Reflective Assignment on Clinical Placement

Answer

Reflective Assignment on Clinical Placement

            I hereby reflect on my experience during my placement at the Stroke and Rehabilitation Ward. The scope of this reflection is limited to a case in which a 76-year-old male was admitted into the Ward with an acute stroke and the multidisciplinary team found it difficult to educate the wife and the patient’s two sons about the poor prognosis of the patient condition on admission since he had signed an advanced directive indicating ‘do not resuscitate’ in case of an emergency. This reflective paper is guided by the reflective cycle: level 3 reflective tool as provided in the Clinical Workbook (2019).

            The first step of the Reflective Cycle requires a description of the event (Clinical Workbook, 2019). The elderly male patient admitted following an acute stroke had signed an advanced directive to decline cardiopulmonary resuscitation in case he loses an ability to make healthcare decisions or in emergency situations. He was brought in unconscious but the breathing seemed stable at the time of admission. The members of the multidisciplinary team struggled to educate the family about the implications of the ‘do not resuscitate order’ with considerations to acute stroke. However, family members wanted to override the order and instruct the team to resuscitate him in case the need arise. This was not done according to the family wishes but the team followed the advanced directive since the patient’s condition deteriorated fast and he died just after36 hours after admission. The family were infuriated and threated to sue the hospital.

The second step of the reflection process is identification of feelings, thoughts, emotions, and my experience and those of others about the case (Clinical Workbook, 2019). As a member of the multidisciplinary team that delivered appropriate care to the patient I felt sorry for the family and but in my mind I thought that it was morally right to adhere to the patient’s wishes rather than those of the family. It was a dilemma in which one was eager to resuscitate the patient to improve his survival but also restricted by the need to follow the patient’s wishes to date. Other members of the team thought that the hospital was not going to be fined or suffer any legal implications since they were justified to follow the patient’s advanced directive.

            The third step of the reflection process is the recollection of values, beliefs, underpinning thoughts, and feelings experiences (Clinical Workbook, 2019). I strongly belief resuscitation could have indeed his survival chances but I could not have done it given the advanced directive since it is ethically and legally bounding. A senior Registered Nurse took her time to educate me about the potential repercussions going against the patient’s wishes in delivery of care or withholding resuscitation until I was fully satisfied with the action taken. We just saw him die slowly.

            The fourth step of the reflection process is analysis of the case (Clinical Workbook, 2019). Standard 1 of the Nursing and Midwifery Board of Australia (NMBA) (2016) requires that Registered Nurses must think critically and analyse cases and the nursing practice. Healthcare professionals have a duty to rescue and provide appropriate care to patients under the Common Law. This includes cardiopulmonary resuscitation. However, in case a patient had signed and advanced directive refusing treatment or resuscitation his/her wishes must be followed regardless of other contrary opinions or decisions from a multidisciplinary team or the family (Australian Resuscitation Council, 2015).

            The fifth step of the reflection process is drawing of conclusions about the case (Clinical Workbook, 2019). The patient received all the appropriate high-quality palliative care indicated for dying acute stroke patients (Alonso et al., 2016). But only cardiopulmonary resuscitation was withheld, which could have improved his survival chances, but it was imperative that his advanced directive be honoured (Australian Resuscitation Council, 2015). In accordance to Standard 4 of the NMBA (2016), resuscitation was not included in the care plan of the patient in question in honour of his wishes.

            The last step is development of an action plan and/or strategies for managing the case at hand and similar cases in the future (Clinical Workbook, 2019). Individuals who sing advance care directives should be educated adequately about the implications of the directive. Besides, they should be encouraged to involve their family members in singing process, so that the family members receive appropriate education about the ethical and legal implications of the signing. This could help tensions between family members and the healthcare staff/hospital in case of emergencies or when a patient loses an ability to make own decisions.