NS3226 Clinical Nursing Practice

An episode of care where you complete an appropriate assessment following a medication you administered

In the current scope of reflection vignette, I will discuss my experience in patient care during my clinical placement (Saunders, Dunn, Merrill, Sullivan, Weisner, Braden, Psaty & Von Korff, 2010). I was given the responsibility to handle two aged patients along with a Registered Nurse. Bothe the aged patient was experiencing extreme pain and was given relief with pain medication. One of the aged patients had experienced fall whereas the other patient had been operated on. The patient had been provided medication post evaluation and risk assessment of their condition; however the pain failed to subside. Both the patients wanted immediate relief and I being an inexperienced nurse was not able to understand how to provide them immediate relief. The RN was absent for some time as she had gone to finish her dinner and I did not have adequate knowledge regarding procedure to manage pain. I feel that I should have read the standards for practices related to pain management handling risks in such extreme pain (Herr,  Coyne, McCaffery, Manworren & Merkel, 2011). When the RN returned she behaved with me rather rudely and did not guide me on ways to provide adequate care to the patients.

While handling the patients, I felt rather helpless and tried to provide them with adequate mental support. I feel there was extreme stress prevailing as I was unable to handle and take care of my regular duties. Due to my inexperience and lack of proper guidance from RN or communication from other nurses in the department, I was not able to take proper care of the patients (Hickman, Nelson, Perrin, Moss, Hammes & Tolle, 2010). From this experience I feel that every nurse need to have adequate knowledge in pain management as specified in the National Safety and Quality Health Service (NSQHS) Standards. The guidance for practice for nurses to have a proper understanding related to the health systems and the individual. I understood from this experience that nurses need to work hand in hand with clinicians and other staffs and there should be proper communication regarding the same. This would allow nurses who are appointed in duty to deliver appropriate care to patients and relieve their pain. Especially in cases of pain in aged care, there needs to be adequate care provided which includes psychological as well as physical care. In absence of such care, there might be greater risks at which the patient might be exposed to.

A situation where you perceived an ethical dilemma, either affecting yourself or a patient under your care

Nursing care can be very complex at times, especially when it requires interacting with patient parties (Koocher & Keith-Spiegel, 2008). During my clinical placement, I was once given the responsibility of a patient, who was facing morbidity and end of life care in a case of carcinoma. Though the patient was in a critical stage, the aged patient of 75 years of age was allowed visitors from his family every day. I had to disclose to his family regarding his deteriorating health condition to his aged wife and only daughter. Other nurses and staffs in the ward were apprehensive to disclose information to the patient related to his condition. Every staff and nurse was however, very concerned regarding his deteriorating health condition. At this stage I faced ethical dilemma of whether or not to disclose the truth to the patient or be deceptive. Often many families request that the patient be not told regarding the situation faced by the patient regarding his medical condition. Though the patient has every right to know regarding his medical condition, it imposes immense challenges on the nurse in telling the patient regarding his medical condition (Wu, Huang, Stokes & Pronovost, 2009). I feel that every nurse has an obligation towards the patient to disclose information according to ethical principles of fidelity and non-maleficence.

Evaluating the various health complications and the condition of the patient’s health, I decided that I will disclose the truth. I felt that it is important that nurses acts ethically according to principles and be faithful to the patient as well as to colleagues. Non-disclosure of information at this stage could have led to depriving the family during key times at the last moment. I gathered all my mental strengths to disclose entire facts to the patient (Gallagher, Bell, Smith, Mello & McDonald, 2009). As I feel that while working with patients, there would be many occasion where there would be need to deal with nursing ethics during difficult situations. From my experience and learning during my course, I gathered that nurses in varied  departments face varied ethical issues where they have to reconcile own values along with professional obligations in nursing. In case any nurse is unable to reconcile such differences, there might arise a challenge. In the view of such challenges, I decided to disclose all relevant information regarding the patient condition to him. Though it was very difficult for me yet I took all the reports and provided them with a brief of his condition. After disclosing of information, I also felt relieved.

Reference List

Herr, K., Coyne, P. J., McCaffery, M., Manworren, R., & Merkel, S. (2011). Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Management Nursing, 12(4), 230-250.

Hickman, S. E., Nelson, C. A., Perrin, N. A., Moss, A. H., Hammes, B. J., & Tolle, S. W. (2010). A comparison of methods to communicate treatment preferences in nursing facilities: traditional practices versus the physician orders for life?sustaining treatment program. Journal of the American Geriatrics Society, 58(7), 1241-1248.

Saunders, K. W., Dunn, K.M., Merrill, J.O., Sullivan, M., Weisner, C., Braden, J.B., Psaty, B.M. and Von Korff, M (2010). Relationship of opioid use and dosage levels to fractures in older chronic pain patients. Journal of general internal medicine, 25(4), 310-315.

Gallagher, T. H., Bell, S. K., Smith, K. M., Mello, M. M., & McDonald, T. B. (2009). Disclosing harmful medical errors to patients: tackling three tough cases. Chest, 136(3), 897-903.

Koocher, G. P., & Keith-Spiegel, P. (2008). Ethics in psychology and the mental health professions: Standards and cases. Oxford University Press.

Wu, A. W., Huang, I. C., Stokes, S., & Pronovost, P. J. (2009). Disclosing medical errors to patients: it’s not what you say, it’s what they hear. Journal of General Internal Medicine, 24(9), 1012.