iStan Reflective Journal 10/17/16

Today, 10/17/2016, during simulation lab my classmates (Nora Magnone, Staci Chastang, and Kasey Douglas) and I collaborated together to provide optimal care to a 28 year old client admitted with severe dehydration related to a 5 day loss of appetite 10 days after a transverse loop colostomy and colectomy. To start off the simulation, we had to go retrieve the patient from the sitting area outside of the Tyson building. When we arrived, he had eaten a large portion of Chik-fil-a and had a cigarette in his mouth. After retrieving a stretcher and getting the patient back up stairs, we worked together to assess his nausea and abdominal pain levels (as he had been on a clear liquid diet since his admit to the hospital) along with address the patients smoking history. After getting the client back into bed, we did a complete head to toe assessment, paying special consideration to his ostomy to check for color of the stoma, and discharge, skin irritation around the site, any leaking from the ostomy bag, and characteristics of the stool in the bag. Aside from this, we administered Zofran 4mg to relieve his nausea, obtained laboratory samples (CBC and and BMP), we provided education on ostomy care, and contacted social services to obtain a counselor for ostomy patients having difficult times coping with their new disabilities. We worked to provide a safe and open atmosphere for the patient to be able to talk and discuss their thoughts and concerns.

Throughout the simulation, I learned the benefits of working together as a team not only to divide and conquer, but also to use each others strengths in a way to benefit the patients and provide optimal care to not only this patient but also others down the line. We reviewed the correct method for labeling venous laboratory blood samples and the importance of assessing all characteristics of ostomies. Lastly, I learned to just take a deep breath and think critically so that regardless of what is going on in and outside of the room, my main concern is my patient’s care and wellbeing.

I do feel that as a whole, I could have utilized the white board more and communicated more information to my group members immediately rather than taking a second to finish my task and then communicating to them. I also feel as though I need to improve on my communication skills with the patient, where as I feel like I asked the patient appropriate questions and communicated well with him, there is always ways to improve patient-nurse interactions and being able to easily ease their fears along with thoroughly educating them is something I strive to work on with each clinical experience.

While watching my peers’ simulation experience, I learned how important and inconvenient it can be to the client to label laboratory tests incorrectly, especially if it is something that the client has already expressed anxiety with previously. I feel as if my group used the white board effectively to communicate with was going on with the patient and everyone was very open as to what they were currently working on and what their next plan of action was. Being as there were 4 people in the room, we were able to split up each task, assist each other as needed, chart, and document all while being completely interactive with the patient with ease. I feel as if every individual who used the phone were able to effectively communicate and used SBAR accurately when contacting lab, social services, and the doctor’s office. I am very pleased with how well my group worked together during this simulation.

I feel as though my simulation experience allowed my group to practice several classroom skills and patient education tools we have learned throughout our nursing careers. We practiced the six rights of medication administration and performed three safety checks before administering medications. We safely transported the client from a chair to a stretcher, through a building and elevator, then back into his bed with the proper technique. While the patient was outside, we made sure to get a brief assessment done so we would know before getting up to the room what extent of care needed to be performed, and we were able to practice our education skills through teaching about the medication given, dietary intake and how it effects GI motility, and we worked to meet the emotional needs of the patient by listening to the concerns expressed over the ostomy and its care. Overall, my group did amazing and I thoroughly enjoyed the opportunity to work with each member!

Kayla Grice