According to the New Collins International Dictionary of the English language, a reflection is to reflect or to be in the state of reflection. (Collins & Brash, 1983) In this essay, I aim to give a brief description of the skills assessment that I underwent, the thoughts and feelings it provoked, the evaluation and analysis of it ,conclusion and lastly my action plan.
REFLECTION OF THE SKILLS ASSESSMENT
As part of the Fundamentals of Nursing (FON) skills assessment, I had to attend a test on week seven. Wound dressing and vital signs were the two subjects of this assessment. I had to draw lots to choose which room and subject I got and then proceed to sit outside the room to read the case scenario within the allocated five minutes. Once the case scenario of taking vital signs was clear to me, I was allowed to enter the evaluation room to perform the necessary procedure on the patient within twenty minutes. During the course of the procedure, all the vital signs such as pulse rate, respiration rate, blood pressure and temperature were recorded on a clinical chart. The entire procedure was then assessed and graded by an assessor, who was observing my nursing skills.
2.2 Thoughts and Feelings
I felt really nervous and anxious before the skills assessment as I was seated outside the assessment room. When the time came for me to read and digest the background information, I felt overwhelmed as at that point in time, remembering the information on the sheet provided was just exhausting. As I was about to enter the room and the previous student came out crying, I felt even more nervous as that gave me an intuition that the assessment might be a challenging one . Despite that, I mustered all my confidence and proceeded with the nursing procedure when my turn came. I carried out the procedure in a calm and smooth manner. After my task was complete, I felt satisfied with my performance and happy with myself for having prepared well for the assessment before-hand as it turned out to be a good experience.
On the whole, the skills assessment was a memorable experience for me as I felt that I had carried out the nursing procedure efficiently, keeping in mind all the protocols that had to be followed. Also, the six domains namely critical thinking, communication, technical skills, management of care, safe practice and professional and ethical practice were carried out to my ability in many instances. Then again, I could have done better in certain areas.
For instance under the critical thinking component, I could have planned my working area carefully. Instead, I was immediately involved in attending to the patient and completing the procedure within the time limit which should not have been the case. As a result I had to move around quite a bit which could have been minimized with careful area planning.
On the part of communication, I tried my level best to re-assure the patient and addressed his anxiety to a large extent. This skill I believe I portrayed well.
In terms of technical skills, I was unsure about my readings for the systolic and diastolic blood pressures and I had to repeat the procedure twice in order to double check my first reading. Even then, I experienced some level of uncertainty with the readings. Thus, I have to improve my skills in this domain to become a better healthcare professional.
To add on, I managed the patient’s care relatively well as I made it a point to ensure that he was feeling comfortable throughout the procedure. Keeping in mind the importance of understanding the emotions of the patient (Matsumoto & Hwang, 2011), I took note of the changes in his facial expressions to make sure he was receiving good care and was not in any kind of stress.
To ensure safe practice I had carried out good hand hygiene however ,I almost had forgotten to clean the ear plugs of the stethoscope, thereby downplaying on safe clinical practice on protecting myself. Furthermore, I had also plotted the readings on the wrong column which was an unacceptable mistake.
Lastly, on the part of professionalism and ethical practice, I believe I had done a commendable job. I kept the patient informed on the risks he was taking by undergoing the cataract surgery. Also, I kept the staff nurse informed of his concerns and his rash that he had developed. Apart from these, all the procedures during the assessment were within the terms of ethical practice.
For in-depth examination, I have analyzed my skills in each of the above mentioned six domains.
Critical thinking is defined as the disciplined, intellectual process of applying skillful reasoning as a guide to belief or action (Paul, 1990). In nursing, critical thinking for clinical decision-making is the potential to think in a organized and sensible manner with the readiness to question and think carefully about the reasoning process used to ensure safe nursing practice and good care. (Heaslip, 1993) In the nursing profession, it is important to plan carefully to save valuable time while attending to the patient. During my practical assessment, I could have placed the hand sanitizer on the same table as I had placed the other medical requisites on. This would have prevented me from constantly shifting to the table close by to perform my hand rubs, saving time. As mentioned by Mr. Tan during lab sessions, area planning is very important. Nurses also need to apply their intellectual skills for sound reasoning. (Heaslip, 1993) Having noticed rashes on one of the patient’s arm, I chose to take blood pressure from the arm with no rashes as placing the non-sterile cuff on the affected hand could have worsened the rash.
As for communication skills, I believe I played a good role as a nurse by clearly explaining the risks involved in the cataract surgery to the patient. As pointed out by Crow et. al, it is paramount for a patient to be aware of his/her medical condition and develop a better understanding of the procedures involved. (Crow, et al., 1999) To add on, I informed him of his various readings to ensure his awareness of his medical status.
In terms of technical skills, I could not distinctively identify the Korotkoff sounds hence had to repeat the blood pressure measurement. When I re-took the blood pressure however, I found it hard to release the pressure as I had turned the valve a little too much making it too tight to be released. It is mandatory for nurses to be fluent in the procedures. (Rennie, 2009) Hence, I should keep in mind not to turn the valve too much to allow easy release of the valve in future.
During the procedure, I constantly made an effort to ensure that the patient was feeling comfortable by questioning him frequently instead of just carrying out the nursing procedure silently. Reference to Bensing, reveals that it is important for nurses to communicate at an emotional level so that the patient feels cared for and also helps disclose his concerns which he might otherwise not reveal. (Bensing, 1991). Also, I addressed the presence of the rash on his left arm and questioned him on how it originated instead of only taking note of his vital signs. These actions I hope would have sent across the message to the patient that I cared for him well.
In terms of ensuring safe practice, I kept the staff nurse informed about the rash the patient had developed on his arm and what medication he had previously consumed which might have led to the allergy. However, I had not plotted the readings taken on the correct column onto the clinical chart. I was unaware of this mistake until I read the remarks on the assessment sheet. Therefore, I have to strictly avoid such a mistake in the future as it may lead to further misinterpretations.
My professionalism and ethical practice was portrayed rather well as I maintained a steady and confident poise which I trust would have also allowed the patient to place his trust in me to carry out the nursing procedure safely and effectively. Butts has given a detailed description of the ethics that needs to be followed in the nursing profession (Butts). Not only that, I ensured that the patient was aware of the side effects and risks involved in the surgery so as to maintain ethical practice.
All in all, this reflection has helped me better identify my mistakes in this skills assessment and how I can further improve myself in the near future. Not only that, it has also aided me in the pursuit of realizing the importance of the six different domains that we were assessed on. This assessment was also a good platform for us to reflect upon ourselves and further improve our nursing competencies bringing our skills to a whole new level. At the end of the day, such assessments are the ones that mould us into trustworthy and reliable healthcare professionals.
2.6 Action Plan
In similar situations in the future, first and foremost, I would quickly run through area planning in my mind so as to maintain minimal movement to save time when I am carrying out my nursing procedure. Then, when I am taking the patient’s blood pressure, I will remind myself not to turn the valve too hard so that it will be easier to release the pressure from the cuff when I am recording the blood pressure readings. Most importantly, I would ensure that I record my findings accurately onto the clinical chart. I hope all these precautions will help me carry out my duty as a nurse efficiently in years to come.