NUR286: ICC Drainage Handover, Reflection and Nursing Practice

This assignment, completed by a nursing student for the NUR286 course, is divided into two parts. Part 1 focuses on a patient handover using the ISBAR (Identification, Situation, Background, Assessment, Recommendation) framework, detailing a patient with breathing difficulties and pleural effusion who had an intercostal drainage tube inserted. The handover includes patient identification, the situation leading to admission, the patient's medical background (including stomach cancer, COPD, and smoking), current medications, and vital sign assessments. Part 2 involves a reflection on the student's experience changing an ICC drainage bag, discussing the challenges faced, such as time management and nervousness, and the importance of applying theoretical knowledge in a practical setting. The student reflects on the need for improved time management, confidence, and preparation to enhance clinical performance and patient care. The assignment is supported by references to relevant nursing and healthcare standards and literature.

[Surname, first name, student number; scheduled lab time/day, tutor full name]
 Use this template for your task 2 written assignment
 Ensure you update the header with your own unique details
 Ensure you use Australian spell check
 Ensure you update your reference list, and this is always on a separate page at the end of
the document
 Use your verbal handover tool as a trigger to structure your handover, noting some
information may/may not be relevant; e.g. under identification stating the patients full
name and age is sufficient if the URN is unknown.
 Short succinct sentences would be appropriate in Part 1.
 Review the course FAQ’s that relate to Task 2 on Blackboard (under ‘Getting Started’ tab)
1

[Surname, first name, student number; scheduled lab time/day, tutor full name]
Part 1
Identification
The name of the patient is John Williams. The date and time of the admission were not
identified and the NOK did not contact. Also, the NOK was not aware of the transfer of the
patient. However, the family of the patient was present during the admission. The date of
birth of the patient was also not specifically mentioned in the paper.
Situation
The patient was admitted to the hospital with some breathing issues. He was facing difficulty
in breathing and was from some respiratory failure due to shortness of breath. From the
provisional diagnosis of the patient’s situation it was found that he had pleural effusion. It is
sometimes referred to as “water on the lungs”. In this condition, build-up of excessive fluid
between the layers of the pleura present in the outside of the lungs. Pleura are thin
membrane that helps in lining the surface of lungs and the inside of the chest wall. The patient
also had an intercostals drainage tube inserted at the left side lung which is inserted through
the chest wall and into the pleural space of the patients’ lung. It works as the drainage system.
Background
On the background analysis of the patient it was found that worked as a police officer and
now he is a retired person. The background analysis produced the fact that he is a patient of
stomach cancer. He was previously admitted to the hospital with a breathing difficulty of six
weeks right after undergoing a gastrectomy for his stomach cancer. In this context,
gastrectomy is a medical surgery which is processed to remove a part of the stomach which is
affected by cancer. In this medical surgery procedure various side-effects are found in the
patients and among them difficulty in breathing is common. Also, John is a patient of Chronic
Obstructive Pulmonary Disease (COPD). On the other hand, John is a smoker as well as a social
2

[Surname, first name, student number; scheduled lab time/day, tutor full name]
drinker. At the same time, he is having a regular bowel bladder habit. He has a symptom of
shortness in breath with a wheezing sound. The NIMC medications for John include variety of
medicines for his multiple health issues. He takes prn Panadol to provide pain relief. Along
with this, he consumes multivitamin tablets to address weakness and other lack of vitamin
related issues. John consumes Salbutamol 5 mg NEB prn and this medicine helps in opening up
the medium and large airways of the lungs which is generally provided to the patients of
COPD. Every four hour in a day, he undergoes IVC flushes. He takes 5ml N\Saline 0.9% which
consists of 9g sodium chloride per litre. When pain indication shows more pain than 7 out of
10, then he needs to take a prn 5 mg Morphine SC to get relief. Also, in order to fight any
infection caused by bacteria, he takes Amoxicillin 1 gm after 6 hours. However, no alert
regarding medicine or allergic symptoms have been found from the background analysis of
the patient.
Assessment
The observation of 10 hours has been completed for the patient and upon the assessment of
the vital signs it has been found that his body temperature is 37.6 degree Celsius which is a
little bit higher than the normal body temperature range. His heart rate (HR) is 78 which lie
within the normal range of heart rate. His SPO2 rate is 96% which is absolutely normal. Upon
the assessment of the respiratory rate (RR) of the patient, it has been found that his RR is 24
per minute which is at the marginal rate of normal respiratory rate. Also, his AE is equal. On
the pain rating scale, it has been analysed that his pain level lies between 2 to 3 out of 10 in a
scale and he is having mild discomfort. He is there in the integrated comprehensive care (ICC)
for 30 mins.
Recommendations
Upon the assessment of his vital signs it is recommended that he requires triflo or incentive
spirometry within an interval of 4 hours. He is also in need of ICC drain on suction which is
3

[Surname, first name, student number; scheduled lab time/day, tutor full name]
having 15cm on Atrium drain in order to control the excessive fluid of outer membranes of
lungs.
4

[Surname, first name, student number; scheduled lab time/day, tutor full name]
Part 2
Being a nursing student I am experiencing several challenging tasks while learning. In this case
study assessment, I also got opportunity to encounter a challenging task. I have chosen a case
study of patient with breathing difficulties and I was supposed to assist the patient in changing
ICC drainage bag in the assessment. Before starting, as a nurse, I was questioning myself about
the process of maintaining all the regulations and standards of nursing and then I set my goal
that I should follow the nursing standards while providing care to any patient and for this
assessment I also remembered all the standards. I also realized that with this task, I will learn
the process of applying theoretical knowledge into practical settings. I was aware of the
medication safety standard and in this regard, while performing ISBAR analysis I was quite
careful. ISBAR analysis is a mnemonic used by the nurses which is extremely helpful to
improve safety of the patients in the transfer of critical information. It ensures accurate
identification and the transfer of essential information. According to the comprehensive care
standard, all the nurses should make comprehensive care plan for the patients after a
thorough diagnosis (Australian Commission in Safety and Quality in Healthcare 2019). I have
also tried assessing the patient in detail however, my lack of experience in this field made me
less confident and I could not provide an error free performance. My practical assessment was
not good enough and I found out some specific reasons behind my poor performance. First of
all, I want to confess my poor time management skill while doing an ISBAR analysis to assess
the patient thoroughly. I could not complete my task for not having any time left. I understood
the importance of time management in this regard. Time management allows accomplishing
more in a shorter period of time (Wheeler 2016). It is also helpful in lowering the stress and
focussing on goals. With effective time management ability, one can improve decision making
ability as well (Mancheri et al. 2018). Also, I was really nervous during my practical assessment
and especially while changing the drainage tube I was highly strung. But, later on I realized
that if I was not nervous, then my performance could have been better than this (Sun et al.
5

[Surname, first name, student number; scheduled lab time/day, tutor full name]
2016). Overcoming nervousness is necessary in order to gain more confidence otherwise it can
always hamper the performance (Sadauskas and Benošytė 2016). Moreover, I was
inexperienced in gathering equipments before assessing the patient which consumed time
and deteriorated my performance. Before starting my assessment, I should gather and set all
the equipments properly to perform the task without any hazard (McNamara 2015). But, all
these poor functioning hampered my performance and I lost my marks. However, I feel the
feedback I received opened my eyes about my faults and drawbacks of working in practical
settings. I will take it positively and consider this as an experience of life so that I can be more
careful and cautious from the next time. Now I have more confidence of working in a clinical
setting independently. In future, I will learn time management so that I can overcome my
nervousness and work more confidently to provide an error-free outcome. I will also, be well-
prepared with all the equipments to manage time while performing the assessment task.
6

[Surname, first name, student number; scheduled lab time/day, tutor full name]
Reference(s)
Australian Commission in Safety and Quality in Healthcare (2019) The NSQHS Standards
[online]. Available from: https://www.safetyandquality.gov.au/standards/nsqhs-standards
[Accessed 18 September 2019].
Mancheri, H., Kolagari, S., Modanloo, M., Abdollahi, H. and Aryaie, M., 2018. Effect of Team-
Based Learning on Study Habits of Nursing Students. Journal of Research Development in
Nursing & Midwifery, 15(1), pp.17-24.
McNamara, N., 2015. Preparing students for clinical placements: The student's
perspective. Nurse education in practice, 15(3), pp.196-202.
Sadauskas, J. and Benošytė, S., 2016. Experiences of social workers providing palliative care for
dying patients in the institutions of palliative care and their ways to overcome stress. In SHS
Web of Conferences (Vol. 30, p. 00022). EDP Sciences.
Sun, F.K., Long, A., Tseng, Y.S., Huang, H.M., You, J.H. and Chiang, C.Y., 2016. Undergraduate
student nurses' lived experiences of anxiety during their first clinical practicum: A
phenomenological study. Nurse education today, 37, pp.21-26.
Wheeler, R., 2016. Soft skills-the importance of cultivating emotional intelligence. AALL
Spectrum, 20(3), p.28.
7