Reflection on Care Plan Online Tutoring
Reflection is the activity of making sense about the events, experiences practices, actions, or situations that occur in the past. Reflection on practice is an important skill of nursing that helps the nurses to make sense of their practice experience and improve their practice according to it (Gausvik et al., 2015). In this essay, the reflection on the care plan, made for two case studies, will be done by utilizing John’s reflective model (Miraglia & Asselin, 2015).
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Description
The nursing care plan was made for the two case studies. The first case study was about a 70 years old male named Nicholas Noble who was BIBA to ED due to the list of sensation and movement in the right arm and slurred speech. Computer tomography of brain (CTB) suggested mild trophy which could be age-related. Nil other concerns were found at CT of the head. Impression for admission was a transient ischemic attack (TIA) related to cardiac history. Other past medical history includes COPD with CO2 retention, IHD, PVD, Type 2 Diabetes Mellitus, Cardiac stunts, mild chronic kidney disease, and elevated BMI. Care plan for Nicholas Noble was to admit in cardiology ward, do ECG, repeat CTB after two days, refer to speech pathology for review, Nil by mouth until reviewed by a speech pathologist, administering IVF, frequent vital signs with neurological observations, alteration in calling criteria related to COPD, physiotherapist referral for cognitive changes and risk assessment and interventions for DVT.
The second case study was about 79 years old lady Thi Minh Tran, who was BIBA with increased confusion and pyrexia related to sepsis secondary to UTI. Her past medical history contains hypertension, hyperlipidemia, falls, and breast cancer with a left mastectomy and nodal clearance. Plan for her includes full septic screening, IVC, IVF, IV antibiotics, alteration in calling criteria, hourly vital signs on the right arm due to left mastectomy and nodal clearance, refer to MO for hypotension, inpatient special and dietician review, medication administration.
The care plan for the patients was made by utilizing the guidelines, policies, academic articles, and personal experience during the placement in hospitals.
Reflection
For any care plan, identifying the needs of the patient are very important (Wang et al., 2015). At the start, I was confused regarding the needs of the patients due to the patient’s complex condition. I read different academic articles and guidelines regarding providing care to patients with TIA and UTI. After identifying the needs of the patients, I was confident in making the mental health care plan by keeping in mind the safety of the patient and providing quality clinical health care. Collaborating with the multi-disciplinary teams to make a holistic care plan according to the need of the patients was also a challenge. Overall, I am satisfied that I made a holistic care plan by keeping in mind the safety of patients and the quality of clinical practice.
The patient’s care needs and application of patient safety were looked after well in the care plan. The frequency of the vital signs and other observations were written every four hours for Nicholas Nobel and no frequency of Vital signs and other observations was written in the second case study. Whereas the guidelines (NHMRC, 2009) and evidence (Erdur et al., 2015) suggests that vital signs along with neurological observations should be taken after every 15 minutes for 1 hour and then hourly for 12 to 24 hours for the patient with cognitive changes. The need for frequent observation was noted and added to the care plan. In the care plan personal needs of the patients were considered and such activity was added which would not harm the patient. For example, TIA is associated with the swallowing problem and guideline for TIA suggests that every patient following TIA should be assessed by speech pathologist before giving food, drink or even oral medication (NSF, 2011). In the care plan, it was done well that speech pathologist was booked for Nicholas Noble at the start of shift and the patient was documented as NBM until review by the speech pathologist.
The advance care planning was made on evidence-based practice and guidelines. Miniating the fluid balance record in the plane care was done well. As both patients were running with IVF. By maintaining the record of the FBC the fluid and urinary retention can be analyzed (Alobaidi et al., 2017). Maintaining the FBC comes under patient safety as the plan for Thi Minh Tran suggests that if the urinary output is less than 30 ml/hr then inform the doctors. Other than that Nicholas Noble was NBM and IVF was running at 60ml/hr. Maintaining FBC is important for patient safety when the patient is NBM and IVF is running (Best & Nurse, 2019). DVT is one of the complications arising in patients with limited mobilization. Patients with stroke or TIA are at high risk of developing the DVT. Including the prevention of DVT in the care plan is important for patient safety and quality clinical practice (Deka et al., 2019).
Influencing Factor
Gathering the information from the case study and knowing the needs of the patients are very important for making a holistic care plan for that patient. I was confused about determining the need for the patient with a complex condition. Influencing factors for that was a lack of clinical experience and knowledge about the complex patients. An external factor that was affecting finding the needs of patients was time management and difficulty in finding the resources about the needs of patients with the complex condition.
I also used my experience from last placements in making the care plan by following the routine of wards. However, the individual needs of patients are looked after in the care plan. The knowledge about the patients’ needs I get during the making of this care plan would help me in a real-life clinical setting to determine the needs of patients. However, time management will be a factor that would play a hindrance role in proving care to a patient in clinical settings.
Improvement
Plan care for both patients should include the referral to the endocrinology for the review of diabetic management. Both the patients were diabetic with elevated blood sugar levels. Previous HBA1C tests of Nicholas Noble indicate poor management of diabetes and a high level of blood sugar level in Thi Minh Tran can be the reason for UTI. Evidence suggests that collaborating the endocrinology in the care plan of the patient helps in the proper management of diabetes and improve the health outcome of the patient (Alobaidi et al., 2017).
Learning
My knowledge about the needs of the patient with complex and critical health has been changed while writing this care plan. I would like to improve my time management skills as during writing the 8 hours of care plan I find it difficult to manage 8 hours and activities of the care plan. In writing the care plan I had a lot of time to edit my plan according to time. However, in a real-life clinical setting, I would not afford to waste time editing the care plan again and again. To improve my time management, I will allocate myself to different non-invasive clinical tasks like vital signs and will practice them on my friends and family members to improve my time management. Secondly, I will learn to prioritize the tasks according to the need of the patients. Prioritizing tasks is an effective way of time management. Thirdly I will improve my skills in delegating tasks to others if find difficulty in time management. Delegating tasks is one of the strategies utilized by nurses for time management.
Nursing Intervention
Nursing interventions carried out for the patients include but limited to taking vital signs and neurological observation, performing ECG, referral to speech pathologist, maintaining FBC and other records, administering medication as charted, looking after personal hygiene for patients, fall risk assessment and motivating patients to use a walking aid, administering and monitoring IVF and encouraging patients to drink water for hypotension, referral to physiotherapist and pathology and radiology department.
References
Alobaidi, R., Morgan, C., Basu, R. K., Stenson, E., Featherstone, R., Majumdar, S. R., & Bagshaw, S. M. (2017). Associations between fluid balance and outcomes in critically ill children: A protocol for a systematic review and meta-analysis. Canadian Journal of Kidney Health and Disease, 4, 2054358117692560.
Best, C., & Nurse, A. C. (2019). Policy for Managing Fluid Balance and Hydration in Adult Patients.
Deka, R., Simpson, D. R., Panizzon, M. S., Hauger, R. L., Riviere, P., Nalawade, V., McKay, R., Murphy, J. D., & Rose, B. S. (2019). Stroke and thromboembolic events in men with prostate cancer treated with definitive radiation therapy with or without androgen deprivation therapy. Prostate Cancer and Prostatic Diseases, 22(4), 600–608.
Erdur, H., Scheitz, J. F., Ebinger, M., Rocco, A., Grittner, U., Meisel, A., Rothwell, P. M., Endres, M., & Nolte, C. H. (2015). In-hospital stroke recurrence and stroke after transient ischemic attack: Frequency and risk factors. Stroke, 46(4), 1031–1037.
Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of Multidisciplinary Healthcare, 8, 33.
Miraglia, R., & Asselin, M. E. (2015). Reflection as an educational strategy in nursing professional development: An integrative review. Journal for Nurses in Professional Development, 31(2), 62–72.
NHMRC. (2009). Emergency Department Stroke and Transient Ischaemic Attack Care Bundle. https://www.nhmrc.gov.au/about-us/publications/emergency-department-stroke-and-transient-ischaemic-attack-care-bundle
NSF. (2011). Clinical Guidelines for Stroke Management. https://strokefoundation.org.au/- /media/27E4DDB3AEA74FA58C409F462A0BF9E8.ashx?la=en
Wang, N., Yu, P., & Hailey, D. (2015). The quality of paper-based versus electronic nursing care plan in Australian aged care homes: A documentation audit study. International Journal of Medical Informatics, 84(8), 561–569.
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