Reflection on My Clinical Practice

I consider myself a naturally reflective person, and I bring that with me to my student nursing experience in clinical practice on a daily basis. However, sometimes this can almost prove more of a blessing than a curse, as happens when I make what I perceive to be a mistake and subsequently have difficulty thinking about anything else for a while afterward. This happened to me recently, when what should have been a small matter became blown all out of proportion. I work in an inpatient unit for women with gynecological problems, caring for four to six patients a day, and in this capacity, I also sometimes function as the charge nurse. My days in control of staff issues and the distribution of beds as charge nurses are often some of the most stressful because of the additional responsibilities of determining the best course of action for patient autonomy and patient advocacy. Though, these challenges can be invigorating as well.

On this particular day as charge nurse, things had been going moderately smoothly, though we were operating at full capacity for the unit. This was rather unusual, and pleasant in its own way. Then the husband of one of our patients came to visit, and the day ceased to be calm. I could hear the murmur of their voices from down the hallway as I worked at my computer, and it was obvious something was not entirely right by the way his voice continually rose in volume as hers continually lowered to the point of inaudibility. Soon, the call button was pressed and the nurse assigned to that patient bustled down the hall to address it. I kept an ear out, but I do not like to go over other nurses’ heads when I am the charge nurse. This might possibly have been a case of ignoring my gut instinct to go to the room myself. Had I not been so rigid in keeping to my original policy, it is possible some of the subsequent trouble could have been headed off at the past. However, inevitably, the amount of sound coming from the room continued to rise, and before long the nurse came to get me. I was already out of my chair when I saw him coming down the hall, and together we hurried back through the short corridor.

It turned out that the problem was simple enough—the patient had mentioned something about not getting enough sleep because her roommate was moaning rather frequently due to pain from uterine cancer. The sleepless patient was under surveillance for her high-risk pregnancy since her pre-eclampsia had recently turned into full-blown eclampsia, and the husband apparently had spent some time on WebMD and other internet sites the day before. He had learned that lack of sleep can be a seizure trigger, which is true, of course (Aragona, 2000), and so what had been a simple concern—the patient’s offhand comment about not getting enough sleep—became aggravated by stress until in the husband’s mind, our failure to get his wife a room of her own equated to malpractice. By the time I arrived, after the husband’s request to speak to someone “in charge,” he was already entrenched in his position.

I explained carefully, trying to stay calm so as to diffuse the situation, that the unit was completely full and we were not able to offer the patient a room of her own at that time, but that things could change at any moment and space might be freed up by the evening. He countered that he had seen the rest of the hospital on his way to the unit and that we clearly had space elsewhere. My response that it was against our usual procedures to put patients in other units did not help at all; I think I was forgetting the important fact that relating to people empathetically usually works better than bringing up high-minded corporate-sounding policy matters. Still, this was a complicated issue that the husband had unknowingly raise; bed allocation in inpatient hospital units is indeed a major area of concern, such that some have gone so far as to create simulations for determining the ideal distribution of beds (Vassilacopoulos, 1985). Perhaps I was being a little over-sensitive and thus defensive to his perceived criticism, particularly as I still sometimes have the irrational desire to be the perfect charge nurse. I also was failing to think through other possible solutions, for the encounter ended with the husband storming out of there, and it only occurred to me later as I was taking the elevator back down to go home that I could have swapped the woman with eclampsia around with another patient. Though I was not able to get her her own room, I could have at least done that, and the compromise might have placated everyone involved. Next time, thanks to the reflection I have now done, I will be more open to such possibilities and thus better able to imagine alternate outcomes.

References

Aragona, M. (2000). Abuse, dependence, and epileptic seizures after Zolpidem withdrawal: Review and case report. Clinical Neuropharmacology, 23(5), 281-283.

Vassilacopoulos, G. (1985). A simulation model for bed allocation to hospital inpatient departments. Simulation, 45(5), 233-241.