SPROUT - assignment (reflection on clinical placement) PDF

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Rebecca Johns C3350870 SPROUT

Situation On placement, after lunch, I stopped by Mr. X’s room to check on him. I noticed he appeared visually uncomfortable so I asked him how are you feeling. He told me the he had bad chest pain I nodded and asked him to rate his pain out of 10. He answered 7/10, so I reassured him I would do something about it. Firstly, I directed Mr. X to sit down and relax while I removed his socks and loosened his other articles of tight clothing. I then proceeded to contact the RN. While awaiting the nurse I took Mr. X’s vitals, the results were blood pressure 134/88, O2 saturation 98%, pulse 81, and respirations 24. After observing Mr. X, the nurse informed me the source of his pain was GORD and administered PRN anti-inflammatories. I checked up on Mr. X shortly after the PRN and asked him to rate his pain again this time he noted no pain. Past experience From previous learning, at university, I was able to utilise my knowledge of PQRST to gain an accurate clinical assessment of his pain. I recalled that effective pain management improves quality of life by increasing a person’s phycological and physical functioning. Promptly after discovering Mr. X was experiencing chest pain, I drew upon previous workplace training that outlined if have suspicions of a person suffering cardiovascular failure you must help the person remain calm, sit down and loosen any tight clothing to reduce the stress on the heart. Further, my university study taught me the importance of collecting vital signs as they determine what treatments are required and are critical in making life-saving decisions.

Read and refer I consulted the RN about possible ways to improve my clinical practice and help identify between a heart attack and GORD. The RN advised me to review an article by Frieling (2018) that outlines heartburn appears as a burning sensation that typically occurs after eating and is usually accompanied by regurgitation of food, while a heart attack occurs at any time and characteristically creates an abnormal heart rate and a dull chest pain. In the case of Mr. X. GORD symptoms as outlined by MacFarlane (2018) can be managed through avoiding certain foods like chocolate or coffee, eating smaller portions, and sitting upright for two hours after eating. The RN further referred me to Michaelides & Zis (2019) article that explains while pain is an individual experience conditions like depression and anxiety commonly result in a decreased pain threshold. The RN explained above all else it is the responsibility of nurses to holistically care for patients and follow best practice to ensure optimum health outcomes.

Rebecca Johns C3350870 Other influencing factors Through reflection of my internal and external beliefs, I was able to uncover blind spots in my understanding of chest pain. My internal belief that all chest pain is cardiac-related is hazardous as it leads to premature closure that results in misdiagnosis and potential for serious injury or death. Additionally, my erroneous internal belief that GORD conditions wouldn’t score a 7/10 as described by Mr. X is inappropriate as it dismisses the individual experience of pain. Further, my external frustration influenced my practice as the AIN’s dismissal of Mr. X’s pain as anxiety-driven irritated me as I know this is not best practice to make assumptions about a patents condition. As anchoring to a diagnosis is dangerous as it inhibits the clinical reasoning cycle and prevents the person from achieving therapeutic healthcare. Moreover, my external anxiety about being in a new environment enabled me greatly empathise with Mr. X’s discomfort. This motivated me to alert the RN as I must advocate for patients to provide them the opportunity to receive high-quality healthcare and health outcomes.

Understanding This situation highlights the danger of anchoring to a diagnosis and the importance of following the clinical reasoning cycle to minimise errors and provide high-quality healthcare. Further, I have learnt pain is an individual experience that can be influenced by emotions and conditions like anxiety and depression (Michaelides & Zis, 2019). This knowledge enables me to treat a person’s physical and mental health in unison to help alleviate pain and promote physical and mental wellbeing. Overall, this experience enhanced my understanding of GORD by providing me first-hand experience and knowledge that can be utilised to help future patients.

Taking it forward Should a similar situation arise in the future, I will need to advocate for the patient by not anchoring to a diagnosis and following the clinical reasoning cycle. To achieve this, I must check my patients medical and social history to better understand their individual needs and tailor my care to provide high-quality person-centred care. Further, as outlined in the Nursing and Midwifery Board of Australia. (2016). Standard 3 I will continually advance my knowledge of disease processes and symptoms through literature to ensure a high standard of practice and to promote patient safety.

Rebecca Johns C3350870

References Athena Michaelides & Panagiotis Zis (2019) Depression, anxiety and acute pain: links and management challenges, Postgraduate Medicine, 131:7, 438-444, DOI: 10.1080/00325481.2019.1663705

Frieling, T. (2018). Non-cardiac chest pain. Visceral Medicine, 34(2), 92-96.

MacFarlane B. (2018). Management of gastroesophageal reflux disease in adults: a pharmacist's perspective. Integrated pharmacy research & practice, 7, 41–52. https://doi.org/10.2147/IPRP.S142932

Nursing and Midwifery Board of Australia. (2016). Registered nurses’ standards for practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professionalstandards/registered-nurse-standards-for-practice.aspx...