Nursing Reflection on General Ward Placement | Assignment Help

Placement as a Student Nurse at General Ward

As a student nurse, my recent experience gained during placement in General Ward was very enriching. I had the main duties to respond towards the patients complaining about the chest pain. I had the role of undertaking the notes regarding vital signs of angina, protocols for delivering oxygen masks and doing the ECG when needed. I had the duty to cross check the medications specially related to IV and correlate them with dysponea or tachycardia. I reported at emergency general ward at 9:00am daily where the patients with suspected cardiac diseases were admitted. My duty was also to monitor the electrocardioscanners and record the ECG strips during the periods when the patients experienced the symptoms of chest pain. As a student nurse at the general ward, my main duty was to act as an observant during the ECG processes and oxygen delivery protocols. During my observations, I learnt that ECG monitoring required preparation that including adequate skin assessment, moistening of ECH electrodes, setting and monitoring of cardiac alarms and ensuring that the ECG tracing was accurate enough. During my observation, I noticed that the “flat trace line of ECG” and the quality of “trace line of ECG” were very important to understand and manage. During placement, I highlighted the management to have a daily routine for checking the leads, display of ECG, electrodes, ECG cables and fresh gel sponge for understanding the problem with the trace lines if any.

Critical Thinking

“Maintain the Capability for Practice”

Throughout the career, using personal knowledge and reflection to update professional skills is considered to be vital for the medical professionals especially in cardiovascular genre (Coyne & Needham, 2015). The third standard of nursing is very important in the cardiovascular ward i.e. “maintaining the capability for practice”. Gilbert and Coyne (2018) stated that the nurse’s role in caring for ill cardiac patients requires the critical thinking skills and appropriate application of the evidence-based practice. In order to be able to provide holistic care, the nurses have to make clinically appropriate decisions for the CV patients. Especially, by maintaining the overall capability for practice, the nurses are trained for delivering high standards of nursing practice (Rajaganeshan & Ludlam, 2016).

It is important to know that the CV care delivery is safe, patient-centred, and culturally appropriate and fits in legal and ethical frameworks of the nursing profession. During the placement the student nurses were required to initiate the debriefing of critical events associated with CV procedures, promote positive culture amongst CV team, interpreting the latest information gained from public/professional sources regarding CV disease management, directing clinical support to less skilled CV team members and participating in professional clinical supervision and peer review processes as required.

At the General Ward, it was required by the student nurses to access the ECG scanners, blood pressure equipment, oxygen equipment and resuscitation equipment. All the student nurses in the ward were demanded to make regular notes of vital cardiac pain signs and link them with the theoretical study that they did. It was also required of them to keep written record of the activities they had performed or observed during ECG monitoring and oxygen delivering. It was mandatory for the student nurses as an observant to assist the patients and carers in debriefing of accurate health information so that it could be related back to the possibility of other heart diseases including tachycardia, acute coronary symptoms, acute pericarditis and aneurysms (Sala, Dicembrino, Dall’Argine, Baiguera, & Gazzotti, 2017).

The nursing students at the General Ward had to follow clinical services capability framework by continuously reading through the sections and guidelines associated with care unit services, interventional services, cardiac medicine services, cardiac outreach services and cardiac rehabilitation services. It was required at the ward to support practice within the legislative and regulative framework of the hospital. The nurses in the ward had obligations to demonstrate delivery of high quality, culturally competent and age appropriate CV services underpinned by effective communication skills. It was also required to ensure that the patients’ safety and care are set at upmost level during the assessment of the disease.

The most important duty of nurses at the ward was to educate the CV patients about self-assessment and self-evaluation of their heart on daily basis. The risks associated with coronary artery disease (CAD) can be reduced by managing health behaviors like blood pressure, cholesterol level, and blood glucose and diet quality. Hence, it is important for heart patients to get routine tests like fasting lipoprotein profile, body weight, Body Mass Index (BMI) and blood glucose to check on the risks associated with sustained heart disease. All the student nurses were also mandated to monitor their own stress levels during dealing with the heart patients and to take appropriate measures if the stress levels started impacting work performance during work hours.

Reflecting on Duty’s Impact on Patients

As the duties revolved around CV patients, so the nature of the responsibilities were usually complex and stressful at the placement in General Ward. During the observations of patients with chest pain, the student nurses were advised to monitor the pre and post procedural care areas closely. It was mandatory for all the student nurses to directly participate in the observation and care of patients undergoing ECG procedures. Patients’ monitoring, medication, administration and patients’ safety were of utmost importance at the General Ward.

According to Coster et al., (2018), nursing skills and specific training aimed at managing chronic patients ill with CV diseases directly impact the health and well-being of the patients. It was pointed out by Hivert (2016) that the nurses must develop professional skills to educate patients suffering from the CV diseases in order to reduce their risks of having chronic heart failures. Sala et al. (2017) also stressed upon the role of nurse in educating patients with CV diseases about self-management and self-evaluation.  Orlando (2019) pointed out that the self-care concept play an important part in the management of patients with CV diseases. It was also identified that nurses must participate in training programs for skills development so that they can themselves gain knowledge on the principles of self-care. Through following self-care principles, the nurses and doctors can improve their behavioral, cognitive and communication skills while easing the management of illness of the patients.

For the nurses, it is important to understand and apply the learning outcomes throughout the placement with the theoretical areas including atherosclerotic diseases, heath rhythm and conduction disorders, heart muscle disorders and structural abnormalities of heart. According to Sala et al. (2017), the proper assessment, planning and management of CV disease include the ECG skills, pharmacology and diagnostic tests. The nurses in the ward required to closely observe the ECG mechanics and rhythm recognition and get the specialist advice for patients with complicated healing during cardiac interventions. Before ECG monitoring, the nurses were required to apply theoretical knowledge of best practice in preparing the equipment that included steps like ensuring adequate skin preparation, using ECG electrodes with moist gel sponge, position of electrodes following agreed protocols, setting alarms according to patient’s conditions, ensuring ECG tracing accuracy and ensuring the visibility of cardiac monitor. All of these skills directly impact the health observation and identification of chronic heart diseases of patients.

Linking Duty with Standard

Throughout the placement at General Ward, the key responsibility areas that the student nurses had were associated with the standard of “Maintain the Capability for Practice”. The duties and the key areas of standard are shown to be linked with each other in the table below:

Standard Relevancy	Duties at Ward as Student Nurse
Demonstrating commitment to lifelong learning of self and others – Linking course learning outcomes to own identified learning needs – Supporting and encouraging the learning of others	1. Took notes of chest pain symptoms and matched them with the theoretical knowledge gained during degree for identifying any discrepancies and diagnosing the type of heart disease 2. Matched the diagnosis with theoretical symptoms on daily basis for improving any lags between knowledge and practical application 3. Kept the peers informed on diagnosis of missing symptoms from patients’ history for improving learning of others as well.
Reflecting on practice and responding to feedback for continuing professional development – Planning professional development based on own reflection on practice – Keeping record of professional development activities	1. Kept daily journal of number of patients observed and their associated symptoms of chest pain 2. Kept the ECG trace copies of all observed patients for analyzing the differences in heart rates fluctuation and the associated chest pain symptoms
Demonstrating skills in health education for enabling people in making decisions and taking actions on their health ­­­– educating patients in self-evaluation – assisting carers in identifying accurate medical information – referring concerns to health professionals – providing information on strategies associated with patient needs – preparing equipment	1. Educated patients on taking extra measures associated with monitoring blood pressure and blood glucose 2. Kept the clients’ family members informed on improving the patient’s dietary intake so that their cholesterol levels and glucose level can be managed. 3. Cross checked the medical information gained from patient or his family members with his history and medicine intake. Informed on the discrepancies to the medical carers involving allergies and non-suitability of some medications 4. Self-reviewed the ECG equipment preparation before the process initiated every time including display checks, cord checks, electrode plugs, trace visibility and gel sponge applications.
Demonstrate accountability for decisions and actions appropriate to role – provide care for patient safety – comply with standards of practice	1. Kept close look at applicable protocols during ECG process including skin assessment and infection areas 2. Ensured the application of fresh gel sponge on electrodes to avoid infection and other bacteria transferring to skin before ECG process

References

Coster, S., Watkins, M., & Norman, I. J. (2018). What is the impact of professional nursing on patients’ outcomes globally? An overview of research evidence. International journal of nursing studies, 78, 76-83.

Coyne, E., & Needham, J. (2015). Undergraduate nursing students’ placement in speciality clinical areas: Understanding the concerns of the student and registered nurse. Contemporary nurse: a journal for the Australian nursing profession, 42(1), 97-104.

Gilbert, J., & Coyne, E. (2018). Acute Care Nursing (6th ed.). Cambridge University Press.

Hivert, M.-F. (2016). Medical training to achieve competency in lifestyle counseling: an essential foundation for prevention and treatment of cardiovascular diseases and other chronic medical conditions: a scientific statement from the American Heart Association. Circulation, 134(15), 308-327.

Orlando, A. (2019). Perspectives From Well-Being to Organizational Health in Congenital Heart Disease’s Nursing Care. Congenital Heart Disease, 281-287.

Rajaganeshan, R., & Ludlam, C. L. (2016). Accuracy in ECG lead placement among technicians, nurses, general physicians and cardiologists. International Journal of Clinical Practice, 62(1), 65-70.

Sala, R. L., Dicembrino, R. B., Dall’Argine, S., Baiguera, M., & Gazzotti, L. (2017). Nurse training in self-management of patients with cardiovascular diseases: a multicentre observational study. Acta Biomed., 88(5), 22-30.