Reflective Essay

Description:

I am on my clinical placement as a stage 5 student on my second week of practicum, I handled a 92

year old woman that came with Acute Lower Respiratory Infection from the Emergency department
admitted in the Intensive Care Unit or Critical Care unit the night before my shift. I will be reflecting
my experience with this patient as it was a basis of learning, after a thorough handover from the night
staff, while me and my buddy nurse stayed for safety checks and initial assessment inside the patient’s
room, the PCA brought the tray that contains yoghurt, peach and strawberries, she started to demand
for toasted bread and eggs with cheese. My buddy then responded to the patient that she was not in
the hotel, she was in a hospital, so the patient requested me to check her personal belongings to grab
the crackers inside her bag, but it was not there, she insisted that it is there, specifying the type of the
pouch, then I actually showed her bag in front of her bringing out her belongings. She was still not
satisfied, she refuses to eat her meal, my buddy then requested the PCA to bring her a toast and eggs.
After that she demanded for her wash, however, the Physiologist checked on her, encouraging the
patient to move out of bed and ambulate to assess her independence, it was when the patient starts to
refuse again, she then complains that she is on pain, she has difficulty of breathing but the physiologist
continues to encouraging her to ambulate to avoid dependency, suddenly when the patient started to
raise her voice saying “Go check the doctor’s order!”. Me, my buddy nurse and the Physiologist were
startled and stayed silent, then the motivation of the physiologist did not end, she still convinced the
patient that she will help the patient to stand, however, she refused, the patient demanded to stay in
bed just for a the day and requested for her bath. My buddy nurse then went out the room, followed
by me and the physiologist as well. So my buddy advised me to not frequently see that patient but I
still went back to do the shower for my patient.

Feelings:

During that situation, I was actually shocked. I did not imagine that a 92 year old can act aggressive,
I do respect elder people but to be that demanding, she can just refuse by being calm and appropriate.
At this kind of situation, the thought of other people concludes health care team members to be their
personal carer and how they demand disappoints me. However, at the end of the day, it is still
important to me, as my duty that I still need to provide care for my patient.

Evaluation:

In accordance to the Nursing and Midwifery Board of Australia Standards 6.1, 6.2, and 3.6 (2017),
one of the coverage of our scope of practice as a nurse is being obligated in providing a safe,
appropriate quality nursing practise being responsive to the needs of a client is a way to actively
engage with the responsibility. Prior the process of providing the morning wash, communicating with
the patient and agreeing to the plan will ease the patient to establish trust and gain cooperation to
make things agreeable on both sides during the interaction (NMBA Standards 2.1, 2.2, 3.2(2017);
Nursing Times, 2016). Since that my buddy nurse said that I can start the shower and she will follow,
so I initiated the morning wash with my patient, changing the sheets alone, although the patient was
cooperative from moving one side to the other, I did not want to let my patient wait for a longer time
so I finished the wash without my buddy coming back to supervise. In this experience, I felt that I
should not have initiated the intervention without supervision as stated in the NMBA Standards of
Practice 6.4 (2017) wherein as a nurse I should provide a safe practice under a direction and
supervision to be effective.

Analysis:
As it has been discussed over in theory, that as a student nurse, we need to be supervised by our
preceptors inside the ward to be able to properly implement our responsibilities. In a deontological
perspective, as discussed by Peate, Nair, and Wild (2014) I need to act accordingly regardless to the
probable consequences of my action, I have still continued to provide the bath for my patient as it is
the right thing to do at the moment and what the patient needs. Moreover, I have also practiced my
patients autonomy, by accepting the power to determine goals peculiar to his own wishes as
mentioned by Husted, Husted, Scotto, and Wolf (2014), wherein the physiologist respected clients’
decision, left without the patient assessing the ability to ambulate and as I have given the morning
wash. However, in a utilitarianism point of view, I believe that, providing the clients needs to
deescalate her from her demands would be better for the patient, the other health care team and to
other patients around, as discussed by Mandal, Ponnambath, and Parija (2016) making a decision
based on the greatest amount of benefit for the greatest amount of people, even though it lead to harm
for few but ends with maximum benefit, so even if I chose to stay and attended to the patient at least
it was effective in deescalating her behaviour. In this learning experience, nonmaleficence is observed
wherein the client have verbalised her pain, considering that pain is a subjective data that is being
acknowledge upon assessment that is why Sommers-Flanagan and Sommers-Flanagan (2015)
supports idea of nonmaleficence is not doing any unjustified harm as the physiologist portrayed, she
have respected the clients complaints of pain and did not insist to continue the ambulation. On the
other hand, I do think about the reaction of my buddy to our patient, although the client is demanding,
I feel that she should have been more nonjudgemental, basing on the history of the client that she has
been in and out in the hospital for no apparent medical diagnosis, the NMBA Code of conduct 3.3e
(2018), states that for a positive and effective communication, a professional nurse should be
nonjudgemental and by not referring to people in a non-professional manner, the way she rolled her
eyes, left the room and asked me to avoid entering the room. I might have not waited for my buddy
to come prior the shower, my intention was clear, being justified by Doody and Noonan (2016) that
doing good may differ from individuals, so I believe that I have done good to my client in this
situation.

Conclusion:

The morning wash went well, all the materials needed have been prepared prior to initiating the act,
the client was satisfied and has been deescalated. Next time, I need to be completely aware of my
responsibilities, the strengths and limitations especially that I am still under the supervision of a
preceptor or facilitator.

Action Plan:

In this kind of scenario happens again, I need to immediately deescalate my patient who ha this kind
of behaviour by not being judgemental and by still attending to my responsibilities as a professional
nurse. I need to ensure that a buddy will be helping and assisting in achieving an intervention to
maximise our duty of care. Lastly, I should keep in mind to be mentally ready to defuse an agitated
or aggressive patient.

References:

Doody, O. & Noonan, M. (2016). Nursing research ethics, guidance and application in practice.
British Journal of Nursing. 28(14). Retrieved from: Retrieved from: https:/
web.b.ebscohost.com

Husted, J. H., Husted, G. P. M. R., Scotto, C. P. M. R., & Wolf, K. P. M. P. (2014). Bioethical
 decision making in nursing (6th ed.). West 42nd Street New York, NY. Retrieved from https://
ebookcentral.proquest.com

Mandal, J., Ponnambath, D.K., & Parija, S.C. (2016) Utilitarian and deontological ethics in
medicine. Tropical Parasitology, 6(1), 6-7. Retrieved from: https:/web.b.ebscohost.com

Nursing and Midwifery Board of Australia, (2017). Registered nurse standards for practice.
Retrieved from www.nursingmidwiferyboard.gov.au

Nursing and Midwifery Board of Australia, (2018). Code of conduct for nurses.
Retrieved from www.nursingmidwiferyboard.gov.au

Nursing Times, (2016). De-escalating anger: a new model for practice. Retrieved from:
www.nursingtimes.net

Peate, I., Nair, M., & Wild, K. (Eds.). (2014). Nursing practice : Knowledge and care. The Atrium,
Southern Gate, Chichester, West Sussex. Retrieved from: https://ebookcentral.proquest.com

Sommers-Flanagan, R., & Sommers-Flanagan, J. (2015). Becoming an ethical helping

professional : Cultural and philosophical foundations. Hoboken, New Jersey. Retrieved from
https://ebookcentral.proquest.com