Learning How to Manage Patients Care in an Effective and Efficient Manner

 Situation

• Describe a Clinical Placement nursing situation you encountered 

I had taken care of two patients on previously two clinical days. I did not have to do medication administration, analyze lab value and I did not have to participate in the physician round, and communicate with the interdisplinary team. I helped the patients with the personal care throughout the shift and performed some simple nursing interventions. I only communicated with the staff nurse about all the health concerns for my patients. However, I did find the shift is very busy. I can hardly find time to fit my breaks in. In the consolidation placement, I will have to take full assignment and take care of the patients regarding all the health care activities. I need to sharpen my nursing skills and learn how to manage patients care in an effective and efficient manner.

 Background

• Describe your relationship to the patient at the time you noticed the situation (e.g., previous contact with patient and/or family, the quality of your relationship).

I tried to build therapeutic trusting relationship with my patients at the first contact. The relationship needs to be professional and within legal boundaries which means I should not take care of the patient if I know that patient out of the health care setting (eg, personal relationship). In this case, the relationship with my two patients is nursing- patient therapeutic relationship. I do not have any previous contact with the patients and I treat them equally without any preference and judgment.

• Consider experiences you have had that helped you provide nursing care in this situation. Describe your formal knowledge (e.g., physiology, psychology, communication skills), previous nursing experience with a similar problem, and/or personal experiences that helped guide you as you worked with the patient.

My previous nursing experience is limited with the actual clinical setting. Every nursing task took me extra time to finish it. I am a novice at nursing profession. It takes me a lot of time to review and actually apply the nursing knowledge that I learned in school to the actual setting. For example, I did a wound care on one shift for my patient. I had to review the supplies and the techniques in my brain first, then go ahead collect them and perform it for my patient. It took me an hour to finish that task. I am confident with more practice, and more strengthening of my nursing skill, I will be able to handle the full assignment in the coming months of the consolidation. 

• Describe your beliefs about your role as the nurse in working on the situation.

In my belief, the nursing role should always be the health advocator for the patients.

• Describe any emotions you had about the situation.

I did find the situation is a little bit stressful when it comes to be a nursing student. I have limited ability to delegate the nursing task. I have to be always there when other people ask for help. There was one incident that a staff nurse asked me to help out, and my patient rand the bell at the same time. As a nursing student, I don’t want to say no to the staff nurse and I don’t want to ignore the need of my patient.

Noticing/collecting data

• What did you notice about the situation initially? 

Initially, I thought only patient care for 2 patients would be a piece of cake. I thought I would have a lot of time to ask clinical questions. For example, what did the wound look like before? What treatments did the nurses apply for the wound care? Did the wound condition improve over the past month? What techniques, what dressings and what lotions are helpful for such patient with thin skin? I knew wound care and skin integrity is a big subject for senior people and I did prepare myself to learn more about this subject. But I was so busy with all the personal care with my patients and I can hardly ask the staff nurse any questions on those 2 days.    

• Describe what you noticed as you spent more time with the patient and/or family 

I had limited time to spend with the family over the last 2 days. But overall the patients and the family are satisfied with care provided.

Interpreting/Assessing situation

• Describe what you thought about the situation (e.g., its cause, potential resolutions, patterns you noticed).

When it comes to time management, I am a novice nurse and a lot of improvement is needed for my nursing skills including both assessment and interventional skills. I wanted to do all my patients care in a perfectly, text book way, and it takes me a long time to finish them at this time. For example, as I mentioned before, wound care took me an hour and head to toe assessment took me 20 minutes to finish for each patient right now. When I told my staff nurse about this, she is very surprised and she said it only took her 5 minutes to do head to toe assessment. I asked her how. She said you can do a lot of assessment by simply looking at and talking to the patients. The potential resolutions for this is that I need to learn a lot of effective and efficient nursing skills from the experienced nurse   

• Describe any similar situations you have encountered in practice before. Describe any similarities and differences you observed when compared with the current situation.

Last semester, I only had one patient and it was very easy for me to handle. This semester, the assignment increased to 2 patients and I never thought time management can be an issue. But it turned out that I was very busy and hardly had any time to communicate with my patients. I was struggling among all the nursing tasks and realized it could me a challenge for me to take of 5 or 6 patients in a chronic setting.

• What other information (e.g., assessment data, evidence) did you decide you needed as you considered the situation? How did you obtain this information? What help with problem solving did you get from your clinical supervisory/staff?

Your conclusion: What did your observations and data interpretation lead you to believe? How did they support your response to the situation? Include pertinent pathophysiology and/or psychopathology.

As I was considering the situation, I found actually I can capture a lot of important patient information at the report time. This would help guide me where my focused assessment should be and can save me a lot of time when it comes to head to toe assessment. I asked the staff nurse how they handle the 5 or 6 patients in a busy shift and do they find it is stressful when having a full assignment. They did inform me that it is always busy but it is doable. They suggest some prioritizing skills and I need to slowly incorporate them to the shift

Responding/Intervention

• After considering the situation, what was your goal for the patient, family, and/or staff? What was your nursing response, or what interventions did you do? List all actions that you took. 

The goal for the patient will be involving the patient and the family into the actual care plan. By involving the patient and the family, it saves time for the care needed and patient will be more motivated to participate in the care activies and it saves time for other important tasks that can not be delegated. I did not do any patient involvement on the last 2 shifts. I was just doing all the nursing cares to my patients and this is something I should be reflecting on.

• Describe stresses you experienced as you responded to the patient or others involved in the situation. 

It is stressful when I feel the time is not enough and I can not finish what I wanted to do for the patient in the shift.

Reflection in Action/ Evaluation of outcome

• What happened? How did the patient, family, and/or staff respond? What did you do next?

I find the last 2 shifts are very busy even though I only handled 2 patients.

The patients were satisfied with my care, and I responded to their needs as soon as I heard the bell. 

Reflection-on-Action and Clinical Learning

• Describe three ways your nursing care skills expanded during this experience.

Overall my head to toe assessment skills were improved during these 2 days practice. My wound care skill is further strengthened, but I need to do them with a faster speed. My prioritizing skills need to be expanded and patients and family need to be encouraged to participate in the care plan

• Name three things you might do differently if you encounter this kind of situation again.

If I have to take care of 5 patients, 3 things that I would do to improve the efficiency include

1. Familiarize myself with the practice environment and get to know the locations and names of the equipments and supplies would allow me to be more organized and effect.
2. I will plan and prioritize a “to do” list for each patients at the beginning of the shift
3. Involve the family into the care plan.

• Describe any changes in your values or feelings as a result of this experience.

I should value more about patient independence instead of just simply do things for them. After 2 days practicing, I am actually a little bit scared towards the consolidation practice. But I am confident that I will be able to handle it after the practice of this semester.