Monday, August 17, 2009

Clinical experience

This is actually my assingment that i had submitted to my lecturer on 17th April 2008. The final mark is quite high actually. This is a story about my experience during my first year of becoming a nursing student and practical in Hospital. Just want to share it with you guys.

"As time goes on, I am now realize that I had reached the end of semester 2 and now its time for I to apply what I had learned for 6 weeks to the clinical practice. From now onward, my responsibilities are much greater because I can now apply a lot of nursing care from medication to injection. On 17th March 2008, Monday is the day for my friends and I to begin our practical day at the first IT Hospital in Malaysia, Hospital Selayang.

My emotion and feeling were under control, compared to as I was on semester 1 which had always been blurred and afraid to do everythings. Hospital Selayang are far more advance and organize rather than our previous posting Hospital so it gives us a fresh start and pleasant first impression, but of course the most important things is the quality of the care. Because without it, we can not ever improve the standards of care.

For the first three weeks from 17th March 2008 to 4 April 2008 I, Aziah were supposed to go to ward 9C that is the medical ward. The Sister and staff nurses are very helpful and kind to us. We had learned lot of new things and gain experiences through their guidance".

In the ward:
"Puan M, 64 years old had Diabetes Mellitus Type 2 for 30 years and Hypertension since 12 years ago. According to her medical diagnosis, she had an end-stage renal disease, retinopathy (cataract) and had a big foot ulcer on her left foot due to serious infection and gangrene. So as I had tried to go through her case, I had identified a few of nursing diagnosis. First is imbalance nutrition related to inability to meet metabolic needs, as evidenced by hyperglycemia. Second is risk for infection related to delay healing and stasis of body fluid. Third is fluid volume deficient related to hyperosmolar urinary losses and inadequate intake, as evidenced by increased urinary output, thirst, and sudden weight loss. Lastly is fatigue related to decrease metabolic as evidenced by overwhelming lack of energy. (Taber’s, 2005)

As I kept on monitoring her case, I felt really sorry for her as she had to deal for such difficulty. Sometimes I can see her looking very depressed so I always try to cheer her up by communicate with her and try to develop a relationship between nurse and patient. As were told by the theory of interpersonal relations concepts.

Peplau (1952) theory explain that the interpersonal process that occurs when an ill person and a nurse come together to resolve difficulty felt in relation to health. (Berman et al., 2008)

Because of her complex healthcare problems there are several medical and nursing intervention used to treat her. So each morning, after we had done sponging to her to promote healing process, I had to make sure that her fluid and electrolyte are balances by administering normal saline according to the regime as prescribe by doctor. Then is to monitor her fluid intake and output, for evidence of any dehydration and hypovolemic hypotension. Next is to monitor her serum electrolyte blood urea nitrogen levels. I also had to monitor her blood glucose level daily usually three times per day. My target is to make sure her non fasting glucose level is within 4.4 – 8.0 mmol/L (Lemone and Burke, 2008). Because when she admitted to hospital her glucose level is 16.7 mmol/L. After that I had to administer her medication and insulin injection. My first experience to give oral medication to her had not gone so well. I was very confused because the names of the medicine are so unfamiliar and sometimes they use the trade name not the generic name. She had to take T. Enalapril, T. Calcium Lactate, T. Rocaltrol, and T.Celebrex (Adams et al, 2008). So when I finally ready to give it to her by following the 5’s right, she refuses from taking it. In my mind I started to think why did she trying to make my life more miserable. I try to persuade her to take it but she did not want.

I said “aunty if you do not want to take this medicine, you can not heal quickly and might give complication to your illness”. Then she replied furiously “I do not want to have it, go away, leave me alone”.

At first I was fed up and just want to ignore her.But because I am still under control, I just report it to the staff nurse in charge.The staff nurse suggest to me to wait for awhile and try to persuade the patient what she really want. So it turns out that she want the tablet to be crushed and dilute it in water; then administer it with syringe. And so i just follow her way.

Then usually she had to be given subcutaneous actrapid insulin, 30 minute before her meal time (Perry & Potter, 2006). Because her blood glucose keep on fluctuating from 15.6mmol/L to 10.4mmol/L. Luckily during the insulin administration Puan Manisah had given a full cooperation. The only problem is that, I felt unconfident that make my heart pounding so fast and my hand kept on trembling. Maybe it is because this is my first subcutaneous injection but I manage to do it under the supervision from staff nurse Melah.

For her foot ulcer at first we had to leave it to the specialist in charge. From what I see in the treatment room the specialist remove part of the dead tissue like a debridement procedure on her infected foot. After that the daily dressing must be done to promote wound healing and prevent the foot from infection. She was also were visited by the dietitian and was taught about the proper diet. Lastly before she is discharged I manage to share some of my knowledge about the foot care for diabetics and types of exercises suitable for her feet.

From this experience I had learned a lot of new things, first is always appreciate that clients are just a normal people who had feeling that need to be expressed. I should not have though about bad things to do toward the patient, because she had developed so many complications and pain. Thus, I now try to understand the client and to control my temper. If only I had tried the tender loving care (TLC) concept when giving the medication, for sure she will listen to me. Next is always be confident and calm to do something challenging. I should not have been afraid to do the injection just because it is my first time. What if something goes wrong? I could possibly hurt the client and for sure I do not want to be called nurse from hell. But now as I kept on giving injection to other clients, I am now more experience and brave. As a saying goes “practice makes perfect”.

As for conclusion, I now know how to manage diabetes mellitus type 2 patients. Moreover I had learned how to deal better with certain situation and had helped me to know better when confronting with other problem. Studying the theory is different from performing it, so in my opinion this practice had made me more aware and understandable about diabetes".

So there you have it. The story of my experience when I was in year 1.


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