Reflective Essay on Clinical Skills | Study

Introduction
This reflective essay focuses on three clinical skills that I have learnt over the period of my
apprentice nursing course which I also use regularly for efficient and appropriate healthcare
delivery to patients. For demonstrating competence in practice and offering substantial care, a
patient scenario will be used to highlight the three clinical skills which are: observation of
blood pressure, fluid chart maintenance, and the application of non-touch aseptic techniques
in catheter management. I will use Mrs X as the patient’s name for confidentiality (NMC
2010). The reflection would utilise the format of Gibbs Reflective Model (1988) as it offers
appropriate distribution of headings to describe the case scenario as well as the care provided
to the patient. HusebøO'Regan and Nestel, (2015) established that Gibbs reflective model
(1988) is a useful source in critically analysing the patient case study and demonstrating
personal reflection. The model combines the following six steps: description, feelings,
evaluation, analysis, conclusion and action plan (Gibbs, 1988). Reflective practice entails
giving detail attention to the hands-on values and concepts which inform everyday actions
leading to developmental awareness (Clouston and Westcott 2005).
I chose to reflect on the clinical skills based on their significance inpatient care. For example,
blood pressure which is described by Jenkins and Tortora (2013) as the force exerts on the
wall of the blood vessels by the heart requires effective monitoring due to the health risks its
fluctuations may cause which can be very devastating to patients. Monitoring blood pressure
has become a global clinical skill used to enhance good healthcare delivery. Fluid balance
chart maintenance on the other hand is required to ensure a balance between the amounts of
water lost from the body to the amount gained (McGloin 2015). The Aseptic Non Touch
Technique (ANTT) will be used to ensure there is no contamination during the procedure of
inserting catheter.The assignment will help to develop a plan, and discuss the efficacy of the
clinical skills that are needed for care competence.

Description
The incident happened during one of my shifts whilst working on a respiratory ward under
the supervision of a senior Nurse Practitioner. Shortly after the start of my shift, Mrs X, a 78
year old woman was admitted to the ward. Upon her arrival to the ward, my supervisor and I
introduced ourselves to her in a warm manner and we highlighted to her some of the roles we
would play in her care. I was assigned to carry out an initial assessment on her which was
required to ensure the safety while treating Mrs X.
I obtained consent from Mrs X by providing her with adequate information regarding the
health assessment process and asking her for permission undertake the initial assessment on
her. I noted Mrs X’s general appearance, attitude and response to my questions. In view of
her general appearance, Mrs X looked very unwell; due to shortness of breath and wheezing
she was very distressed and reluctant to fully concord with treatment. I carried out base line
observations by checking all the vital signs and documented on the observation chart as
required by Trust policy and procedure which stipulates that healthcare providers must keep
clear and accurate records NMC Code (2018). Throughout this process I ensured that Mrs X
privacy and dignity was maintained at all times. Considering Mrs X was unsettled at the time
of admission, I developed a rapport with her by holding her hand and respectfully reassure
her that we are there to help her. I also maintained good eye contact, smiled and listen
attentively to her concern about the pain around her abdomen. As I was concluding the
assessment, she smiled at me and commended me for being kind to her. From her reaction, I
could tell that she was reassured by my approach and this helped me to get useful
information from her during the assessment. Mrs X lives alone and has a diagnosis of severe
chronic obstructive pulmonary disease (COPD) resulting in shortness of breath. She also has
a diagnosis of type 2 diabetes.

Due to the deteriorating condition of Mrs X, my action was to continue hourly monitoring.
As a result of this, I used the blood pressure machine to monitor Mrs X’s blood pressure and I
made sure I washed my hand prior to performing the skill. Mrs X was seated when I first
performed the check; she was encouraged to keep up a comfortable posture during the
procedure. The procedure was repeated, this time I sought permission from Mrs X and I
encouraged her to stand up if she could and she consented without any persuasion. There was
no significant difference between the seated and standing blood pressure readings. In
addition, I identified that Mrs X was having urinary retention and due to her worsening
condition, a decision was made to insert a catheter after a bladder scan showed 800mls of
urine. A catheter was inserted using non-touch aseptic techniques to relieve the urinary
retention.
Feelings
When I first attended to Mrs X, I was nervous because of my limited experience in providing
care to a patient with such a deteriorating condition. I was nervous when I spoke to Mrs X
about the procedures involved in inserting the catheter. I noticed that I was being observed by
my supervisor and I became very anxious and conscious. I was emotional when the catheter
was being inserted because of the sharp pain associated with the invasive procedure, and
seeing how unstable and uncomfortable she was throughout the process. I believe as an
apprentice nursing associate (ANA) nurse I have a responsibility to take care of my patients. I
felt happy when Mrs X consented to having her blood pressure and all her vital signs done
including the insertion of catherter, which is an invasive procedure, without any persuasion. It
is also emphasized that the basis for providing effective healthcare is good communication
(Moss 2012); I believe Mrs. X consented because of the rapport I already established with
her.
Evaluation

As per Trust and ward policy Mrs X was placed on hourly monitoring of vital signs including
her blood monitoring. The National Early Warning Score (NEWS 2) was an essential tool for
the monitoring and assessment of Mrs X. The NEWS2 procedure was used to provide a
standard process for addressing clinical deterioration by using six physiological parameters
which include respiration rate, oxygen saturation, systolic blood pressure, pulse rate,
temperature, consciousness level or new confusion and weighing for supplemental oxygen for
critically ill patients. The guidelines are aimed at monitoring the patient’s clinical conditions
and triggering clinical response (Zaidi, Bader-El-Den, & McNicholas, 2019). I have
effectively used the NEWS 2 guidelines in monitoring the patent’s vital signs. This has
helped improved my knowledge skills and boost my confidence. I have realized that being an
ANA it is my responsibility to explain to Mrs X about what I want to do and the reasons for
doing it, though she is very unwell but I still went ahead to communicate with her using my
verbal and nonverbal communication skills to make her understand the interventions needed
for her care such as checking the hourly vital signs.
In addition, the rapport I established with Mrs X during assessment process provided her with
much reassurance about her condition and how it would be managed. Although I was initially
nervous and worried especially with the way Mrs X presented on admission but the good
thing was that, my confidence levels increased after a short while and I was able to apply my
cinical and interpersonal skills including calmness, empathy, observation of blood pressure,
fluid chart maintenance, and the application of non-touch aseptic techniques in catheter
management, in managing the situation as I was also reassured by my supervisor. I have
learned how to ask questions especially when I am not sure of what to do. Also, my
understanding of ANTT has further been widened and I have been using it regularly in my
practice.
Analysis