Reflections in Clinical Practice: Nursing Incident Report

This report is a reflection on a clinical practice incident by a nursing student during training at a surgical ward. The student recounts the case of Ms. Borgart, who underwent gallbladder and appendix surgery, and analyzes the administration of medications such as Tylox and heparin. The report highlights a medication error involving metoclopramide, leading to adverse effects, and uses the Gibb's reflective cycle to evaluate the actions taken and the outcomes. The student reflects on the importance of understanding drug dosages, potential side effects, and the need for thorough patient assessment to avoid errors and improve patient care. The action plan includes devising individualized care plans, seeking guidance from mentors, and ensuring effective communication during handovers. The reflection underscores the significance of clinical knowledge and the impact of negligence on patient well-being, providing valuable lessons for future practice.

Running head: BACHELOR OF NURSING
Reflections in clinical practice
Name of the Student
Name of the University
Author Note

1BACHELOR OF NURSING
Previous experiences help healthcare professionals to learn and acquire skills that assist
them in future practice. This essay contains my reflection on an incident using the Gibb’s
reflective cycle. This reflection on the incident will provide me the opportunity to observe and
evaluate my actions that are related to holistic healthcare of patients. I came across Ms. Borgart
during my training at the surgical ward. She was admitted at the ward for an operation in her
gallbladder and appendix. The registered nurse in charge of the ward explained her case to three
nursing trainees including me. We were advised to monitor her signs and administer proper
medicines to reduce her suffering pre and post operation.
Several hours before the surgery, she started complaining of acute abdominal pain die to
inflammation of the appendix. I tried to reduce her pain by administering a capsule of Tylox that
contained 500mg acetaminophen and 5mg oxycodone. Oxycodone acts as a narcotic pain
reliever and acetaminophen blocks prostaglandin synthesis. The response of the brain towards
pain gets altered (Blieden, Paramore, Shah, & Ben-Joseph, 2014). She reported less pain within
two hours. This oral administration was a good practice. Before being taken for surgery, a nurse
administered heparin sodium subcutaneous injection of the dose 2,000 USP units/2 mL. Patients
undergoing abdominal surgery lie at a risk for post-operative thrombosis. The nurse injected
heparin owing to its anticoagulant property. This was a good practice as heparin acts as blood
thinner and reduced complications from blood clot after the surgery (Anders & Trautmann,
2013). Finally, a day after the operation, Ms. Borgart started complaining of heartburn during her
meals. A third nurse administered intramuscular injection of 20 mg metoclopramide. She
repeated the process after 4 hours. The patient started showing hand tremor, headache and severe
diarrhea (Parkman, et al., 2012).

2BACHELOR OF NURSING
I administered Tylox due to its strong analgesic property that was needed to relieve the
pain symptoms. Acetaminophen increases the effect of the opioid oxycodone and treats severe
pain (Bullock & Manias, 2013). Thus, this oral administration was a good practice. I also
understood that individual differences in pain sensitivity pose challenges in clinical sector. The
nurse who administered subcutaneous heparin injection displayed a good clinical knowledge of
the steps that need to be taken to reduce blood clots before abdominal surgery. She left the
needle inside for 10 seconds to prevent any bruising (Adams & Urban, 2015). However, the
medication error that occurred due to overdose of metoclopramide by the third nurse led to
serious side effects in the patient. Thus, I realized that a nurse is expected to demonstrate
accurate knowledge of drug dosage and its probable side effects on a patient after closely
evaluating the medical history.
This event helped me realize that evaluation of the observation charts, medical history
and vital signs is essential for providing care to a patient. Nurses should also be aware of the
permissible drug doses for adults and the complications that can arise (Zaccagnini & White,
2015).
My action plan will include understanding the needs and interest of each patient and
devising a care plan accordingly. I will seek help from my mentor before administering an
increased drug dose to the patient. I will also try to pass on relevant information related to the
patient to other nurses during handovers (Hamric, Hanson, Tracy, & O'Grady, 2013).
Thus, it can be concluded that the reflection made me more aware of medication errors
that arise due to negligence or lack of clinical knowledge. The event helped me gather findings
that I will be able to use and put to practice in future surgical ward settings.

3BACHELOR OF NURSING
Bibliography
Adams, M. P., & Urban, C. (2015). Pharmacology: Connection to Nursing. . Pearson Education.
Anders, D., & Trautmann, A. (2013). Allergic anaphylaxis due to subcutaneously injected
heparin. Allergy, Asthma & Clinical Immunology, 9(1), 1.
Blieden, M., Paramore, L. C., Shah, D., & Ben-Joseph, R. (2014). A perspective on the
epidemiology of acetaminophen exposure and toxicity in the United States. Expert review
of clinical pharmacology, 7(3), 341-348.
Bullock, S., & Manias, E. (2013). Fundamentals of pharmacology. Pearson Higher Education
AU.
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2013). Advanced Practice
Nursing-E-Book: An Integrative Approach. Elsevier Health Sciences.
Parkman, H. P., Mishra, A., Jacobs, M., Pathikonda, M., Sachdeva, P., Gaughan, J., &
Krynetskiy, E. (2012). Clinical response and side effects of metoclopramide: associations
with clinical, demographic, and pharmacogenetic parameters. Journal of clinical
gastroenterology, 46(6), 494-503.
Zaccagnini, M., & White, K. (2015). The doctor of nursing practice essentials. . Jones & Bartlett
Learning.