Reflective Essay: Analyzing a Leg Ulcer Patient Care Scenario

This reflective essay details a nursing student's experience with a 56-year-old patient suffering from a chronic leg ulcer, complicated by type 2 diabetes and financial hardship. The essay uses Rolfe's reflective model to analyze the case, highlighting the importance of effective communication, holistic patient assessment, and patient safety. It critiques the initial healthcare approach, emphasizing the need to consider the patient's mental state and socioeconomic factors, which led to a lack of adherence to treatment and the need for surgical intervention. The essay reflects on the student's learning, emphasizing the need for improved communication skills, risk assessment, and ethical considerations in nursing practice to prevent similar adverse outcomes. The essay also discusses the broader issues of the patient's financial instability and the impact on her granddaughter, underscoring the importance of comprehensive care planning.

Running head: REFLECTIVE ESSAY
REFLECTIVE ESSAY
Name of the Student:
Name of the University:
Author Note:

1REFLECTIVE ESSAY
The paper aims to discuss a care scenario of a patient with leg ulcer following the
reflective model of Rolfe. A 56-year-old patient reported an aching pain in the lower area of
her left leg. She also stated that her left leg feels heavy all the time, and the wound was not
healing. She is experiencing this problem for two weeks now, and it is really difficult for her
to walk properly now. After medical examination, the doctor found that the area of her leg
was swollen and appeared red in colour. There was also visible ulceration. After examining
her medical history, it was found that she was diagnosed with type two diabetes mellitus six
years ago. She has been taking metformin drugs for her diabetic condition. However, upon
her medical check-up, it was found that her blood pressure is higher than usual. She also has
tachycardia along with her hypertension condition. The patient was a widow, and she had a
grocery store in the market. She only had a nine-year-old granddaughter for family, after
losing her son and daughter-in-law in an accident one year ago. With her medical condition,
it was really difficult for her to keep the shop running. They were already experiencing a
financial problem since the shop was their only source of income. That is why the patient
wanted to get better soon. However, when the doctor informed her that this would take about
two months to heal completely, she became very upset but agreed to follow the advice to get
better soon. After two weeks from then, our healthcare center received a call from the patient,
when she informed us that she could not walk anymore, and her wound has not healed either.
When I reached her home, along with my supervisors and examined her condition, it was
found that the condition has gone through a progression, and the patient is in need of a
surgical intervention now. The following sections will describe a reflection on the entire
scenario from a personal perspective.
The patient was suffering from a chronic leg ulcer condition. The condition results
from the poor activity of the veins in the leg of an individual (Dogra & Sarangal, 2014). The
normal function of the veins involves carrying the blood from various organs, including the

2REFLECTIVE ESSAY
legs to the heart. However, due to high blood pressure conditions or some other condition, the
veins fail to work properly, and as a result, the blood flows in the opposite way through the
veins. The high pressure creates lesions on the skin, and the microbial infection at the site is
the principal reason for the wound formation (Vasudevan, 2014). This condition does not
improve without any treatment and is closely associated with the diabetic condition in the
elderly. One of the effective treatment measures for this condition was the application of the
compression bandage at the area of ulceration to force the blood flow upwards through the
veins (Nair, 2014). However, the treatment procedure requires time for healing the wound
completely. The patient was facing financial problems because she was unable to do her job
as a shopkeeper due to her physical condition. I was a student nurse, and I was a part of the
medical team, who were assigned to look after the patient after her call. I listened to her story
while I was making assessments on her condition. She told me that she is worried about her
granddaughter. She predicted that it would be difficult for her to pay the fees for school
anymore if she cannot open her shop within the week. However, considering her condition, I
informed her that she has to be in complete bed rest for at least two weeks. She seemed very
upset after learning my assessment. She informed me that she had shared the same
information with the doctor about her situation before. However, the doctor only prescribed
her with medications for her hypertension condition and taught her about the application of a
compression bandage. I understood that the doctor did not consider her mental condition and
the financial difficulty she mentioned to be experiencing. The doctor was satisfied when she
agreed to take proper rest and to apply the compression bandage properly. However, I learned
after communicating with the patient that she did not take proper rest as it was advised for
her. She was opening her shop and working with her aching leg. That day she finally called
our healthcare center was the day when she could not stand at all due to the severity of her
pain. I was feeling bad because the situation arose only because the doctor did not remember

3REFLECTIVE ESSAY
to explain to the patient about how necessary it was for her to get proper rest and keep her
legs uplifted. It was unfortunate that there were no financial arrangements made for her, so
she can get the necessary rest without feeling anxious about the future of her granddaughter.
The experience was very unfortunate, yet I understood the limitations in the healthcare
practice from this experience.
I learned from this experience that it is also necessary for the healthcare staff to
understand the mental condition of the patients besides making assessments on the physical
health condition of a patient. They must also be able to predict all the possible risks to the
health of their patients and properly communicate with them. There should be a proper
explanation provided to the patients about their health risks and the rationale behind the
advice. It is necessary for the patients to understand why they should follow the instructions
provided to them by the nursing staffs. If a patient understands their own health risks along
with the rationale behind their treatment plans, they will be more efficient in the management
of their own disease conditions (Stoner et al., 2018). For providing quality care to the
patients, it is necessary to follow all the components of quality care, which are the efficacy,
efficiency, timely, patient-centred, equity, and patient safety (Seow & Bainbridge, 2018). The
use of effective communication is necessary to attend all these components of care. In this
experience, the safety of the patient was compromised due to the inefficacy of the
communication. The steps for effective communication with the patients involve treating the
patients with proper respect, effective listening, making correct assessments on the patient’s
condition, informing the patient about their conditions and possible health risks, and finally
discussing their care plan with them (O'Hagan et al., 2014). The doctor failed to carry out the
last step of effective communication, which resulted in an unfortunate event. He was only
focusing on the priority care requirements of the patient. He assessed the priority
requirements for her, which was the treatment of her leg ulcer with compression bandages.

4REFLECTIVE ESSAY
After that, he prescribed medications for her to control her hypertension condition. However,
he did not assess the other possible risks to the patient’s health, resulting from the socio-
economic aspects and her impaired mental health condition. The patient was stressed, and he
could not predict that she might be ignoring his advice to improve her financial condition. He
did not explain to her the actual necessity of her taking bed rest and keeping her left leg
uplifted. His actions resulted in the compromisation of patient safety. The rationale behind
the treatment measure was that it helps to improve the blood circulation in the legs along with
the compression bandage, which already pushes the veins together to improve the blood flow.
It has been found from a study that the likelihood of the healing of the pressure ulcers is
lower in the patients who live alone (Parker, Finlayson & Edwards, 2016). Even though the
compression therapies are considered to be effective in treating the leg ulcer conditions in
most of the cases, there is also a considerable risk for the failure of this therapy in the
treatment of leg ulcers. A study found that an impaired condition of the calf-muscle pumps
due to standing for a long time, poor adherence to the compression therapy, and many other
aspects can be directly associated with the non-healing event of the venous ulcers (Scotton,
Miot & Abbade, 2014). There are also various complications associated with the event of
non-healing of the leg ulcers in the patients. There is a risk of severe infection in the area of
the ulceration, which might lead to sepsis or a requirement of amputation (Malyar et al.,
2016). The patient had diabetes. It has been found from the studies that there is a high risk of
diabetic patients requiring surgical interventions for the management of their diabetic foot
conditions (Malyar et al., 2016). I was not directly involved in the diagnosis of the patient at
first. However, I feel that the doctor should have used proper risk assessment tools for
predicting these risks in the patient. There should have been an arrangement of some
financial resources for her during the time of her healing. That would have assured her, and
she would not have started working until she is completely healed. The doctor should have

5REFLECTIVE ESSAY
taken her mental health into consideration. She was an older adult individual, and the
combination of her diabetic condition and anxiety might present significant health risks for
her. The doctor should have developed a care plan that addressed the aspect of the impaired
mental health condition in the patient as well. If the doctor had followed all these measures,
possibly, she would not have been in requirement for surgical intervention. From this
experience, I understood the necessity for following all the steps of effective communication
in nursing. I learned that the aspect of patient safety is closely associated with the level of
efficacy of communication in nursing. The healthcare staff, including the nurses, cannot
afford to compromise this particular aspect of quality care. Ensuring patient safety is one of
the priority requirements for healthcare workers. According to the healthcare ethics, it is
necessary for every healthcare to focus on doing good to their patients only, and they are not
allowed to harm their patients, whether intentionally or unintentionally (Butts & Rich, 2019).
The compromisation of the safety in a patient falls under the category of unintentional harm
by the healthcare workers. This experience taught me that the nursing staff like us must be
completely efficient in our work in order to avoid encountering these kinds of regretful
experiences. The broader issue of this situation was that my patient was in the requirement of
surgical intervention for treating her leg ulcer condition. Her financial condition was not
sufficient for affording the expense of the surgery. The patient was also worried about her
granddaughter. She is a nine-year-old child and cannot live in the house alone during the time
the patient has to stay in the hospital post her surgery. There is also a long-term problem
regarding her financial condition. It will take a long time for her to achieve a complete
recovery, and in the meantime, their shop will remain closed, which is the only source of
income for the patient. Thus she fears that they will have to starve even if she manages to
achieve a full recovery post her surgery. The patient also predicts that there will be no money
left for the education of her granddaughter, either.

6REFLECTIVE ESSAY
I learned from this experience that I need to improve the standard of my nursing
practice in order to ensure that there will be no repetition of this experience. I decided that I
need to practice effective communication, and I also require to develop competency in
practice. It is very important for the healthcare staff like us to follow every step of effective
communication in order to build a proper therapeutic relationship between the nursing staff
and the patients. For ensuring patient safety, only making correct assessments of their
conditions and developing a care plan for them cannot be considered as enough. I must also
communicate with them properly, use the correct assessment tools, and predict the health
risks in the patients considering their mental health and the socio-economic conditions. I must
make sure the mistake made with this patient does not get repeated. However, now it is my
duty to make sure that she receives proper treatment along with ensuring her overall mental
and physical well-being. After assessing every aspect of the patient's requirements, I
understood that I must arrange some financial resources for the patient to afford her medical
expenses along with her future expenses. I also need to make an arrangement for her
granddaughter to reside safely during the time of her stay in the hospital. I also need to
develop a proper intervention, which will be addressed at her impaired mental health
condition resulting from the stress and anxiety from her current condition. After her surgery, I
must also monitor the patient closely in order to assess any possible risks to her health. I must
also help her with the management of her disease conditions or advise her to seek the help of
other professionals if the self-management is challenging for her. As a result of all these
interventions, the patient is likely to achieve a full recovery within a short time period. She
will also be able to resume her old life with her granddaughter very soon, which will be free
from her painful disease conditions and anxiety. My understandings of this experience will
help me improve the standard of my nursing practice in the future. I will be able to share this

7REFLECTIVE ESSAY
experience with my fellow healthcare workers and provide them teaching about the
consequences of ineffective communication in the field of healthcare.
Hence it can be concluded from the above discussion that the patient was an elder
adult, who was experiencing an ulceration condition in her left leg initially. The patient had a
history of diabetes, and after medical examination, it was found that she also had
hypertension condition. Both of these conditions are closely associated with the leg ulcer
condition, and the area of ulceration appeared red and swollen. The doctor diagnosed her with
venous leg ulcers and advised her to apply compression therapy and take complete bed rest
for her condition. The patient was a shopkeeper, and she only had a nine-year-old
granddaughter for family. Her financial condition was not well, and the shop was the only
source of income for her family, and if she has to take complete bed rest, they will be left
with no money. She was anxious after hearing the advice. The doctor was informed about all
these aspects when making an assessment on her. However, he did not remember to explain
to her how important it is for her to follow my advice strictly. He did not explain all the
possible risks to her health if this ulceration condition is not healed within a certain period of
time. After two weeks from then, our healthcare center received a call from the patient, when
she informed us that she could not walk anymore and her wound has not healed either. I
learned that she did not follow the doctor’s advice of taking complete rest, and she was
working continuously with her aching leg. I understood that the situation arose from a
mistake made by the doctor in making effective communication. I decided to help her
properly this time by addressing all her physical and emotional requirements in order to
ensure her fast recovery. I also decided to improve the standard of my nursing practice by
developing competency in making effective communication with my patients to ensure there
is no repetition of this event.

8REFLECTIVE ESSAY
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9REFLECTIVE ESSAY
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