Running Head: Critical Reflection 2 1

Critical Reflection

NURS 3020

Bethany Carr

Trent University
Critical Reflection 2 2

During my tenth shift at Ross Memorial I was assigned to work with an Registered Nurse

(RN) Jane (pseudonym). Jane was assigned four patients for her day shift; one independent

patient who is participating in medical assistant in dying (MAID), one patient one person assist

who was being discharged, one two person assist and one patient that required a Hoyer/ceiling

lift. I was assigned to the patient who was being discharged for the unit, so I helped Jane with all

of her patient load for the day. The patient which required to people’s assistance, Bill

(pseudonym) used the call bell which I answered and asked me if someone was going to help

him with his inhalers because he “hadn’t used them in a while”. When I approached Jane about

the matter she stated those were his 8 o’clock inhalers. She notified me that sometimes he can be

instructed to take them, and he will on his own, and other times he will not remember to take

them after being instructed. Jane instructs me to go remind him those are from this morning and

he can take 4 inhalations of his Atrovent and one inhalation of his Advair. He also had as needed

(prn) Ventolin on his bedside table with other inhalers. Bill uses an AeroChamber so that he can

get all the medication in more than one breath. I asked Bill to take a deep breath out then put the

mouth piece, which was a mask, to his face and press the inhaler once, I allowed Bill to take

three slow deep breaths and then allowed him to breath normally, I repeated his four more times

and took a one-two minute break between medications. I asked Bill to rinse his mouth with water

once we were finished. Bill then complained that I did not know the special and specific

technique that the respiratory therapists (RTs) usually do. I asked Bill what I did incorrectly that

I can approve on for next time, and he told me I “just didn’t have the technique that was

required”. I notified Jane that Bill had taken his required inhalations, and his statements about

my lack of technique, and she assured me not to worry about it that he was just use to a specific

routine.
Critical Reflection 2 3

After this situation on my tenth day, I was left feeling somewhat unsure and questioning

the technique I thought I knew and understood. This brought me to the AeroChamber website

where I looked at the instructions for use, the only step I seemed to be missing was holding the

breath for as long as possible after each dose (AeroChamber®, 2014). Knowing that I the correct

concepts in my learning but still feeling unsure I searched for journals which talked about

metered dose inhalers (MDIs) and correct/incorrect use by nurses. In the study is says the

baseline inhaler technique assessment ranged from 100% for specific and RTs to 20% for nurses.

After people had attended a workshop on how to properly use inhalers their post workshop

assessment was much higher for inhaler technique (Basheti, et al. 2014). I think based on having

one lab that does not have high focus on the use on inhalers could lead to incorrect inhaler use by

students. I myself have never used an inhaler and those rely on reading step by step instructions

and then gaining my own habit on how to use one, this can also make it more difficult for myself

to explain how to use an inhaler as I have never had the experience. Between sources I have

looked at to continue my learning, I am still unsure of whether to do the next dose directly after

holding the breath and returning to normal breathing or whether I should be waiting one minute

between puffs to allow it to better enter the lungs. I think a way to improve student comfort and

skill is to offer a more hands on lab like the study offered the participants, because learning

correctly once and lead to better management of symptoms for patients and less medication

errors in the long run. A small part of one lab I do not think facilitates a student’s learning

enough, it should be as important as oral medication administration.

The reason I chose to reflect on this event is because it was again, one of the only things

that came to mind of what went “wrong” when I have been at placement. At the time, the patient

made me feel incompetent because I didn’t know what I was doing in his eyes, and then I tried to
Critical Reflection 2 4

assure myself that I wasn’t a RT, so I wouldn’t have the same technique as one. I do not think

this is a very good mind set though, because inhaled medication administration is very important,

and technique is most important part. I want to be “as good” as an RT when giving someone

inhaled medications. I also have not had the opportunity to witness or work with a RT, so I

believe that would be a valuable chance to get to enhance my skills and correct any bad habits or

misunderstandings before they form. As the patient was older and had previously experienced

being given inhalers by RTs, meeting me a young nursing student could be off putting to explain

what he experienced that he thought was wrong. I know people get into habits and you can’t

explain what was wrong, you just know that wasn’t the way you are used to. Though my nurse

assured me not to worry about my lack of RT technique, it made me feel better at the time, I now

want to increase my knowledge so that I could have good technique and be able to provide

proper medication administration. As stated above, I do not have a lot of experience with

inhalers besides in lab and seeing my boss (a pharmacist) briefly explain to patients how to use

their new inhalers. I think reflecting on this experience will only help me become a better nurse

because I will know how to better help my patients especially when using an AeroChamber.

Overall, this situation and reflection are ones that can help me become a better nurse as I

finish my Acute Illness placement at the Ross. I think an opportunity to leave the floor or

accompany patients to see different specialists such as RTs would be valuable to learning if

possible. It would help facilitate learning and lead to reduced errors by students and in turn, new

nurses. In the future I will continue to question my technique when patients make comments on

it, so I may reflect and see if I can improve in my own practice to help patient outcomes.
Critical Reflection 2 5

References

AeroChamber®. (2014, October). Retrieved March 14, 2018, from

https://www.nationaljewish.org/treatment-programs/medications/inhaled-medication-

asthma-inhaler-copd-inhaler/metered-dose/aerochamber

Basheti, I. A., Qunaibi, E. A., Hamadi, S. A., & Reddel, H. K. (2014). Inhaler Technique

Training and Health-Care Professionals: Effective Long-Term Solution for a Current

Problem. Respiratory Care, 59(11), 1716-1725. doi:10.4187/respcare.02671