 26 residents. She had just started the role as an Enrolled Nurse few months back. It was a really busy day as most of the regular carers were on leave and most of the shift was covered by agency staff. As there were many agency staff who were new to the nursing home they required very good orientation and assistance. Therefore the Enrolled Nurse whom I was working with was busy orienting them and assisting them.

On that day we were only able to start medication round later than normal time. We were going very well and after giving medication to 15 residents all of a sudden one of the carer reported that a resident had a seizure. After hearing the news we quickly rushed to the room. The patient was a diagnosed case of epilepsy, at that time we found him on supine position with continuous fits. Both of us assisted the patient to lie down on her left in a lateral position. The Nurse requested me to get oxygen cylinder .Unfortunately there was no oxygen in the ward so I had to go to the main nurse station to find it. By the time, we got an oxygen cylinder his convulsion had already stopped .The patient was cyanosed. Oxygen was then administered via Hudson mask. The nurse didn’t realize to apply the guddle airway. Then I request RN that I want to try it and did it.

 Patient started to breath normally, gained his normal color back .By the help of RN we managed to get him to the nearest hospital via ambulance. Even ambulance staff was surprised to see airway .They appreciated mainly airway management.After the incident we both continued with our medication for the remaining resident. There were usual interruptions like phone call from the carers, family members, receptionists, hairdressers, RNs. We only managed to provide medication to around 5 more residents. As we were running out of time the nurse was rushing with the medication.  It was just by accident that I found that the medication she provided to the current resident was not correct as the name was similar to the resident in the previous room but with a different surname. I asked her about it and then she realized that she made a very big mistake by giving wrong medication to the previous resident. She took the medication sachets and had a look and found that it did not match with the medication chart .She then started getting very anxious and then we reported the above incident to the RN and filled out the incident report form.

I had observed the procedure after the incident such as reassurance to the nurse, patients full set of observation monitoring, notification to the Medical officer and family members. On that day the patient had difficulty in breathing and feeling of weakness so as per Medical officer’s advice the patient was sent to hospital for better treatment.

After four days later we got a phone call from hospital nurse said that the patient died due hypoxia.As a student RN nurse, my role was to work with the nurse on duty. I did through observation, questions if there are any quires. From that particular day I have realized the importance of being a regular staff and as a nurse in charge of the ward one required to be highly responsible. Nurses need to check the emergency equipments such as oxygen, masks, suction etc. Nurses should not rush during medication time, should always follow eight rights and also understand the importance of nurse patient ratio and the effects of interruptions during medication time. From this incident i will be a good leader, and also i will think about airway management.