Reflective Essay on Group Patient Care

Reflective Essay on a Group Patient care in a Clinical Setting
1. Introduction
This essay is a reflection of my encounter with a patient in a clinical setting
(Casey and Wallis, 2011). It will show how much effective I was to demonstrate my
clinical and interpersonal skills as a nurse working with a team of health care
professionals in a busy critical care unit. I am going to focus primarily on one patient
and how my group working as a team could provide the effective care to the patient's
satisfaction. In accordance with the NMC professional code no name will be used to
protect patient (nhs.uk, 2017) as well as group members’ confidentiality
(England.nhs.uk, 2012).
Implementing effective teamwork skills is a necessity in nursing (Sullivan. and
Garland, 2010).. I would think about the dynamics of my own personal experience (
Huber, 2013) .about the clinical encounter and how a team can be more effective in
providing a better solution. A well-coordinated teamwork plays an important role in
faster and better realization of a common goal in a team assignment. I was posted to
the cardiac care unit where the patient turnout is more and the treatment is time-
critical. A team is therefore essential for such an emergency unit (Sinatra-Wilhelm,
2012). Each team member plays his or her specific role and takes on various
responsibilities that together can ensure that the team functions well and achieve a
common goal. A well planned team care improves the coordination, completeness,
effectiveness, efficiency and quality care for the wellbeing of both the caregiver and
patient. To accomplish this, the transformation to group based primary care is
required for most of the practices, conceptual changes in the orientation of care is
necessitated with group dynamics and in providing training and education to primary
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care staffs and patients to understand their roles and responsibilities (Dong and
Temple, 2011). The team I am referring includes clinical staff, such as doctors A and
B, both cardiac specialists, myself as a student nurse trainee, doctor assistant C, a
specialized nurse D who is also my mentor. However, my team also included other
professionals, which may be needed in case of urgency, such as care manager F,
dietician G, pharmacist H, as well as non-clinical staff such as receptionist I.
I am going to use Gibbs’ Reflective Cycle model (Gibbs, 1988) to present my
reflection as it is a very popular model for such types of reflective essays. Reflection
(Davies, 2012) is excellent tool to learn from experiences.
It is seen as a important methodology especially for experts who learns through
understanding all through their profession (Jasper, 2013). Generally reflective process
is the way to learn from an earlier exercise or encounter (Husebø, O'Regan and
Nestel, 2015) to gain new insight about oneself and/or practice (Jasper, 2013). This
technique is viewed as an approach to promote the professional and self-improvement
of independent and qualified professionals, and ultimately stimulates both individual
and professional growth (Jasper, 2013). The “reflective cycle of Gibbs” dates from
1988 and includes six reflection stages that empower the reflector to reflect all stages
of an activity or experience (Brookes.ac.uk, 2017).
2. Description
During my posting at the acute cardiac care unit, I encountered a patient named Mr J.
The real name has been kept confidential due to confidentiality, “Standards of
conduct, performance and ethics for nurses and midwives article 5, 6 and 7” (Myatt,
2015), is about respecting people’s right to maintain confidentiality (Borneuf. and
Haigh,2010). I am going to maintain this confidentiality throughout my career. Mr J
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aged 50 was admitted to the acute cardiac care unit with severe chest pain. I got an
information beforehand that Mr J has to be admitted immediately and I should make
necessary arrangement. I called my mentor D and we two arranged necessary
equipment ready for the patient. I got the patient history and found that he was
admitted to the same ward one year back with similar symptoms. His body weight is
90 kg , height 175 cm, BMI was 30.5 ; it shows that he was overweight. At the time of
admission patient was complaining about breathing problem for last two weeks and
the situation became worse on the day of admission (Dewar and Nolan., 2013). The
specialist doctor A and B were informed and A is expected to arrive within one hour
and B will be delayed as he was busy with a surgery. However assistant physician C
was available.
Before admission to the hospital, patient was taking prescribed medicines to control
blood pressure and hypertension. He was not having any allergy to any medicine and
he had not taken any traditional medicines. His family history showed that his father
died of heart disease 10 years ago and his brother was also suffering from
hypertension. Mr. J drinks occasionally. At the time of admission the patient was
having senses and was able to talk slowly but from facial expression we can make out
that he was suffering from acute pain.
Immediately after placing the patient on the bed physician C conducted some
diagnostic investigation known as PQRST pain assessment where P stands for
position of pain, Q stands for quality of pain whether it is a dull ache, pricking or
crushing pain. R stands for radiating pain, Common sites include the anterior chest,
shoulders and arms, S stands for severity of pain and T stands for duration of pain.
After analysing the symptoms the assistant doctor C talked to the specialist doctor A
over phone and dictated me to record the symptoms. He informed the specialist nurse
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D to immediately act on the following. I was assisting my senior to conduct the
following:
A 12-lead ECG is to be performed and the output should be checked by a medical
super at the earliest; to continue access to a defibrillator and to conduct diagnostic
tests such as a full blood examination (FBE), troponin and electrolytes. Other tests
included liver function test, urea and electrolyte test and cardiac enzyme.
I informed pathological department to come and collect the necessary samples for the
tests mentioned by the physician C. The assessment of the chest pain of the patient
was necessary as it would help in diagnosing the root cause of the pain so that prompt
and appropriate measures can be taken to reduce the pain and treat the root cause. The
patient’s SPO2 was found to be 92%. Oxygen therapy is only indicated in the hypoxic
patient with a SpO2 less than 93%,. The heart beat was 105. It is very much on the
higher side and blood pressure was 175/95. It is very much high. I took the body
temperature which was recorded as 370C.The temperature was normal. I assisted my
senior nurse to apply urinary catheter to the patient to monitor the fluid outflow. I was
told to observe the readings of different parameters like heart beat and blood pressure
on an ongoing basis. The entire diagnosis process was going on in a very calm
environment which is a necessity for a heart patient. The specialist physician arrived
within one hour and went through the data collected so far and based on the
symptoms and available data Mr J was diagnosed with congestive cardiac failure
(CCF) with fluid overload. The patient was also suffering from hypertension. The
doctor prescribed a number of medicines which are to be administered as per dose and
period for next seven days. The patient’s daily fluid intake was restricted to half litre
per day and oxygen therapy has to be given using a face mask as the patient was
having short of breath. After 12 hours the patient started showing improvement.
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