Nursing: Clinical Reflection of the Nursing Students' Performance

Categories: Nursing

Reflection, Pages 4 (936 words)

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Mahlanze and Sibiya (2017, pp 79-86) states that “Nursing students are placed in clinical practices to correlate theoretical knowledge with practical nursing skills in a clinical environment and to socialize students into personal and professional behaviors and practices”.

The aim of this essay is to reflect on a practical skill completed as a student nurse while on placement at a healthcare facility delivering care to a patient. The subject is the removal of an intravenous cannula from an individual admitted to the unit with a neck of femur fracture.

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The Nursing Times, (2017) states that intravenous cannulas are used on patients for the administration of fluids, nutrients, IV medications, blood products and for procuring blood specimens. The NMC, (2018) states that nurses and nursing students are to always uphold the professional code of conduct by respecting a patient’s right to privacy and confidentiality. Therefore, for the purpose of this piece, the patient will be referred to as John to protect his right to privacy.

Gibbs, G. (1988) cycle of reflection which is involves the description, feelings, evaluation, conclusions and action plan will be used to discuss my experience of the nursing practice. Barksby et al. (2015), suggest “using a model when reflecting can help users focus on learning and self-awareness after an incident”. Similarly, Moon (2004) recommends the use of reflection in practice when dealing with challenges encountered in the clinical environment, and Husebø et al. (2015) and Sun et al. (2016), agree that reflection in practice has its own learning values and contributes to better learning.

Prior to this incident, I had been shown the process of removing a cannula by my mentor and then observed performing the skill on several occasions.

After arriving on the ward for my first night shift, I was asked by the nurse in charge to remove a cannula from the patient named John who was deemed medically fit for discharge. She told me that she had full confidence in me and that I could do it as she had seen me removing cannulas several times before under supervision. I started the process by seeking consent and explaining the procedure to John. Having gained his consent, I slowly and gently removed the tape securing the cannula until it was all loosened from John’s arm. I then began to pull the needle gently and swiftly out of the vein and placed some gauze over the area to prevent bleeding and secured it with tape. I took the cannula in a dish to the clinical room to dispose of it using appropriate sharps procedures. When I returned to the patient shortly thereafter, I was shocked to see he was bleeding profusely from his hand from the site of entry. The nurse in charge was holding on to John’s hand reassuring him that the bleeding would soon stop and at the same time she was applying pressure to the cannulation site. She told me not to be alarmed because she could see how frightened I looked. She said John had told her that I had done an excellent job removing the cannula, but she reminded me of the importance of applying pressure to the insertion site after removing a cannula in the future.

When I was first asked to perform the task, I felt very excited and confident to complete the task. I was delighted to be given the responsibility to carry out the procedure unsupervised, for the first time. Also, because I had cared for John before and formed a therapeutic student nurse patient relationship with him, I felt even more confident to do it. I was able to successfully remove the cannula and felt competent and confidant having done so. However, once I returned and saw that my patient had bled so much, I became very anxious and scared. I was confused for a moment trying to think of what I had done or not done to cause that much bleeding. However, even though the nurse assured me that I had done an excellent job I could not help but feel at the time that I had disappointed both John and the nurse who had placed their trust in me to deliver care safely. I believe my future performance will improve significantly especially as I had a discussion and was made aware of the issue that caused the incident.

In hindsight, despite the mishap that occurred and how I felt at the time, the nurse had full faith in my ability to perform an invasive task competently. I did manage to complete the task however I was not thorough enough which was a problem. In this case the patient lost blood, but his health was not compromised due to the action of the nurse in charge. My mistake was an omission of action as opposed to an incorrect action. However, as a professional and competent practitioner I would be expected to carry out such a procedure to the high standard expected.

The royal college of Nursing, 2007 outlined that nursing students are to achieve High quality, practice-based education in a clinical environment in which they can apply their knowledge, learn key skills and achieve the required competence for entry to the register. However, the NMC, (2018) states student nurses need to “recognize and work within the limits of their competence. I do feel that the environment was safe and that I was tasked to perform a procedure I had knowledge of as well as some prior experience. I believe that with greater experience a situation like this could still occur, but I am now mindful of the immediate steps I would need to take to remedy the issue.