Simulation Learning Experience Reflection

Look back
As a second year nursing student, I felt more confident in Simulation Learning Experience (SLE) practicum in that, I could integrate my nursing knowledge, skills, and clinical experience into the practice. In the simulation scenario, I simulated the primary nurse caring for a patient with post-operative complications. I learned about general procedures regarding how to approach a patient with post-operative complications. I learned how to effectively decide which assessments are priority, as well what signs and symptoms posed specific concern in such a scenario. I thought I had done quite well for some part; however, there was a situation in which I did not act as I should have. Elaborate
A female patient with a postoperative
left total knee arthroplasty, entered my floor that morning. Before she came in, she had vomited three times. My primary assessments focused on pain and the wound. The patient did not complain of pain, but I found a large amount of blood leaking out of the dressing. After analyzing the current vital signs and the lab results from last shift, blood pressure 90/40 mm/Hg was the main issue, so I decided to call the doctor. The doctor ordered : “2 NS boluses, 500 cc each and 2 units of PRBC’s and to increase the IV maintenance from 75cc/hr to 125cc/hr.” I hung up the IV bags and set up the IV pump, then I called the blood bank. After the blood arrived, my partner disconnected the IV line and connected the blood bag to the saline lock. My patient still complained of dizziness, the blood pressure was 90/50mm/Hg. Under that situation, I really did not how to act in this situation. In this scenario, I also paid close attention to the patient’s temperature and assessed the level of the patient consciousness, and so on. I believe that there were many problems in the scenario that I was unable to address.

Analyze
I was good at several assessments and interventions in that scenario, which could demonstrate my strength. A patient with a postoperative left total knee arthroplasty required specific assessments. According to Smith (2010), the priority care process should be respiratory and circulatory function, pain, temperature, and surgical site. I focused on pain assessment first, which is very important. Lucas (2008) stated that adequate pain management is essential in that, it can make patients mobilize as soon as possible after surgery. As cited in Smith (2010), the most effective interventions for pain include both pharmacological and non pharmacological approaches. Another good intervention I did was paid more attention on temperature of the patient. According to Smith (2010), if the core temperature was less than 36℃, this could mean that the patient had hypothermia. Hypothermia may compromise immune function and cause postoperative pain, bleeding, and delay drug metabolism resulting in a prolonged hospital stay. If the temperature was higher than 37.7 ℃ after the first 48 hours of a surgery, then infection should be considered. As well I assessed the patient’s level of the consciousness and sensory and motor status, which was an essential assessment, although they may not be prior assessment in this scenario.
I also figured out some of my weaknesses in this scenario, which should be noted and improved in the future.
For a postoperative patient, assessment should begin with an evaluation of the airway, breathing, and circulation (ABC) status (Smith, 2010). I assessed the airway and carried out suction, then administered oxygen, but I did not do it immediately. She had vomited three times, keeping the airway patent and administrating oxygen are very important for postoperative care (Smith, 2010). In fact, concerning treatment of hypotension in PACU, should always begin with oxygen therapy to ensure hypo-perfused organs meet the need of oxygen (Smith, 2010). The common cause of hypotension is fluid loss, IV fluid boluses will be given to normalize blood pressure (Smith, 2010), which is the reason why the doctor ordered the IV and blood transfusion. When transfusing blood or blood components, assessment is required before, during, and after the transfusion. If the client has an intravenous line in place, assess the venipuncture site for signs of infection or infiltration and patency (Jantzen & Molzahn, 2010). In fact, we did not do very well in blood transfusion and we should keep the IV line running and set up another blood transfusion line in the other
arm.
The scenario was too short, if I had more time, I should assess potential urinary problem and gastrointestinal problem. Kwong, Kistler, Mills, Wildgoose, & Klaskala (2012) stated that venous thromboembolism prophylaxis is also an important intervention nursing care for the postoperative patient. In a word, I can clearly figure out my strengths and weakness through the Simulation Learning Experience (SLE) practicum.

Revise By participating in the scenario of post-operative complications, I realized that health care should be varied with the changing of the patient’s situations. As cited in Alligood & Tomey (2010), Nightingale stated that any nursing process must be strictly followed in accordance with natural rule. The safety of a patient is the most priority (College of Nurse of Ontario, 2002), so it is very important for nurses to apply critical thinking for a nursing process (College of Nurse of Ontario, 2008). As cited in Alligood & Tomey (2010), Parse noticed that the human is unitary human-living-health and human beings have their own rhythmical patterns of daily life. The intervention of nurses should adapt to the clients’ patterns, and an appropriate nursing process needs to be formed based on the clients’ different medical situations. In this scenario, I assessed the patient following the nursing process of postoperative care, although some of them need to be improved. I deemed the patient in the unitary of human and health environment and adhered to the rhythmical patterns of human being. I assessed pain, wound and attention on temperature, which demonstrated compliance with the particular nursing care in the postoperative unit.
New perspective After the SLE lab practicum, I realized it is important to do more research on new nursing perspectives and techniques. Research will enrich my nursing experience and improve my nursing practice in the future. Furthermore, I need to be aware of the importance of nursing theories and apply them into daily nursing practice, because nursing theories can assist nurses to fulfill their clients’ needs.

References Alligood, M., & Tomey A.
(2010). Nursing theorists and their work (7th ed.). Maryland Heights, Missouri: Elsevier Mosby.
College of Nurse of Ontario. (2002). Professional Standards, Revised 2002: Practice standard. Retrived March 20, 2013, from http://www.cno.org/Global/docs/prac/41006_ProfStds.pdf
College of Nurse of Ontario. (2008). National competencies: In the context of entry-level Registered Nurse practice Professional Standards, Revised 2008: the standard of care. Retrived March 20, 2013, from http://www.cno.org/Global/docs/reg/41037_EntryToPracitic_final.pdf
Jantzen, D., & Molzahn, A. (2010). Fluid, electrolyte, and acid-base balances (4th ed.). Toronto, ON: Elsevier Mosby.
Kwong, L.M., Kistler K.D., Mills, R., Wildgoose, P., & Klaskala, W. (2012). Thromboprophylaxis, bleeding and post-operative prosthetic joint infection in total hip and knee arthroplasty: a comprehensive literature review. Expert Opinion On Pharmacotherapy, 13 (3), pp. 333-44, DOI:10.1517/14656566.2012.652087
Lucas, B. (2008). Total hip and total knee replacement: Postoperative nursing management. British Journal of Nursing, 17(22)
Smith, D. (2010). Nursing management: Postoperative care (7th ed.). Toronto, ON: Elsevier
Mosby.