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A 25-year-old man sustained a high-level spinal injury during a game of rugby. He is in a tilt ‘n’ space wheelchair, has six-hourly catheters and attends regular physiotherapy sessions. Whilst attending one of his physiotherapy sessions he develops Autonomic Dysreflexia. This is his first episode and he is very frightened. A Medical Emergency Team (MET) call is made by the Physiotherapist, calling in a Doctor, a Senior Nurse and a Student Nurse. The MET must determine the cause of his Autonomic Dysreflexia before his symptoms escalate. The clinical reasoning cycle is used to demonstrate the inter-professional practice
In this reflective essay, a scenario of a patient is covered as my experience of nursing him. The Driscoll model of Reflection Cycle significantly helped me to demonstrate and reflect on my thoughts and ideas in a concise and at the same time expressive way. Keeping in mind the confidentiality of the patient, I would not disclose his real name and call him patient A. (Driscol, 2007)
Being a part of the Medical Emergency Team (MET), I am always at toes for emergencies as a student nurse to learn and practice things influentially. This time it was a case of a 25 years old person who got injured during a rugby game and experienced an intense-level of spinal-injury. Due to severe injury to the spinal cord, he has been attending the treatment over a tilt ‘n’ space wheelchair for better accessibility. It is difficult for him to attend the physiotherapy sessions and thereby, he is diagnosed with another pain for life, Autonomic Dysreflexia. As a student nurse, it was nerve recking for me to deal with such an emergency case. Autonomic Dyreflexia is a condition where there is a spinal injury above the sixth thoracic vertebrae of the spinal cord. The doctor and the senior nurse observed the case and realized that patient A was critically injured. His skin colour changed and he experienced muscle spasm. It was difficult to determine the exact cause, but it could be estimated that patient A could have had urinary tract infection or anal infections or kidney failure. The probable reason could be a blocked catheter also.
I felt numb looking at patient A, who underwent physiotherapy sessions. Life was miserable for him at that moment. The patient requires sincere physiotherapy sessions for improvement and better recovery. (Howatson-Jones, L., 2016) Not only this, his body is undergoing extreme pain, with catheters for six straight hours. It was until this when I saw him and my emotional state escalated. I was horrified by his medical history and the amount of pain he was undergoing every second. The senior nurse and the Doctor were also stunned by the patient’s gaze and the kind of will he had that kept him alive and gave him the strength to cope up with all the agony. I came by patient A and with the stress, I could not even ask him about his health for taking down note. I decided not to disturb him and eventually went on to consult for his diet. I was given the responsibility to look after him with his daily meals. (Hesse, D., 2016) Though it was ardent to look at him at the other hand nursing him, gave me the confidence of dealing with emergency and critical patients. Even after such a severe health issue, patient A did not fear death and was full of hopes. His smiling face gave me the courage to keep my ongoing training alive and professional. Patient A was fond of reading and discovering new stories. (Borgstrom, E., Morris, R., Wood, D., Cohn, S. and Barclay, S., 2016) Unfortunately, due to his condition, he was not allowed to read and strain his body, both physically as well as mentally. Thus, I decided to read him a story until the time he would be in the emergency ward. Watching him engrossed in the story, I felt relieved. Partially, I was still stressed out about patient A’s condition. The doctor told me that he needs to be operated. He had six-hourly catheters, and thus, the infection was due to this that he developed Autonomic Disreflexia during the physiotherapy sessions. (Jacobson, J. and Jeffries, P.R., 2018)
Previously, the case took a toll over my thoughts and disturbed me mentally. I consulted the senior nurse regarding my mental status as of that moment; she guided me and motivated me to stay alert concerning the patient’s health. She also asked me to stay with the patient and nurse him for his steady recovery( Bailey, S., 2017) I assured her to keep my professional duty updated and calm my stressors. Talking out my thoughts with the senior nurse made me feel relaxed and at ease. Patient A was critically ill, he was given the required medications, nifedipine and nitrates. I check his blood pressure level and the pulse rate, his pulse was more than the normal and experienced high blood pressure level. He was still not stable. I could have been standing there with a resting normal face but deep inside I was terrified and nervous. This was my first such emergency case. I did not expect it to turn worse. But intentionally I knew this experience would help me in the future for my new cases. Doctor asked me to get him dressed for the surgery. I was more nervous and afraid than Patient A. (Naber, J. and Markley, L., 2017) I asked him to allow me to dress him and told him about the surgery. He readily agreed and was still with the same facial gesture. The doctor, senior nurse, patient A and I were ready for the surgery. (Banton, T., 2020.)
The entire scenario made me mentally and emotionally stronger. Being in the emergency ward, I was occupied with work for most of the times. The schedule was hectic but worthy. (Legare, T.L. and Armstrong, D.K., 2017) As a nurse, I learnt that there would be such circumstances where I would lose hope and get anxious but I need to understand the situation and focus more on the patients and their health condition. Being tasked at the emergency ward, my psychological strength improved and I got a hold over it. This is crucial because we need to make the patients calm and relieved. This can only be achieved if we are strong and mentally determined. Initially, I was an introvert that made me lose contact of my senior colleagues, through this situation I took hold over it and asked my senior to help me by lending me emotional support. Communication is very important in such a sudden and alarming career. We need to have a bend towards the patients that could make them feel at ease. This would not only make the treatment process easier but would also give them a chance to be expressive and calm. (Trimble, T. and Jankens, A., 2019)
Such critical cases like that of patient A should be dealt with utmost care and alertness. Not every patient is like him. Most of them lose hopes and could imagine their lives fall apart. Trusting the treatment and most importantly, believing in themselves is the need of the hour. Emergency cases must never be delayed and looked upon carefully. I aim to make the initial process more hassle-free and urge the doctors to be more expressive with the patient. (Borgstrom, E., Morris, R., Wood, D., Cohn, S. and Barclay, S., 2016) Communication with the patient, talking to him, helping him with his mental consciousness would ease the case to a larger extent. This would not only help the patient but would also assist the medical staff in collecting medical history precisely. The next time, I face such a situation again; I would ensure that I do not make the patient more uncomfortable by being nervous and scared. I need to understand that me, being a nurse is my conscious decision and got to bear with my profession with utmost sincerity. As a nurse, I should not be agitated and strained in front of the patient. By concluding the assignment, I would like to address my flaws and turn them into my strength by working upon my nervousness and anxiety.
It can be concluded that, Driscol’s reflective practice allowed me to look back at my experience, which helped me to learn from it with better understanding. Reflective practice is essential for professional and personal growth, hence shall be done by me often for obtaining clarity in particular matters.
Bailey, S., 2017. Academic writing: A handbook for international students. Routledge.
Banton, T., 2020. Basic Elements of a Reflective Essay. Available at SSRN.
Borgstrom, E., Morris, R., Wood, D., Cohn, S. and Barclay, S., 2016. Learning to care: medical students’ reported value and evaluation of palliative care teaching involving meeting patients and reflective writing. BMC medical education, 16(1), p.306.
Hesse, D., 2016. Reflection and the Essay. A Rhetoric of Reflection, p.288À299.
Howatson-Jones, L., 2016. Reflective practice in nursing. Learning Matters.
Howell, K., 2018. Self Reflective Essay.
Jacobson, J. and Jeffries, P.R., 2018. Nursing, trauma, and reflective writing. NAM Perspectives.
Legare, T.L. and Armstrong, D.K., 2017. Critical reflective teaching practice for novice nurse educators. Teaching and Learning in Nursing, 12(4), pp.312-315.
Naber, J. and Markley, L., 2017. A guide to nursing students' written reflections for students and educators. Nurse education in practice, 25, pp.1-4.
Trimble, T. and Jankens, A., 2019. Using Taxonomies of Metacognitive Behaviors to Analyze Student Reflection and Improve Teaching Practice. Pedagogy: Critical Approaches to Teaching Literature, Language, Composition, and Culture, 19(3), pp.433-454.
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