Consolidation of Learning

I have come to understand that in order for a student to develop professional nursing skills, he or she needs to have the ability to apply knowledge from theory into practice. This I believe is a fundamental key to the success of becoming a competent nurse. My practice and the invaluable experiences I have gained from my placement, as a nursing student, have enabled me to reflect on the dimensions of nursing practice. I can testify that clinical practice is really an essential component of learning process for any nursing student.

My Clinical practice has allowed me to have direct experience with the real world of nursing, to practice the clinical skills required for the job and to learn about the responsibility of the nurse. Reflecting back at my previous semesters, I can begin to say that my acute clinical experience has served as a wonderful and memorable learning opportunity for me to practise some of the skills that I have learned. I had a lot of mixed feelings going into this clinical because I did not know if I was going to make a difference. And little did I know how much this experience would impact me.

As I reflect on this experience, I realised that I finished my clinical not only with more experience than when I started, but with a different aspect of nursing all together. In this paper, I will discuss an in-depth factual experience on my role in caring for a hypertensive patient. I will critically analyze my actions, feelings and strategies that I used to deal with the situation. I will also present how I was able to connect the knowledge that I had gained from my nursing classes and clinical laboratory. Over the course of my clinical placement, I was assigned to different patients with different illness.

Caring for these patients has deepened my understanding of the need to develop my intellectual capacity for good clinical judgement and safe decision making. While caring for these patients, I encountered situations that were both positive and negative. Regardless of the outcome of these situations, I believe I have learned one or two things from them. There was a particular event that really stood out for me among the patients that I cared for. The reason why this event stood out is because of the impact it had on my learning. This event helped me to start pulling information from all the resources available to me right on the spot.

THE SIGNIFICANT NURSING EVENT I was on an evening rotation on this fateful day. I had done my patient research and ready to carry out my care plan for my patient. Unfortunately, I was not able to implement this care plan because my patient assignment was changed due to staffing issue. An undergraduate nurse was the primary nurse of the same patient that I was assigned to. Due to the policy that I have to be monitored by a registered nurse, my patient assignment was changed. I was then assigned to an eighty two year old woman diagnosed with acute renal failure with history of hypertension.

I had very little time to quickly research my patient diagnosis; my primary nurse just gave me brief information on her status. I had to quickly go in to do my initial assessment and take her vital signs. As I approached her room, I was prepared for all reactions, but my patient responded with soaking kindness. I introduced myself, asked her how her day was going and informed her of the care that I will be providing for her. Then I began to perform a head to toe assessment and I explained the rationale of each test and action. My patient would always smile and respond with “I know that you are a student just do what you gotta do”.

Then I began to check her vital signs and realised that her blood pressure was way over the normal range120/80. I was startled, so I decided to check the blood pressure on the opposite arm, just to reaffirm the data obtained previously. This time around I knew I had obtained the same data, which were 180/ 98. I auscultated her lungs fields bilaterally and there was an adventitious sound. I palpated her peripheral pulses for their strength and equality and auscultated her apical pulse rate to check for the rhythm and the quality of heart sound and I could hear an abnormal sound of blood rushing.

In this paragraph, I will discuss on my feelings and thinking that took place in the event. Based on my knowledge about the implications of high blood pressure and knowing that she is hypertensive and over eighty years old, that would increase her risk of having stroke or heart attack. I was fearful of handling this patient being my first time of experiencing this situation. Reflecting in action, I began to have a therapeutic conversation with my patient. Understanding my own values and beliefs I composed myself and tried not to sound scared, while I was asking questions regarding how she was feeling.

I used all my senses of perception to assess her and asked if she was having chest pain or feeling light headed. My patient complained of being fatigue, a little bit dizzy, and that she was finding it hard to breathe, and then I knew something was certainly wrong. This can be supported by (Quote) At the same time I did not want her to panic or aggravate the situation. I knelt down and checked if there was any urine in her Foley catheter bag, but there was nothing. I asked her when was the last time that her bag was drained and she replied that she was not sure if it was early in the morning or at midnight.

Then I noticed that she had edema in her lower extremities, I inspected her legs and palpated the areas of edema, noting the tenderness and pitting. I went on to ask her if she had been going for a walk around the unit and if she knew her blood pressure baseline, and she responded that it’s been very high lately, but for me I was not really satisfied with the data. Certainly my patient was having fluid retention, and other symptoms which might be as a result of her kidney failure or hypertension. Given the assessment and further investigation this was a possible indication of stroke or heart attack.

While reflecting in action, I told myself that I needed to act fast as soon as possible because I could not tell what the outcome will look like. According to the Canadian Nursing Association (CNA, 2008) state that nurses should provide safe, compassionate, competent and ethical care. Instantly I knew I had to quickly determine my goal of care for my patient because I was certain that something was wrong. I came up with three goals, firstly I have to make sure that her blood pressure get lowered and controlled.

Secondly, make sure that she was having adequate urine output and lastly, encourage her to go for a walk in order to increase her blood flow. In order to achieve these goals I had to find a way to get hold of my primary nurse or instructor, to inform them on what was happening to the patient. Carper, (1978), notes that it is of paramount importance to understand the clinical situation, act timely and appropriately for the good of the patient. This was an opportunity to take what I had learned from my courses and in lab and apply to real situations.

I was not really prepared but I was very excited to use my skills and knowledge that I had gained so far from the nursing courses and laboratory. At the same time, I always had it at the back of my mind to always make sure I stay within my scope of practice and also critically think about the care I want to provide to the patient. I excused myself and told my patient that I needed to see my primary nurse. I quickly logged in to the SCM to check her flow sheet and realised that her previous data was 139/85. I checked to see if there was any order or medications if her blood pressure gets beyond certain parameter.

I found that an order was made and that if her blood pressure get above 180/100, hydrazaline should be given every four hours and patient should be monitored continuously. I researched the drug class, it usage, side effect and contraindication of hydrazaline, so that I know what I am giving my patient and what I need to watch out for after administration. My findings deepened the knowledge about implications of high blood pressure and what I thought and knew. In response to my findings, I knew for sure that she was having the signs and symptoms of stroke or heart attack.

I was really eager to pass on this new information to my primary nurse and instructor. I really felt that I had paid full attention to my patient while performing my head to toe assessment. Tanner (2006) stated “that clinical judgement is more influenced by what the nurse brings to the situation than the objective data about the situation at hand” (p. 204). I hurried quickly and informed my primary nurse on what was happening, and she came with me to get the medications. As we approached the room the nurse took the patient vitals again, I believe that she needed to confirm the data herself.

My nurse got the same data and asked me to administer the medication to the patient. My primary nurse then asked me what my goal of care was for the patient and I responded with what I had planned earlier. I began to evaluate if my intervention was achieved by monitoring my patient’s blood pressure and ensuring that her other vital signs were all in the normal range. About fifteen minutes later, I asked my patient if she was still having the signs and symptoms that she mentioned to me earlier, and she replied that she was feeling much better.

Brunners & suddant stressed that educating the patient on self care is a therapeutic regimen that is the responsibility of the patient in collaboration with the nurse. I began to educate my patient on the importance of lifestyle changes and medications to control the blood pressure. I emphasized on the concept of controlling her blood pressure, rather than curing it. I encourage her to develop a plan for weight loss, limit food high in salt and fats and increase intake of fruits and vegetables. It was all a new experience getting to see the symptoms and effects in first hand.

Everything makes so much more sense when you get to connect the dots yourself. Although I did not have enough time to research on my patient diagnosis, this experience really impacted my learning because I realised that in the real nursing world, nurses do not have any knowledge about the patient that they will care for. This has really made me reflect on my actions and my future practise. It also made me to really value the learning from the class, clinical labs and evidenced based research. Above all, knowing my patient was very integral to my practice and this event raised some questions for me.