Melissa Amos

January 24, 2015

NURS 3021- Reflective Writing
Identification
The clinical experience that stands out in my mind from the
beginning of this clinical rotation took place on the first shift on the
unit. During this shift I was assigned a patient that was total care. This
meant I was to bath, dress (if needed), change, and essentially care for
every aspect of the patient. I went in to the unit expecting these
needs. While most of the care was challenging for me, as I have no
previous experience caring for patients who require total care there
was one aspect of the care that stood out in my mind. This moment
was when I realized the patient had not had a shower in over 3 weeks.
While it is understandable that showering every day or every few days
may simply not be plausible on the unit and bed baths may have been
performed in the interm I was still startled.
Description
Upon entering the room with my patient as well as another it was
evident that there was a smell. This smell was not a distinct smell in
fact it smelt somewhat like a locker room, however it was clear that a
patient needed to be changed or washed. Upon performing morning
care both patients did not need there briefs changed and therefore it
was plausible to assume that the smell was being produced because
they needed to be washed. Investigation of the Kardex revealed to me
the last date recorded for a proper full body shower for my patient was
December 28th 2014. As the date was now the 16th of January I thought

Melissa Amos
January 24, 2015
this was odd. When I asked the nurse about this she stated that the
patient could be showered, and that I should be able to do it without a
problem. This suggested to me that the reasoning behind the lack of a
proper washing regime for the patient was not because of a physical
impairment associated with the patient but was instead due to other
factors such as availability of the staff, and belief in the need to shower
the patient.
I personally believe that if the patient is able to use a shower
chair and be washed in that manner then that is how the staff should
wash them. This is because it reduces the possibility of improper
cleaning and allows the nurse to thoroughly clean the patient as well
as their bed, and in the process help to get a complete and through
exam of the patients skin integrity.
During the shower experience the patient appeared to enjoy the
warm water and complete cleaning, however it is difficult to tell as
they are non verbal and understanding their state of mind is difficult at
best. I believe that the patient enjoys being showered in the shower
room as they appeared to express this enjoyment. Because of this I
would assume that weekly showers would be beneficial, as it allows for
a in depth clean as well as the patient enjoys it.
Significance
Prior to this experience I was aware that rotating and
repositioning the patient who is at risk for pressure ulcers is important.

Melissa Amos
January 24, 2015
This knowledge came from the RNAOs Best Practice Guideline (BPG)
Risk Assessment and Prevention of Pressure Ulcers. This guideline
suggests the monitoring of skin integrity is crucial and doing so during
daily activities such as bathing and rotating. Additionally looking at the
RNAOs Checklist of Nonverbal Pain Indicators (CNPI) we can see that a
non verbal patient is still able to express pain, joy and other emotions.
Using this as a guide for future interactions with patients I may be
better able to understand the extent of their ability to communicate
with me, allowing me to understand when they may be trying to
communicate pain or joy to me.
Implications
This experience will make a difference in the way I practice
because now I will thoroughly check all charts and Kardexs before
performing care in order to see if there are any basic needs not being
met. Additionally I will now especially in my school placements attempt
to make sure that all patients receive complete care to the best of my
ability as they may not be receiving it otherwise due to staff & staffing
obstacles. Additionally I plan to seek out more opportunities to perform
these basic needs as at appears they may be overlooked in some
circumstances.

Melissa Amos
January 24, 2015

References:
Registered Nurses Association of Ontario. (2003). Checklist of
Nonverbal Pain Indicators (CNPI) Retrieved January 27, 2014 from
http://www.healthcare.uiowa.edu/igec/tools/pain/nonverbalPain.pdf
Registered Nurses' Association of Ontario. (2005). Risk Assessment and
Prevention of Pressure Ulcers. Retrieved January 27, 2014 from
http://rnao.ca/sites/rnaoca/files/Risk_Assessment_and_Prevention_of_Pressure_Ulcers.pdf