My hub placement for “Ongoing Healthcare Needs” was with an elderly female rehabilitation ward. For this reflective piece I am going to write about a situation I encountered on that ward. I will be following “John’s model of structured reflection” as a basis to structure this document.
Description of the Experience
Mary (changed name) was admitted with right cerebrovascular accident (CVA) and was now just waiting for residential placement. One of the side effects left over from her stroke was that she had a drop-foot for which she had a splint and a walking stick; she had declined to use a frame. Mary was one of the patients on my team so I was getting to know her quite well during my first two weeks on the ward. I was working with another patient when I saw Mary twist on her ankle and try to steady herself on her stick. This had the effect of spinning her round and she fell to the floor onto her left hip. I ran to help, she was in a lot of pain and slight shock, I called down the ward for help several members of staff came to help saying “do this” and “do that” all at the same time, I was quite over whelmed. Mary was rolled back and forth onto a sling, hoisted up and placed on her bed, all the while I was looking after her head, I did not know what else to do so I talked to her to calm her down, which was difficult due to all the commotion. On initial examination the senior nurse on duty said it looked like she had broken her femur, which was later confirmed. Her residential placement was cancelled and she was transferred to stepping hill.
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What was I trying to achieve?
We were trying to achieve several things. At the outset we were trying to perform an initial assessment of Mary in order to establish if she had sustained any injuries due to the fall and if moving her would aggravate any injuries sustained. The second objective was to make Mary more comfortable and calm her down, as she was quite frightened. Finally the aim was to move Mary back to her bed where she could wait for the doctor to arrive. All the while it was important to maintain a safe environment for both patients and other members of staff.
Why did I respond as I did?
As I was new on the ward, I was still quite anxious about whether I was performing all my tasks correctly and didn’t want to over step my boundaries as a student. Also I did not know the staff members that came to help, very well and did not feel confident to enough to ask them what they were doing and why. I was also still quite shocked, as I had never seen anybody fall that heavily before and this was my first incident in a ward situation, I was therefore quite overawed with the whole situation.
What were the consequences of my actions, for: the patient, others, and myself?
*For Mary there were no direct consequences from my actions as there was plenty of trained staff around to cover. She may have felt a little more discomfort, as I got slightly uncoordinated in my organisation of the sling due to being flustered. However, if anything me being there calmed her down, as we got on well and I think she trusted me.
*For the other members of staff I thought that their opinion of me and my ability would drop, as the attitude on the ward was that as an ‘up and coming “M.A.D.” (making a difference) student’ I should know how to do everything. I felt like I was getting in their way and slowing them down. However after speaking with them after the incident they said I coped very well.
*As a result of my actions and feelings, I felt like a spare part not wanting to get in the way and slow down the process, I also lost a little confidence in my ability to deal with difficult situations.
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How did I feel in this situation?
What internal factors were influencing me?
From the moment Mary fell, I was shocked and upset to see the pain and distress she was experiencing. Throughout the entire procedure I felt inadequate, helpless and annoyed. I felt as though I wanted to intervene to try to calm the patient and reassure her that if she just relaxed it would all be over in just a moment. I was quite annoyed with myself, as this was the perfect opportunity to practice some of the basic incident procedures and I just seemed to be fumbling around. I felt helpless
Did my actions match with my beliefs?
What factors made me act in incongruent ways?
In refection my actions did not match the beliefs I hold about myself. From my time on other ward placements I thought I had built up a good professional attitude and could work my way around difficult situations as I have a very logical mind. I knew I would have to deal with this type of situation, but I was not prepared for my reaction, it felt very out of place for me as I have never responded in such a way before.
What I was not prepared for was how much; the lack of familiar surroundings would affect my actions and how nervous I felt about giving a good impression to the other members of staff.
The main factors that made me act in such a way were nervousness, lack of confidence and surprise.
What knowledge did or should have informed me?
During the ward introduction I was shown where all the ward policies and protocols were kept. Whilst I had looked at them I could not recall the correct procedure for dealing with a fall on the ward. I also didn’t know what we were looking for in the examination of Mary. Afterwards I studied all the incident procedures and asked the staff about what sort of thing I would look for in a fall victim. I could also have read more case studies on dealing with difficult and new situations.
How does this connect with previous experiences?
Before I commenced my training I had worked in a nightclub where I dealt with many first aid incidents. In these situations I was always the most qualified person there as I’d attended life saving classes since I was a child. This gave me an edge of confidence and I found it easy to deal with new and shocking incidents, but when Mary fell I was the least qualified there and felt very self conscious of my actions and ability to help her without getting in the way or hurting Mary.
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Could I handle this better in similar situations?
I have learnt that it is important to have a little more self-confidence and to talk to staff to achieve the best results for all. If I face a similar incident I would like to think I would handle it better by being more forward and talking to the other members of the team, because that is what we are, a team.
What would the consequences be of alternative actions for: The patient, others, and myself?’
*If I had been more active in my participation whilst feeling overwhelmed with the situation I may have caused unnecessary discomfort to Mary, although I might have been able to comfort her better.
*If I had been less hesitant it could have made the rest of the staff more confident in working with me, as it would have given a good impression from the outset. It would also have taken less time to get Mary comfortable.
*If I had kept my emotions under control and been more confident I believe it would have made me feel much happier about the whole situation and would have given me a good start on which to base the placement day.
How do I now feel about this experience?
I now feel better about this experience; I learnt that it is important not to show too much emotion when faced with a challenging situation. It has also taught me to have a bit more confidence in my abilities and to participate in more clinical skills, as the more I encounter different situations the better I will become in dealing with them. I can’t spend my entire training watching others doing the work if I am to learn how to do it myself.
Can I support myself and others better as a consequence?
Has this chanced my way of behaving?
I would like to think that this experience has changed the way I will respond in the future. I am confident that if faced with a similar situation I am now more confident and better equipped to deal effectively with the incident.
Reference
Johns. C., Freshwater. D. (1998) Transforming nursing through reflective practice. Bailliere’s Study Skills for Nurses Vol 2 Bailliere Tindall pp 201-226
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