Reflective Essay on Patient Safety and Clinical Quality in Nursing

This reflective essay, based on Gibbs' Reflective Cycle, examines the student's learning journey through three patient safety and clinical quality-focused activities. The essay begins with descriptions of case scenarios, including falls, appropriate patient management, and blood transfusions. It delves into the student's feelings and thoughts during these scenarios, highlighting instances of both satisfaction and insufficiency in nursing practices. The evaluation stage assesses what worked and what didn't, analyzing the effectiveness of interventions and the importance of comprehensive assessments. The analysis section explores the 'why' behind certain practices, such as the administration of intravenous antibiotics and the challenges of medication charting. The essay concludes with a synthesis of key learnings, emphasizing the importance of geriatric assessments, fall prevention, and the management of post-transfusion reactions. An action plan outlines the student's commitment to improve skills in nursing assessments, patient care, and patient safety practices.

REFLECTIVE ESSAY.
Patient Safety and Clinical Quality Focused Activities.
Description.
According to (Husebø, O'Regan & Nestel, 2015, pp.368-375; Johns, 2017; Finlayson, 2015,
pp.717-730), the first stage which is description includes outlining the case scenarios. The first
case is a case of Mrs. Andrew who fell in her bathroom. And taken to the accident and
emergency department for further investigation of an injury. Some interventions were
implemented to manage her current condition. The case scenario is that of Mr. Collins from the
second video and it outlines how he was managed appropriately and ended up with a positive
outcome. The case of blood transfusion and management will also be described and lastly, is the
simulation of medical safety.
Feelings.
Being the second stage of Gibbs’ reflective cycle, the feelings and thoughts I had during the
three scenarios will be outlined. From the first case of Mrs. Andrew in the first activity I had the
feeling of insufficiency that an intense could have been done to come up with nursing diagnoses
that could have helped in management (Welsh, Gordon & Gladman, 2014 p.290). For the three
case studies in activity three, I was satisfied with how the management was done appropriately,
the same applies to the case of Mr. Collins who reported appropriate management of his falls that
led to prevention of recurrent falls. The knowledge I got from blood transfusion amazed me as I
learned new information which I wasn't aware of before. Therefore, a thorough assessment
would have revealed what's actually is the major problems associated with their conditions
(Welsh et al. 2014 p.290).

Evaluation.
Being the third stage in the cycle, it is all about evaluating whatever worked out and what didn't
work out in the case scenarios. The positive thing that took place in the case of Mrs. Andrew in
activity one, when she was moved to the acute medical unit a drip was started to manage her
fluid balance. When the ward team discovered that she was developing a low blood pressure
when standing they stopped a couple of her cardiac medications to manage the orthostatic
hypotension. The other case scenarios in activity 3 for Mrs. Grace, Michael Donovan, Mr.
Clarke, were managed appropriately. For example, with the case of Mr. Brian Clarke who had
cellulitis, was referred to a wound care specialist and was prescribed with IV antibiotics. Correct
comprehensive assessment revealed that he was allergic to penicillin and this led to withholding
cephazolin and clindamycin was ordered as an alternative. With the case of Mr. Donovani,
medicines prescribed were charted on the National Inpatient Medication Chart. Among the 10
rights for correct medication administration, right for documentation is the sixth right for drug
administration (Huang, Y.H. and Gramopadhye, 2014, pp.1712-1724). The bad thing that
happened with Mrs. Andrew is that she spent almost two weeks in the hospital and still no clear
diagnosis of her progressing memory impairment and the recurrent falls were made. The part of
Blood transfusion in activity two was covered adequately and the difference in circulation before
transfusion and after transfusion outlined. This revealed the disadvantages of blood transfusion
as it increases the cases for mortality and morbidity.
Analysis.

This part of the reflective essay normally answers the question of why? The administration of
Intravenous Antibiotics to manage cellulitis in Mr. Clarke from activity 3 was useful as it
improved my knowledge on the cellulitis condition that it is managed by the administration of
Intravenous antibiotics. It also made me understand that the administration of antibiotics can be
ineffective in managing some conditions as a result of resistance (Raff, A.B. and Kroshinsky, D.,
2016, pp.325-337). This was evident with Mr. Clarke case scenario who had already been
prescribed with IV antibiotics before. However, the intense comprehensive assessment revealed
that he was allergic to penicillin and this let to withholding the cephazolin and the doctor ordered
clindamycin via a phone this required the presence of a second nurse to confirm the charting of
the drug ordered via phone. The charting of the medication prescribed to Mr. Michael Donovan
gave me a challenge of mastering the other rights for correct medication apart from the right of
documentation. The thorough comprehensive nursing assessment was not done with Mrs.
Andrew which made her not diagnosed with dementia and her repetitive falls. This is a challenge
and I will ensure a comprehensive assessment is done to rule out any differential medical
diagnosis. The case has also made me learn that geriatric assessment is supposed to be done to
the elderly patients who are more than 65 years, for the risk of falls and neurological impairment
conditions. The knowledge of morbidity and mortality associated with blood transfusion
reactions and the decreased rate of flow of the blood components in post-transfusion has helped
me learn that strict monitoring is needed to the post transfused patients. It has also made me learn
that there are three types of blood transfusion reactions. The delayed, those that happen
immediately and those that happen within 24 hours of transfusion.
Conclusions.

In conclusion, the case scenarios made me learn some new things and an emphasis on the things
I knew before was also evident. Having gone through the presentation of the case of Mrs. Betty'
and the video on the case of Mrs. Andrew, I am now aware that an increase in age is an intrinsic
risk factor of falls. Therefore, people above 65 years should be monitored consistently and any
risk factors detected managed early enough before it causes harm. Falls can cause problems
including fractures of the femur (Ambrose et al. 2015. pp.85-93), this is the reason why Mrs.
Andrew was taken to hospital for further investigations of any injury caused by the fall. I also
learned that patients who have been involved in fall previously develop fear which leads to
disability that can result in recurrent falls. I should, therefore, develop good nursing assessment
skills in the future to ensure that I perform a comprehensive assessment to come up with the
central diagnosis and rule out a differential diagnosis, this will help in the effective nursing
management and care. From the video on blood transfusion, I learned that the post-transfusion
reactions increase morbidity and mortality. Therefore, the rate of blood transfusion should be
reduced this is because, from the knowledge of the professors involved in the video is that
anemia can be corrected without the need for transfusion, blood loss can be reduced
significantly, and, any cases of oxygen insufficiency can be managed by other means apart from
transfusion. From the case scenario of Mrs. Andrew, I have learned that elderly should get early
anticipatory care, support and education on how to manage falls and neurological impairment at
home before they become acute requiring hospital admissions. In activity three I have learned
that medication ordered via telephone should be charted and evidenced by a second nurse and the
doctor who has ordered the medication to sign the charted document within 24 hours.
Action Plan

In future when I will be practicing, when I happen to work with a group, I will teach them about
the importance of comprehensive nursing assessment as a tool for ruling out differential
diagnosis and remain with a specific diagnosis. With a specific diagnosis, it is easier to care for
the exact needs of the patient. Having gone through the three case scenarios I have now seen the
need of reading and be knowledgeable enough and for I to develop the required skills, I will deep
myself into the literature to get to learn more of the patient safety practices and put the
information learned into practice, for example, caring for the post transfused patients. I will,
therefore, do a thorough practice on how a comprehensive assessment is done while under the
supervision of a qualified registered staff until I become an expert as well. Consistent reading
will expand my mind know and it will make me be aware of the safety nursing practices. Early
anticipatory care, education, and support to the elderly are paramount as this will help them learn
on how they can take note of early neurological impairment signs such as the loss of memory
and confusion and be able to manage them appropriately. education on how falls can be managed
and prevented at home is also important to the elderly to keep them free from the risks associated
with falls such as fractures. Patients who have been transfused should be managed appropriately
within the first twenty-four hours and those going home after the twenty-four hours be given
helpline numbers to seek assistance any time the reactions show up for immediate management.
When I will be working in future and I receive a telephone order to change a certain medication,
I will record it in the Telephone Orders section of the NMIC, and, ensure that it is signed by the
doctor who has given out the order within 24 hours.

References.
Ambrose, A.F., Cruz, L. and Paul, G., 2015. Falls and fractures: a systematic approach to
screening and prevention. Maturitas, 82(1), pp.85-93.
Brock, A., 2014. What is reflection and reflective practice?. In The Early Years Reflective
Practice Handbook (pp. 25-39). Routledge.
Finlayson, A., 2015. Reflective practice: has it really changed over time?. Reflective
Practice, 16(6), pp.717-730.
Howatson-Jones, L., 2016. Reflective practice in nursing. Learning Matters.
Husebø, S.E., O'Regan, S. and Nestel, D., 2015. Reflective practice and its role in
simulation. Clinical Simulation in Nursing, 11(8), pp.368-375.
Welsh, T.J., Gordon, A.L. and Gladman, J.R., 2014. Comprehensive geriatric assessment–a
guide for the non-specialist. International journal of clinical practice, 68(3), p.290.
Huang, Y.H. and Gramopadhye, A.K., 2014. Systematic engineering tools for describing and
improving medication administration processes at rural healthcare facilities. Applied
Ergonomics, 45(6), pp.1712-1724.
Raff, A.B. and Kroshinsky, D., 2016. Cellulitis: a review. Jama, 316(3), pp.325-337.