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Formal Clinical Reflection

Ariel Skinner

College of Nursing, University of South Florida

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Formal Clinical Reflection

In my final semester of nursing school, I completed my preceptorship placement on a

post-surgical/telemetry unit at Moffitt Cancer Center. On this floor, we most commonly cared for

patients recovering from thoracic surgeries who needed to be on telemetry monitoring. In this

paper, I will describe a significant clinical situation I experienced on this unit and reflect upon

my actions, feelings, and lessons learned.

Noticing

O.T. is a 36-year-old female who was admitted to our post-surgical/telemetry unit after a

lobectomy to remove a cancerous mass from her right lung. She came to our unit with a chest

tube to help with drainage and lung expansion after the surgery. On the day she was in the care

of my preceptor and I, she had already been on the unit for several days and was getting ready to

go home. She had gotten her chest tube removed the day prior and, after a chest x-ray that

morning, discharge orders were put in by the provider.

To prepare for discharge, my preceptor and I entered the patient’s room to go over

discharge paperwork and provide patient education. At this time, the patient and her husband

began to express concerns about her condition and questioned her readiness for discharge. She

stated that the area of the surgical site and around the removed chest tube was looking

increasingly swollen, and she could feel the accumulation of subcutaneous air on her right side.

Interpreting

In order to make a decision, my preceptor and I physically assessed the patient to obtain

objective data about her concerns. Both my preceptor and I visually inspected the site, comparing

it to her left side, and noticed increased swelling and redness. We also performed palpation and

felt subcutaneous air around the removed chest tube site when the patient coughed. Based on this
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assessment, we supported the patient’s concerns and decided to contact the provider with an

update on the patient’s condition.

Responding

My preceptor and I immediately left the patient’s room and paged the doctor to let them

know of her concerns and our assessment findings, so that the decision to discharge could be

revisited. The literature supports this decision, as research shows that there is an increased risk of

untimely readmission when a patient’s needs are not fully met at the time of discharge (Krook et

al., 2020). Furthermore, even if the patient turned out to be fine and there was no reason to delay

discharge, it is still important to encourage patient empowerment and allow the patient to express

her concerns with the plan of care (Krook et al., 2020). Given the vulnerable position of the

patient, it is the duty of the nurse to serve as an advocate and communicate with the provider to

ensure the patient’s needs are addressed (Vitale et al., 2019).

At this point in time, there was nothing left to delegate to other members of the

healthcare team—we let the patient know we had paged the doctor and kept checking in on her

in the meantime.

Reflecting

Overall, I believe it was the right decision to notify the doctor of the patient’s concerns

and our assessment findings. Unfortunately, the desired outcome was not achieved—the provider

called my preceptor to receive a more detailed report about the situation, and the provider stated

that the subcutaneous air was normal and that the patient was ready to be discharged. We

informed the patient of this update, and she was discharged shortly after. However, the patient

sadly was readmitted to the hospital later that night through urgent care with a pneumothorax and
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had to have her chest tube put back in. This confirms our concerns were valid and that she was

not ready to be discharged in the first place.

With the outcome of this situation, I think something that was done well was taking the

patient’s concerns seriously and initially advocating for the provider to address her concerns.

However, what I could have done better is continuing to support her when the doctor stated that

she was ready for discharge. If this situation was repeated, I would further advocate by

requesting for the provider to come to the unit and physically assess the patient prior to making a

decision about discharge.

Conclusion

In conclusion, this patient scenario was an excellent learning experience and provided a

lesson that I will take with me going forward in my nursing practice. Going through this situation

reminded me why nurses have a duty to serve as an advocate for their patients above all else.

Patients in the hospital are in a vulnerable situation, and it is one of our biggest responsibilities to

ensure that their concerns are properly addressed so that negative outcomes like the one

described above can be avoided.

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References

Krook, M., Iwarzon, M., & Siouta, E. (2020). The discharge process— From a patient’s

perspective. SAGE Open Nursing, 6, 1-9. https://doi.org/10.1177%2F2377960819900707

Vitale, E., Germini, F., Massaro, M., & Fortunato, R. S. (2019). How patients and nurses defined

advocacy in nursing? A review of the literature. Journal of Health, Medicine, and

Nursing, 63, 64-69. https://doi.org/10.7176/JHMN/63-08