Case Study: Reflecting on a Nursing Experience in Hospital Setting

This report presents a reflective analysis of a registered nurse's experience during a hospital placement, focusing on a case study involving a patient admitted to the Emergency Department with respiratory distress, suspected of having ARDS. The reflection utilizes Borton’s Model and the Situated Clinical Decision Making Framework to critically evaluate the experience. The case study details the patient’s condition, assessed through the Roper Logan Tienary model, encompassing aspects such as safe environment, communication, breathing, and other activities of daily living. The nurse's actions, including an error in medication administration, and the subsequent learning process are thoroughly discussed. The reflection highlights the importance of meticulousness, critical thinking, multidisciplinary approaches, and culturally competent nursing care. The report concludes with insights on how the experience enhanced the nurse’s skills, knowledge, and confidence in handling critical situations and aggressive patients. References to relevant literature are included to support the analysis.

Introduction
The essay will discuss about my experience as a registered nurse in a hospital.
Through this essay, I will share my one of my career experience which will describes
with the help of Borton’s Model of reflection. The case study will be critically evaluated
with the help of the Situated Clinical Decision Making Framework. The frame-work will help
to understand underneath causes of nursing. Essential of Care is an evaluation program
which is related to the evaluation procedure which will help to assess the effectiveness of
nurses and the midwives in a care provision framework or more precisely in a clinical
ward or hospital scenario. This case study will take help of Roper Logan Tienary model to
evaluate condition of the patient. Using the standardized frameworks, the reflection will give
an in-depth analysis of my experiences and how my knowledge and skills have been
upgraded. This essay will reflect one of my experiences in my second year placement.
Discussion
The case study (What?)
When I was in my second year placement, I was appointed to a patient who was
admitted to the Emergency Department as he was suffering from respiratory distress.
Doctors suspected that the person might have suffered from ARDS (Acute respiratory
distress syndrome). Mr. X was an elderly person and he was admitted in the hospital after he
was shortness of breath and unusual rapid breathing yesterday 10.30pm. His partner called
the ambulance on 8.30pm as they lived quite far from the hospital, the ambulance delayed to
reach his place. The condition of patient will be analyzed with the help of Roper Logan
Tienary model; in the following discussion (Holland & Jenkins, 2019).
Safe environment

His body temperature was 40 C. He had bradycardia with 60 bpm. He was suffering
from hypotension (Kolarik & Roberts, 2017). He had problem in ambulation or movement
and he was an elderly person. Therefore he had high chance of fall. He was a patient of
hyperglycemia and had mild glaucoma.
Communication
His native language was not English as he was an aboriginal person. When he was
assessed by the nurse, he was confused and disoriented. However, after primary treatment,
there was no such signs. He was very agitated and anxious.
Breathing
His respiratory rate was 35 bpm in 98% SpO2. Crackling sounds were heard during
auscultation and his breathing pattern was irregular. Pain was present while coughing and
unknown colored mucous was produced. He smokes 3 cigarettes in a day and was a chain
smoker.
Eating and drinking
Nasogastric tube was administered to patient to the patient as he was unable to
swallow any solid food. He was overweight and doctors suspected food habit is responsible
for high level of cholesterol in him.
Elimination
He did not have any problem in elimination as he was producing adequate amount of
urine.
Personal hygiene

Skin turgor was present in his left arm. The attendant took good care of his personal
hygiene. He was reluctant to take help in dressing when attendant tried to help him. He
cannot perform his daily activities without any assistance.
Mobilization
He had gait therefore he needed support to walk. However, he did not use any
equipment to walk.
Working and playing
Mr. X was retired from the post of financial consultant of a law firm. He was a
national level shooter and was interested in horse race. The person used to play football
earlier.
Expressing sexuality
His first wife was died due to drug overdose 20 years ago. 15 years ago, he got
married again. He divorced his second wife 5 years ago. He is now living with his partner,
Gwen for 4 years.
Sleeping
He was having respiratory distresses during sleeping.
Dying
He did not express any fear for dying but very reluctant to admit his health
condition. He is an aboriginal and have faith in alternative medicines. He had no child with
his first wife. However, he has a son and a daughter with his second wife. He lives with
Gwen and her daughter. His son lives in USA. His daughter lives with her mother.

When he was admitted to hospital, artificial ventilation was administered to him for
maintaining his respiratory rate. When I visited him he addressed me as student and he
was very angry with my seniors as they appointed me to take care of him. The allocated
nurse come to the scenario and managed the situation. I was assisting the allocated Registered
nurse in treatment of the person. As I knew the native aboriginal language as I spent my
childhood aboriginal dominated areas due to my father’s posting . My senior nurse help
me to administer the nebulizer to the patient as per the schedule.
One day Mr. X had fever and I gave him the allocated medication for the respiratory
distress through the nebulizer. The patient’s respiratory rate could not be controlled after
using the nebulizer. Therefore I asked help from my senior nurses and they came to the
patient’s cabin and told me that I should have tried to manage his fever and
dysrhythmia. One of them asked me whether I recheck the medication chart or not as
doctor might change it. I rechecked and found that doctor changed some medications. They
also told me due to the medication overdose mild respiratory acidosis had developed. I was
very scared and admitted that I should have checked the medication chart of the patient
first. They did not suspend me as my senior requested the supervisor to give me another
chance to improve . I assisted the ADL supporter and the pulmonologist later in the
treatment .Moreover I could make a good bond with Mr. X and his partner Gwen with
the help of therapeutic communication .
So What?
I was very anxious and nervous when I could not manage the respiratory distress. I
was performing my daily and responsibility but did not recheck the medication chart. Now I
have become more careful and competent as a nurse. I never fail to check the medication
chart and the assess vital signs after taking charge of a patient. Now I help many student

nurses in managing such conditions. When I help some student nurses in managing critical
situation of the patient I demonstrate them the proper actions and procedures. I am recalling
the incident as the case not only helped me to improve my skills and knowledge but also
my critical thinking. After that consequence, I felt guilty but my senior made me
understand my mistake with compassionate and empathy. Her support helped me to
improve the promptness and readiness during attending a patient. I became determined to
serve the patient and maintain all the duties allocated to me. After that incident, the patient
was very agitated but we somehow convinced his partner that shifting him to another hospital
would not be a good idea. We really worked hard for to make a good rapport with the patient
and succeeded later.
Now what?
The incident motivates me to understand the patient condition in a better way to
administer better medication. The person was aboriginal and was reluctant to consume the
recommended medications as he believed in the alternative medications. I had an opportunity
to educate the patient with better knowledge and understanding of the conventional
treatment procedures(Smith et al., 2016). My skills as an educator was improved and the
patient could able to understand the importance of the medications and therapeutic approach
of the treatment.
This incident gave me an insight of multidisciplinary approach and interdisciplinary
relationship in the treatment of critical patients. In the critical condition, a nurse should assess
the root cause promptly with logical reasoning (Marques et al., 2019). I could have reacted
more rationally and obviously rechecked his medication chart along with his vital signs.
Immediate interventions should not be delayed by any cause. Prompt reporting of medication
errors will restrict the adverse effect of the error on patient. For this case study I could

become competent to manage and treat aggressive patients. During communication with the
patient I used to maintain the culturally competent nursing approach and showed respect to
the patient’s belief and cultural faith (Freeman et al,2016 ). I helped the support worker
during teaching activities for daily life improvement. Assisting the patient in the breathing
exercises helps me to improve my patience. Main learning from the case study was to
maintain compliances and the standard procedures during treatment. All the student nurses
and Registered nurses should maintain effective communication during treating the
aggressive patients.
Conclusion
Thus I can only say that like every incident of life , the above discussed incident
was an eye opening case study which helps me to improve my nursing qualities and
competencies. The incidence helped me to improve my understanding of culturally competent
behaviors towards the patients. We should not hurt patient’s any cultural beliefs and should
not behave improperly with the aggressive patient. This case study made me more confident
as a nurse to execute my duties to the patients.

References
Freeman, T., Baum, F., Lawless, A., Labonté, R., Sanders, D., Boffa, J., ... & Javanparast, S.
(2016). Case study of an aboriginal community-controlled health service in Australia:
Universal, rights-based, publicly funded comprehensive primary health care in
action. Health and human rights, 18(2), 93.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394990/
Holland, K., & Jenkins, J. (Eds.). (2019). Applying the Roper-Logan-Tierney Model in
Practice-E-Book. Elsevier Health Sciences.https://books.google.co.in/books?
hl=en&lr=&id=erKMDwAAQBAJ&oi=fnd&pg=
Kolarik, M., & Roberts, E. (2017). Permissive hypotension and trauma: can fluid restriction
reduce the incidence of ARDS?. Journal of Trauma Nursing, 24(1),
19-24.10.1097/JTN.0000000000000257
Marques, F. M., David, C., dos Santos, A. F., Neves, S., Pinheiro, M. J., & Leal, M. T. (2019,
October). Clinical decision-making skills in nursing: senior students’ perceptions. In
World Conference on Qualitative Research (Vol. 1, pp.
270-273).https://www.proceedings.wcqr.info/index.php/wcqr2019/article/view/
289/280
Smith, S., James, A., Brogan, A., Adamson, E., & Gentleman, M. (2016). Reflections about
experiences of compassionate care from award winning undergraduate nurses–What,
so what… now what?. Journal of Compassionate Health Care, 3(1),
6.https://doi.org/10.1186/s40639-016-0023-x