Reflective Writing On Nursing Skills

In this essay, I will pen down reflections as a part of my interview for the post of Registered nurse. I have selected the question ‘How has your training prepared you for a nursing career’. I will reflect on an incident, which occurred whilst I enrolled for my nursing training in college (McAllister, 2013). I will utilize the various aspects of reflective writing model to discuss my training experience and its future implications. I will focus on my knowledge, emotions and action to elucidate how an incident during my training prepared me for a career as a registered nurse.

The incident- From the very beginning of my training, I had spent a great deal of time observing how the senior staff approached all patients. I had completed 8 months of my nursing training when this incident occurred. I consider it as an important and critical in-house incident which acted in the form of a wake-up call and created a challenging environment. Mr. Sly, aged 65 years had been admitted in the hospital after he sustained a fracture on twisting his left-ankle in a water puddle. On admission, he complained of severe pain due to fractures to the lateral malleolus on his left ankle. Pain is an unpleasant emotional and sensory experience caused due to tissue damage (Williams & Craig, 2016). The accident resulted in undue anxiety to him and his family. A doctor treated his fracture with plaster-cast immobilization and assigned a nurse to take care of him. However, the nurse in-charge did not make any effort to look after his needs or talk to him. He was distressed and had to be calmed down by his family members.

My feelings- During our training sessions, I noticed that the nurse-in-charge did not attend him, nor did she keep a record his medical notes. This incident was upsetting, as a staff was responsible for his distress. I could feel his pain and agony. I was anxious and nervous at the same time as I wanted to help him but could not do so without assurance from a senior nurse. There was swelling and bruising in his ankle. Based on my training knowledge, I felt the need of talking to him and recommending my senior to increase his drug doses.

Evaluation- I approached him and introduced myself to build a good rapport. I knew what was to be done but needed a reassurance from a senior registered nurse. I tried to initiate contacts with the senior RN who could provide him necessary resources for relief. I assured him I will be back and went to the senior to talk about his condition and how to relieve his pain. My training academics helped to understand the pathophysiology of his twisted ankle. I approached the senior for a reassessment and change of medicine dose. I took his medical charts along and showed that he was on a five hourly administration of 10mg morphine. Morphine is the most effective opioid to reduce acute pain. My mentor analyzed his charts and we changed the dose to five hourly administration of 20 mg morphine (Macintyre & Schug, 2014). A competent and responsible nurse was advised to look after him following the declining unprofessionalism of the former nurse-in-charge.

Explanation of the situation- We analyzed his medical charts because these records are the best way to monitor a patient’s conditions and needs (Abell, 2015). On analysis, she confirmed my thought of increasing the analgesic dose to reduce his pain (Macintyre & Schug, 2014). On getting back to him, I obtained his informed consent for the reassessment and told him there might be a need to increase his drug dosage to reduce his pain. This seemed to calm him a little. I had the theoretical knowledge that lateral malleolus occurs due to fractures at the end of fibula bone and morphine is the most commonly used opioid to treat acute pain (Odak et al., 2016). It works on the central nervous system. We also prescribed some antiematics to reduce his nausea. He reported good spirit and better health conditions after the reassessment. I worked hand-in-hand with my mentor and observed how she administered the drug and monitored the changes observed in the patient.

Understanding- I felt that the unprofessional attitude of the nurse-in-charge hinders care-giving practices. A nurse should always be empathetic towards patients. After a change in dosage of medicines, he did not complain of acute pain and we discharged him the day after. He thanked me for being a patient listener and communicating his problems to the senior. I realized that timely intervention of my mentor helped to reduce his discomfort (Bridges et al., 2017). Instead of being moved by pity for the patient’s condition, I should always seek guidance from a senior. Intervention form a senior always leads to a quicker outcome. I learned that a patient’s medical record is a fundamental aspect of nursing practice. Accurate documentation minimizes chances of errors and provides evidence for increase in drug doses when required. I also learned that pain is often related to subjective experiences (Wilcox et al., 2015). My future practice would include exhaustive study on pain management and patient records documentation. I will reflect on the ways of increasing effectiveness of nursing practice. I will prioritize my patients, show empathy towards them and try to make them feel comfortable. I will also focus on the use different assessment tools and VDS (verbal-description scales) to assess pain intensity and response to opioids (Athlin, Carlsson & Gunningberg, 2015). I will also sharpen my communication skills because effective communication with a patient is a prerequisite for building a strong patient-nurse relationship.

Therefore, I conclude from the incident mentioned above that, my nursing training helped me gain knowledge on the different aspects of nursing practice and providing care and relief to patients. I will try to utilize my training experience on my placement as a registered nurse.

References

Abell, C. H., Bragg-Underwood, T., Alexander, L., Abell, C. E., & Burd, V. (2015). Nurses’ Knowledge and Attitudes toward Implementation of Electronic Medical Records. International Journal of Faith Community Nursing, 1(3), 74.

Athlin, Å. M., Carlsson, M., & Gunningberg, L. (2015). To receive or not to receive analgesics in the emergency department: the importance of the pain intensity assessment and initial nursing assessment. Pain Management Nursing, 16(5), 743-750.

Bridges, J., May, C., Griffiths, P., Fuller, A., Wigley, W., Gould, L., ... & Libberton, P. (2017). Optimising impact and sustainability: a qualitative process evaluation of a complex intervention targeted at compassionate care. BMJ Quality & Safety.

Macintyre, P. E., & Schug, S. A. (2014). Acute pain management: a practical guide. CRC Press.

McAllister, L. (2013). Reflective Practice: The What, the Why and the How, of Reflection?. The ANZTLA EJournal, (7), 50-63.

Odak, S., Ahluwalia, R., Unnikrishnan, P., Hennessy, M., & Platt, S. (2016). Management of posterior malleolar fractures: a systematic review. The Journal of Foot and Ankle Surgery, 55(1), 140-145.

Wilcox, C. E., Mayer, A. R., Teshiba, T. M., Ling, J., Smith, B. W., Wilcox, G. L., & Mullins, P. G. (2015). The subjective experience of pain: An FMRI study of percept-related models and functional connectivity. Pain Medicine, 16(11), 2121-2133.

Williams, A. C. D. C., & Craig, K. D. (2016). Updating the definition of pain. Pain, 157(11), 2420-2423.