Reflections on Nursing Responsibilities in a Surgical Ward

Learning Log Reflection

Reflection 1

In my placement in the surgical ward, I am mostly allocated to care for patients with bowel obstruction surgery. After the surgery, during recovery phase, stoma is attached to the patients as their intestine and stomach require some time for regaining normal activity. I had the responsibility to manage and replace the stoma bags on intervals to ensure effective care of the patients. This is because untimely changing of stoma bags lead to leakage and skin irritation. In changing and managing the stoma bags, I ensured they are changed once a day. I also washed my hands before and after changing the stoma bags to maintain hygiene and ensured skin of the patients remain dry thoroughly after changing the stoma bags.

Reflection 2

In my placement, I was allocated to care for 6 patients in the bay and among them, one of the patients with arthritis had pressure sore. Thus, I ensured the patient is to be provided air mattress as it distributes the pressure leading to avoid development of extra pressure on the existing sore that may worsen the condition. However, the patient expressed unhappiness with using an air mattress and demanded to offer him a normal foam mattress to have clam sleeping experience. I did understand his demand and immediately meet his need. However, I asked him to avoid lying on the side of his pressure sores as it would lead to hindered wound condition. Moreover, with change of the mattress, I ensured his position is changed every 2-3 hours to avoid development of further risk of pressure sore on other parts of the body and avoid pressure on the current sore area.

Reflection 3

As registered nursing working in the surgical ward, I had the responsibility to monitor patients for detecting vital signs based on which their health condition and progress can be analysed by the healthcare professional. In this context, I ensured to keep record of the vital signs of the patients on regular basis after certain intervals in the board attached at the end of the bed. In the record of vital signs, I mention the time when the vital readings are taken to ensure the professional understand the way the vital signs of the patients have fluctuated to determine any risk present for the patients. Moreover, the records are vital signs are continuously kept as reference for the health professionals to check the way the patients are responding after the surgery

Reflection 4

As a registered nurse, while caring for the patients with bowel obstruction surgery I educate them regarding the nature of foods and drinks they are required to take to maintain enhanced health and avoid further blockage of bowel. I mentioned to them why eating small portions of solid food more often is necessary compared to taking increased amount of solid food at a time. I inform them to chew their food well so that it can be macerated effectively for smooth pathway through the stomach and intestine. I also ask them to take increased amount of water often and cut down caffeine as it would irritate the bowel.

Reflection 5

In the surgical ward, while working as nurse I have the duty to educate patient to comply with the specific surgery determined for them by the healthcare professionals. I execute this by providing them information about the need of the surgery in relation to their present health condition and the way it is going to assist them in leading a better and healthy life after the surgery. In the process, to provide adequate evidence for awareness of the patients regarding the surgery I personally involve in learning and analysing current research information. This is because I feel that without effective evidential proof the patients cannot be made aware of the need for the surgery.

Reflection 6

In the surgical ward, while caring for the patients with bowel obstruction surgery I ensured them enhanced care is provided. This is established by me as the registered nurse by developing timely communication with the patients and listening to their needs. Moreover, I offer them information regarding the care available for them to allow them to provide informed consent regarding their care. This is because it leads me having effective direction regarding preference of care activities of the patients to be included in the care to offer them increased care satisfaction.

Reflection 7

In the surgical ward, while acting as a registered nurse I have the responsibility to change dress, maintain hygiene and monitor the surgical wounds of the patients. During changing of dress of a certain patient who has gone bowel obstruction surgery, it was seen that the individual was non-cooperative in nature. The person mentioned that his privacy is not maintained and avoid me to allow changing his dresses as I am a female nurse. In this condition, I compassionately and politely interacted with him regarding I way I could maintain his privacy by using movable partition to avoid others peak towards him while changing dresses. I also develop communication regarding the way he could help me change his dress without compromising his privacy. It led the patient to comply with my care and avoid making further issues.

Reflection 8

In the placement, I usually require dressing surgical wounds of the patients to ensure they avail enhanced health condition and avoid infection. In this purpose, I ensure to maintain moist wound environment as it promotes enhanced healing. Moreover, I regularly check the wound area to identify any extra exudates that may lead towards maceration of the wound to be removed. This is because removal of excessive exudates from the wound creates an enhanced barrier against the fluid contamination or bacterial growth on the skin in the wound area.

Reflection 9

In the surgical ward, as a registered nurse I have the responsibility to manage patients after surgery and I was allocated the role to role to remove chest drainage from a patient who has undergone surgery. In the process, before initiating to remove the chest drain I ensured the sedative and pain control provided to the patient is adequately implemented by following guidelines. I performed effective hand hygiene before initiating the process so that no harm due to transmission of dirt or microorganisms occurs to the patient. I maintained continuous and smooth traction along with pinched the edges of the skin together to remove the drain so no additional bruises are faced by the patient during the chest drain removal. After removal of the chest drain, I quickly sealed the hole by occlusive dressing as it is the immediate wound hygiene to be maintained as well as ensures prevention of blood loss. I further instructed the patient to try to breathe normally so that effective breathing is restored.

Reflection 10

As a registered nurse in the surgical ward, I have the responsibility to administer adequate and appropriate medication to the patients with bowel obstruction surgery to ensure their effective management of health. In order to administer them medication, I follow the five rights which are right drug, right patient, right dose, right route and right time. This is to ensure avoidance of any error in medication administration that may hinder the health condition of the patients.

Critical Reflection on Professional Development

Reflection in nursing is important as it leads individuals to critically analyse and think regarding their experience to determine the strength and weakness of their skill and knowledge related to practice In this study, reflection regarding the care of stoma bags attached to most of the patients in the surgical ward is to be discussed. For this purpose, Gibb's reflective cycle is to be used. This is because it allows the nurses to analyse their healthcare experiences over time to determine the strength and weakness of their different skills in practice (Li et al., 2020). The reflection to be made is to be executed on the basis of two selected domain of nursing which are professional values along with nursing practice and decision-making.

Gibb’s Reflective Cycle

The Gibb’s reflective cycle contains six phases which are as follows:

1. Description: In the description phase, the detailed incidence is reflected During management of stoma bags attached to the patients with bowel obstruction surgery, I ensured they are removed and changed each day in timely manner from each patient to avoid overflow of waste materials. In this purpose, I keep track of time when the stoma bags are checked for the last time for each patient and personally investigate the condition of the stoma bags after they are attached to the patients. This is to ensure enough spacious stoma bags are attached to patients. I also ensured my hands are cleaned before and after changing of the stoma bag to avoid transmission of infection to the patients. I used warm water to gently wipe the stoma area clean and use dry-wipe to pat gently so that no moisture is left near the skin of the stoma. This is to ensure protection of bacterial growth that may cause infection in the area for the patient. In order to dispose the urine and faeces from the stoma bag, I initially empty them in the toilet and later dispose the bag in the area for clinical waste. However, it was seen that I never checked for leakage of stoma bags before administering it to the patient. Thus, in a certain instance, due to my carelessness, I attached a leaked stoma bag on a patient which lead to overall of urine in the individual's bed creating an unhygienic condition. I intervened the condition with immediate effect so that the stoma bag is replaced and avoid any further leakage along with changed the bedsheets of the patient to maintain hygiene. Moreover, in another instance, it was found that bleeding from the area where the stoma is attached to be patients are seen. It was later realised by that I carelessly rubbed the area instead of swiping it indicating that I inflicted damage to the area out of my careless care.
2. Feelings: In the feeling phase, the thinking regarding the experience is shared and reflected with bowel obstruction surgery, I feel that I effectively abided the professional values domain in nursing. The professional values in nursing mention that nurses are to always care for patients in enhanced manner and safeguard them from any harm or abuse I feel that it is seen that I have ensured the stoma of the patients are timely changed and removed so that overflow of urine and faeces is avoided hat leads to hindered hygienic environment for the patients. In the current care environment, I feel that I have effectively abided by the professional values as I autonomously manage and cared for stoma attached to the patients and took responsibility to resolve error in stoma management caused to the patient. However, I feel I lack effective ability to take decision regarding the way enhanced nursing management of stoma can be ensured for patients. This is because I failed to determine all the aspects to be considered such as assessment of stoma bag for leakage before attaching it to the patient and avoiding rubbing of the area.
3. Evaluation: According to nursing professional values, the nurses are to work autonomously and are responsible along with accountable in providing safe, person-centred and compassionate care to the patients by ensuring their rights and dignity . The experience led me to evaluate that though I was able to manage care for the patients autonomously but failed to assure safe care. This is because out of careless I rubbed the stoma area that led to unnecessary bleeding for the patient. The Nursing practice and decision-making domain mention that nurses are required t be aware of the limitation and hazards of common intervention (NMC, 2018). In this context, it can be evaluated that I failed to make effective decision for stoma care among patients. This is because I avoided considering the limitation such as leakage in stoma bag may be present which may lead to overflow of urine and create unhygienic condition for the patients.
4. Analysis: The nursing professional values inform that nurses are to work as per their competency and skill while offering care to the patients (NMC, 2018). In the current situation, it can analysed that I have hindered competency in managing and caring for stoma in surgical patients as I failed to ensure the limitation to be faced and way they can be controlled prior to their occurrence in the care scenario. The nursing practice and decision-making domain inform that patients at risk are to be identified and immediate care is to be taken to avoid harm (NMC, 2018). In this context, it can be analysed that I have the ability to make decision regarding the way risk towards patients are to be managed and avoided. This is because with reporting of leakage of urine from the stoma bag of the patient I immediately took action to avoid further risk towards the patient and ensured hygienic environment.
5. Conclusion: The reflection led me to learn that I have effective ability to safeguard patients and has autonomous skills to manage and care for stoma among surgical patients. However, I lack effective nursing practice skills regarding the way limitation and problems to be faced in stoma care are to be identified and resolved.
6. Action Plan: In future, I have planned to take separate training regarding stoma care so that the problems to be faced with its management can be determined by me before its occurrence to avoid the issues to be raised. Moreover, I have planned to improve my concentration n delivering care so that careless which leads to deteriorated health impact to patients can be avoided.

References

• Li, Y., Chen, W., Liu, C., & Deng, M. (2020). Nurses’ Psychological Feelings About the Application of Gibbs Reflective Cycle of Adverse Events. American Journal of Nursing, 9(2), 74-78.
• Markkanen, P., Välimäki, M., Anttila, M., & Kuuskorpi, M. (2020). A reflective cycle: Understanding challenging situations in a school setting. Educational Research, 1-17
• McKinnon, J. (2016). Reflection for Nursing Life: Principles, Process and Practice. London: Routledge
• NMC. (2018). Standards for competence for registered nurses. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-competence-for-registered-nurses.pdf [Accessed on: 15th June 2020].
• Tanaka, M., Okamoto, R., & Koide, K. (2018). Relationship between Reflective Practice Skills and Volume of Writing in a Reflective Journal. Health, 10(3), 283-288