Reflective Journal Med Surg, Ridge Meadows, Maple Ridge.

Student Name Dermot Connolly Stenberg College April 21st / April 22nd 2013

Sunday April 21st 2013 I think it was a good idea to wait a few weeks before assigning each student two patients. I feel it gave us the opportunity to get our feet wet on the floor and settle in on the ward. This was my first week to have two patients and I felt comfortable enough not to be nervous about it. One of my patients was the same patient from last week while the second was one I selected myself. My first patient WF is an older patient suffering with dementia. He is at times very confused, aggressive and is easily agitated. As a result, I spent most of my time this week with WF. To begin with, he had pulled out his feeding tube the day before which meant all his medications were on hold until it was correctly reinserted and its placement verified via X-ray. He had also started pulling on his IV line which meant his original line had to be removed with a new one started on his other arm. This was great experience for me as I got to witness a blocked IV line through the resistance felt in an IV flush and the subsequent blood discharge that followed. I also got to experience the removal of an IV line and witness the placement of a new one. WF needed three trips to the X-ray department to verify his GI tube placement which was hard on him and increased his agitation. Once placement was confirmed, we were in a position to administer all his morning medications, his IV medications and restart his tube feed. By the time WF was settled in bed from his busy morning, it was 11am. It had being a busy morning but I had still being able to administer personal care and medications to my second patient while also taking care of WFs needs.

As I reflect on my first day, I felt I managed my time reasonably well. I have developed a routine where if I dont have time to chart, I will at least prioritize recording the patient vitals. That at least gives the physicians some data to work with in the absence of any detailed charting. I am certainly more comfortable administering medications via the GI tube and hanging IV medications. I still need to work on the finer details such as recognizing that walking up the corridor wearing a contaminated smock is far from best practice. Monday April 22nd 2013 As expected, my second day was a lot less stressful than my first. I felt I had settled into a routine quiet quickly and I was comfortable to administer personal care and medications without feeling under too much pressure. In particular, the importance and correct use of soft restraints when treating and caring for a patient was something I learned this week. My second day was essentially a carbon copy of my first only a little more settled. I was able to spend additional time completing safety checks on both my patients and double checking my charting and medications. The one take away I had from my second day was the relationship I felt I was building with the other nursing staff and care aids. Throughout this week, both the care aides and the nursing staff were extremely helpful in helping answer any questions I had, and guiding me whenever I was in doubt. As I come towards the end of my clinical rotation, I can see that the relationship between me and the other staff is stronger as I feel their trust in me has increased.