Reflection On Subjective Assessment

During my initial subjective assessment the patient was positioned in a high sitting position. During the subjective assessment the patient mentioned that she frequently felt dizzy when rotating her cervical spine suddenly. This finding alerted me to the fact that she may have vertebrobasilar insufficiency. I later made the decision to position the patient in side lying to enable me to auscultate her basal lobes and assess her basal expansion. I was concentrating very hard on listening to her air entry, which was made particularly difficult as the ward was extremely noisy at the time. Suddenly my clinical educator arrived unexpectedly to observe me. I continued with my assessment of the patient’s lower lobes and when I ‘d finished the assessment
I asked my patient to sit up. I proceeded to finish my notes and was so busy writing down all my objective findings that I failed to notice that my patient was feeling dizzy. My clinical educator immediately stepped in to support the patient until she recovered from her dizziness. Together we made sure that the patient was made comfortable, reported the incident to the medical team and recorded the incident in the patient’s notes.
I felt shocked , extremely embarassed and distressed to discover that I had been so intent on completing my notes that I had failed to recognise a change in the patient’s condition and may have compromised her safety. I was aware that I started to feel very uneasy during the incident and found it difficult to maintain eye contact with my educator. I felt very relieved that the patient was safe and that my educator had been present and was able to respond quickly to ensure that the patient was supported when she began to feel dizzy. I was also relieved as my educator who had remained calm throughout the incident offered me the chance to find a quiet place to exchange some feedback and reflect on the incident.
I felt pleased with my initial subjective assessment of the patient, which seemed to flow well and was also pleased that I had noted from the patient’s responses to my questions that she had a tendency to suffer from vertebrobasilar insufficiency. However during my objective assessment, I had been so focused on positioning my stethoscope in the correct place that I failed to consider that a sudden change in the patient’s position accompanied by cervical rotation could exacerbate the VBI signs. I had also felt under considerable pressure as my educator had been present and I was determined to demonstrate my auscultation skills.