PNH210 LEARN Note – Elyssa

LEARN NoteElyssa Anne Medel141489187PNH210Elizabeth Villar-Guerrero October 14th 2019LEARN NoteIt was last September 28th 2019 when I finally met the patient that was assigned to me in unit A4 – Geriatric and Medical Rehab at Providence Hospital. I was anxious about how my patient would respond to me and how I would do my assessment, even though I have thorough understanding of how to perform head-to-toe assessment theoretically. I also felt that way because it was my first true patient experience. At school, we would practice either with the simulation mannequin or with a classmate. As per routine, we would start our shift by checking patient’s chart to see if there’s a new order from the physician. Then, we would continue by taking vitals before they began their breakfast. As I served my patient’s breakfast, I noticed that his weight is less than his body requirement. That is when I realized that his nutrition is affected by his recent GI surgery due to the complication with his ileostomy bag. After breakfast, the nurses in the unit started to administer medications then right after, it was time to give or assist patients for shower/bath. I told my patient that I was going to give him a shower. The patient asked to give him an hour before going to the shower as he felt really tired. He stated that he did not get enough sleep last night and he also stated that he feels very tired whenever he drinks his medications. I decided to help my nurse with the other patients since he didn’t want to go yet. I mentioned what my patient told me to the nurse. She then urged that I go back and persuade him as he often does it. I came back to speak to him. The patient argued that he’s too cold for shower that day and also, he is scared that I may cause complication to his ileostomy bag. I assured him that I would take extra precautions to protect his stoma but he still refused. I told my nurse what happened on my second attempt and she decided to assist me to get my patient up. The patient got very upset. I felt like I got him upset as I kept coming back to his room and interrupting his rest. Although I believe it was because since it was our first encounter and I will perform an intimate care already. According to Yachnin et al., (2017), “Requiring assistance for a private and personal activity such as toileting can be detrimental to a person’s self-esteem and sense of well-being, and may contribute to depression”. I am aware that my patient is also dealing with depression so I tried to empathize with him but sometimes patients do not understand why we insist in doing our care and that all we ever wanted was to help them reach optimal health. Even though I feel that the patient was just diffident, I still felt useless to the unit at that point that I couldn’t even manage one patient. I felt powerless. According to the College of Nurses of Ontario [CNO] (2006), “The nurse-client relationship is one of unequal power. Although the nurse may not immediately perceive it, the nurse has more power than the client”. This guideline made me realize that I should be firm when dealing with situations like this. This also enlightened me that I should be able to show my clinical instructor, the nurses in the unit, and most especially the patient that I am confident and comfortable doing in doing my task and what I was asked to do. I also sought advice and took some points on how to improve myself with the nurse with whom I am working with as the nurses know the patient very well. Although I was a little unhappy with how I handled the situation, I will count this as a learning experience for everything I had or will witness and encounter. Also, I strongly believe that accepting feedback from my clinical instructor will help me improve not only my skills in the clinical placement but also in my future nursing career. ReferencesPractice Standard – Therapeutic Nurse-Client Relationship, Revised 2006. (2005, January). Retrieved October 1, 2019, from https://www/cno.org/globalassets/docs/prac/41033_therauptic.pdf. Yachnin, D., Finestone, H., Jutai, J., & Chin, A. (2017, May 12). Can technology-assisted toilets improve hygiene and independence in geriatric rehabilitation? A cohort study. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/17483107.2017.1358303.

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