Reflective Essay: Clinical Skills Application in Patient Care

This reflective essay, written by a nursing student, examines the application of three crucial clinical skills: blood pressure observation, fluid chart maintenance, and the use of aseptic non-touch techniques (ANTT) in catheter management. The essay utilizes Gibbs' Reflective Model to analyze a patient scenario, demonstrating the student's experience with a 78-year-old patient, Mrs. X, admitted with severe COPD and type 2 diabetes. The student reflects on their feelings, evaluations, and analysis of the situation, including the challenges and successes encountered while applying these skills, such as the initial nervousness and the subsequent development of confidence through effective communication and collaboration with a supervisor. The essay highlights the importance of patient consent, communication, and the use of the NEWS2 guidelines for monitoring vital signs. The student also discusses the significance of ANTT in catheter insertion and the role of clinical supervision in enhancing patient safety and improving clinical practice. The essay concludes with an action plan for continued professional development and improved patient care.

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

 Why did things go well?
The interaction with Mrs X was essential in assisting me to practice and improve three
clinical skills namely: observation of blood pressure, fluid chart maintenance, and the
application of non-touch aseptic techniques in catheter management. I realised that good
nursing practice is enhanced when healthcare practitioners establish a good relationship with
their patients. The relationship I established with Mrs X was facilitated using good
communication skills such as effective listening, use of gestures, restating of patient
information to obtain clarity, use of non-verbal cues such as appropriate facial expressions,
gestures and maintaining eye contact, helped me to assess her. Childs et al (2009) and Bach
(2009) reinforced the importance of good communication in healthcare delivery. As a nursing
associate it is my responsibility to have the ability to communicate effectively, with sensitivity
and compassion, and to manage relationships with people, this is central to the provision of
high quality person-centred care (Kornhaber, Walsh, Duff, & Walker, 2016). I utilized a
diverse range of communication skills and strategies to ensure that the patient, her family and
caregivers were supported to be actively involved in their own care wherever appropriate, and
that they were kept informed and well prepared (NMC 2018). Gaining consent the Mr X
explain how blood pressure is taken I reduced her anxieties and she consented to have her vital
signs checked. I believed the reason why Mrs X gave her consent almost immediately was
because of the explanation about the procedure I provided her. According to the NMC (2010)
patients consent to treatment once they comprehend the procedure. When I gained Mrs X
consent, I reassured her and made her feel comfortable.
The treatment procedure turned out to be rather complex and at some point I doubted my
nursing competencies. The distress state exhibited by Mrs X and her unwillingness to talk to
staff when she was brought to the ward made me nervous and I felt that her condition was a
life-threatening one and would be difficult for me to meet her needs. Additionally, Mrs X

urinary fluid retention was diagnosed to be caused by oedema, fuid overload. Therefore, a
decision to insert a catheter was taken to relieve Mrs X of pain due to bladder discomfort and
concerns of her going into acute renal failure also to monitor the urine output to ensure an
accurate fluid balance. I took the procedure to insert the catheter upon myself because it
would have been the third catheterisation I have done, since my simulation practice at
university. Unfortunately the procedure turned out to be a difficult one because of Mrs X
anxiety and complain of abdominal pain. I requested my supervisor to carry out the procedure
herself with another qualified nurse and myself present. I felt incompetent for having not
completed the task as assigned to me.
This would have created a wall between Mrs X and the care I provide to her which made me
nervous while providing additional care to Mrs X.
To alleviate the feeling, I engaged my supervisor and discussed about the situation. The
supervisor assured me that collaboration and consultation in the clinical setting is a normal
occurrence that is encouraged to promote patient safety. I realised that understanding and
appreciating the differences that may be present among the people we care for without
prejudice or being judgemental is significant in providing individualised care for our patients
(Henderson & Jones, 2017).
From the situation, I made sense about the importance of consultation in enhancing patient
safety. Consulting with my supervisor was an important strategy for ensuring that Mrs X
received the best care and addressing the challenges that I had encountered during the
catheter insertion procedure. I appreciated the importance of clinical supervision as a strategy
for improving the clinical and academic outcomes of nursing students. I appreciated that
clinical supervision helps to increase awareness and help to improve professional,
interpersonal and communication skills. I was able to understand the ability clinical
supervision in providing personal growth, developing a caring attitude towards the patient

and promoting patients’ safety. I learnt that exposure of students and entry-level professionals
through clinical placements helps them to achieve important clinical skills (Amsrud, Lyberg,
& Severinsson, 2015).
The supervisor also requested the support of another experienced nurse in the procedure. The
aim of involving a colleague nurse was to achieve collaborative decision-making and ensure
patient safety. The actions align with Skagerström, Ericsson, Nilsen, Ekstedt, & Schildmeijer
(2017) who stated that nurses play a critical role in enhancing patient safety. By engaging the
nurse, I was able to observe the process of collaboration between nurses, maintenance of
hygiene in invasive procedures, and collaborative decision-making. The situation was a
unique learning opportunity for me to make sense about clinical processes and interactions.
The theoretical knowledge I had gained from my coursework and personal research was
essential in enabling me to achieve three essential skills including observation of blood
pressure, fluid chart maintenance, and the application of non-touch aseptic techniques in
catheter management. During my course, I learnt about nursing standards and guidelines, that
entailed creation of therapeutic relationships, effective communication, patients’ rights to
autonomy and informed consent and collaboration. The theoretical knowledge made sense to
me as I interacted with my supervisor and other nursing professionals. I also gained important
knowledge from my supervisor, who was an experienced nurse. The supervisor was always
available for consultation. In particular, when I was unable to successfully insert the catheter,
the supervisor demonstrated to me how to achieve my clinical roles in complex situations. I
also learnt how to achieve effective collaboration in enhancing patient outcomes.
Conclusion
It is important to know that patients are the first priority of the nurses. The various skills
demonstrated in looking after Mrs X has shown how much knowledge I have acquired in my

learning. In the past, I used to perform procedures without having the knowledge of what
they were or the rationale behind them but, now I have acquired knowledge that is evidence
based and relevant to my practice.
In my role as ANA, I will continue to promote patient's interests and maintain their dignities
as individuals during treatment and care process using good communication skills (Collins,
2009). My knowledge and competence levels on how to perform blood pressure,maintaining
fluid balance chart and using ANTT skills have increased after my simulation practice. I will
always make sure that accurate readings are made and documented, report any deviations
observed and intensify further if need arises. I will always work with other health
professionals to make recommendations in the patient's treatment plan. This module has
indeed helped to know how significant it is to work in partnership with other healthcare
professionals and I will always take this with me in my future practice. I will also carry on
improving my communication skills to advance good care delivery in my practice.
Action plan
In addition to developing the skills required by the NMC, I will take every opportunity to find
National Institute for Health and Care Excellence (NICE) Guides for professional guidance
and compliance with healthcare best practice. I am trying to avoid untrusted health
information website and ensure adherence to appropriate Trust policies and guidelines I
would opt for the use of analgesia especially where patients are in severe pain to curtail the
discomfort.
Overall, my future plan is to raise awareness of patients' cultural, psychological, emotional
and spiritual needs, and meet these needs based on best practice guidelines. Vahdat et al.
(2014) has established that nurses are directly involved in decision-making to treat patients.
Therefore in my role as ANA, it is important that I am able to identify patients’ potential

conditions for effective recommendations and actions. Tappenden et al. (2013) mention that
nurses are best informed of individual patients if they constantly monitor their signs and
symptoms and work with other medical team to improve optimal patient health. In my role as
an ANA, I would facilitate patients with clinical guidance and explanations to reinforce the
basic clinical knowledge and skills for effective care intervention.I would continue to work in
partnership with my colleagues, other healthcare professionals and always seek for
clarification on any matter regarding patient care that I do not know about..

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