Clinical Practice Experiences Of An Undergraduate Registered Nurse

Providing Patient-Centered Care

1. Demonstrated ability to assess, plan, implement and evaluate nursing care. 

I am able to think rationally and can critically link theory to clinical practice for rationale decision making in my clinical practice. While on the third year clinical placement in an emergency ward I was given the handover of a 34-year-old male accident victim patient with an abrasion injury on his right knee. I was actively involved in the discharge planning of the patient after his wound care and dressing. I assessed the patient’s vitals including heart rate, blood pressure, respiration rate, pulse and temperature. I observed his wound that revealed slough and exudate. I assessed his previous medical records which revealed that patient had a history of hypertension. He did not present with any chronic debilitating disease such as diabetes. I informed the supervising nurse of my observations and consulted the multidisciplinary team regarding the type of dressing required for his wound care. After documenting the observations on the patient’s medical record, I gained patient’s consent for the new intervention plan. I utilized aseptic technique for the wound dressing. On completing the dressing I made sure that the patient felt comfortable and then I updated the information to the nursing supervisor and the physician. Finally, I completed the ISOBAR handover for the next shift to ensure patient’s safety from infection. After three days the patient was discharged home when the wound was free of slough and exudate. This process allowed me in delivering a holistic patient oriented care plan

2. Ability to recognize and respond to clinical deterioration. 

I am able to recognize and respond to clinical deterioration and I have the ability for rationale decision making in my clinical practice in such scenarios. While on the second year clinical placement in an emergency ward during the night shift I received a case of an infant who was unable to breathe due to chocking resulting in airway obstruction. I was actively trying to dislodge the blockage that resulted in chocking. I assessed that the patient was unable to breath, his heart rate was constantly decreasing, his pupils were dilated and his parents were panicked. I immediately held the infant in a face down position along with support from my forearm with his head lower than his bottom position. I then used the base of my hand to give five blows on the infant’s back in the middle between shoulder blades. However, in spite of repeatedly doing this procedure, the blockage was not getting out, instead infant’s body started turning pale. I immediately contacted the multidisciplinary emergency team for the rescue of the baby. The team arrived within no time and performed CPR. The baby was laid in face up position and the emergency team performed chest thrust by pushing the baby’s breastbone in the middle by placing two fingertips. By giving 30 chest compressions at the rate of 100 to 120 per minute, the child grasped for breath and was able to regain his consciousness after some time. The parents were given training for the technique of removing any blockage in infant in future and the infant was discharged home after checking his vitals including respiratory rate, heart rate, temperature, and pulse.

Recognizing and Responding to Clinical Deterioration

3. Understands own professional limitations and seeks appropriate assistance when required. 

I can work within my scope of practice as an undergraduate registered nurse and I understand my own professional limitations and know that I need to seek assistance when I face a situation beyond the scope of my practice. While on the third year clinical remote placement as a remote area nurse, I received a case of 62-year-old male patient who presented with signs of cardiorespiratory distress: chest pain, tachycardia, hypotensive, and sweating. I was actively involved in the clinical assessment and care plan of the patient. I assessed the patient’s vitals including hear rate, B.P, respiration and temperature. The patient was hypotensive and there was diminished air entry on left side of chest. Based on my clinical judgment I assessed that the patient had pneumothorax. I had not performed an emergency needle decompression previously and I was not authorized to perform decompression as an undergraduate nurse. I called the emergency service assistance team to assist me in the procedure. Within no time, the team reached for help and performed the emergency needle decompression with a cannula after cleaning the area with an aseptic cotton swab. I carefully observed the procedure. After sometime the patient was stable, as his respiration rate and blood pressure became stable.  After 5 days in the ward, the patient was discharged home with medication intervention and observing hemodynamic stability.

4. An ability to interact effectively with people of diverse cultures. 

I attempt to practice in a culturally safe clinical practice. . While on the third year clinical remote placement, I was involved in the care plan of a 16-year-old indigenous male patient who as recovering from drug addiction.  I was actively involved in the clinical assessment and discharge care plan of the patient. I assessed the patient’s vitals, his medical history, psychological and lifestyle factors. As the patient was a minor, it was important to involve his family members in the care plan. The patient lived with his mother and father in a two bedroom house. He had two sisters and a younger brother. As the patient was an adolescent, he was undergoing from emotional and mental distress due to social isolation from his friends and family. I felt that it was important to involve his parents in his care plan and discharge process. I arranged a meeting with his parents and arranged an English translator and an aboriginal health care worker to remove the language barrier.  The patient was planned to be discharged on community treatment order, and the discharge plan was discussed with his parents. I also explained them about the emotional support that their son required at home with assistance of an aboriginal health care worker. The parents were happy that their son was to be discharged home on CTO and they agreed to this discharge plan and promised for regular follow up of the patient. On the day of discharge a CTO order was faxed to community’s health clinic. The patient was discharged home with all the support in place.

5. Demonstrated ability to apply evidence-based decision making. 

I am able to use Evidence based practice in my clinical practice framework for best patient outcome. In my second year clinical placement in the night shift ward, I was given the handover of a 55–year-old male patient who presented with signs of acute exacerbation of COPD. The patient presented with acute shortness of breath and his medical records indicated long standing history of COPD, increase in quantity of phlegm and change in the color of phlegm. He was a chronic cigarette smoker and was unable to quit his smoking habit despite several efforts. His medication history included the use of Salbutamol. Based on my knowledge of evidence-based practice approach, I knew that the patient required three EBP interventions to help in the management of his COPD. The interventions included pharmacological intervention, patient centered care plan, and management of depression associated with chronic COPD. After discussion with the physician and utilizing my knowledge of EBP I realized that his medication regime should be changed from budesonide to tiotropium as it is effective in preventing acute exacerbation of COPD episode and hence preventing further hospitalization. Also, it has comparatively less adverse drug reactions (e.g. Cushing’s symptoms). The physician changed his medication to tiotropium. Also, using patient centered approach I counseled the patient for quitting his smoking habit by explaining the long term side effects and health risks associated with chronic smoking. The patient started recovering from the signs of acute exacerbation of COPD gradually after medication intervention and counseling. The patient was discharged home after 15 days of intervention after significant improvement in exacerbation symptoms.

6. Demonstrated application of WHS practices. 

I have thorough knowledge of workplace health and safety measures and I utilize WHS practice in my clinical practice. During my second year clinical placement in the ward, I received a case of a 28-year-old male patient who was diagnosed with hepatitis B. I assessed the patient’s vitals and medical history. His medical report and blood reports revealed bilirubin value as 12, his SGOT and SGPT were also raised. I assessed his B.P, which was 110/80 mm of Hg. The patient presented with high grade fever and history of dysentery. His sclera had yellowish discoloration.  I know that hepatitis B is contagious via serum and blood of the affected patient. I coordinated with my nurse supervisor to move the patient in an airborne infection isolation room. Once the patient was moved to the AII room, I placed a signboard outside the room door mentioning all the necessary precautions that were needed. I also placed protective equipment inside the patient’s room to prevent contamination such as gloves, hand sanitizer, mask and a yellow bag for waste disposal. When the patient’s relatives arrived I educated them about hand hygiene precautions and also educated them about respiratory hygiene. These precautions prevented the spread of infection and ensured a safe clinical environment for the patient as well as his care takers.