What were your primary concerns related to patient care? What were you primary concerns as a senior nursing student preparing for your final simulation?
Due to the fact that the patient has a chest pain related to acute coronary syndrome, my primary concern is to intervene as a soon as possible since if that does not happen he might be taken to the cardiac arrest since he is in unstable condition. As a senior nursing student, my first goal was to analyze and check the first problem that has brought the patient into the hospital by gathering information. Thereafter, I checked through all means how the patient could feel better by looking at the best intervention possible though doctors assistance.
Did you miss anything in getting report on these patients? If so why? Were you distracted? Did you receive too little information? Did you receive not enough or incomplete information? Were there environmental distractors?? What actions could you have taken to improve your patient report? What systems are in place that would assist you? (SBAR, etc.) Describe them.
I tried to get everything about my patient by carefully listening to the report of the nurses who were in the previous shift; however the information I received was not substantive enough to reveal the condition of the patient; especially the current situation. The major distractor of the report is that the patient was not interested in answering some of the questions as he felt very tired. However, I suppose using PASSMESAFELY report would have been the best option.
Did you have the required clinical knowledge and skills to manage the patient illness? If not, what concepts were you missing?
I have the skills and clinical knowledge to manage this patient and prevent him from dropping blood pressure and going into heart attack. Some of the experience and skills were acquired after reading a study by Martin, L., Murphy, M., Scanlon, A., Naismith, C., Clark, D., & Farouque, O. (2014). Timely treatment for acute myocardial infarction and health outcomes: An integrative review of the literature. Australian Critical Care, 27(3), 111-118. Particularly, acute coronary treatment is one the infections that require keen timing that in every operation carried. As stated by martin et al. (2014), every procedure must be timed to give correct interpretation of the findings.
How did you prioritize the patient information/data? On what did you base choice of intervention?
My priority on the patients information was based on the severity of his illness and the symptoms he presented. Particularly, the patient had a chest pain, no shortness of breath, crackles on the bilateral lungs, hypotensive, tachycardia, unstable oxygen saturation. To be specific, Airway, breathing, and circulation analysis were my top priorities. In the case of the patient, the airway was not compromised, his breathing was normal that is, 24 breathe per minute. Notably, his circulation was slow and reduced due to low blood pressure. Following the low blood pressure, I called my doctor to inform him about the incidence of the reduction of the blood pressure and asked for treatment orders. Due to that, the doctor ordered bolus normal saline (NS), and dopamine running at 5mcg/kg/min, maximum 20mcg/kg/min. then, it was titrated to keep the systolic blood pressure above 90.
What were your strengths during the clinical scenario? What areas do you think you could improve upon? How did you utilize the nursing process to enhance your clinical reasoning?
During the simulation, I could I identify some of the strengths that made me perform excellently in the program. They include team work that allowed me engage with other doctors in holistic manner. Additionally, I have assessment skills and able to recognized condition and symptoms in my patient. Moreover, I was also able to pick and follow the doctors orders from the doctors chart. However, I need to work on my communication skills which include verifying the doctors orders. Additionally, I need to take caution in timing. For example, I took a long time on setting up the pump to run the dopamine after I got the calculation. I did not check the monitor and set the 15 minutes cycle for vital signs to be taken. I was solely depending on what the monitor to tell me what was happening on my patient. I assessed my patient before I administered the dopamine drip; however, I did not reassess him 15 minutes after to see if his condition improved. Perhaps, it is the reason why his condition did not get better.
How would you approach this clinical scenario if you had to do it over again? Which objectives were you unable to achieve?
If I had to this again, I had to put emphasis on particular parts. First, I have to practice on my pump setting skills, drug calculation for drip, and re-verbalize the doctor order in order not to make the same mistake again. Secondly, I will incorporate assessment and critical/clinical reasoning skills, to create priority interventions for patients who have complex multi-system health care needs. Third, I will utilize effective communication skills in providing care to diverse patient populations and in collaborating with the professional team. Lastly, I will integrate patient care technologies, information systems, and communication devices that support nursing practice.
How would you summarize this experience?
My entire simulation was of great importance to me since it offered me an opportunity to practically apply the theoretical lessons I learnt in class. Generally, I have gained knowledge on how to handle patient. Lastly, I have learnt that as a nursing student, the patient is my first priority in order to ensure the patient safety in hospitals.
Martin, L., Murphy, M., Scanlon, A., Naismith, C., Clark, D., & Farouque, O. (2014). Timely treatment for acute myocardial infarction and health outcomes: An integrative review of the literature. Australian Critical Care, 27(3), 111-118.
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