Adult To Ill Health Reflection
Reflection: Adult to ill health. Y2 SEM 2
This reflection will reflect upon a key skill that I still need to develop in clinical practice. It will mainly look at numeracy. A significant event will be outlined in order to demonstrate my knowledge to the key skill and then discuss key skill in relation to nursing practice. The Gibbs model of reflection (1988) will be used to reflect on what happened; discuss my actions, thoughts and my feelings. A Personal Development Plan will be provided to show how future learning needs will be met (see appendix 1). Personal development plans are individuals plan for what an individual knows about a skill, what they need to know and how they plan on achieving their own set goals. (Grit 2009).
Newell (1997) …show more content…
described reflective practice as a way one can examine their own actions, thoughts and feelings. Furthermore, he states that reflection provides data for self- examination and increases learning from experience. When you reflect on a situation you do not simple see more, you see differently. The different way of viewing a situation is reflected in statements about commitment to action (Atkins and Murphy 1994). I will reflect in first person. It can be justified and appropriate to write in the first person, as it would be deceptive to discuss such a personal experience using the neutral objective of the third person (Webb, 1992).
It was during my 2nd year of my nurse training in a Northwest West Hospital. I had been on placement for about 5 weeks and I was working alongside my mentor. It was a neuro-surgery ward and we were looking after patients with neurological problems. Names will be changed in order to protect confidentiality (Nursing and Midwifery Council (NMC), 2008). A patient I will call Mr Smith, was a 32 years old male who had been admitted to our ward. He was having a craniotomy after he had had severe brain damage. Because of the nature of the surgery, the trust policy states that antibiotics should be administered to patients undergoing the surgery to treat 7 possible infection. Gentamycin was prescribed for him and a start dose was to be administered intravenously before the surgery.
I had worked with my mentor most of the time. I had done quite a lot of drug calculations and my mentor was very confident with my numeracy skills. I had always done my calculations correctly and had passed my drug test in year 1.
I volunteered to do the calculations as it was one of the goals I wanted to achieve on my personal development plan. I calculated and told her the rate we were supposed to set the pump to. My mentor had previously complained of headache that day and she did not double check whether I had done it correctly. Cohen (2007) states that calculation errors can be avoided by cross checking of calculations.
She administered the gentamycin intravenously and I had set the pump.
We were supposed to administer 100mls within 20-30; rather I had set the pump to infuse faster than it should have been. Cohen (2007) pointed out that administering drugs faster than intended could cause unintended responses and unnecessary suffering to the patient. We handed over Mr Smith to the next shift. The patient complained of hearing sounds in his ears, nausea, and dizziness and felt very weak. Gentamycin is toxic to the kidneys and auditory nerve if given at a high concentration. (Richard and Edwards 2005).The nurse who had taken over the care of Mr Smith from us realised that the gentamycin had been administered faster than it was supposed to be given. She checked in the British National Formulary (2010) for the side effects and found out it was the side effects of infusing gentamycin faster that Mr Smith was then suffering with. We completed an incident form to report the incident as the trust policy states. Chua, Tea and Rahman, (2009) pointed out that nurses were failing to report near misses or errors because of being ashamed about what their fellow colleagues would think of them and fear of punishment by their employers. They encouraged nurses to report all the incidents for future
purposes.
Before we had administered, I felt competent and proud of my abilities on drug calculation. I was very impressed by my calculation and my mentor had praised me on how well I was managing drug calculations.
When the patient complained about hearing sounds, nausea and dizziness, I just thought that it was nothing to do with the gentamycin we had administered. After I found out that it was the gentamycin which had caused Mr Smith drowsiness, nausea and vomiting. I felt that I had failed the patient and was so ashamed of myself. I was so nervous and was hoping that the patient would be fine. I felt very useless and felt that the nursing profession was not for me. I felt like quitting the course if worse was to happen to the patient. My mentor tried to reassure me emphasizing that mistakes do happen. By her body language, I could tell that she was disappointed with me and I had lost her trust. I felt that she would never trust me with anything even though she had acknowledged that it was a common drug error.
I went home that day feeling that I had to stay and make sure that the patient was fine. I wanted to ring the ward to find out how the patient was l but I was so scared. I felt so relieved when I went to placement the next day and find that the patient was fine. The side effects had stopped few hours after I had left.
Looking at the event I now understand the importance of numeracy skills in nursing practice and the importance of correctly administering drugs. Chapelham (2005) pointed out that there was evidence that medication errors were on increase and some of the errors were occurring because of poor numeracy skills. She advised that nurses should be very careful when administering medication so as to deliver care safely. I understand that mistakes do happen but they are better avoided because they can harm patients. Patients trust health professionals with their care so we should not put them at risk because of our mistakes. Chua, Tea and Rahman, (2009.
Before the incident I felt competent and the best even though I am still supernumerary. I was working under the supervision of my mentor and my mentor had been happy with my calculations. After the mistake was recognised, I felt awful, disappointed, useless, a failure and not trustworthy with patients care. The most significant emotion I felt is useless and a failure. (Randle 2001) states that when ones self-esteem is low, they doubt themselves and has negative self beliefs.
The bad part of the experience of the incident is that worse could have happened to the patient and I don’t think I would have coped if worse had happened to him. I thought that I could not be nurse because I had failed my numeracy skills during administering drugs which is a common skill needed in nursing. Chapelham (2005) identified that administering medication was the most common skills that nurses perform and numeracy key skill plays a big role when administering drugs. I was happy with the outcome of the incident because the patient recovered from the side effects of the gantamycin.
The wrong part of the incident is that I caused unnecessary suffering to the patient as a result of my error and I felt very guilty, a failure and upset about my error. A study by Chua, Tea and Rahman, (2009) on drug administration errors found out that nurses were causing unnecessary suffering to patients because of drug errors which result from poor numeracy skills. Since that incident I have practiced my calculation and to aim to improve my drug calculations using blackboard. Since then I always double check my calculations.
The incident may have happened because of not double checking the calculation and could have been rectified before the gentamycin was administered to the patient. A study carried out by Sheu et al (2007) to understand why medication administration errors occur found out that one third of errors occurred because of wrong doses and some errors and near misses were discovered through double checking. Cohen (2007) also agrees that calculation errors can be avoided by cross checking of calculations. I caused unnecessary suffering to the patient which could have been easily avoided with good numeracy skills. Now I realise that I could have avoided unnecessary suffering to the patient if it was not for my error. I also should have asked my mentor to do her own calculations and compare them against mine.
I am now aim to improve my drug calculation and will not do calculations in rush as this could have been the reason why the drug error occurred. In future I will not rush when calculating and will always double check before administering the medication. I will discuss with my fellow students of the incident and advise them of the effects of numeracy errors and how it can be harmful to our vulnerable patients, who trust us on the care we give to them. McCabe and Timmins ( 2006) states that if nurses fail to deliver care safely, patients will not trust them.
My reflection was a negative one but I have learnt from my error and it will help me to improve my numeracy skills and avoid unnecessary suffering. I was happy that the patient was fine after the whole incident and that was a very good learning experience for me. It has also prompted me to improve my numeracy skills and setting of pumps. I have since then practised drug calculations and will continue practising my numeracy skills.
This reflection will reflect upon a key skill that I still need to develop in clinical practice. It will mainly look at numeracy. A significant event will be outlined in order to demonstrate my knowledge to the key skill and then discuss key skill in relation to nursing practice. The Gibbs model of reflection (1988) will be used to reflect on what happened; discuss my actions, thoughts and my feelings. A Personal Development Plan will be provided to show how future learning needs will be met (see appendix 1). Personal development plans are individuals plan for what an individual knows about a skill, what they need to know and how they plan on achieving their own set goals. (Grit 2009).
Newell (1997) …show more content…
described reflective practice as a way one can examine their own actions, thoughts and feelings. Furthermore, he states that reflection provides data for self- examination and increases learning from experience. When you reflect on a situation you do not simple see more, you see differently. The different way of viewing a situation is reflected in statements about commitment to action (Atkins and Murphy 1994). I will reflect in first person. It can be justified and appropriate to write in the first person, as it would be deceptive to discuss such a personal experience using the neutral objective of the third person (Webb, 1992).
It was during my 2nd year of my nurse training in a Northwest West Hospital. I had been on placement for about 5 weeks and I was working alongside my mentor. It was a neuro-surgery ward and we were looking after patients with neurological problems. Names will be changed in order to protect confidentiality (Nursing and Midwifery Council (NMC), 2008). A patient I will call Mr Smith, was a 32 years old male who had been admitted to our ward. He was having a craniotomy after he had had severe brain damage. Because of the nature of the surgery, the trust policy states that antibiotics should be administered to patients undergoing the surgery to treat 7 possible infection. Gentamycin was prescribed for him and a start dose was to be administered intravenously before the surgery.
I had worked with my mentor most of the time. I had done quite a lot of drug calculations and my mentor was very confident with my numeracy skills. I had always done my calculations correctly and had passed my drug test in year 1.
I volunteered to do the calculations as it was one of the goals I wanted to achieve on my personal development plan. I calculated and told her the rate we were supposed to set the pump to. My mentor had previously complained of headache that day and she did not double check whether I had done it correctly. Cohen (2007) states that calculation errors can be avoided by cross checking of calculations.
She administered the gentamycin intravenously and I had set the pump.
We were supposed to administer 100mls within 20-30; rather I had set the pump to infuse faster than it should have been. Cohen (2007) pointed out that administering drugs faster than intended could cause unintended responses and unnecessary suffering to the patient. We handed over Mr Smith to the next shift. The patient complained of hearing sounds in his ears, nausea, and dizziness and felt very weak. Gentamycin is toxic to the kidneys and auditory nerve if given at a high concentration. (Richard and Edwards 2005).The nurse who had taken over the care of Mr Smith from us realised that the gentamycin had been administered faster than it was supposed to be given. She checked in the British National Formulary (2010) for the side effects and found out it was the side effects of infusing gentamycin faster that Mr Smith was then suffering with. We completed an incident form to report the incident as the trust policy states. Chua, Tea and Rahman, (2009) pointed out that nurses were failing to report near misses or errors because of being ashamed about what their fellow colleagues would think of them and fear of punishment by their employers. They encouraged nurses to report all the incidents for future
purposes.
Before we had administered, I felt competent and proud of my abilities on drug calculation. I was very impressed by my calculation and my mentor had praised me on how well I was managing drug calculations.
When the patient complained about hearing sounds, nausea and dizziness, I just thought that it was nothing to do with the gentamycin we had administered. After I found out that it was the gentamycin which had caused Mr Smith drowsiness, nausea and vomiting. I felt that I had failed the patient and was so ashamed of myself. I was so nervous and was hoping that the patient would be fine. I felt very useless and felt that the nursing profession was not for me. I felt like quitting the course if worse was to happen to the patient. My mentor tried to reassure me emphasizing that mistakes do happen. By her body language, I could tell that she was disappointed with me and I had lost her trust. I felt that she would never trust me with anything even though she had acknowledged that it was a common drug error.
I went home that day feeling that I had to stay and make sure that the patient was fine. I wanted to ring the ward to find out how the patient was l but I was so scared. I felt so relieved when I went to placement the next day and find that the patient was fine. The side effects had stopped few hours after I had left.
Looking at the event I now understand the importance of numeracy skills in nursing practice and the importance of correctly administering drugs. Chapelham (2005) pointed out that there was evidence that medication errors were on increase and some of the errors were occurring because of poor numeracy skills. She advised that nurses should be very careful when administering medication so as to deliver care safely. I understand that mistakes do happen but they are better avoided because they can harm patients. Patients trust health professionals with their care so we should not put them at risk because of our mistakes. Chua, Tea and Rahman, (2009.
Before the incident I felt competent and the best even though I am still supernumerary. I was working under the supervision of my mentor and my mentor had been happy with my calculations. After the mistake was recognised, I felt awful, disappointed, useless, a failure and not trustworthy with patients care. The most significant emotion I felt is useless and a failure. (Randle 2001) states that when ones self-esteem is low, they doubt themselves and has negative self beliefs.
The bad part of the experience of the incident is that worse could have happened to the patient and I don’t think I would have coped if worse had happened to him. I thought that I could not be nurse because I had failed my numeracy skills during administering drugs which is a common skill needed in nursing. Chapelham (2005) identified that administering medication was the most common skills that nurses perform and numeracy key skill plays a big role when administering drugs. I was happy with the outcome of the incident because the patient recovered from the side effects of the gantamycin.
The wrong part of the incident is that I caused unnecessary suffering to the patient as a result of my error and I felt very guilty, a failure and upset about my error. A study by Chua, Tea and Rahman, (2009) on drug administration errors found out that nurses were causing unnecessary suffering to patients because of drug errors which result from poor numeracy skills. Since that incident I have practiced my calculation and to aim to improve my drug calculations using blackboard. Since then I always double check my calculations.
The incident may have happened because of not double checking the calculation and could have been rectified before the gentamycin was administered to the patient. A study carried out by Sheu et al (2007) to understand why medication administration errors occur found out that one third of errors occurred because of wrong doses and some errors and near misses were discovered through double checking. Cohen (2007) also agrees that calculation errors can be avoided by cross checking of calculations. I caused unnecessary suffering to the patient which could have been easily avoided with good numeracy skills. Now I realise that I could have avoided unnecessary suffering to the patient if it was not for my error. I also should have asked my mentor to do her own calculations and compare them against mine.
I am now aim to improve my drug calculation and will not do calculations in rush as this could have been the reason why the drug error occurred. In future I will not rush when calculating and will always double check before administering the medication. I will discuss with my fellow students of the incident and advise them of the effects of numeracy errors and how it can be harmful to our vulnerable patients, who trust us on the care we give to them. McCabe and Timmins ( 2006) states that if nurses fail to deliver care safely, patients will not trust them.
My reflection was a negative one but I have learnt from my error and it will help me to improve my numeracy skills and avoid unnecessary suffering. I was happy that the patient was fine after the whole incident and that was a very good learning experience for me. It has also prompted me to improve my numeracy skills and setting of pumps. I have since then practised drug calculations and will continue practising my numeracy skills.