Complete a reflection journal and submit to your faculty (or as directed) within 24 hours of completing your clinical learning experience. Reflective journaling provides

Reflection

Mona Reed

Chamberlain University

NR324-62980

April 4, 2022

Introduction

In my most recent nursing situation I was tasked with continuous visual monitoring with a patient who was admitted for an overdose. The patient is a 15-year-old female in Child Protective Custody. She is a resident of CPS and often run away from there care staff. As one of the care staff assigned to this patient in the hospital, there are many partners of the interdisciplinary team collaborating to decide the best form of action in this challenging situation. Creating a climate of trust and respect is critical to establishing a therapeutic relationship. You need to communicate acceptance of the patient as a person by using an open, responsive, nonjudgmental approach (Harding et al., 2020).

Background

As a continuous visual monitoring partner, I am there to observe the changes in the patients’ healthcare, mood, behavior, and prevent further injury. This patient is newly admitted and therefore this is my first encounter with the patient. However, I’ve had many encounters with similar patients. My patient does not respond well to demands or has any structure. She is very emotional; agitated and continuously stating she is leaving the hospital. Prior to my shift the patient pulled out her IV, put on her regular clothing and proceeded to leave the room. At this point to provide safety for the patient and staff, security was called because of the age of the patient. Although there is no previous contact with this patient my relationship with them for 12 hours is to be a listening ear and respond when appropriate or when the patient initiate communication.

My experiences working in this type of nursing care situation has allowed me to reflect on a variety of mental health issues, drug issues, homeless, and complicated individuals who feel the need to cause harm to themselves or others. As a student with Chamberlain, I have learned to provide therapeutic communication versus non-therapeutic communication to patients in these situations.

Spending the amount of time with patients, especially minors in these situations feel as if the impact is minimal. The history of physical abuse, mental trauma or suicidal patients experiences for an extended amount of time make me feel defeated. However, having a collaborative team of nurses, behavior health specialist, child life, child protective services, social workers, psychiatric team, and medical physicians developing a care plan has some measure of encouragement that your efforts are helping the patient. I have a heart felt and concern for patients who do not value their own life.

Noticing

Initially I observed a suicidal individual who appeared to be in a lot of emotional pain. This individual did not want to actively engage in conversation and questioning from the care team. The patient wanted things to be on their terms and wanted to have control over the situation. Before working with children, I found it difficult to give minors control, but it’s the wording and how you respond to the situation that is important.

As I spent more time with the patient after all specialist exited the room, the patient calmed down and was able to ask basic need items. Providing food and shelter are two important needs I believe people forget to address first. The initial combated patient was compliant with me after we ordered food of her choice, given a change of clothing and blanket for comfort. Although this was a give and take, it was effective. As a nurse, you have a key role in learning patient needs and expectations early to form effective therapeutic partnerships (Potter, 2023).

Interpreting

The situation is described as overwhelming for me and the patient. I think the approach should have been more subtle and not the entire team including security. I know its hospital protocol to enter the room and introduce yourself along with your title, but what drug induced 15-year-old female patient want to be bombarded with 13 hospital personnel looking at her. One staff member asking her to change into a hospital gown, one asking her to sit down on the bed, another asking her name and date of birth, and others giving her demands. It was chaotic, anxiety induced and I’m sure confusing for the patient.

I have encountered similar situations in a school setting with special education and behavior students who are on medication for various reasons. In comparison the situation is not much different just handled differently. The staff is more focused on deescalating the situation rather than getting the information for documentation.

Other data needed for this patient at the time was vital signs taken every 4 hours while the patient is receiving Dextrose 5% and 0.9% sodium chloride. After the patient exhausted herself, we were able to obtain vitals signs. The patient seems to function well with only the preceptor and me in the room, therefore as I held her hand to provide therapeutic comfort, the nurse was able to proceed with checking her IV and respiratory without the foot restraints previously placed on her because she earned it, but the arm restraints remained a bit longer.

Responding

After considering the situation my goal for this patient is to provide a safe and nonjudgmental environment. The nurse response was consistent with protocol. The interventions provided addressed her stomach pain. I provided a heating pad for her stomach, fluids, therapeutic communication, played cards, board games, and walked the unit.

The stress brought on from these patients is due to the unpredictable behavior they exhibit. As I came into an already hostile situation it escalates more and was very alarming especially with limited information. Most children who overdose are transported to the emergency room unresponsive or incoherent. They are unable to answer questions until they feel safe. After my patient was extubated, she became manic.

Reflection-in-Action

Although each situation has been different among teen overdoses and the reasons behind their actions, the root cause is always the same. These teens open up and communicate to the only person in the room with them for a long period of time and its leads back to not having any hope. After reminding my patient that she is in a safe environment, she talked, and I listened to her struggles. I was very methodical regarding how I responded as to not trigger her or feel as if she was being judged. At the end of my shift, I made sure they felt valued and included them on deciding how they want to spend their day within hospital protocol. Including teens in decision making will allow them to feel they have some control.

Reflection-on-Action and Clinical Learning

Three ways my nursing skills expanded during this experience is through communication, empathy, conflict resolution. I provided my patient with therapeutic communication/techniques, I was empathetic to her needs, and we developed a way to earn some walking privileges through cooperation with staff.

Three things I might do differently is not be quick to restrain, offer options, and more approachable techniques. When I encounter another troubled teen, I would not be so quick to ask for an order for restraints. I think it wasn’t necessary after giving it more thought. I would give them a couple of options to meet me halfway and give them a small measure of control over their situation. Early on the patient would not put on the identifying purple scrubs that would allow hospital staff to know her unit and floor. Plain clothing is not allowed because of elopement of the patient. Last, seek more ways from child life or behavior health on approachable techniques for disturbed children.

This situation is different from the other teens because there was not a point of reference. This patient is in CPS custody and group homes for more than a year; therefore, her care staff has not been consistent. CPS came but could not reference any knowledge of what type of person she is and had no file of documentation. I should have additional information from CPS documentation. Each time I have encountered an unruly teen, the hospital calls security. I do not agree with 6 very large, uniformed security personnel coming to assist the nursing staff. I understand safety for staff is important but 99% of the time they result back to acting like a sweet child in a soft manurable voice. Just like hospitals have a respiratory team, there should be an initial team to respond to children exhibiting suicidal thoughts and safety behaviors. The only team present are just trying to get their documentation done and then put an untrained monitor to observe the patients for 12 hours. A more skilled person should come for several hours and visit with the suicidal patients to get a better understanding.

Reference

Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Lewis's medical-surgical nursing: Assessment and management of clinical problems (Eleventh). Elsevier, Inc.

Potter, P. A. (2023). Fundamentals of Nursing. Elsevier.

Mona,

Your reflection was very interesting and well written. I enjoyed reading about how you used therapeutic communication, touch and a nonjudgmental behavior with this young lady.

Great job!

Satisfactory PASSED 4/5/22

Professor Turner

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