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Gibbs Reflective Journal of Licensed Nurse

FACULTY OF HEALTH SCIENCES

School of Nursing, Midwifery and Paramedicine

NRSG367: TRANSITION TO PROFESSIONAL NURSING

Unit rationale, description and aim: This unit focuses on contemporary issues impacting on the transition from student nurse to graduate registered nurse within various health care settings. Transition is seen as a multidimensional and complex process. The key issues addressed relate to knowledge and strategies in the areas of leadership, teamwork, clinical decision making, critical thinking, advocacy and responding to change in the healthcare environment as related to technology and models of care delivery. The unit extends and consolidates concepts from both foundation and nursing practice units and is delivered in a blended learning (mixed mode) format.

LEARNING OUTCOMES 

The Bachelor of Nursing (BN), Bachelor of Nursing (Enrolled Nurses with Diploma in Nursing) (BNENDN), Bachelor of Nursing/Bachelor of Paramedicine (BN/BP), Bachelor of Nursing (Mental Health) (BNMH) and Bachelor of Nursing/Bachelor of Business Administration (BNBADM) course  are professional programs that require development of particular attributes for accreditation purposes. These are also included in the Learning Outcomes.

There are five (5) key themes that link the content in the online modules ensuring students have a deeper understanding of the complexity of the issues addressed in each. These themes are: • Leadership; • Collaborative care; • Evidence based practice; • Transition to practice and; • Information technology.

ASSIGNMENT 3: Reflection on two Registered Nurse Standards of Practice

Purpose:

This assessment requires students to reflect on two of the AHPRA Registered Nurse Standard of Practice.  Students are to provide a structured response describing the relevance and importance of the standards they choose reflecting on experiences from your undergraduate nursing clinical practice experiences and your imminent role registered nurse.

AHPRA Registered Nurse Standards of Practice  http://www.nursingmidwiferyboard.gov.au/Codes-GuidelinesStatements/Professional-standards/registered-nurse-standards-forpractice.aspx  Standard 

1 Thinks critically and analyses nursing practice  Standard 

2 Engages in therapeutic and professional relationships  Standard 

3 Maintains the capability for practice  Standard 

4 Comprehensively conducts assessments  Standard 

5 Develops a plan for nursing practice  Standard 

6 Provides safe, appropriate and responsive quality nursing practice  Standard 

7 Evaluates outcomes to inform nursing practice.

Answer

Nursing reflective journal

Introduction 

For this reflection, Gibbs reflective journal is considered since it is perfect to describe my feelings, thoughts, and behaviors that I faced as a licensed nurse. Gibbs model has six stages and all the six stages have their importance of their own. For instance, the description describes the scene, feelings describe the emotion, and evaluation tells us how the problem could have been handled better. Furthermore, the analysis shows the literature review and action plan and conclusion enlightens upon the recommendations of how such a problem could be avoided. 

Gibbs reflective model

Figure 1: Gibbs reflective model

Description 

I was placed in the operation theatre on July 22, 2017.  There I saw a 3-year-old boy who was recovering from surgery.  Just when I was happy that child had a successful operation, another patient was introduced in the theatre. For confidentiality, I will not say the original name the patient but will consider her as Joanna. She was admitted for pregnancy. She was made unconscious during a surgery and after the operation was made, she gained her consciousness. When she woke up, she seemed a bit distressed and as soon as she saw the boy, she started crying.  Since Joanna was Mexican she did not have enough understanding of English there was a communication barrier between us.  I tried to calm her down but was unable to do so. I believe she in her mind could not bear this picture of this 3-year-old child who was just recovering from the serious injury. The staff tried to reassure her but was a failure. The more Joanna saw the boy the more upset she was getting. I could not stand this and ask for interpreter right away. The 3-year-old boy was getting upset too since she was crying all the time. When the interpreter arrived Joanna was able to communicate and then I and the team of doctors found out that the sight of the 3-year-old boy was upsetting to her. She furthermore stated that it was the last thing she wanted to see after she woke up from anesthesia. 

Now on June 9, 2017, I was placed to take care of old women. She was 75 years old and due to kidney failure, she was not able to move from bed. She needed a kidney transplant but was not available. So the doctors kept her alive using medication. The doctor said to her family that both her kidneys were damaged and only a transplant could save her life. Her family had given up all hopes and begged the doctor to arrange for the kidney as soon as possible. The doctor said that they are trying their level best to arrange a replacement kidney. After two days of turmoil, the doctors were unable to arrange for the kidney transplant and she died on the spot. During the two days, she screamed in pain each time her kidney was not stable. She uses to hold my hand and say stop giving me medication and just let me die. I could not see this pain and wanted her to get relief but this was not in my hand as I was a nurse and my only duty was to save the patient and not let her leave to die. 

Feelings 

For the first entry, I was upset because I could not understand what the Joanna was growing through due to the language barrier. I was not able to take decisions quickly and hence I was in a constant tension and turmoil. I also felt sad for the 3-year-old boy who was just recovering. The boy was also upset seeing the women cry and there was nothing I could do at that point in time.  I feel that Joanna showed abnormal behavior because she just woke up from anesthesia and this sight might have been too harsh for her. The other nurses assumed that the presence if the boy might be made her upset but I could not absolutely be sure until and unless an interpreter was brought.

For the second entry, I felt completely helpless as there was nothing I could do. The doctors had given up all the hopes for her recovery and only a miracle donor could have saved her. Now I also feel the doctors did not try hard enough to save her because they were limited to only our hospital. I feel she could have been saved if the doctors tried a little harder searching for a kidney donor in other hospitals. My hearty cried in pain when she held my hand and said she wanted to die. As a nurse this is the last thing that anybody could hear and here was I taking care of this women but also finishing her all chances for survival.

Evaluation 

Joanna was in a tough spot right from the start as I was not able to help her due to the language barrier. Keeping the Joanna in the same rooms worsened things for Joanna. Furthermore, the doctors and I were not able to assess her nausea levels and pain and were not clear what exactly I was doing. I was against abortion but still, I acted in a compassionate manner in a case for Joanna. I was able to set aside my beliefs and thought about the betterment of the person rather than myself. Even at this tough spot, I was able to hold clinical governance using NSQHS standards.

The old woman was not helpless right from the start. The delay in the doctor treatment was the main problem. If the doctors treated her more quickly, then they would have known earlier that her both kidneys were damaged and preparations for her transplant could have been made earlier. Even in this situation I was able to maintain medication safety using NSQHS standards

Analysis

The abortion act of Australia is pretty complicated.  It is different in different parts of Australia. While in New wales and Queensland abortion is a criminal offense but can be allowed in certain circumstances (Holloway and Galvin, 2016). For example, in Queensland, a 12-year-old was lucky enough to have an abortion and this was legal since the permission was given from the Supreme Court (Alligood, 2017). Furthermore, recent studies have stated that than 80,000 abortions take place every year in Australia (Butcher et al, 2018). The recent survey had shown that the majority of individuals living in Australia support abortion (Billings and Halstead, 2015).

Now it also has to be noted that abortion is one area where health officials may raise the objection. The nurses may not take part in the involvement but must continue taking care of the patient at all cost regardless of nurses personal beliefs and moral grounds (Christmals and Gros, 2017)

For the old women, all the nursing standards were followed.  The registered nurse is bound to follow all the seven standards of nursing at all cost (Christmals and Gros, 2017).   Some of the standards are 

  • Following nursing practice, while thinking critically, this means analyzing and accessing the best possible evidence that involves findings which can be used for quality practice (Parahoo, 2014) 
  • Engages in a professional and therapeutic relationship,  this means that that the registered nurse is able to communicate effectively with the patient maintain the patient's culture, values, beliefs and rights (Parahoo, 2014).

Conclusion 

From the statement in this reflective report, it is clear that interpreter should have present when Joanna woke up from anesthesia. The interpreter would have served as the medium of communication and I would have able to calm from her distress, pain, and anxiety. In addition, Joanna should never have been brought the same operation there in which the 3-year-old boy was present. 

For the second case, the doctor already knew that her kidney was in danger but kept her hope alive by saying that transplant should be arranged. According to me, the doctor had a lack of preparation which leads the women to die. The doctors should have told their family members that they are unable to proceed with her treatment and so they should see someone else. 

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