Critical Reflection In Contemporary Nursing Practice

Experience with Urinary Tract Infection Patient

Question:

Discuss About The Nursing In Turkish Breast Cancer Patients?

In contemporary nursing, critical reflection is an important virtue that a nurse practitioner must possess in order to take charge of a situation in an accurate manner. Contemplating a scenario by reverting to the scenario and understanding of the context through modification of future outcomes is performed through critical reflection. Driscoll’s Model of Refection renders a suitable framework is appropriate in this regard. accounting to this model, reflection to one’s professional experience is achieved through three vital processes that attend to questions ranging from what, so what and now what (Bulman 2013). Therefore, in nursing practice it is possible to link theory with practice through this model of reflection. Ability to demonstrate various nursing skills is made possible through this model thereby depicting a thorough understanding and insight on the given scenario (Kelly et al.). As part of my professional practice in nursing, I came across certain demanding situations in which I had to apply my prudence and pragmatism to arrive at pertinent conclusion through accurate decision-making skills. Analysis, review and evaluation of my experience will be done by virtue of applying this Driscoll’s Model of Refection (Morton et al. 2017).  Considering the fact that critical reflection is an essential attribute in nursing practice, I will try to interpret my experience in a way so that there remains ample scope for improvement through identification of the gaps in practice. All discussions will be made in line with the accepted codes of conduct and professional standards. In the following section, discussion will be made with respect to a patient admitted at the urology ward of clinical practice. Further, a scenario with respect to a patient undergoing mastectomy due to breast cancer admitted in breast endocrinology ward will be discussed.

What?In this section, give a thorough description of the clinical scenario/encounter.  This should be something that challenged you on a professional or personal level whilst undertaking your first PEP.

In course of my PEP, I came across an 80-year-old female patient who was admitted in the urology department following complaint of urinary tract infection with history of dementia, hypertension and hyperlipidemia. Cath examination of urine confirmed urinary tract infection. One morning while assisting her for toileting, I found her to be somewhat disoriented and confused. She also had arthritis, ambulated with the aid of walker, and sat on chair for most of the day. Patient reported pain at the suprapubic site and in pelvic region with sensation of burning pain during urination that was indicative of urinary tract infection (Nicolle 2013). Therefore, I found it challenging to tackle her situation with priority being reducing and reliving her sensation of pain and discomfort to account for optimal wellbeing.

Experience with Breast Cancer Patient

Further, in course of my professional experience placement, I came across a 50 year old lady who survived breast cancer and underwent modified radical mastectomy in her right breast following 6 cycles of chemotherapy. However, 4 months after operation she complained of a lump formation nearby the incision area without any discharge and was admitted for performing further surgery. The patient also had symptoms of nausea and vomiting that severely impaired her quality of living. Besides these, she suffered from hair loss that lead to distorted body image. Fatigue and loss of appetite was also reported in her (Cheng et al. 2014). On interacting with her, I was of the opinion that she suffered from depression owing to her condition and refrained from communicating with anyone while on admission to the ward. Moreover, she also refused to take prescribed medications and showed reluctance to follow instructions as suggested for her to abide by. Hence, I faced particular challenge interacting with her and making her act in compliance with the prescribed medications. 

So What? This is an analysis of the event. How did you feel at the time and is this different to your feelings after the event? What did you do well and what could you have done better? What were the effects of what you did or didn’t do?

On encountering the situation relevant to the patient, I was a little perplexed as how to approach it. I prioritized pain reliving for the patient to offer better outcomes. I promptly resorted to applying heat through hot water bag in the pelvic region to provide mitigation of pain sensation alongside relief from spasm. Within 15 minutes the pain subsided and patient reported feeling better. Further, I administered her with Ciprofloxacin as prescribed by doctor to accentuate her recovery. Research has provided empirical evidences that antispasmodic agents are effective in bladder irritability and analgesics are suitable for pain mitigation (Flores-Mireles et al. 2015). Patient expressed positive responses on administration of the medicine as she was visibly in a better position without any sign of grimacing pain or discomfort. However, I feel that besides medications I could have encouraged her to frequently void by increasing her fluid intake to promote renal blood flow thereby allowing bacteria to be eliminated from urinary tract.

Reviewing and carefully analyzing the case history of the patient, I became sure about the present situation of her. Physical pain associated with her treatment for breast cancer was followed by feelings of depression and confusion. Therefore, adjunct to the physical therapy, I also resorted to counsel her for complying by the prescribed medications and follow general guidelines imperative for her health and wellbeing. I encouraged her to take small meals frequently so that the symptoms of nausea and vomiting may be kept under control. I also explained to her the course of treatment that might exert beneficial effects in treating her condition. Side effects following administration of drug tamoxifen that might lead to hair loss were also clarified to her so that she does not have any misconceptions about the therapeutic effects directed to her. Moreover, I also encouraged her to perform frequent ambulation so that fatigue may be well managed. Within one week, I found visible signs of improvement in her condition as she gradually made efforts to walk by her own and started taking meals at frequent intervals. Nausea and vomiting signs declined considerably. However, I feel that I could have consulted with a registered psychiatric nurse to intervene in the situation and harbor positive outcomes at earliest possibility. Breast cancer survivors are most likely to suffer from misconceptions due to lack of knowledge and hence nursing interventions must be directed to treat their condition effectively (Bayram, Durna and Akin 2014). 

Analysis of Experiences Using Driscoll's Model of Reflection

Now What? You should identify what is the main learning you took from reflecting on your practice? What are the implications for you in future clinical practice based on what you have described and analysed? What two key areas within your practice can you improve and what help/strategies can you identify to assist you to modify your practice if a similar situation arises in your next PEP?

Reflecting on my practice, I came to acknowledge the urgency of administering medication depending upon case situation to facilitate speedy recovery and healing of the patient. In my future clinical practice, I aim to apply this knowledge of medications in treating urinary tract infections in case of elderly female patients who are more prone to acquire the condition because of their advanced age and other hormonal imbalance states (Castle et al. 2017). The two areas within the scope of practice which I feel can be improved are that of staff training and clinical governance as both has the potential of strengthening the services available in the context of healthcare unit. If similar situation arises in course of my professional experience placement, I would prefer consultation with the attending physician to ensure maximal positive outcomes and able guidance.

On evaluating the patient condition, I came to know that it is crucial to undertake a person centered approach to render holistic care to the intended audience (Kang and Suh 2015). Thus, evidence based practices in alliance with person centered care may be beneficial for breast cancer patients. Two key areas which I feel have scope of improvement in this regard are clinical supervision and multidisciplinary approach to therapy. Breast cancer might account negative repercussion and therefore clinical supervision and collaboration among healthcare professionals might assist in clinical practice in similar situation (Zhou et al. 2014).

Conclusion

In future practice, I will be able to apply the knowledge gained for treating urinary tract infection in case of similar situations for other client by addressing the signs and symptoms judiciously. Further, in course of the experience gained from treating the patient suffering from breast cancer and undergoing mastectomy, I understood a different aspect associated with this threatening illness. Addressing of the psychological dimension to any illness is also of importance in achieving holistic outcomes for the patient. Hence, critical reflection to these events will be of paramount significance to imply definite changes.

Reference List

Bayram, Z., Durna, Z. and Akin, S., 2014. Quality of life during chemotherapy and satisfaction with nursing care in Turkish breast cancer patients. European journal of cancer care, 23(5), pp.675-684.

Bulman, C., 2013. Getting started on a journey with reflection. Reflective Practice in Nursing, fifth edn. Oxford: Wiley-Blackwell.

Castle, N., Engberg, J.B., Wagner, L.M. and Handler, S., 2017. Resident and facility factors associated with the incidence of urinary tract infections identified in the nursing home minimum data set. Journal of Applied psychology, 36(2), pp.173-194.

Cheng, K.K.F., Devi, R.D., Wong, W.H. and Koh, C., 2014. Perceived symptoms and the supportive care needs of breast cancer survivors six months to five years post-treatment period. European Journal of Oncology Nursing, 18(1), pp.3-9.

Flores-Mireles, A.L., Walker, J.N., Caparon, M. and Hultgren, S.J., 2015. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews. Microbiology, 13(5), p.269.

Kang, J. and Suh, E.E., 2015. Perceptions of quality of patient-centered nursing care among women with breast cancer. Perspectives in Nursing Science, 12(2), pp.115-123.

Kelly, J., Watson, R., Watson, J., Needham, M. and Driscoll, L.O., 2017. Studying the old masters of nursing: A critical student experience for developing nursing identity. Nurse Education in Practice, 26, pp.121-125.

Morton, N., Vincent, W., Schiessel Harvey, N. and Curzon, R., 2017. ‘Thank You for Taking the Time to Understand’: A Critical Reflection on Peer-led Interventions in Early Experiences of Higher Education. International Journal of Construction Education and Research, pp.1-17.

Nicolle, L.E., 2013. Urinary tract infection. Critical care clinics, 29(3), pp.699-715.

Zhou, K.N., Li, X.M., Li, J., Liu, M., Dang, S.N., Wang, D.L. and Xin, X., 2014. A clinical randomized controlled trial of comprehensive intervention in female breast cancer patients after radical mastectomy: results on depression, anxiety and length of hospital stay. International Journal of Nursing Sciences.