The event occurred in the fourth week of my practice. I was tasked with the duty of checking patients’ vitals and providing basic care. I witnessed a situation whereby a buddy nurse refused to give a patient the level of comfort she deserved because the nurse thought that the patient’s request was not a priority. As a result, the patient’s care was compromised because I did not defend her right to comfort by granting her a request to use the toilet. The issue was about the patient’s right to quality care and how a nurse (in this case me) can advocate for that patient if his/her rights have been ignored or violated by a fellow practitioner.
In my opinion, the nurse’s refusal to help the patient simply because her request was not a priority was not justified. I believe that as a nurse, it is my duty to help all my patients get quality care and the level of comfort that they require. The nurse’s behavior was unethical and I wanted to make sure that she understood that. This was important to me because I do not believe in double standards. One cannot provide service to one patient and ignore another. I believe in being fair regardless of my patient’s prevailing status, and I would like my fellow nurses to showcase the same level of professionalism in all their endeavors.
Elaborate
It was on a Wednesday during the fourth week of my clinical practice. An occupational therapist came in to dress the patient and assist her to do some motion exercises in bed as part of her daily exercise routine. Afterward, we transferred her to a wheelchair. Later on, the patient asked me to assist her to get to the toilet. I had to go and ask the buddy nurse to come and assist because the patient needed two people to help her get to the toilet. The nurse responded by saying that she was busy dealing with other patients and that my patient had to wait.
I went back to the room and relayed the message to the patient. Twenty minutes later, the nurse came into the room and started working with other patients. My patient was really pressed and I was getting overly concerned about her. I asked the nurse for her assistance and she told me to wait. I felt powerless and useless. I wanted to help my patient but I could not do it alone. I tried thinking of ways I could help her alleviate her discomfort. I knew and understood her need to go to the toilet. This was an uncontrollable action and if not addressed it would be messy and embarrassing for the patient.
What pained me was the fact that her request was simple and logical. It would not take much time. I could not understand why the nurse allowed this to happen well knowing how delicate the situation was. In school, we were taught how to defend patients and advocate for their rights. I wondered whether the nurse attended those classes. A nurse should be caring not dehumanizing. I looked at my patient and saw sadness in her face. I placed my hand on her shoulder and told her to hold on for a few minutes as I try to find other alternatives.
Analysis
The key issue in this event was that I failed to advocate for my patient’s right to comfort. According to Morse (1996, p. 6), providing comfort is a process that “includes discrete, transitory actions such as touching, or broad, longer-lasting interventions, such as listening (as cited in Kozier et al, 2010, P. 385). I failed to provide comfort because the patient eventually soiled herself. If I had listened to her and taken action immediately, this humiliating situation could have been averted.
Similarly, Heijkenskjol, Ekstedt and Lindwall (2010) assert that patients may participate in the delivery of their own care. This means that they can advice or recommend a course of action that benefits them and helps in the healing process. I did not do this because I failed to listen to my patient, which led to her embarrassing herself. My failure to advocate for my patient led to a situation whereby her care was compromised.
Revision
Looking back at the event, I believe that I was wrong and that I could have done more to help my patient. I comforted the patient by holding her shoulder and reassuring her that it was alright. However, I compromised her care by not listening to her, and taking swift action in response to her request. I will work hard towards developing positive therapeutic relationships with my patients. This means listening to them, taking actions swiftly and providing viable alternatives in cases where procedures are not working efficiently. For example, in this situation, I would have called in another nurse to help me when I realized that my buddy nurse was too busy. Alternatively, I would have provided the patient with a bedpan if no one was available to help me take the patient to the toilet. These alternatives would have helped the patient get the comfort she deserved and assist me in fulfilling my duty as a patient’s advocate.
New Perspective
It is my duty as a nurse to provide patients with the level of care they deserve despite the prevailing conditions. Patients have rights and as nurses, we are obligated to protect and avail these rights to patients without compromise. I believe that I can become better at my job if I learn to evaluate situations and come up with viable solutions to these situations. In some cases, the help that we are expected to get may not arrive on time. As such, we must be proactive in order to ensure that our patients get the best care under all circumstances.
References
Heijkenskjol, K., Ekstedt, M., & Lindwall, L. (2010). The Patient’s Dignity from the Nurse’s Perspective. Nursing Ethics, 17(3): 313-24.
Kozier, B., et al. (2010). Fundamentals of Canadian Nursing: Concepts, Process and Practice (2nd Canadian ed.). Toronto: Pearson Education Canada.
A community health nursing course is essential in equipping the nurses with the skills to advocate for healthy lifestyles. The three crucial objectives of this course are: analyzing the impact of lifestyle and environment on the public’s health and applying culturally competent health strategies to the care of communities, families, or individuals. Lastly, building relations with the community members, local leaders, community groups, and private organizations to achieve mutually set health goals. Meeting the first objective was to research the causes of health disparities within the population. The significant causes of health issues included exposure to toxic substances and lifestyle behaviors. The cultural competent health strategies objective empowered me to want to be culturally competent. I ensured I learned about other cultures, attended diversity-focused conferences, and interacted with diverse groups within and outside my department to ensure I met this objective. I participated in community volunteer works, both related and non-related to medicine. The interaction enhanced my relationship with the community and helped me achieve the third objective. I understood the population’s health issues as I interacted with them.
The biggest challenge in this course was the grueling lectures. Lectures involving this course consisted of complicated theories and concepts that required forcible background knowledge on subjects such as Biology and Anatomy. Engaging in further research and reading on materials covered in class helped build strengths rather than letting challenges overcome me. I was involved in study groups with my peers and shared study tips, thus improving my performance and overcoming challenges. Since nursing requires much reading apart from having long lectures, I engaged in skim reading first. I looked at the headings, subheadings, highlighted terms, and summaries through this reading technique to help identify the most critical information. The materials I accessed that helped support my success included instructor notes, course textbooks, and websites such as WebMD, World Health Organization, and Mayo Clinic. The problem-solving process in my student life applies to my post-education life as it will significantly contribute to effective nursing performance. Having the ability to solve problems will promote healthy relationships and boost confidence and motivation. With the problem-solving skills, I will be able to apply the theoretical knowledge acquired now to solve real-world patient problems.
Given the opportunity to work in a hospital as a professional nurse, a healthcare team member, or a global citizen, my first step will be to practice what I learned in the form of theory from this course. The learning theories learned are helpful in healthcare practice in several ways, shown below. Dealing with children and teenagers becomes easier with cognitive development, which focuses on thinking, reasoning, and perceiving changes. Theoretical knowledge ensures one understands certain diseases, symptoms, and treatments. Understanding the academic work is essential in applying my treatment skills to the public and making it more effective. Treatment gets enhanced by using theoretical knowledge to prevent practical health disparities. In times of critical thinking, problems related to health need to be solved, and one simple mistake can lead to severe consequences; a reference needs to be made on the theoretical knowledge where steps are outlined to prevent or taste specific issues. Information about all health issues is typically learned theoretically. The adeptness can be retained for a long time by applying spaced repetition. With the retention, the information will be helpful during treatment, where critical thinking skills need to be used to prevent issues from worsening.
Self-reflection allows nurses to analyze their experiences in practice and incorporate changes in the current and future practice to improve the outcomes. Reflective nurses are resilient, have improved wellbeing, and are professionally committed. Healthcare providers require encouragement to provide evidence-based care to patients, which relies on experience and prior studies. Self-reflections aid in the advancement of the nursing profession through the change of individual goals.
Confidentiality is critical in the disclosed or published case studies (Gogo et al., 2019). The paper provides a self-reflection analysis based on a case of an elderly patient who presented to the nursing home where I worked with the signs and symptoms of urinary retention.
Mrs. X, a 70-year-old patient presented with the inabilities to urinate, a distended abdomen, and discomfort on the lower abdomen. The patient also had diabetes and had been on medications for three years. For three months, the patient had been having problems with urination.
She was unable to empty her bladder by voluntary micturition and was experiencing overflow dribbling of urine due to bladder distention. Additionally, from an ultrasound done to estimate the amount of urine retained, the nurse identified that the woman had a high post-void residual. The patient also had a history of an injurious fall that immensely affected the pelvic function and had physiotherapy sessions for three weeks.
Mrs. X’s medical problem with voiding started days after experiencing the fall and is currently using crutches to maintain stability. A review of systems indicated positive findings on the genitourinary system and the musculoskeletal system. All vital signs were within the normal range. Generally, the patient was rather anxious and stressed due to her inability to void. The initial management aimed at helping the patient void the retained urine.
The priority was the use of non-invasive treatment methods for fear of hurting the anxious patient. The remaining option was treatment with the use of muscle relaxants to help the urinary sphincter muscles relax. The medication prescription was also meant to lessen my work of going through an aseptic procedure to save time for the overwhelming number of patients.
Since the physicians in the nursing home were busy, I decided to prescribe drugs to the patient. The medication of priority was 0.4mg of tamsulosin taken once daily for seven days and dutasteride 0.5mg taken once a day for seven days. After 48 hours, there were no signs of improvement, which initiated the need for another treatment therapy.
Furthermore, the patient got diagnosed with a urinary tract infection due to prolonged retention of urine. The patient got subjected to more stress and the family members were getting agitated and were losing trust in the healthcare providers. During this time the patient together with the family members were involved in making appropriate patient care decisions. A Foley catheter was inserted to remove the urine. Prolonged retention of urine can have effects on the kidneys.
The main issue of concern in the case scenario was the provision of care without patient and family involvement. The decision to prioritize medication over other treatment therapies such as the use of a catheter to drain the retained urine before advancing to other treatment therapies only involved one individual. Medications take longer to bring the desired effects on patients (Krueger et al., 2020).
The patient and the family lacked knowledge of the condition and the complications that could be associated such as urinary tract infections. Therefore, adequate patient and family education was critical before setting the goals of care and collectively developing strategies for their achievement. Patient and family involvement brings a feeling of trust in the care provided and makes them own the outcomes of care.
Another issue of concern lied on the inability to involve other healthcare workers in the management of the patient. Currently, the healthcare system advocates for patient care using interdisciplinary approach and teamwork approach (Gogo et al., 2019). A correct determination of providing early care to reduce the patient waiting time was prudent but a wrong decision was made on the priority treatment therapies. Even though the physicians were busy, a consultation could have contributed to making a correct choice.
Proper consultations could have solved the problem early and prevented the establishment of a urinary tract infection. The main goal of primary care was to reduce the symptoms and preclude the development of complications. Thus, a catheter to drain the urine could have been the first option.
Reflection of the Case Study
A quick intervention was required to relieve the symptoms that accompanied the urinary retention. A non-invasive therapy was preferred to an invasive therapy for fear of the effects on the patient. The client presented with stress and the introduction of a catheter into her urethra was presumed to increase the depression. Diabetes causes strengthening and contraction of the bladder muscles to prevent voluntary muscles (Billet & Windsor, 2019). To avoid trauma, discomfort, and increasing the risk for urinary tract infections, removal of an invasive catheter was recommended. The medication was anticipated to bring muscle relaxation within the first twelve hours but it took two days without success.
As a result of making decisions without consultations and poor priority of interventions, the patient and her family members were subjected to stress. From the observations, they lost trust in the care provided in the nursing home. The patient remained in discomfort for the period before further actions. The facility aims at providing care that is patient and family-centered but for this case, the actions made were contrary to the expectations.
My colleague health workers were disappointed because I failed to involve them in patient care. On consultation with other healthcare workers, patients, and the family, better interventions were made. The actions negatively affected the performance appraisal and facilitated my transfer to another ward.
I experienced a sense of guilt and self-blame for the wrong decisions that greatly affected me, the patient and family, and the colleagues. The shame decreased my self-esteem and it was difficult to cope with the situation. I acknowledged and accepted the mistakes and apologized for the situation that could have spoiled the image of the organization, which works on set standards. The patient and the family members became dissatisfied with the care provided.
The care received did not meet their expectations and even requested for a transfer but after assurance, the transfer was canceled. Since then, the client asked many of questions whenever a healthcare provider was attending to her. Furthermore, she demanded care from another nurse other than me. The situation initiated a change on the limits to which caregivers practice in the organization, an action which hinders the achievement of the future of healthcare goals.
Factors Influencing Actions Made
Unclear hospital policies and guidelines contributed to the development of the situation. Policies that define the roles of each healthcare provider are critical in the elimination of errors in care. In some organizations, nurses are prohibited from reviewing patients, prescribing drugs, and ordering tests without supervision from doctors. However, the nursing field is evolving at a high pace and it is aimed at eliminating the barriers that hinder nurses from exercising to their full potential.
In the discussed case, the nurse was supposed to review the patient in consultation with the physician on duty before determining on the actions to follow. Critical thinking is key when deciding the priority interventions of care (Billet & Windsor, 2019). A policy that puts surgery and medical treatment as the last therapies of care is required to minimize their effects on patients. In the nursing home, a clear policy, which indicates the protocols in patient care, is required.
The hospital culture discourages the use of invasive urine catheters because they increase the risk of urinary tract infections. Besides, shortages of non-pharmaceuticals such as catheters and lubricating gels in the facility influenced my decision.
The management of the nursing home failed to organize continuous medical education to keep the healthcare providers updated on the current trends of patient care. Understaffing of physicians significantly contributed to the wrong actions. The adequacy of physicians encourages teamwork and minimizes errors due to increased supervision (Krueger et al., 2020). Furthermore, the facility was overwhelmed with patients and I had to save time to attend to other patients.
External factors considered included the general condition of the patient. Urine retention is associated with an increased risk of infections, thus, insertion of a catheter multiplies the risk. Evidence from research indicates that catheters increase the risk of infection, especially in female patients who cannot use a condom catheter.
Furthermore, a catheter does not permanently solve the problem unless the patient agrees to use it for a long period. Indwelling catheters predispose patients to stigmatization, which affects their self-esteem (Billet & Windsor, 2019). The patient came from a poor socioeconomic background and was not insured hence could not afford surgery.
In the clinical setting, consultations and experience act as the best sources of knowledge for healthcare providers. Throughout practice in hospitals, I had not managed an elderly patient with urinary retention to gain experience in managing the condition. Besides, I was a new nursing practitioner who had just graduated from school.
Even though I was uncertain about my actions, I never consulted my colleagues, seniors, and online materials that are vital in the provision of evidence-based practice. After the incident, the team manager showed me a poster on the wall that had guidelines concerning the management of urinary retention. All the time of my hospital experience, I had never bothered to read the posters on the walls.
Given another chance, I will employ an inter-professional approach in the provision of patient and family-centered care. At first, I never involved the patient and the family in the care, an act, which had negative impacts on my therapeutic relationship with the patient. The patient lost trust in me and requested a change of the care provider.
I had the choice of discussing the available treatment options with the patient and her family and together decide on the best intervention based on the goals of care. After the prescription of drugs, the physician could have been informed to evaluate the management and suggest therapy change if necessary. Since the goal of primary care was to reduce the symptoms, a catheter could have drained the urine within the shortest time possible as compared to drugs, which take longer to act and sometimes get accompanied with interactions and side effects.
Learning from the Experience
As the saying goes, the experience is the best teacher in learning. The situation discussed above-provided lessons for use in future practice. I realized that patients and the family need to take the center in healthcare delivery actions taken should be based on their emotional wellbeing. Also, healthcare delivery needs to be based on an inter-professional and teamwork approach. I have discovered that all human being make errors and through the errors, they learn.
I actively involve myself in research and continuous learning to keep myself updated with the current trends in patient care. I have explored the various strategies of involving patients and their families in care.
Currently, I am an advocate of patient-centered care and I encourage my colleagues to be ambassadors of multidisciplinary and teamwork approach in care. Mrs. X’s case has significantly influenced my way of practice. My actions are based on consultations and whenever I am not sure about something, I do not do it.
I aspire to provide quality nursing care in collaboration with other healthcare providers with the consideration of the emotional, social, and cultural wellbeing of the patients and their families. Additionally, I am committing myself to long-life learning and continuous research to aid in the provision of evidence-based care.
Conclusion
Self-reflection is a critical aspect for nursing practitioners to help them use their experience to shape their future experience (Vicdan, 2020). In the clinical setting, errors occur and should be used to effect positive changes that improve the care outcomes. Actions need to be done with rationale and ought to consider the emotions of self and others. Individual goals should translate into the general nursing goals that define the future of nursing. I recommend an increment in the publishing of self-reflection studies of nursing practitioners to be used as evidence for present and future practice.
References
Billet, M., & Windsor, T. A. (2019). Urinary retention. Emergency Medicine Clinics, 37(4), 649-660. Web.
The quote above made a deep impression on me. It made me realize the importance of stopping and reflecting on the causes of events, the reasons for our actions and the best way to proceed. Rather than establishing our focus on other people’s perception of us, we should focus on carrying out our duty to pursue our passions without restraint. It made me realize that for every single action, it is essential to ask ourselves questions like, why am I doing this? Does the end-result of this action positively contribute to my development and personal fulfillment? How does it contribute to the wellbeing of the society at large? Even though the answer might not present itself immediately, the intricate journey of life has a tendency of revealing the answers to these questions. However, this cannot freely happen in a mind that does not take the brave step of stopping and reflecting. It only takes place in a mind that is free to explore and question certain fixed boundaries of societal norms.
As much as we live in a world where no man can live as an island, it is imperative that one considers his weaknesses and strengths in relation to his dreams and ambitions. Whereas the world might form their own biased opinion of me as an individual, this should not be the basis from which I should determine my real self. I should gauge my capabilities and weaknesses and pursue my dream without considering the distractions from society. On the other hand, I believe that as an individual, I should acknowledge their opinions analytically so that I pick everything that positively contributes to my development as an individual while selectively leaving out every opinion that might act as a speed bump on personal development.
All of us live with ambiguity and intractable issues. Our differences, however, reveal themselves through the diversity in which we respond to these conundrums. Some people just wait in the expectation that “time will heal all wounds,” while others make the utmost exertions in order to tackle problems head-on. I believe that the process of dealing with some of life’s intractable problems imparts upon us the art of patience and diligence so that we won’t make choices in haste that we will later regret. These experiences can later become valuable resources.
Those of us living busy lives in modern society want to experience instant results. However, life frequently serves up both disappointment and success to help us find the direction and path that is most suitable for each of us. In order to draw a proper “self-portrait” practical experience is of paramount importance. Even though criticism is imminent in such circumstances, with a firm resolve to overcome present obstacles as well as a burning desire to pursue your goals, you will slowly approach your dreams through the process of trial and error. Through this process, one can tend dreams for the future, helping them grow. By living our lives and making mistakes, I believe we can find our own path.
Even if loneliness and sorrow line my path, I will continue to paint my self-portrait and pursue my dreams. Success and failure are all parts of life. The quote, “At present you need to live the question,” tells me to be brave and pursue my work with pride as the shortcut to success.
Participation in class discussions and online activities is important in any learning endeavor because it promotes effective learning activities, stimulates creativity, and instills confidence. Active contribution to discussions is a reflection of competency of the skills I have gained in class. This paper provides a self-reflection on course participation concerning various learning elements.
All-Over Class Participation
I participated adequately in class and online discussions (High rating). I only missed one out of the 12 on-campus sessions. However, my contribution to the attended sessions was up to the recommended standards. I stuck to the objectives of the course throughout the sessions. Consequently, I posed questions meant to complement the learning objectives to engage my classmates during discussions (Akkaya & Demirel, 2012). I avoided using ‘leading questions’ that could otherwise prompt the answers and in so doing enhanced critical thinking and creativity. I also avoided asking ambiguous questions that could lead to unnecessary discussions and wastage of time (Etemadzadeh, Seifi, & Far, 2013). I tried my best to provide precise answers and made a habit of giving other students a chance to speak without interruption.
Listening and Reading Skills
Listening and reading are important in grasping and mastering the course content. Listening requires focus and concentration with the ability to analyze different situations critically while reading requires internal listening. Therefore, poor listening and reading skills are indicators of failure. Throughout the course, I demonstrated an interest in my peers’ and instructors’ contributions. During the class sessions, I used keywords to note down the ideas presented by others. I also strived to make eye contact with my audience during discussions.
Class Preparation
I prepared for class by completing required readings (High rating). Before every class and online session, I read ahead on the topic to be discussed as suggested by Ding, Kim, and Orey (2017). The designated course readings were useful in this regard. I found that this approach prepared me for the discussions because the preparation helped me to anticipate various questions on the discussion topics.
Quality of Contribution
Though I made significant contributions to the class, I was not able to answer all questions posed to me as comprehensively as I had wished, which indicated that my preparation was not as thorough as I thought. I had small problems in linking some of the readings to the discussion. These problems may have been caused by internal interferences such as mental state and nervousness (Staveley-O’Carrol, 2015). Nevertheless, most of my answers were accurate. Therefore, I rate myself as high in this aspect.
Impact on Seminar
My contributions were useful in stimulating new ideas and setting the base to recognize the strengths of other people. Therefore, I grade myself in the high category in this aspect. The use of real-life examples and happenings in the contemporary world helped me to deliver my sentiments effectively (Bosangit & Demangeot, 2012).
Frequency of Participation
Maintaining consistency in schoolwork requires frequent participation in class. The frequency of participation is also an indication of classroom attendance because it is impossible to participate in a class where one is conspicuously absent (Heaslip, Board, Duckworth, & Thomas, 2017). Frequent participation also encourages other students to be active participants in the class. I rate my frequency of participation as high because I attended all class sessions except one.
Conclusion
In conclusion, I rate myself in the medium category for all the aspects of class participation. However, I rate my participation in group activities and all other categories as high. Overall, my performance was good because this was my first semester even though I aim for a score of 10 come next semester. This reflection has helped me to identify my strengths and weaknesses, which will help me perform better in the coming semester.
References
Akkaya, N., & Demirel, M. V. (2012). Teacher candidates’ use of questioning skills in during-reading and post-reading strategies. Procedia – Social and Behavioral Sciences, 46, 4301-4305. Web.