Reflection on Nursing Proficiencies Accomplishment

This reflection discusses a nurse's visit to a family with a baby suffering from diaphragmatic hernia. It covers the event, reaction, analysis, future planning, and overall reflection. The nurse provides support to the family and helps them cope with the challenges they are facing. The reflection also highlights the importance of family support and the impact of external factors like the COVID-19 pandemic.

Reflection related to the
nursing proficiencies
accomplishment
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Table of Contents
About this reflection .......................................................................................................................3
Reaction of the event.......................................................................................................................3
Event Analysis.................................................................................................................................4
Future Planning...............................................................................................................................5
Overall Reflection...........................................................................................................................6
REFERENCES................................................................................................................................7
Online .........................................................................................................................................7
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About this reflection
Reflection on the daily experiences forms an important part in the practice of the nurses.
It helps in provision of nursing care in an enhanced manner. Recently, I visited a family with a
baby boy suffering from diaphragmatic hernia. Congenital diaphragmatic hernia is a type of
condition in which the muscle that separates the chest and abdomen contains a hole due to which
the contents of abdomen go up into the chest (Chandrasekharan. and et.al., 2017). I was very
concerned about the baby as it is a life threatening illness as the baby is not able to breathe
properly as there is a hole in the muscle which is there in between chest and abdomen. When I
visited their home I observed that the mother was suffering from antenatal anxiety, and she was
also aware about the critical condition of his baby. The baby's father was also brain injured, but
they both were equally concerned for their child. The mother is too strong, and she is confident
enough about her decisions. I also observed that the baby was not able to suck and swallow milk.
The baby was having a NGT tube and because of that the mother was not at all happy as the
baby's nose bled sometimes. At the time of feeding also the baby's oxygen saturation goes down.
The baby also have problem in hearing at lower frequency. I watched the health advisor with
whom I visited was checking baby's weight and length of the baby. I communicated with the
family and know about their concerns and problems that they were going through. I also changed
the name of the baby because of confidentiality (Proficiency 6).
Reaction of the event
The family which I visited have so many troubles as the baby boy was just was only 15
weeks old and has congenital diaphragmatic hernia. The baby was born from C/S and the weight
of the baby was 3.2 kg at the time of birth and after 15 weeks he was 6.05 kg. As per the need of
confidentiality the name of the baby has been changed for the purpose of this reflection. The
physical growth was baby was good enough. I gave the parents a feeling of relief that the
physical growth of the baby was good, and they need not concerned about this aspect. As the
mother was also suffering from antenatal anxiety. It was due to pregnancy she was little worried
and stressed. I observed that mother also have various other symptoms of antenatal anxiety such
abrupt mood swings, and she was easily annoyed and irritated from small things. I provided her
support and talked positively and counselled her to lower her stress level (Proficiency 28).
She was concerned for her baby too it was also a reason for her antenatal anxiety as she
had a fear of baby's heath. I listened to the mother very carefully and in a non-judgemental way
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and also I tried to understand her feelings so that I can effectively help her to deal with the
situation. I have studied and have knowledge about cognitive behaviour theory, so I tried to
apply in this situation. As per this theory I can gain an understanding and insights of the feelings,
thoughts which are bothering the patient (MacGill, 2018).
By undertaking this theory into this situation I was able to identify the thoughts or
concerns by which the mother was worried and after that I helped the mother in overcoming the
thoughts or concerns which were bothering her to a great extent (Proficiency 5). When I was
undergoing this case I also identified various cause and their effects related to congenital
diaphragmatic hernia. I also came to know the problems which is faced in congenital
diaphragmatic hernia such as there is problem in sucking and swallowing milk by the baby.
From NGT tube nose bleeding can occur. By observing the condition of the baby as he was
suffering from many problems simultaneously and due to all these, the parents were all the more
concerned for their baby's health. I was trying my best and help them in any possible and also I
have sympathy for the parents too. Also, the baby have pulmonary hypertension, heart Condition
and also enlarged kidneys (Cornec-Le Gall, Alam. and Perrone, 2019). He also had chest
infection and due to this the lungs were affected of the baby.
Apart from all these problems the mother was standing so strong and handling all this
very bravely. Personally I also faced a problem of communication as wearing the mask creates
an obstacle in communication. The problem of hearing and with the mask it was difficult to form
meaningful connections with the family.
As there was also Covid-19 going on and the movements of people were restricted also
the shops were closed and there were many more problems. This also impacted on the mental
health of parents as they felt helpless and also there was no family visits because of lock down.
So there was no emotional support to the parents.
Event Analysis
According to Orlando's nursing theory, the nurses are required to analyse patient's
behaviour by using their perceptions as well as it also helps the nurse to find out the nature of
patients distress (Gaudet. and Howett, 2018). On analysing the event through Orlando's Nursing
Process Discipline theory, I found out that the baby needs help by observing the behaviour.
However, the theory also states that not every time the need may not be correct as they appear.
For observing and finding out the need of the baby and the reason for its cry I used my
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perception, thoughts and feeling to know the behaviour pattern of the baby. Also, by this theory I
was also able to find out the nature of the patience's distress and after analysing this, help will be
provided to them by me.
Function of professional nursing – As per this, the need of the patients is found out and meet the
same (Toney-Butler. and Thayer, 2019). As also the family was feeling helpless, and I found out
and took care of them. Here the need was making the baby swallow and suck the milk.
Presenting behaviour – In this patient's immediate need is found out (Yekefallah. and et.al.,
2017). I found out that the situation is problematic and the baby is not swallowing and sucking
milk.
Immediate reaction – It is the internal response and my internal response was care, concern and
support to the family.
Nursing process discipline – In this concept the nurse cannot assume the impact of her response
to the patients (Alligood, 2017). I clarified this by clearing all the problems with the mother.
Improvement – In this the patient's situation is resolved. Improvement is considered if the
problems faced by the family is reduced to some extent.
Future Planning
If in the future the same situation arises and the family is facing many problems at a time
then extra support groups will be engaged to help the family. And in future if baby is suffering
from congenital diaphragmatic hernia I will keep a respirator at the time when the mother is
giving birth to a baby. I will keep this respirator as some cases may become serious and it needs
to be treated with extracorporeal membrane oxygenation (ECMO).
Also we will keep a lung bypass machine which helps the baby in gas exchange when his
lungs are resting. It also observed that when a baby suffers from this a nasogastric tube or
orogastric tube with suction to decompress the bowel is required and a bag mask ventilation
should be avoided.
Due to NGT, the baby's nose was bleeding therefore in future if any situation like this
occurs then various precautions for the same will be taken. NG tube is a thin tube which is
inserted through nose and goes down to stomach which helps in giving food and medicine
(Rizzo,Douglas. and Lawrence,2019). There are many risks when inserting this tube such as
abdominal cramping, swelling, diarrhoea, nausea, vomiting and regurgitation of food or
medicine. Therefore, to lower the complication we will ensure that the tube is always taped
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securely to the baby's face. Also, will check the signs of leakage, blockage or kinks in the tube
and other precautions. After the intubation we will confirm multiple ways if the tube is correctly
placed in the stomach or not.
I will also take care of the fact that in case of any emergency or unnatural events like
pandemic there need to have extra facilities to people in these types of cases like pregnancy or
any health issues.
Overall Reflection
From thinking and writing about this event I was getting a mixed feeling as on one hand
it was very concerned about the baby and their parents and on the other hand it was also feeling
so proud on the baby's mother apart from suffering from her own illness and the baby's problems
she was taking strong decisions and handling everything so confidently. I admire the strength
that the mother has while dealing with the above problems. I also felt bad for the baby as he
cannot do anything and also cannot express his pain of suffering from several illnesses. While
thinking and writing about the event, I also feel the pain of the mother as having a baby with this
condition and when she herself is dealing with health issues. I also observed that due to any
unnatural situation there are several impacts such as in case of Covid-19 the family had on
access to support groups making the situation and their conditions all the more critical (Reljić,
Pajnkihar. and Fekonja, 2019). I have a feeling of sympathy and also I feel proud and admire the
strength of mother in the way she was handling the situation. I also felt that at this time of
hardships family support is required even though I and the health visitor were there to help them
and also we showed our concern towards them but the place and importance of family is
different.
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REFERENCES
Books and journals
Alligood, M.R., 2017. Introduction to nursing theory: Its history and significance. Nursing
Theorists and Their Work-E-Book, p.1.
Chandrasekharan, P.K. and et.al., 2017. Congenital diaphragmatic hernia–a review. Maternal
health, neonatology and perinatology. 3(1). pp.1-16.
Cornec-Le Gall, E., Alam, A. and Perrone, R.D., 2019. Autosomal dominant polycystic kidney
disease. The Lancet. 393(10174). pp.919-935.
Gaudet, C. and Howett, M., 2018. Communication and technology: Ida Orlando’s theory
applied. Nursing science quarterly. 31(4). pp.369-373.
MacGill, V., 2018. Reframing cognitive behaviour theory from a systems perspective. Systemic
Practice and Action Research. 31(5). pp.495-507.
Reljić, N.M., Pajnkihar, M. and Fekonja, Z., 2019. Self-reflection during first clinical practice:
The experiences of nursing students. Nurse education today. 72. pp.61-66.
Rizzo, S.M., Douglas, J.W. and Lawrence, J.C., 2019. Enteral nutrition via nasogastric tube for
refeeding patients with anorexia nervosa: a systematic review. Nutrition in Clinical
Practice. 34(3). pp.359-370.
Toney-Butler, T.J. and Thayer, J.M., 2019. Nursing process. StatPearls [Internet].
Yekefallah, L. and et.al., 2017. Orlando’s nursing process application on anxiety levels of
patients undergoing endoscopy examination. International Journal of Epidemiologic
Research. 4(1). pp.53-60.
Online
ORLANDO'S NURSING PROCESS DISCIPLINE THEORY. 2020. [Online]. Accessed
Through<https://nursing-theory.org/theories-and-models/orlando-nursing-process-
discipline-theory.php>
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