Introduction
A clinical reflection is necessary for a nurse who needs practice and exposure in the medical field because it helps to think and consider different options during emergencies. Reflective practice is included in the course of nursing education so that nurses can include theoretical knowledge in their practical experiences. It makes them develop thought process so that they can think about their victories and failures in situations, which can lead them to enroll into effective future practices. A critical reflection can help in postoperative complications, missed diagnosis, treating dissatisfied patients and failed medical procedures. This essay will have a description of an incident, which will help me reflect on therapeutic relationships and provide me with an opportunity to critically analysing the situation of the patient. After the description, it will have a critical analysis of the patient and the procedures used for her treatment. This incident will showcase me as an intern in a healthcare organisation, and I will be placed in the geriatric ward. Interns need to be more aware and alert about the procedures going around them because they are hired to get trained and learn for their future practices. The patient in this context is suffering from pressure ulcers grade 2, and that requires intense care and support from the medical team. Her real identity will not be revealed because of the implementation of Professional Codes of Conduct and Data Protection Legislation, which focuses on the anonymity and confidentiality of a patient’s personal information. This assignment requires me to follow the safety and privacy policies for the effective confidentiality of the patient. My reason to choose this incident is that it made me understand some complicated issues during a treatment that gets affected by the condition of the patient. Erin was vocal about her pain, and this was an input for me, which made me explore and learn more about the medical field.
Description of the Incident
I was working as an intern in the geriatrics ward in the hospital under the supervision of a senior nurse. During the internship, I was given the responsibility to take care of a 65-year-old patient named Erin, along with other nurses, to speed up health recovery. Erin was suffering from Grade II pressure ulcer and required extensive care and support from the nurses (Legg, Sissons, & Cleary 2017). One of the other nurses in the responsibility of Erin’s care took me to her and introduced us to each other. As the patient was suffering from partial thickness loss of dermis and epidermis, the patient was diagnosed with grade 2 pressure ulcer. In such condition, the nurses are required to actively assist the patients in their daily activities and provide interventions such as turning the patient to other side every two hours, keeping the skin dry and clean, help maintain patients range of motion, mobility and activity and ensure adequate intake of calories and protein by the patient (Davis et al. 2018).
As an intern, it was my responsibility to look at her past medical history and relevant records that can help me with understanding her case in detail. She had a medical history of diabetes mellitus, which was another reason for her increasing complication found in her pressure ulcer. My senior nurse used to administer her vital signs and medication that was prescribed by the doctor for her fast recovery. I used to assist in some of the procedures done to Erin such as dressing, medication and daily assessment of her condition. The nursing team used to be in adamant about her requirements and necessities because she had a critical situation, which needed supervision and monitoring. Her pressure ulcer was easily contaminable because she had grade 2, and it is observed that it caused due to pressures in a certain area (Bhattacharya and Mishra 2015). This requires changing sides and increasing the pressure relief, which will help in reducing the intensity of the complication. When the ulcer is not uniform than the infection is more widespread, and friction might be the cause. This ulcer is found in patients who are physically inactive due to certain reasons such as immobility or serious health complications, which is not allowing them to perform their daily chores or nature’s call. Unhygienic practices or direct contact with faeces or urine increases the risk of bedsores or pressure ulcers (Kusens 2016). Erin is suffering from pressure ulcers due to her old age, which is not letting her be physically active, and that is one of the major reasons for her slow recovery. When I got a chance to interact with Erin after a day, I realised that she needs to be made aware of the consequences of this complication because she has to be equally corporative during her treatment. She was easy to approach, but due to the issue of ageing she was not able to comprehend certain things, which I used to talk about (Nazarko 2016). I helped her in taking her medicines, taking water, and going to the washroom and made her bed before going to sleep. She acknowledged my efforts and expressed that her wound pains are not letting her sleep properly during the night. People around her needed to be completely sanitised and had a habit of using gloves and masks when they were treating her. This made me realise that some nurses will not be able to empathise with the needs of such critically ill patients because they have shift timings that are not flexible for them to look after every patient. This can lead to burnout and stress in nurses and dissatisfaction in patients (Fan and Taylor 2016). I was an intern so I was able to be with her and check her recovery every day, which includes meeting her needs and daily requirements because she was immobile.
This made me realise the importance of a therapeutic relationship between a health practitioner and a patient. It also made me reflect on my inbuilt skills that are required in the field of nursing and which will help me in providing holistic care to every patient. A nurse should be compassionate, patient and easily approachable so that she can deliver quality care and safety. Patient’s mental health should also be made a priority so that they do not suffer from anxiety or mental stress during their treatment because older people generally get anxious about their lifespan (Andreescu and Varon, 2015).
Analysis
The critical reflective part of this incident will be given in this section and the reason why this patient and interaction has been chosen for this critical analysis (Fook 2017). It is important for me because I was able to relate and sympathise with Erin because of the issue she was suffering from made her go through a severe amount of pain and restlessness. The most impactful part was that she was not able to do anything about her condition as she was dependent on the nurses to look after her wellbeing. She used to get optimum care and supervision because she was incapable of moving or doing any physical activity that leads to her increasing rate of pressure ulcer. The themes in which I will focus on is the idea of therapeutic relationships and positive patient outcome.
The concept of therapeutic relationship is seen in this incident because it has interaction between the healthcare professional and the patient, which was informative. It involves the engaging of a nurse and client for a purpose that will lead to a positive outcome in terms of their therapy or treatment. It is said to be a psychodynamic perspective, according to the researchers who have investigated this area. This concept has helped in predicting the treatment adherence, concordance and outcome through several patient/client engagements during treatment and diagnosis. A therapeutic relationship has 3 core conditions known as empathy, unconditional positive regard and congruence that is required for efficient therapeutic relationship (Schachter, Kächele and Schachter 2014). The components of a therapeutic relationship in a psychoanalytic perspective are working alliance, transference and real relationship. Transference, as described by Freud, is ‘friendly affectionate feeling’ when the transference is positive. Working alliance is also known as therapeutic alliance, which is different from therapeutic alliance. It is a conjoint effort between a therapist’s analysing side and a client’s reasonable side (Martin and Chanda 2016). It has 3 parts known as goals, bond and task, which has its significance in the flow of this communication. Having an effective therapeutic communication will help the nurse as well as the patient during the treatment procedures because it enhances the powerful exchange of information between them. Erin was demotivated and had anxiety issues regarding her treatment because her ulcers were increasing day by day, and she needed assistance for every task. This made her feel frustrated about her life, which led to poor communication. However, after continuous questioning and interaction sessions, she revealed that she is not satisfied with her condition. Illness has effects that make a person negative about all aspects of their life. Especially in Erin’s case, it is evident that she is bedridden, which is making her feel disassociated from everyone. Another issue to be seen here is the role of the nurses during the whole situation. Pressure ulcers require assistance and monitoring because if it is not handled hygienically, then it can increase and reach level 3 and 4 (Bester and Van Deventer 2015). The satisfaction of the medical team is as necessary as the patient because they are the caregivers, and if they are not in a good space mentally, then they won’t be able to reflect constructively. As seen above, critical reflection is necessary for the growth of the nursing profession because it makes them think about their achievements and failures in the past, which will guide them in following the correct practices.
According to Erikson’s psychosocial theory, the stage of trust v mistrust can be included to understand the behaviour of Erin in the ward. She was corporative during her stay and was allowing me to help in all her daily tasks in which she needed support. She is a 65-year-old woman, which made her inactive for certain activities. This incident can show that she trusted me for all her requirements, which validates this theory (Syed and McLean 2017). It is difficult to trust people in a new environment and especially for people who are already anxious and stressed about their health. The attachment theory also signifies a similar aspect for infants, but it can be used in this context as well because an ageing person has similar tendencies with a newborn. Older adults tend to get restless and act immature when they are told to behave in a certain manner (Zhang et al. 2015).
It is a major task to look after patients who are infected or easily contaminated, which was seen in this case. Pressure ulcers spread with time if it is not treated with the correct protocol, and this requires a significant amount of experience and practice in this field.
The care she was getting was improving her problem-solving skills because she was being guided and trained while making any move, such as going to the commode, getting up for a walk or eating and drinking. She tried to turn by herself during dressing, but she was unable to, this increased her zeal and motivation regarding her treatment. She started feeling that she can recover soon if she keeps practising like this (Moore and Patton 2019).
A positive patient outcome is a major goal for people working in the healthcare sector, and different medical organisations work together with various techniques to meet the requirement of patient satisfaction. There are several ways to achieve a positive patient outcome, and some of them includes facing challenges, promoting proper diagnosis, supporting optimal treatment plan, indulging in activities that will enhance the mental health of healthcare professionals in the organisation, improving outcomes through creating transparency between client and nurses, ensuring care to patients and supporting them after they are discharged and eventually using connected care to promote better outcome. During this incident, it can be said that the patient had a positive outcome because she was treated well with extra support for her daily chores (Moore and Cowman 2015).
It is seen that when individuals realise they are vulnerable to a threat, they tend to get distressed and agitated. This was quite evident in Erin’s situation because she was suffering from pressure ulcers and had a history of diabetes mellitus, which is the reason for the grade 2 level. Nurse-patient relationship in health organisations in affected by the conduct of the patient as well as the nurse and this depends on the diagnosis, treatment and follow up. The registered nurses should be well aware of the consequences of such disease because it can spread all over the body if not treated specifically.
When I interacted with her the next day, she shared stories about her personal life, and this made it evident that the therapeutic communication was taken in a positive light. As she had no one to take care of her when she was in her house, she used to cry in vain and call her long-distance friends. This took a toll on her wellbeing in the emotional segment because she used to feel that she is alone and had no companion to relieve her of her miseries (Miles et al. 2017). The social and economic factor contributed to her distress before she was admitted to the hospital. The day she was admitted, she hardly interacted with anyone, but the next day she was getting involved with others. This showed improvement in her demeanour and behaviour, which was only possible through therapeutic communication, and that led to positive patient outcome. Erin was given the recommended medications and care as prescribed by the experts. However, another thing that helped her was therapeutic communication because it made her evolve and express about her deteriorating condition (Moore and Webster 2018).
Conclusion
To conclude this essay, I will express that it was a complicated yet challenging experience for me as an intern to serve a critical patient like Erin. She helped me in realising several issues that needs to be given importance while treating a patient. Erin was suffering from anxiety and had constant stress about her health, and one of the severe issues might be death, which made her feel restless more often. Pressure ulcers are a type of bedsores that need constant monitoring and surveillance, which allows dressing and medications. Infection control is also necessary during this time as the patient is extremely vulnerable during this period. Her mental health was not in a positive state, which made me feel careful while interacting with her and it was evident that I needed to be aware of the consequences of negative behaviour with Erin (Nikayin 2016). She used to live alone, which made her more mentally deprived of affection and care. This might be one of the reasons she was interactive with other nurses and me during her stay. An empathetic approach is beneficial for the patient as well as the healthcare expert for the delivery of quality care and production.
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