Reflective Writing Assignment 1

Melissa Amos
NURS 3020
October 14th 2014
Identification
The experience that I will be looking at this week is one that occurred the second week of
placement. This incident involved a patient that had undergone surgery the day before
and had a complete knee replacement. The patient had gone to physiotherapy that
morning and was up and walking, additionally the nurse with the assistance of physio had
taken her to the bathroom. When I answered her call bell she said she needed to use the
bathroom. However her nurse said that she was not able to get up without the assistance
of the physiotherapist. This means that the patient had to void in a bedpan. After
positioning the bedpan I gave the patient privacy and answered her bell when she rang.
While removing her bedpan it appeared that she had overflowed the pan and therefore the
sheets on the bed needed to be changed.
Description
The patient became very upset upon needing her sheets changed and it appeared that she
was trying to stop herself from crying. I believe that she was reacting to the event in this
manner because she was both embarrassed and felt as though she lost her independence.
Understandably she was upset about voiding onto the bed, this behaviour is one that
many people view as shameful. I believe that she felt as though she had lost her
independence because not only was she not able to use the bathroom by herself as she is
used to, she also had to have nursing students change the bed and help her bath herself.
Once I saw that she was upset I began to talk to her stating that it was not her fault, that
she had no need to be embarrassed because sometimes accidents happen and most

importantly I attempted to explain to her that she was not a burden to us and that we did
not mind helping her in this situation. Additionally we tried to change the linens as
quickly as possible and when we were done I tried to allow her to perform as much care
as possible on herself in the hopes of helping her to regain some of the sense of self that
she may have lost. It was clear to me that she valued her independence and ability to care
for herself so my actions were intended to allow her to do that to the best of her ability. I
believe that this is congruence with CNAs code of ethics, because I tried my best to help
improve the quality of care for the patient.
Significance/Implications
Therapeutic communication was imperative throughout this interaction. Because the
patient was upset with what had happened and it was not a normal part of her daily life it
was important to react in a sensitive manner and to make her feel that her concerns were
being listened to and that she was not being judged in any way. Literature relating to
therapeutic communication such as the RNAOs best practice guidelines would have
beneficial in this circumstance. Additionally I could use the BPG promoting continence
using prompted voiding to better inform my practice. An intervention that I could have
used would be to assess barriers to successful toileting, such as the belief from the staff
that incontinence is a normal part of aging especially post surgically. Additionally I could
have used promoting voiding before my patient felt the need to urinate to help minimize
the amount of fluid in the bedpan and therefore reduce the likelihood of overflow as well
as allowing more time before urination must occur.
After experiencing this situation I plan ahead more in my practice. Looking back
on this situation I could have tried a different method in order to make voiding more

comfortable such as using the commode chair. In my practice now I tend to try and look
for other ways to make the patient more comfortable and to help them retain their sense
of self. In similar situations I now find that I am trying to use other methods to help the
person maintain their dignity. I try to have them walk if possible, if not I try to use the
commode chair, and if neither of these work then I attempt to make the use of the bedpan
as comfortable as possible for the individual.

Reference:
Registered Nurses' Association of Ontario. (2002). Promoting Continence Using
Prompted Voiding. RNAO Best Practice Guidelines. Retrieved October 8, 2014,
from http://rnao.ca/bpg/guidelines/promoting-continence-using-prompted-voiding