I am writing this reflective journal in accordance with the CNO`s reflective practice standards and the LEARN model. Though my time on 600A has only just begun I have learned so much. Like many second year students, this is my first experience in the hospital. It has proven to be much different than my previous clinical experiences. My time with my first client stands out in my mind as a key learning experience.
I like to believe that I am caring and compassionate with everyone I meet, especially in a professional setting. This particular client was a lady in her early 80s. She was good natured and very easy to get along with. She was cognitively aware and quite bright. As a result of bowel surgery she had an ostomy. This was new to her and I could tell she was unsure about it. My first day with her we did a lot of chatting and sharing. She told me about her husband, children and career as a kindergarten teacher. This helped build a certain level of comfort with me as a caregiver.
I had her to come for walks with me down the hall and once she was up and moving she said she felt much better. I helped her with her first shower post-op. I made her feel more comfortable by promising to stay outside the door while she was in there. When she was finished, I helped her to apply lotion to her dry skin and at her request gave her a good back rub. My shift ended and I said my goodbyes. My client told me she was sad to see me go and was looking forward to my return the next morning.
That night when I went home I did some research into ostomies. Through my textbooks and previous experience I had a solid knowledge of the basic care but just in case I wanted to refresh.
I was excited to return to clinical the next morning. My client had a big smile for me when I walked into her room. Throughout the evening the ostomy nurse had come in, did some assessments and quickly taught my client how to empty and clean the appliance. Unfortunately since the nurse was very busy she did not have the time practice with her. My client told me she was unsure and nervous about performing the task. Since I had taken the extra time to do the research the night before, I was able to take the client into the bathroom and walk her through the steps. I had the knowledge necessary to put my client at ease and make her feel more comfortable with this new situation.
My client went home that day while I was still on shift. Before she left she thanked me and told me she wouldn`t have felt ready to leave if I had not been able to teach her about the appliance. She even made sure I met her husband and he thanked me as well. I felt very proud to be a student nurse that day. I believe I had a positive impact on that client. I took the time to care for the client and attend to her post-operative needs.
As the former president of the CNO, Sandra Ireland said, “Nursing is not like any other job — it is a profession that allows us to influence lives in ways that we know and ways that we cannot imagine. Clients and families carry with them the words of comfort, caring and encouragement you say during difficult times and throughout the rest of their lives.“ (Ireland, 1998) My client had a big adjustment to make and I was there to offer the support she needed. By taking the time to care about my client, not only as a client but as a person I was able to make her stay at the hospital a better experience for her and her family. She felt comfortable and well cared for and her husband was more at ease knowing people were there to care when he couldn`t be. I was able to anticipate the client`s needs and prepare myself to assist with those needs as they arose.
The Sault College Practical Nursing Program beliefs on caring are outlined in the student success guide. It states, “Caring is the essence of nursing practice. When caring is the foundation for helping relationships, each person is a partner in growth towards optimal health. The interpersonal connection between caregiver and client transcends time, gender and technology. It is our view that caring, as an interpersonal interaction can be learned. A caring nurse strives for competence and excellence in the professional practice.
Caring can be modeled, acquired, practiced, perfected and evaluated.” (Sault College of Applied Arts & Technology School of Health & Community Services, 2008) Based on this principle of caring I feel I did a good job of caring for my client post-operative needs. I was able to form a caring relationship with her. I was competent in the skills I performed with her and she left me healthier than when we first met.
My care was lacking a holistic approach. Looking back I did an excellent job at caring for this woman and her new ostomy but I forgot about just the woman. Lois White explains, nursing the whole person: physical, emotional, intellectual, psychological, spiritual and sociocultural, is essential to ensure the health and well-being of a client in the healthcare system. By ignoring the other areas I did not provide the best care I’m capable of. She may have had some self-esteem issues related to having this appliance or concerns about how others will react, especially her family and friends. An ostomy is a huge adjustment to make and as the nurse I could have offered some support.
The more time I get to practice caring and working on interpersonal connections with clients the better I will be at caring. I believe caring is an art and a skill and they only way to perfect it is to do it. I will try spending more time thinking and planning how I am going care for my clients. I will reflect on how my work with clients affected them and gauge this with their reactions. The client themselves are in the best position to evaluate my skills as a caregiver.
This week when I return to the clinical setting I will put my new approach into action. After data collecting I will think about more about the holistic person than just treatments involved with their current surgery or illness. I will do my best to identify any issues fears the client is facing and offer support for these. I will speak to my client about their mental and social wellness and do my best to assess their status within my scope. If nothing more I may be able to offer brochures or phone numbers for support groups in the area.
While working with the nurses, I will observe their interactions with the clients and the care they provide. I will attempt to use the good I see and learn from the bad. If I find someone with a style of caring I truly admire I will find time to discuss it with them and take in any jewels of wisdom they have to offer me.
At the end of the day or when I find a quiet moment I will reflect on the care I provided that day. I will think about my clients, and how I made them feel. My goal is receive positive feedback from all the clients I interact with each clinical day, whether it is verbal or a simple smile. I will leave my clients knowing that I provided them with the best, holistic care I could.
I would also like to take some time either on a break or after clinical ends and really talk to my classmates about how they feel they are doing. We could discuss not just the new skills we learned and may have preformed, as per usual, but their progress with caring. Through this reflection I expanded my definition of care. I have always provided good care for my client’s ailments but I never took the time to really think about everything they may need to feel well again. Secondly I realized in order to be a truly caring nurse you need to take the time to think about your actions and interactions with clients. Reflecting back on the day, whether it is formal and written as in this journal or with classmates on the way home, will help me learn, grow and develop as a nurse.
Ireland, S. (March 2004). President`s message. The Standard, 29 (1), 4. Sault College of Applied Arts & Technology School of Health & Community Services. (2008). Practical nursing program student success guide 2008-2009. Sault Ste Marie, ON.
White, Lois. (2000). Foundations of Nursing: Caring for the Whole Person. Albany,NY: Cengage Learning