Nursing Reflection General Ward Placement Online Tutoring

1.0      Appendix

1.1      Placement as a Student Nurse at General Ward

As a student nurse, my recent experience gained during placement in General Ward was very enriching. I had the main duties to respond towards the patients complaining about the chest pain. I had the role of undertaking the notes regarding vital signs of angina, protocols for delivering oxygen masks and doing the ECG when needed. I had the duty to cross check the medications specially related to IV and correlate them with dysponea or tachycardia. I reported at emergency general ward at 9:00am daily where the patients with suspected cardiac diseases were admitted. My duty was also to monitor the electrocardioscanners and record the ECG strips during the periods when the patients experienced the symptoms of chest pain. As a student nurse at the general ward, my main duty was to act as an observant during the ECG processes and oxygen delivery protocols. During my observations, I learnt that ECG monitoring required preparation that including adequate skin assessment, moistening of ECH electrodes, setting and monitoring of cardiac alarms and ensuring that the ECG tracing was accurate enough. During my observation, I noticed that the “flat trace line of ECG” and the quality of “trace line of ECG” were very important to understand and manage. During placement, I highlighted the management to have a daily routine for checking the leads, display of ECG, electrodes, ECG cables and fresh gel sponge for understanding the problem with the trace lines if any.

2.0      Critical Thinking

2.1      “Maintain the Capability for Practice”

Throughout the career, using personal knowledge and reflection to update professional skills is considered to be vital for the medical professionals especially in cardiovascular genre (Coyne & Needham, 2015). The third standard of nursing is very important in the cardiovascular ward i.e. “maintaining the capability for practice”. Gilbert and Coyne (2018) stated that the nurse’s role in caring for ill cardiac patients requires the critical thinking skills and appropriate application of the evidence-based practice. In order to be able to provide holistic care, the nurses have to make clinically appropriate decisions for the CV patients. Especially, by maintaining the overall capability for practice, the nurses are trained for delivering high standards of nursing practice (Rajaganeshan & Ludlam, 2016).

It is important to know that the CV care delivery is safe, patient-centred, and culturally appropriate and fits in legal and ethical frameworks of the nursing profession. During the placement the student nurses were required to initiate the debriefing of critical events associated with CV procedures, promote positive culture amongst CV team, interpreting the latest information gained from public/professional sources regarding CV disease management, directing clinical support to less skilled CV team members and participating in professional clinical supervision and peer review processes as required.

At the General Ward, it was required by the student nurses to access the ECG scanners, blood pressure equipment, oxygen equipment and resuscitation equipment. All the student nurses in the ward were demanded to make regular notes of vital cardiac pain signs and link them with the theoretical study that they did. It was also required of them to keep written record of the activities they had performed or observed during ECG monitoring and oxygen delivering. It was mandatory for the student nurses as an observant to assist the patients and carers in debriefing of accurate health information so that it could be related back to the possibility of other heart diseases including tachycardia, acute coronary symptoms, acute pericarditis and aneurysms (Sala, Dicembrino, Dall’Argine, Baiguera, & Gazzotti, 2017).

The nursing students at the General Ward had to follow clinical services capability framework by continuously reading through the sections and guidelines associated with care unit services, interventional services, cardiac medicine services, cardiac outreach services and cardiac rehabilitation services. It was required at the ward to support practice within the legislative and regulative framework of the hospital. The nurses in the ward had obligations to demonstrate delivery of high quality, culturally competent and age appropriate CV services underpinned by effective communication skills. It was also required to ensure that the patients’ safety and care are set at upmost level during the assessment of the disease.

The most important duty of nurses at the ward was to educate the CV patients about self-assessment and self-evaluation of their heart on daily basis. The risks associated with coronary artery disease (CAD) can be reduced by managing health behaviors like blood pressure, cholesterol level, and blood glucose and diet quality. Hence, it is important for heart patients to get routine tests like fasting lipoprotein profile, body weight, Body Mass Index (BMI) and blood glucose to check on the risks associated with sustained heart disease. All the student nurses were also mandated to monitor their own stress levels during dealing with the heart patients and to take appropriate measures if the stress levels started impacting work performance during work hours.

3.0      Reflecting on Duty’s Impact on Patients

As the duties revolved around CV patients, so the nature of the responsibilities were usually complex and stressful at the placement in General Ward. During the observations of patients with chest pain, the student nurses were advised to monitor the pre and post procedural care areas closely. It was mandatory for all the student nurses to directly participate in the observation and care of patients undergoing ECG procedures. Patients’ monitoring, medication, administration and patients’ safety were of utmost importance at the General Ward.

According to Coster et al., (2018), nursing skills and specific training aimed at managing chronic patients ill with CV diseases directly impact the health and well-being of the patients. It was pointed out by Hivert (2016) that the nurses must develop professional skills to educate patients suffering from the CV diseases in order to reduce their risks of having chronic heart failures. Sala et al. (2017) also stressed upon the role of nurse in educating patients with CV diseases about self-management and self-evaluation.  Orlando (2019) pointed out that the self-care concept play an important part in the management of patients with CV diseases. It was also identified that nurses must participate in training programs for skills development so that they can themselves gain knowledge on the principles of self-care. Through following self-care principles, the nurses and doctors can improve their behavioral, cognitive and communication skills while easing the management of illness of the patients.

For the nurses, it is important to understand and apply the learning outcomes throughout the placement with the theoretical areas including atherosclerotic diseases, heath rhythm and conduction disorders, heart muscle disorders and structural abnormalities of heart. According to Sala et al. (2017), the proper assessment, planning and management of CV disease include the ECG skills, pharmacology and diagnostic tests. The nurses in the ward required to closely observe the ECG mechanics and rhythm recognition and get the specialist advice for patients with complicated healing during cardiac interventions. Before ECG monitoring, the nurses were required to apply theoretical knowledge of best practice in preparing the equipment that included steps like ensuring adequate skin preparation, using ECG electrodes with moist gel sponge, position of electrodes following agreed protocols, setting alarms according to patient’s conditions, ensuring ECG tracing accuracy and ensuring the visibility of cardiac monitor. All of these skills directly impact the health observation and identification of chronic heart diseases of patients.