Assignment Task
Topic
Using an example from your previous clinical placement experience, reflect on your demonstrated ability to recognize and respond to a patient’s clinical deterioration.
Description
What happened? Describe the event in detail, including who was there; what were you doing; what happened; in what context did it happen; what part did everyone involved play in the event.
This reflection is based on my stage 4 clinical placement, where I was assigned to a general medical ward at Fiona Stanley hospital. During my placement, I noticed a patient had increased work of breathing, upon checking the patient’s vital signs, found the patients oxygen saturations were below the normal parameters.
Feelings
Describe own feelings, thoughts and perceptions. Think about how the event made you feel; how do you think the others involved felt; how were you feeling prior to the event; how do you feel about the outcome.
Although I was confident in my ability to recognise the patient’s deterioration and aware of the appropriate interventions, I felt very nervous and overwhelmed as I have only had simulation experience of patient deterioration and have never been involved in a Medical Emergency Team (MET) call. The patient’s deterioration happened quickly and required prompt intervention and escalation. Evaluate the situation. What was good or went well; what was bad or what didn’t go well. (Previous attempt) On evaluation of my actions, I informed the registered nurse straight away of the patient’s vital observations and deterioration resulting in interventions and quick response. The patient’s oxygen saturation level was in the MET criteria. Whilst waiting for the team to arrive, in an attempt to increase the patient’s oxygen level, I sat the patient upright, and provided reassurance to the patient. Encouraging deep breathing is aimed at increasing oxygen levels which I have done in simulation. However due to my nerves and lack of experience in a MET situation, I forgot to do A to E assessment and this is a reminder to stop and think even in stressful situations.
Evaluation:
On the evaluation of my actions, I ensured the patient’s safety by staying within my scope of practice (Nursing and Midwifery Board of Australia [NMBA 2016]. I sat the patient upright and provided 15 litres of supplemental oxygen to the patient via a non-rebreather mask. My positive aspect was that I could identify that the patient was deteriorating as his oxygen saturation level was in the Medical Emergency Team (MET) criteria. However, my negative aspect was, as I was aware that the patient’s oxygen saturation was not in normal parameters, I did not press the emergency button immediately instead, I tried to seek advice from the senior nurse first. The delayed reaction time to initiate a MET call could harm the patient.
Analysis
Analyse the situation. What sense can you make out of the experience; if things didn’t go so well how did you or others contribute to this; why did things not turn out as perhaps they should have done; what questions have been raised from the encounter. (previous attempt) Clinical assessments are essential in nursing to identify signs of clinical deterioration (Massey et al., 2017). Nursing and Midwifery Board of Australia (NMBA) standard 5 states that it is crucial to understand and know vital sign parameters to be able to escalate care promptly. The observation charts have parameters that require review of the patient by the treating team and emergency escalation, and these charts allow nurses to visualise the observation trends and quickly identify changes and escalate where indicated (Mohammmed Iddrisu et al., 2018). Early recognition and response to deterioration are vital to providing appropriate care and intervention is applied and escalated if required (Mohammmed Iddrisu et al., 2018). I immediately recognised the patient’s increased work of breathing and deterioration and escalated to the registered nurse (Nursing and Midwifery Board of Australia, Standard 1, 2016).
The patient had an undiagnosed infection, antibiotics were prescribed, and supplemental oxygen was to retain adequate oxygen requirements. It is crucial to reflect on clinical practice in order to promote growth and development. Reflection can identify areas for improvement, and continuing professional development helps nurses acquire the information and skills necessary to increase knowledge and understanding to improve nursing abilities (NMBA, 2016). The A to E assessment involves a systematic approach to identifying deterioration, and this is a skill that has been the focus of stage 5 practical unit and will ensure I cover all aspects that can assist in clinical deterioration detection. The patient was thankful for the care I provided, which made me feel better and helped with the disappointment I had in missing a step in the interventions.
Action plan
Develop a plan of action for the future should a similar situation occur again. Think about whether or not you would act differently. To further develop my knowledge and skills, I will continue practising clinical deterioration scenarios in practical classes and seek assistance and advice when I am unsure. I will continue to review class content to ensure I am confident in following an A to E assessment to identify deterioration and not miss important steps. I will also seek feedback and advice from my preceptors when I am out on placement to improve my skills and build on my knowledge. I believe that confidence will come with experience and I aim to continue to learn and improve to provide the best patient care. I feel that I would like to be involved in a MET call during my next practicums, as this will help me exactly what to do if a patient’s condition is worsening or their vital signs show abnormally low readings.
