Reflective Journal of a patient with HIP replacement, pain, and Dementia
Reflection is the ability to recapture one’s experiences, think about them, evaluate them, and thus draw meaningful conclusions. In the nursing practice, the role of reflection cannot be underestimated, especially in the part that it plays in the creation of professionals that are autonomous and critical thinkers. In fact, reflective practice in nursing goes an extra mile to foster desirable nursing care, and this will be reflected in the contents of the reflective journal displayed in the sections below. In the present reflective journal, I will address a hospital experience when working with a kind of a unique patient.
I was in charge of offering care to my patient (Mrs. S) in the hospital’s surgical unit. Mrs. S had just gone through surgery for hip replacement, and she was in pain. She was also battling dementia. I was working under the supervision of my mentor while I was stationed in the unit. The critical competency that resulted in my mentor pairing me up with my patient was to build communicative skills when working with select patients. When speaking of special, I am referring to a patient that has a demented brain, and who had just gone through surgery.
My duties would often involve changing the dressing of Mrs. S’s hip surgery wound. During the early days of my assignment, I would perform this role under the strict guidance of my mentor, who would always engage herself in a conversation with the patient. I would only follow the guide on changing the dressing the wound from my mentor. The procedure that I was to follow was the non-touch one. Don't use plagiarised sources.Get your custom essay just from $11/page
On one occasion, my mentor was held up with another patient, and so I had to undertake the morning care routine by myself, given that I was slotted for the first shift. This time, the only different aspect was that the patient appeared distressed. In the course of offering care to Mrs. S, he condition became worse. Her facial expression displayed a slight frown with a frightened face. She then began grunting, while breathing quite heavily. These were just but examples of symptoms of patients that were cognitively impaired and who were experiencing pain. Out of nowhere, Mrs. S began yelling and calling out for help. During this time, I tried to remain calm and talk to Mrs. S in slow sentences that were mostly short. In some instances, I had to repeat myself to make sure that the patient understood me, which I am not quite sure if she understood me or not.
At first, I was hesitant to talk to the patient because all along, my mentor was the one who engaged her when she was supervising me. I knew of the patient’s demented condition and the fact that conversing or dealing with such patients, especially in pain management, or in the course of undertaking nursing tasks was likely to be a problem because of the possibility of there being a lack of proper understanding. This is because the patient was discomfort and as distressed thanks to the pain felt from the hip replacement pain. I believe that this was, in turn, affecting the behavior of the patient, which was worsened by the dementia condition.
As a professional, in several occasions I had dealt with different kinds of patients suffering from different kinds of diseases but the experience with most of them was awesome due to their high level of corporation when it came to administering them with drugs (Gove et al, 2017). However, I had never before encountered with dementia patients, it was really a challenge to me because she could turn violent especially when it came to administering drugs to her. She could turn violent whenever I tried to give administer drugs to her, and I had to struggle with her for long before I could manage to overcome her and take the drugs. It was really a difficulty situation for me as a new trainee into the profession. I remember some of the situations when she could overpower me completely to and extent of giving up on her but observing the pain and agony she was experiencing I could not afford to let her to die (Kessler et al, 2016).
It was not until when she got very tired that I could manage to administer the drugs to her and could leave me with injuries. It was an experience that almost made me develop negative attitude towards my career as a nurse but through many inspiring moments we were taken constantly by our peers I gained hope. Out of my experience with Mrs. S, I learned that as a professional in the field of nursing, there were more challenges than what I was expecting and the only way for me to withstand those challenges was by being persistent (Kessler et al, 2016).
My endurance level was considerably low because many times I could give up on attending to this patient only until I could be questioned by the supervisor which I came to consider as unethical behavior in the nursing profession. In order to improve on endurance, I will expose myself to such kind of conditions so as to familiarize myself with them while learning how to control my emotions.
Frustrations and stress was the other challenge I faced from my stay with Mrs. S, which was especially due to many times I could endure sleepless nights watching over the patient who rarely could sleep and when she fell asleep after few minutes would be up. I could sometimes find her in other wards disturbing other patients who were under critical conditions. I can vividly remember one time she moved to the neighboring ward and disconnected all the breathing support system of a patient only to notice the incidence when the patient was almost gone. It was really a frustrating encounter trying to re-connect the system in order to save the life of that innocent patient. I felt like I dismantling the support which had been put in place to support her movement but again that would expose her into more suffering.
It was really a stressful experience which made me write a resignation letter to the hospital manager but because he had probably undergone through such experiences, he denied me the chance but rather called me for counselling session. One thing and for sure, I had to improve on managing stress and frustrations to be able to cope with the challenges of my profession.
The patient required constant attention and that was another challenge I faced over the period with Mrs. S considering that as a person I had my own personal issues supposed to attend. I was entitled to manage all what he was doing, always keep following her closely and supervising her because she could no longer see the extent of the dangers which could arise out of her actions (Kessler et al, 2016). Caring for her when under crises was another frustrating time for me; it was also very difficult because I had to stay on top of it for 24 hours a day. Paying constant attention was another greatest difficulty because she was very forgetful and could often put herself at risk when near cleaning products like detergents because she could easily drink it. The experience required utmost patience to withstand, a quality I lacked as a new professional in the field of nursing.
Lots of patience was required to care for this patient because dementia had completely changed her personality and overall behavior making her unable to even do the simplest tasks. I was supposed to deal with her unpredictable and frustrating behaviors. I lacked patience to do all that and that made me struggle a lot. I knew I was supposed to improve on being patient and therefore I used the tactic of managing day to day life to achieve that as a caregiver (Xiao, Wang, He, Bellis, Verbeeck & Kyriazopoulos, 2014)
Attending to Mrs. S on daily bases made me exhausted not just physically but also emotionally too. It made me experience diverse emotional conditions, from sadness to frustrations and anger. And dealing with these emotions was not an easy task because I could spend days without having a smile on my face and fully stressed. The condition affected my personality to a large extent as well as my eating habit and ended up slimming within a very short period of time. What I had pursued in studies for five years as my profession had turned to be my daily source of stress, I had to improve on the way I controlled my emotions in order to succeed in my profession (Kessler et al, 2016).
After engaging the patient in numerous short and repetitive conversations that were aimed at calming her down and reassuring her, Mrs. S finally relaxed, and she stopped shouting the words “help me, help me,” which I took to mean that she was most likely frustrated because of the presence of an unmet nursing care need. When I shared the experience with my mentor, I realized that Mrs. S was uncomfortable in the hospital room and wanted to be taken around the hospital to gain new experiences asides from those in the surgery unit
From the scenario, I learned the importance of communication in nursing, especially when providing care to patients with dementia, especially those in the paint. According to the Nursing Times (2016), it was noted that a nurse plays an instrumental role in nursing care to dementia patients through the active listening of their patients, empathy and the provision of the right environment. The arrangement of the above elements can thus result in desirable patient outcomes, which are characterized by the development of therapeutic relationships.
One thing that I gathered from the incident revolving around Mrs. S was that pain assessment in patients with dementia is a hard nut to crack. The challenge in the said assessment is felt where there is a lack of adequate communication (Achterberg et al., 2013). The loss of communication, as noted by Achterberg et al. (2013) is attributed to the fact that patients with dementia have a limitation in the subjective reporting of pain, which is expected in adults who are cognitively healthy. For patients with dementia, different kinds of pain present different kinds of challenges, and so understanding this fact is necessary for a nurse caregiver.
As much as the experience was challenging to me, I learned that communication was an essential element in the nursing world. As a nurse, hacks for verbal and non-verbal communication must be at my fingertips. This is especially true when looking to develop a therapeutic and healing environment for my most frail patients. For instance, when working with patients with dementia, and who are in surgical unit battling pain too, like Mrs. S. I realize that I should not have let just my mentor interact with the patient while I was under supervision, I should have taken the initiative to learn how to communicate with dementia patients who are also experiencing pain following a surgery. I should have taken heed of the fact that effective communication, as pointed out by Ahmad (2014), fosters the quality of care that is offered to patients. As such, I believe that I would have boosted the quality of the relationship between Mrs. S and me from the word go, had I acknowledged the aim of engaging her early on, from the time when I was working with my mentor.
In summary, I can point out that the experience helped me to learn a lot about nursing profession as a new entrée into the profession among them, I learnt that as a nurse communication skill of great important, controlling emotions, being patient and the art of managing frustrations. In fact, sharpening those areas of my weakness, nursing career has proved to be rewarding. I will keep maximizing on these skills I learnt in order to offer quality services to the patients, empower, and motivate them.