Description: During my placement into the cardiac critical unit, I came across a incident where my senior nurse was in ethical dilemma as the old patient had signed ADC document saying he does not want prolonged treatment. He suffered brain death but his heart was functional and the family members wanted her to give him prolonged treatment.
Feelings: I was stressed on this as I never thought of this type of ethical dilemma for the nurse.
Evaluation: The nurse had to abide by the ACD (Advanced Care Directives) document of the patients to respect autonomy and on the other side the family’s wish was to be also fulfilled. The nurse followed the instructions of the patient and stopped the care after the patient was diagnosed with the brain death (Dennis et al., 2016).
Analysis: The nurse continued to carry out her duty of care and as a cardiac critical care senior nurse, she used her decision making skills to not give prolonged treatment care to the patient (Meehan & Landry, 2016). This ethical dilemma placed her in a tough situation but she responsibly then handled the family and informed them about the same.
Conclusion: In such cases, the nurses are supposed to follow the autonomy of the patient as signed by them prior to the initiation of the care.
Action plan: I learnt that I would also apply my nursing principles and take care of the duties professionally. I will also abide by the nursing consideration of the patient care in future practice. I will take care of the ethical dilemma and will also abide by providing the best of nursing care to the patient.
Description: During my placement in cardiac care centre, I was taking care of the patient who was admitted because she suffered from heart failure that was followed by a traumatic event that she could not handle. I was working as a cardiac critical care nurse where I was supposed to inform the family about the brain death of the patient
Feelings: I was very nervous as I had no idea on how to inform to the family about her current condition of brain death.
Evaluation: It is very important for the nurses to be in contact with the patients’ families and support them. The real experiences states that this is a very difficult situation for the nurses but they should be trained for such situations (Moghaddam et al., 2018). They face the challenge of right and duty requirement because they face the feeling of guilt for the patient.
Analysis: The nurses must inform the patients’ families and should also support them. This is an expression of obligation to the patient right in taking care of them (Yazdimoghaddam & Manzari, 2017).
Conclusion: It is the nurses duty to take care of the patients’ families after revealing the truthful condition of the patient.
Action plan: In future, I will take care of my duty and will learn different ways so that I can overcome the feeling of guilt.
Description: This is the case when I was on my shift and I observed that my colleague was informed by her senior nurse check if the patient has developed some allergy with his medication. Upon physical examination, it was found out that he has developed allergy over his body. My colleague administered the substitute medicine that had no allergy side effect.
Feelings: I was shocked to see this because this is out of the scope of practice of cardiac critical care nurse.
Evaluation: The scope of practice of cardiac critical care nurse is to administer the prescribed medication to the patients and not to give substitute (Urden et al., 2017).
Analysis: The nurse should have informed the doctor upon physical examination and I realised that she was not well aware of her scope of practice. The nurses must only comply within their scope of practice for safe and high quality nursing care delivery (Mackinson et al., 2018).
Conclusion: The nurses must act within their scope of practice and any nursing care beyond their scope of practice can harm the patient safety.
Action plan: I will take care that next time when I will encounter any such situation, I will speak it up and try to convince my colleagues to read and act within their scope of practice.
Description: During my placement in cardiac critical care unit, I was informed by my senior nurse to the patient and family members in the patient’s plan of care and I thought that the patient is too ill to be involved so I directly designed his plan of care and not involved him and his family members. I was guilty when my senior nurse catch hold me of doing this.
Feelings: I was shocked that I did not comply by my standards of practice.
Evaluation: The involvement of the patient and their family members I very important as their participation is involved with desired patient outcomes. The critical care nurse must always take care of the patient with their best efficiency and must also comply with their standards of practice (Hardin & Kaplow, 2019). I learnt this from my senior nurse who taught me the importance of involvement of the patients in their own care plan.
Analysis: The benefits of involving the patient in their own care plan are known but for the cardiac critical patient, it may serve best of benefits for the patient (Sillman et al., 2019).
Conclusion: The cardiac critical care nurses must always act in accordance with their standards and must always involve the patient in their care plan.
Action plan: In future, I will always practice as per the standards and will always involve the patient so that a culturally safe nursing care can be delivered to the patient and also because it will help in achieving the desired outcomes.
Description: During my placement in cardiac critical care unit, I was told to administer the certain medication to patient who was admitted in ICU following comorbidities. The senior nurse instructed me to administer the medication through IV route. I started administering the medication and she stopped me and said that I will teach you first because you have no experience in this.
Feelings: I was shocked because even after certain days in the critical care unit, I was unable to administer the medication through the proper route of administration. I was shocked because the medication errors are very common mistake committed by the nurses but I never believed that I would be the one committing a medication error.
Evaluation: When my senior nurse instructed me on the procedure of IV route of administration of the medication I learnt the importance of education and training in the administration of medication procedure.
Analysis: Clinical governance is very important framework that makes the nurses accountable for their actions and also urges them to improve the clinical nursing practice and the quality of care (Cleary & Duke, 2019). It facilitates the creation of environment in which the excellent clinical care can be flourished. The nurses thrive to improve the quality of care that they deliver to the patients because there is always a room for improvement (Breathnach & Lane, 2017).
Conclusion: The conclusion drawn is that the clinical governance holds paramount importance in the clinical setting. It allows the nurses to be accountable for their actions and also is very important in safeguarding the high standards of care.
Action plan: In future, I will take care of my nursing practice and will always thrive to improve the quality of care that is delivered to the patients. I will take proper training and educational sessions to learn the correct ways of administration of medicines through proper and correct route of administration. I will always look forward to learn from my seniors and will teach my juniors about the correct procedure that should be followed.
Description: During my placement in cardiac critical care unit, the patient was admitted in the ICU for cardiac arrest and he was already paralysed. He met an accident and had fractured his right leg. He insisted me to position him properly so that he can sleep comfortably. I did not know the exact positioning method but I continued doing it and the patient started crying in pain. To this, my colleague nurse stopped me and she did help the patient with positioning.
Feelings: I was disappointed with my learning and practice as I did not know the correct method of positioning for fractured patients.
Evaluation: My colleague nurse taught me to use the evidence based practice in such cases if the patients wants a specific method but we are not aware of it. The nurses must always use evidence based practice as it is reliable and safe (Fry & Attawet, 2018). The evidence based practice is one of the strongest pillar of clinical governance that makes the nurses to deliver the safest and high quality of nursing care to the patients. It allows clinical effectiveness as it helps in delivering the clinically effective interventions that are safe for the patients.
Analysis: The clinical governance is very important for the nurses and its one of the strongest pillar that is evidence based practice has proved its efficacy for the betterment of the patients (Patterson & Coppens, 2017). There are many evidence based positioning and mobility practices available for the access by the nurses and the nurses have the power to integrate the best available evidence from the research into clinical practice.
Conclusion: The clinical governance allows the nurses to grow and learn and also to integrate the best available evidences into their practice for the benefit of the patients.
Action plan: In future, I will make it a habit to use evidence based practice into my nursing care so that the patients can be benefitted.
Description: during my cardiac critical care placement, there was a case when I was taking care of a patient who was admitted to the ICU after cardiac arrest. He had medical history of hypertension, diabetes and high cholesterol levels. He developed pressure ulcers in his foot and this caused him extreme discomfort.
Feelings: I was very disappointed because the pressure ulcers were very painful to the patient and it was an outcome indicator.
Evaluation: The pressure ulcers are the patient outcomes that are determined to be the nursing- sensitive because they depend on the quantity and the quality of nursing care. Later when I talked to my senior, she told me that this outcome indicator can be easily prevented. It is the nurse sensitive indicator and this can be easily prevented if the nursing care quality can be enhanced. The nurses must improve their quality of nursing care so that the patient outcomes related to the nursing care are positive and the patients are satisfied with the nursing care (He et al., 2016). The pressure ulcers develops due to multiple reasons first the patient is diabetic and second the patient has been bedridden since long time. The low quality of nursing care led to the development of pressure ulcers in the patient.
Analysis: The quality and quantity of nursing care is very important to prevent the nursing sensitive patient outcome indicators. The patient satisfaction is also associated with the enhanced nursing care quality and the quantity and this will also result in positive patient outcomes (Howard, 2019).
Conclusion: The nurses must always thrive for improving their quality of care so that the outcome indicators that are bad can be prevented.
Action plan: In future, I will always learn new measures to improve the nursing care and will evaluate the process and quality care by measuring through outcome indicators.
Description: During my placement in the cardiac critical care, I came across the second nursing sensitive indicator that is the process indicator. It was the tough time for me when I had to see the families of the patient suffering and crying when I used to inform them about the brain death of the patient. I was high dissatisfied with my job and wanted to quit.
Feelings: I was very sad and did not want to continue my nursing job because I had no control over my emotional side when I saw these families crying.
Evaluation: The process indicator measure method is the nursing job satisfaction (Havens et al., 2018). The nursing job satisfaction is very important factor in governing the quality of nursing care provided to the patients. My senior nurse and my colleagues consoled me telling that this is part of nursing responsibility and there are times when the work gets over the mind and as humans we start to take these things closely.
Analysis: The nursing job satisfaction is considered as the process indicator that states that if the nurse is dissatisfied with her job then it is the process that is to be blamed. The nursing job satisfaction can be achieved if the process is smooth and effective in providing satisfaction to both the nurses and the patients (De Simone et al., 2018).
Conclusion: The conclusion drawn is that the nurses job satisfaction is. Reflection of the process indicator that plays a very important role in determining the quality of the nursing care delivered to the patients.
Action plan: In future, I will ensure that I am always satisfied with my job and work so that when it will be reflected in my practice, the patient satisfaction can be achieved.
Description: I am a cardiac care critical nurse and I have encountered various events that have led to me to learn greatest lessons for my job but this incident changed my life. Once I was attending an elderly patient and I was so busy in doing my job that he wanted to say something but I did not concentrate on him. My colleague went up to him and talked to him as he wanted to talk about his health condition and his mental health because he felt lonely.
Feelings: I was shocked to learn this as I never expected this of myself.
Evaluation: The nurses must use holistic care approach when in critical care unit and must have a good relationship with the patient so that the patient can talk to the nurse about his issues and the concerns (Arnold & Boggs, 2019).
Analysis: The nurses must not only have a therapeutic relationship with the patients but also talk to their patients on regular basis to understand their needs and requirements (Kisorio & Langley, 2016).
Conclusion: The conclusion drawn is that the nurses must not get carried away in their work to a level that they are not able to concentrate on the non- pharmacological needs of the patient. The nurses must use a holistic approach for the patient care and should talk to the patients on regular levels so that their needs can be fulfilled.
Action plan: In future, I will always be there to talk to my patients and listen them carefully. I will be enhance my competency and communication skills so that the patients feel comfortable while talking to me and my other colleagues.
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