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Reflective account on my experience in managing a group of patients in a care setting

Reflective account on my experience in managing a group of patients in a care setting

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An essay for the 2011 Undergraduate Awards (Ireland) Competition by Antje Jacob. Originally submitted for BSC General Nursing at Dundalk Institute of Technology, with lecturer Ailish McArdle in the category of Nursing
An essay for the 2011 Undergraduate Awards (Ireland) Competition by Antje Jacob. Originally submitted for BSC General Nursing at Dundalk Institute of Technology, with lecturer Ailish McArdle in the category of Nursing

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Published by: Undergraduate Awards on Aug 31, 2012
Copyright:Attribution Non-commercial

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10/27/2013

 
Table of contents
Part A ..............................................................................................................................2Part B ..............................................................................................................................6Description of the Experience .................................................................................... 6Reflection ................................................................................................................... 7Influencing Factors .....................................................................................................8Evaluation ................................................................................................................ 10Learning ................................................................................................................... 11Conclusion ................................................................................................................13Reference List ...............................................................................................................14Appendix ...................................................................................................................... 16Patient Details .......................................................................................................... 16Johns Model of Reflection ....................................................................................... 171
 
Part A
Each day that I was on duty on a medical ward, I was assigned 6 patients to managefor the day. One particular day, I was looking after ward 1 and 2, which are two 3- bedded wards. Due to the word limit, this assignment will only look at the time between 8.00 and 15.30. (Further information on the patients can be found in theappendix).After the handover, the nurse and I went to start attending to the patients’ individualhygiene needs. As we started attending to Philomena’s* hygiene, the nurse stoppedand disconnected the NG feed so we would be able to change her clothes. Beforereconnecting the feed she checked the pH to ensure the tube was still in the correct position. As the pH paper indicated a pH of 6.5 and clinical guidelines for enteralfeeding indicate that only if the pH was below 6 could the feed be commenced, shedid not reconnect it. Instead, she instructed me to recheck the pH an hour later.Margaret* and Jane* were also given full assistance with their hygiene needs, whichincluded checking their pressure areas as well. As no abnormalities were detected atthat time we could move on to the next ward.Ward 2 is an isolation ward for patients who have screened positive for MRSA andare consequently cared for according to the MRSA protocol. This includes hibiscrubwashes and isolation precautions. None of the patients were for reswabbing that day.Rita* and Emily* only needed minimal assistance and Catherine* was self-caringwith her hygiene needs.After we had attended to all patients under my care, it was nearly time to go for  breakfast. However, before I left the ward, I went to recheck Philomena’s pH again.This time it was 4, so I documented it, flushed the NG tube with 50mls of sterilewater, reconnected the tube to the feed and recommenced the feed at 75mls per hour.2
 
After I came back from breakfast, all patients on the ward had been attended to. So Istarted checking the vital signs of my patients. The physiological observations track and trigger system (POTTS) is being used in this hospital. This gave me a goodindication of the condition of the patients under my care, along with my visualobservation skills.Philomena and Jane scored 0 on their POTTS charts. Before recording Margaret’sobservations, I also obtained her weight. When I recorded her vital signs anddocumented them in her POTTS chart, I realized that she had a POTTS score of 4,although she did not look distressed. She had an increased respiratory and heart rateand reduced SpO
2
at 87% on a 40% oxygen mask. Since her POTTS score was high Iinformed the staff nurse I was assigned to work with and also the doctor from her consultant team that was on the ward, so he could review her.Rita and Emily scored 0 on their POTTS charts. However, Catherine scored 1, as her  pulse was raised. Since she is on Salbutamol nebulisers, which can also lead totachycardia, I was not overly alarmed about her. While I was recording Catherine’svital signs I also discussed her peak flow chart with her. She had started this after shewas reviewed by the medical team that morning. As Catherine was recording themherself I observed her to ensure she was using the correct technique. That morning her  peak flow readings were 150 L/min.As it was nearly lunch time I started documenting what had happened during themorning in the patients’ progress notes. Like that I would have time to assist the patients that needed help with their lunch. Meanwhile, the doctor, who had reviewedMargaret, documented that she was sitting out and did not appear distressed and tocontinue the same treatment and care. After all patients had finished their lunch, the3

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