SNPG903: Creative Idea - Nursing Care - Reflection - Assessment Answer

Creative Idea Assignment

Assignment Task

Introduction

This piece of reflective writing is based on Rolfe et al.’s (2001) reflective model. The model states that under any given situation, there are three simple questions that need to be asked:

• What? (Describe the situation)
• So what? (Theory & knowledge building)
• Now what? (How to improve the situation)

For the purpose of writing this reflection overview, the scenario has been presented in Appendix 1. To maintain confidentiality as per the Nursing and Midwifery Board of Australia (NMBA), the patient’s name has been changed to 'Bret'.

What?

While reflecting on this incident, I first started by defining the problem. In this case, a schizophrenic patient had levied allegations of physical assault against a Special Care Nurse. The patient is forgetful due to his medical condition. He is also in a confused state of mind because of hyponatraemia (metabolic disturbances). The alleged incident occurred two days ago and hence, cannot be exactly verified. There are question marks on the patient’s claim. The analysis of this situation centers around my reflection on the actions I took. Were my actions appropriate or was there a wide scope of improvement?

My role in the situation was that of a recipient. After hearing the allegations, I tried to evaluate the two sides. On one side, there was the seriousness of the allegations made; on the other, there was a threatening harm that any false allegation can cause to the professional reputation of the Special Care Nurse. I knew of Bret’s medical condition of psychosis and confusion. However, I admired his recalling capacity and also the fact that he cried while recounting the incident. (Nicol, 2004)

I feared of inadvertently supporting false allegations. After intense reflection, I came to the conclusion that I did the right thing by reporting the matter and filing the report. As a Nurse, I was responsible for advocating Bret’s pain, which seemed right. (Brooke, 2013)

So what?

Theoretically, the analysis of the situation is straight. Jasper (Jasper, 2007) says that being a professional medical practitioner, it is your duty to give the best care to your patients. While analyzing a similar situation, he supports that a professional nurse should share such incidents of alleged patient abuse with their seniors. He says it should be done even when the patient’s reliability is under question (Jasper, 2007).

I thought of the possibility of talking to the Special Care Nurse outside my official capacity, but later decided that in the given situation, nothing would change the appropriate course of action. This goes well with the thoughts of Tschudin who examined many similar situations (Tschudin, 2003). This kind of self analysis provided me a deep insight into my complex situation. It reinforced my belief that I did the right thing by taking the necessary required actions.

Now what?

In the scenario where Bret had reported the abuse, it seems quite appropriate that the whole episode will be investigated professionally. The Ward Sister’s action of removing the Special Care Nurse from the ward also looked appropriate. Another course of action would have been to suspend the Special Care Nurse from work. However, given the circumstances where the patient is confused and psychotic, the veracity of his allegations is still under question. Her suspension would have been prejudiced and inappropriate (McMillan, 2005).

While reporting the incident, I apologized to Bree and assured him that nothing of this sort will happen again. This showed I took his complaint seriously (Kozier, 2008).

In a reflective overview, I had two possibilities. One, I believed Bret and two, I didn’t. This leads to a much deeper analysis. As per Cruess & Cruess, the journey from a student to an 'expert practitioner' is marked by the person’s understanding to function from a holistic point of view. This concept is called a ‘professional intuition' (Baillie, 2005). If I again encounter a situation like this, I would be in a better position to deal with it. I will have more confidence in my decisions and would not need to reflect at this length. Such reflection helped me in realizing that one of the best ways to evolve in a profession is to see beyond rules and function holistically in inappropriate situations (Schön, 1987).

Scenario:

An 80 year old patient, named Bret, was admitted to the hospital’s schizophrenic ward, of which I was the in-charge. Needless to say, he was diagnosed with schizophrenia. He was also suffering from other ailments like hyponatremia and confusion. The patient and his kin were informed of his grim situation, given the critically low level of sodium in his body, Bret was put on a maximum fluid level of 700 mls per day. But due to Bret’s mental state, he was always demanding fluids. If denied, he would start shouting and disturbing other patients. He also got aggressive many times. Due to these reasons, a senior nurse in the hospital requested for a Special Care Nurse to assist with the patient’s healthcare facilities. The request was duly grated.

I took complete care of the patient, including his personal hygiene. One day, Bret started crying. When I asked him the reason, he said, “Two days ago, the special care nurse pinched me in the arm and slapped me.” I asked him why he didn’t inform anyone the same day. He said, “I was frightened. I could not dare to speak. I wanted her to complete the ward round and go. But later in the day, I forgot about it. Please remind me about the incident when my son visits me. I will inform him of all that has happened.”

I comforted him that the incident will never happen again. I asked for an apology and promised him that the special nurse will not care for him from now on. I reported the entire matter to the Ward Senior. Both of us then filed an Incident Report Form (IR1).