After watching the video, reflect on the nursing care given to the patient in the video. When writing the guided reflection, consider the following questions:
1. Identify the assessments performed. Were these assessments adequately prioritised?
2. How effective was the communication between the two nurses? Did it promote teamwork?
3. How effective was the communication between the nurses and the patient?
4. Identify the post -op orders. Were all of these discussed?
5. Based on literature, are there any recommendations to improve for future practice?
Post-operative care is aimed at preventing or recognizing post-operative complications in order to help the patient get back to their normal physiological activity, a prioritized and complete assessment should also be applied (Tollefson, 2012). I am going to carry out an in-depth reflection about a video that of a Ward nurse that receives a clinical handover of a patient who has undergone an appendectomy. I am going to provide an insight on some nursing interventions as well as nursing assessments that were carried out by the nurses. Moreover, I am going to comment on the interaction and communication between the nurses and Karen, the patient. My paper will also identify the post op orders that were performed.
Five Assessments Required for Postoperative Care.
The assessments conducted on the patients were prioritized to ensure that the patient recover well.
In the video, I observed how the PAR nurse provided a verbal report to the surgical nurse about the patient in the beginning after which they performed thorough nursing assessments. I noted that the nurses performed a head to toe assessment by starting with the neurological assessment. The neurological and neurovascular assessments that they did aimed at identifying vital diagnostic signs that would then be used to assess any post-operative complication such as hypovalaemia, pain; respiratory complications, infection, or electrolyte imbalance that can cause disorientation, restlessness, and delirium. I learned from the literature that long surgical procedure that takes quite a long time with prolonged anesthetic administration may result to redistribution of heat in the body from the centre to the periphery this exposes the patient to hypothermia risk (Brown & Edward, 2012). The nurses appropriately performed neurological assessments and a GCS score of 15 with reactive and equal eyes were their results.
When neurovascular assessment was conducted, the nurses determined that the patient had normal pulse as well as blood pressure. They then sought to examine if they could identify any signs of swelling, warmth on the legs. They further checked the peripheral pulse, which was normal too. According to Tollefson (2012), a patient cannot walk effectively after surgery and therefore, he/she has higher chances of developing Deep Vein Thrombosis (DVT) therefore clinicians should apply Ted stockings to promote circulation of blood in the legs. The nurse, however, did not explain adequately the rationale of using the Ted stocking. Respiratory assessment was also conducted. Chest infection and pneumonia are some of the complications of the respiratory system that are likely to be determined by this assessment. (Brown & Edward, 2012). Moreover, analgesic opioids can induce respiratory distress (Bryant & Knights, 2010). In addition, the nurses assessed the wound at the surgical site to identify if there was any sign of bleeding and redness. During the assessment they noted that the wound was oozing and this prompted the need of a cotton pad application as surgical dressing. However, I observed that hand hygiene technique was not properly observed before touching the surgical wound. This is against clinical practice which recommends that aseptic techniques should be put into consideration especially when handling wounds (Koutoukidis, Lawrence and Tabbner, 2008).
The fourth assessment done was on Karen’s circulation, which includes color and appearance of skin (Brown & Edwards, 2012). The nurses learned that Karen had no swelling and good peripheral pulses. This was an indication that Karen was less likely to have potential circulation problems. Nurses also assessed Karen’s urinary function through asking her urgency to go to the toilet. Brown and Edwards (2012) stated that both quality and quantity of urine should be examined for postoperative patients, because potential complication may happen such as impaired urinary elimination or urinary retention. The assessment approach of the nurses was good but then they should have gotten an informed consent from Karen and carry out an assessment on her level of pain before commenting the respiratory exercises of the patient. I also observed that they checked for redness, inflammation and blockage at the IV site and also ensured that the Patient Controlled Analgesia (PCA) used for pain control was functioning well. The two nurses generally did a good assessment and in a systematical order. However, it is better to assess breath sounds at first before neurological assessment, and assess limb movement when carrying out neurological assessment.
Communication between Nurses and the Patient
Communication is one of the most important aspects when providing care to patients and should therefore be taken into account. Literature defines clinical handover refers as the transfer of professional obligations, duties, and accountability of patient care from one healthcare official to another (Government of South Australia, 2014).In the video, communication between healthcare officials, that is, between nurses and also between the patient and nurses was not effective. For instance, the two nurses began the handover without introducing themselves, especially the receiving nurse since she was the new person to Karen this could be a source of confusion to the patient. However, the PACU nurse explained the handover clearly about Karen’s situation and showed good teamwork when performing the assessment. Team work was exercised when they were examining vital signs and when the receiving nurse asked the PACU nurse to put the side rail up together.
In a few cases, the communication between the patient and the nurses was not therapeutic. They performed some procedures without getting Karen’s consent. An example is when they took the blanket off Karen’s legs and lifted the rails of the bed without letting her know about it. It seemed that she felt nervous prompting her to ask why they were doing it. Then, the PAR nurse explained the rationale to the patient. They should have informed her prior to the procedure. However, in some occasions the nurses interacted with Karen appropriately. For instance, the nurse aided patient in performing the respiratory exercise such as taking deep breaths and coughs. She also supported the incision with pillow and explained the reason for doing it. The nurses already had established a conducive environment that made the patient feel at home. The tone of voice, facial persons, and eye contact and body gestures of the nurses helped in creating siren environment for negotiation. The patient responded appropriately to the queries the nurses asked which helped to gain in depth understanding about how she was feeling and she provided her another blanket when she reported that she was feeling cold. At last, the nurse showed Karen her PCA buzz and told her that she would come back to check her shortly, this might decrease her anxiety and showed good therapeutic interaction.
According to the Department of Health and Human Services (2014), post-operative orders should include surgical care, DVT prophylaxis, medication, IV fluids and nutrition order. In the video, the receiving nurse asked orders related to Karen’s care while doing the assessment, which included the antibiotics and antiemetics as well as oral paracetamol for pain which belongs to medication order; TED stockings which refer to DVT prophylaxis; when can Karen eat and drink which is the nutrition order. The wound dressing order was done through surgical care in the video and also the IV fluids order was also taken into account. I therefore, think that the post-op orders were all well discussed in this video.
Based on the available literature, one recommendation that requires improvement for future practice is ensuring that the patient is under continuous surveillance and care. Nurses should provide psychological care to enhance recovery of the patient. The focus should not concentrate solely on the physical care as sometimes patients are mentally affected and are therefore affected when they are discharged. When practiced accordingly, this will achieve greater heights by ensuring the quick recovery of the patient. It is also important to uphold ethical standards at all times when rendering health care to patients. Furthermore, I think they should have documented the vital signs as they were been taken, because if it’s not documented it’s not done.
After watching the video and reflecting, I must admit that proper communication between the nurses when rendering various services such as, clinical handover, are crucial for the patient’s safety. Another factor that should be observed monitored closely is therapeutic communication between the patient and the nurse since it promotes the patient’s health.