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Reflective Journal

A reflective journal is a learning experience journal in which the writer writes about the knowledge gained during a particular assessment (Warwick, 2015). Its purpose is to make the readers learn from the writer’s experiences and follow them while working and by nurturing them efficiently, it teaches us skills that can be used all throughout our practice (Jones, 2016). It should be a detailed journal of the experience, the situation and what all are the learning outcomes from it. In this journal, I am going to discuss the various clinical learning outcomes that I have experienced during my clinical placement in medical surgical department. As a nurse, I have come across many incidences which were great practical learning sources for me. In this journal, I will be sharing few of my learning experiences using Gibbs reflective framework model which would help me in discussing every aspect (Maloney et al., 2013). I will be discussing the importance of hand hygiene, time management skills and how to manage the work load effectively in order to give the best to the patients. These are the things I learnt during my practice that I will be sharing in detail.

During my practice, I was cleaning an old man’s wound after he had undergone abdominal surgery. I forgot to follow the hand hygiene that is very essential. I did not wash my hands with alcohol or soap and I was cleaning the wound with my unwashed hands. I cleaned the wound and then shifted to the next patient repeating it, that is, with the unwashed hands. When my registered nurse asked me about the same, I told her that I forgot to do so.

I got anxious as it was my first ever clinical placement experience. I got alarmed by this and spoke to my mentor about the same. She looked into the case and told me to be cautious. The incident was extremely challenging for me and I regret not washing my hands before cleaning the wounds of the patient. I am pleased to the mentor’s reaction and how softly she explained me the importance of hand hygiene. As stated by WHO, hand hygiene and prevention of surgical site infections are the major prevention techniques (WHO, 2019).

 It was stated that hand hygiene is considered to be the most important routine that is needed to be followed in order to prevent infection and cross contamination (Fox et al., 2015). Following hand hygiene can help in preventing the infection and controlling it as well. Taking the case of multiple patients with unwashed hands may lead to infection. Infection spreads easily from one person to the other if proper hygiene is not maintained. The nursing and midwifery council code of professional conduct states that a nurse should identify and minimize the risk of patients (Nursing and Midwifery Board of Australia, 2015).

Looking back at the incident, I learnt a lot of things related to hygiene and how a simple practice of hand hygiene can prevent patients from getting infection. I realized the need to learn various hygiene forms including that of uniform hygiene. In future, I will always remember to wash my hands before and after every patient and ensure the well being of the patient. Decontamination of hands is very important in infection prevention and control. The hand hygiene and the environment hygiene in hospitals is very important (Vaidya, 2013). The environment is supposed to be kept clean and disinfected.

The second experience during my clinical placement was based on work load. It was the hectic time when there were many patients admitted to the healthcare. I was working as a student nurse under the RN in a ward. There were around 20 patients in a ward. I was instructed to take the vitals of the patients in a ward. I was taking the vitals that included heart rate, blood pressure and respiration rate and so on. After noting down for about 4 patients, as I moved to the fifth patient the blood pressure rate noted down by me was high. I did not pay much attention to it and moved on to the next patient as I was told to do for eight patients. I then took vitals for rest of the patients. By the time I was completing my task for the last patient, the fifth patient started complaining of uneasy feeling and pain in the left side of the upper body. MET call was made and the doctor was notified about the situation. He was immediately checked by the doctor and the first thing the doctor checked was blood pressure. The doctor was surprised to see the high rate and spontaneously reacted to it.

 I got very scared for a moment but RN told me to calm down. I got so nervous because it came to the patient’s life and my mistake would have harmed him a lot. The patient’s family kept on asking me but I could not tell them the scenario. The RN later told me the importance of each and every vital and how a careless mistake could end up on a patient’s life. Hypertension is considered very dangerous and if it is left uncontrolled, it may lead to a disability, a poor quality life or even heart attack which may be fatal (Mayo clinic, 2019). 

 According to Nursing and Midwifery Board of Australia it is in the code of conduct for a nurse’s honesty, integrity and professional behavior which is mandatory to be adhered. It under the heading of adverse events and open disclosure states that if the patient is harmed by a healthcare, it is nurse’s responsibility to inform the family and the patient as well. They need to be open and honest in communicating (Nursing and Midwifery Board of Australia, 2015). 

Later, I was taught how to manage time and how quality is the utmost factor in work. I was told about the protocol that needs to be followed by the nurse in case of hypertension. It is even allowed to the nurse to administer in case the doctor is away (Himmelfarb et al., 2016). Patient with such complication is given extra care. Hypertension should be taken care of first then the other vitals plays role. It is one of the major public health challenge and major risk factor for most of the diseases (Research gate, 2016).

It was a great learning experience for me as I pay attention to each and every vital and its reading and even the slightest of increase or decrease in the values is considered by me now. I would keep this as goal of learning all throughout my life in nursing.

During my clinical placement, I experienced on time management. I was working as a student nurse under the RN in a hospital. During the supervision of my performance, I was given a lot of work because she believed that I would do it well. I had a lot of work piled up that day. It was so much for me that I could not manage my time. I somehow in working for different patients, taking their vitals and doing other work forgot to take care of the patient that returned from surgery. The hamper in the patient care lead to its consequences and I was questioned by my registered nurse regarding the same.

 I told her that I forgot to take care of him and how I could not manage everything well. I spoke to my mentor about it and I was very disappointed by my work. She looked into the matter and spoke to me regarding it. I felt so bad that a patient needed my care and I failed at it. I later realized that I should have managed my time well and should have taken care of another patient and would have been successful in completing my tasks for the day.

 It is mandatory for the nurses and midwives to follow the NMC code and guidance for best practices (Royal College of Nursing, 2019). It is the duty of the nurse to take care of the patients. providing physical aid and care is a nurses first duty. Apart from this, they are also supposed to provide emotional support to the patient and family members (Verywealth, 2019).

 I learnt that the time management is very important and every patient in the hospital needs to be taken care of. Managing time and dividing it equally for each and every patient depending on the need is very important. The professionalism is when a nurse is able to perform all the tasks assigned without any negative effect on the patient’s health. 

In future, I will aim to develop the time management skills and to practice that no matter what but a nurse should perform best even if they are under the pressure. 

The conclusion drawn from my experiences at nursing are that a nurse is the one taking care of the patient and is responsible for the well being. Time management, work load management, assertive skills, the hygiene and several other factors should be learnt and practiced by the nurses. As in my case, I forgot the hand hygiene and cleared the wound of the patient directly with unwashed hands. Hand hygiene, dress hygiene, self care of the nurse is very important. A nurse should adhere to the Nursing and Midwives Board of Australia guidelines thoroughly and should never violate any code of conduct. Every patient for the nurse is important and all should be treated equally. I learnt that the work load should be managed such that the nurse would forget to take care of the patient and every patient should be considered and taken care of.

References

Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., ... & Bader, M. K. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal of Critical Care, 24(3), 216-224.

Himmelfarb, D., Cheryl & Commodore-Mensah, Yvonne & N. Hill, Martha. (2016). Expanding the Role of Nurses to Improve Hypertension Care and Control Globally. Annals of Global Health. 82(2), 243-253.

Jones, L.H. (2016). Reflective practice in nursing (3rd edition). London: Sage Publications limited.

Maloney, S., Tai, J. H. M., Lo, K., Molloy, E., & Ilic, D. (2013). Honesty in critically reflective essays: an analysis of student practice. Advances in health sciences education, 18(4), 617-626.

Mayo clinic. (2019). High blood pressure dangers: Hypertension's effects on your body.

Retrieved from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868

Nursing and Midwifery Board of Australia. (2015). Professional standards. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Researchgate. (2016). Assessment of Knowledge on Hypertension, its consequences and management practices among hypertensive patients - A descriptive study. Retrieved from https://www.researchgate.net/publication/310817627_Assessment_of_Knowledge_on_Hypertension_its_consequences_and_management_practices_among_hypertensive_patients_-_A_descriptive_study

Royal college of nursing. (2019). Duty of care. Retrieved from https://www.rcn.org.uk/get-help/rcn-advice/duty-of-care 

Vaidya, A. (2013). 10 best strategies for infection prevention and control. Clinical leadership and infection control. Retrieved from https://www.beckershospitalreview.com/quality/10-best-strategies-for-infection-prevention-and-control.html

Verwealth. (2018).  Different types and roles of nurses. Retriebved from https://www.verywellhealth.com/what-are-the-different-types-of-nurses-1736354

Warwick. (2015). What is reflective journal?. Retrieved from https://warwick.ac.uk/fac/cross_fac/iatl/study/ugmodules/humananimalstudies/assessment/reflectivejournal

WHO.(2019). Infection prevention and control. Retrieved from https://www.who.int/infection-prevention/about/ipc/en/

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