A Reflective Essay of an Overseas Nurse free essay sample

This is a reflective essay which will address a recent experience gained from the Intensive Treatment Unit (ITU) that occurred during my placement and while under the Overseas Nurses Programme. This will utilize John’s Model for Structured Reflection (MSR). This essay will also be integrating the first learning outcome of the course. This incident involves a 48-year old female who came in to the Accident and Emergency (AE) with chief complaint of shortness of breath, productive cough and pleuritic chest pain. A nose and throat swab for swine flu was done. Swine flu is a â€Å"respiratory illness caused by a new strain of influenza virus which has been named pandemic (H1N1) 2009 influenza by the WHO† (Health Protection Agency (HPA), 2009, p. 01). The swab was required by the Trust’s â€Å"Practical advice for investigating individuals with possible swine flu infection† (Hospital Policy, 2009, p. 01). Initially, she was admitted to the regular wards but she deteriorated and was subsequently intubated and hooked to a mechanical ventilator and transferred to the ITU. The patient was then admitted on a regular bed in the ITU, during this time the isolation rooms of the ITU were not available. It was mentioned at the morning rounds by the doctors if she needed to be transferred to an isolation room because of the query of swine flu. The doctors replied that she might only be a severe case of pneumonia as can be seen on the Chest X-ray. They also explained to the patient’s family that she is being treated for pneumonia and is also receiving antibiotics. Staff nurses who come in contact with the patient wore no protective equipment other than regular aprons and clean gloves, including myself and my mentor. Late in the afternoon, the result of the swab was confirmed by the microbiology department as positive for swine flu. WHAT ARE THE KEY ISSUES WITHIN THIS DESCRIPTION THAT I NEED TO PAY ATTENTION TO? Concerns regarding infection control were one of the primary issues to be dealt with in this situation. Breaking the news to the patient’s family was also a concern then. WHAT WAS I TRYING TO ACHIEVE? WHY DID I ACT AS I DID? As soon as I heard about the results, I was waiting for the next intervention we should perform. Aside from properly documenting the results on the care plan, it was also included in the doctor’s progress notes. The Nursing and Midwifery Council (NMC) (2008) strongly suggests that nurses keep accurate and clear record of events and care given to each patient; thus, justifying action done during that time. Secondly, we were concerned of moving her into a side room for infection control purposes. The Health Protection Agency (HPA) (2009) enumerates ways in which Swine Flu can be transmitted. Amongst them are â€Å"large droplets from coughing and/or sneezing by an infected person within a short distance (usually 1 metre or less) of someone; touching or shaking the hand of an infected person and then touching your mouth, eyes or nose without first washing your hands and touching surfaces or objects (eg door handles) that have become contaminated with the flu virus and then touching your mouth, eyes or nose without first washing your hands† (HPA, 2009 p. 01) The need to inform the family was also addressed; this was done by the doctors, charge nurse of the shift and my mentor. Follow up information was then provided by me. Stillwell (2007) identifies the family’s need to be rightly informed of the patient’s current situation as well as their right to take part in decisions concerning treatment for their patient. Coordination with the other members of the health team such as the microbiologist, doctors, physiotherapists and other nurses was of importance at that time as well. It was recognised by Doenges, 2006 that interrelation between the different healthcare disciplines direct towards providing individualised and holistic care to patients. WHAT ARE THE CONSEQUENCES FOR MY ACTIONS? FOR PATIENT AND FAMILY, MYSELF, PEOPLE I WORK WITH? It has been recognized by Cesario (2009) that the most common safety issue for patients and healthcare workers is hospital-acquired infections. By deciding to move the patient into a side room, we created a sense of safety for the patient and family as well as the other healthcare professionals involved in her care. HOW DID I FEEL ABT THIS EXPERIENCE WHILE THIS IS HAPPENING? As soon as my mentor approached me and told me she was positive for swine flu, I felt nervous since I was not using appropriate protective equipments for my patient’s case. I was also concerned that my patient was not on solation, during a time that the ITU had a full census, with visitors coming in and out of the area all day. It seemed to me that these people are at risk for this disease. The Nursing and Midwifery Council (NMC) strongly suggests the nurses â€Å"work with others to protect and promote the health and well-being of those in your care, their families and carers, and the wider communityâ₠¬  (NMC, 2008, p. 05). By failing to place the patient in an appropriate isolation room, it felt like we were unable to meet this certain standard set by the NMC. HOW WERE OTHERS FEELING? HOW DID THE PATIENT FEEL ABOUT IT? HOW DID I KNOW THE PATIENT FEELS LIKE THAT? There was no clear assessment of the patient’s feelings during that time because she was intubated and sedated. The family appears concerned both for their patient as well as for themselves. They needed further explanation from the doctors regarding the course of the treatment. They were also informed of the need to seek treatment as soon as signs and symptoms of swine flu appear. The doctors and other nurses were concerned of the safety of the other patients and the risk of nosocomial infection because she was not placed initially in a side room. WHAT INTERNAL FACTORS INFLUENCED MY DECISION MAKING PROCESS? Being a new staff under supervised practice, it felt like I had less power to insist on transferring the patient. It was also not possible because the rooms were full. The doctors also mentioned there is no need to transfer because they thought it was plainly pneumonia. WHAT SOURCES OF KNOWLEDGE DID OR SHOULD HAVE INFLUENCED MY DECISION MAKING AND ACTIONS? The decision to transfer the patient was guided by infection control measures for the safety of the patient and others. Information given to the family was in accordance to the NMC’s code of conduct to provide information to the patient and family as well. COULD HAVE I DEALT BETTER WITH THE SITUATION? I believe that we made the correct actions at that time although it could have been better if patients who are queried for swine flu are placed into isolation rooms as a precautionary measure. Doing so would prevent the stress of transferring the patient from one bedspace to another. On the other hand, Woodrow (2006) believes that breaking the news regarding patient’s outcomes be done in a private room and away from distractions instead of it being done in the bedside. If this was done, the family could ave been more relaxed sitting in a room and will be able to understand the patient’s situation, treatment and prognosis more. Both parties could have been more focused on the conversation and the condition could have been discussed in more detail. HOW CAN I MAKE SENSE OF THIS IN LIGHT OF PAST EXPERIENCE AND FUTURE PRACTICE? Although the experience put stress to myself and the other staff, it became a learning experience for e veryone. It teaches us to prioritise putting patients in side rooms if they are queried for such illnesses. This seems better than putting other patients at risk just because the diagnostic tests have not arrived yet. It also reminds us to properly document results and interventions provided for each patient. It also prompts us of the importance of the family in patient care because they need information as much as the patient. I also learned that calmness and composure of the medical staff as well as the environment is essential in delivering news to patient and family.