Introduction
As a second-year nursing student, I have recently completed my clinical placement in the NICU, surgery, community, and gastroenterology. I will soon attend my last placement in the surgical ward. My second placement as a student in surgical nursing was significantly informative. During this placement, I encountered a patient bleeding at the surgical site.
This experience was particularly significant, given that it is common in the surgical ward. For instance, according to Aeschbacher et al. (2021), “Surgical site infections (SSIs) are the second most frequent healthcare-associated infections in the United States and Europe” (p. 2). The rate is reported to be between 1.9% and 5.4% in general surgery (Shah et al., 2020). Therefore, using the Boston model of reflection, I will discuss a previous clinical case involving a patient who bled at the surgical site and utilize the knowledge I gained over the course of the duration to choose an alternative response.
Description of the Case
During my second placement in the surgical placement, I was caring for Mary, an African American woman aged 32 years old. I had been tasked with caring for her since she had just undergone a surgical procedure. Mary was recovering well after surgery, and I ensured everything was as expected.
However, on the second day after surgery, I noticed something else with the patient. Mary started bleeding at the surgical site, dropping the pressure in her blood. Since I have learned over my course duration that bleeding in the surgical site is a serious condition, I knew she needed prompt and immediate advanced care from the physician and other professionals involved in her treatment.
As a nursing student, I immediately informed the care team of the developing situation and advised that she required a quick intervention. Immediately, the care team ordered a blood transfusion for Mary to help stabilize the dropping blood pressure and prevent any complications that the excessive blood loss might cause. As a nursing student, this experience allowed me to advance my knowledge and skills in caring for patients after surgery. I stayed keen and focused on how the team attended to Mary, even though I wanted her to recover from the bleeding. I did not step an inch from Mary’s bedside and ensured that I was keen to note any crucial signs and offer her any assistance.
Even though the care team’s intervention was successful, the particular case has always been on my mind. How the care team intervened showed me how severe bleeding in the surgical site needed to be managed. For instance, in a study by Chiariello et al. (2022), “2 patients (9%) died in the intensive care unit from severe respiratory failure, shock, and multiple organ failure” (p. 1919). This condition remains a significant complication during and after a surgical procedure, leading to increased mortality and morbidity rates (Al-Attar et al., 2019). Additionally, as a nursing student, I learned the importance of being ready and accountable in ensuring my patients recover effectively and are free from complications, such as bleeding at the surgical site.
Feelings
My experience with Mary when she was bleeding from the surgical site provoked many emotions. For instance, when I noticed she was bleeding from the surgical area and her blood pressure dropped significantly, I was worried and alarmed about her well-being, especially since I knew how serious such complications were. As a nursing student, I am responsible for recognizing the signs and symptoms my patient is experiencing and taking appropriate measures to manage any developing situation (Molina-Mula & Gallo-Estrada, 2020). Therefore, I felt a sense of responsibility to intervene immediately and prevent any further complications.
The incident also made me feel proud of myself for holding up during such a new experience. I remained calm during the experience and focused on how we could help Mary recover. It taught me how to compose myself during emergencies in the surgical ward and support my patients (Clarke et al., 2021). I could think critically in urgent situations, make appropriate decisions, and work in a team to ensure my patients receive the needed care.
However, despite all the success in managing the patient’s condition, I also felt guilty and doubted myself. What could have happened if I had made a different decision, and how could I have avoided the complication? I questioned my ability as a healthcare provider and if I was reluctant in my role.
Evaluation
While caring for Mary, my experience led to significant professional and personal growth. For instance, I learned that an immediate response is an appropriate way of intervening in bleeding in surgical sites to avoid more complications or death. According to Gerdessen et al. (2021), it is always recommended that the healthcare provider offering care to a patient who has just undergone surgery should monitor for bleeding in the surgical sites. It is an urgent situation that needs to be attended to to ensure a positive outcome immediately. With this knowledge in mind, I immediately informed the care team, who cared for her.
This experience also made me learn the benefits of patient-centered care. Kuipers et al. (2019) note that patient-centered care is “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” (p. 1). It involves making care more tailored to a patient’s needs.
Another study indicates that patient-centered care is associated with more favorable outcomes, including greater quality of life and well-being of patients, increased care quality and safety, greater patient satisfaction with care, and more (Edgman-Levitan & Schoenbaum, 2021). In Mary’s case, I prioritized her safety and comfort by offering the support she needed during care. Additionally, I have realized that if I had offered Mary patient-centered care from the beginning, we could have prevented the bleeding from happening.
Analysis
When recalling my experience with Mary, I realized that bleeding in the surgical site is a common and severe complication in the surgery ward. In a study by Elassal et al. (2021) on 13 patients, findings suggested that “An identifiable source of bleeding was found in 11 (84.6%) patients” (p. 1). This rate is significantly high, and healthcare providers must implement strategies to prevent or manage surgical site bleeding.
Therefore, as a nursing student, I have learned that preventing and managing bleeding in surgical sites requires patient-centered care and a comprehensive understanding of wound care and various interventions. Some of these medical interventions include medicines such as tranexamic acid and blood transfusion (Seidelman et al., 2023). I ensured that during this placement, I gained enough experience caring for surgical wounds and monitoring for essential signs and symptoms.
Next Steps
In the subsequent placement, I look forward to learning more about effectively preventing and managing complications that patients from surgery are exposed to, such as bleeding in the surgical sites. As a nursing student, I need to possess the knowledge and skills to care for a post-surgical patient, ensuring their treatment is safe and focused on their needs (Vaismoradi et al., 2020). To perfect my knowledge and skill, I will continue to seek feedback from all the professionals I come across, including my clinical instructor, in my subsequent placement. Additionally, since things are changing as time goes by, I will also need to be updated on the current evidence-based guidelines and practices that would help me effectively prevent and manage surgical complications, such as bleeding in the surgical sites.
Conclusion
In conclusion, based on my second placement in the surgical ward, I realized how common and severe bleeding in surgical sites is. It is a type of complication that can lead to more complications in a patient or death and therefore needs to be managed as quickly as possible. The knowledge I gained during this placement helped me learn more about handling different situations and the need to support patients throughout. In my subsequent placement, I will apply all I acquired in my second placement and prevent similar complications in my patients. I will be focused on monitoring vital signs and alerting other healthcare providers whenever there is an issue.
References
Aeschbacher, P., Nguyen, T.-L., Dorn, P., Kocher, G. J., & Lutz, J. (2021). Surgical site infections are associated with higher blood loss and open access in general thoracic practice. Frontiers in Surgery, 8. Web.
Al-Attar, N., Johnston, S., Jamous, N., Mistry, S., Ghosh, E., Gangoli, G., Danker, W., Etter, K. & Ammann, E. (2019). Impact of bleeding complications on length of stay and critical care utilization in cardiac surgery patients in England. Journal of Cardiothoracic Surgery, 14(1), 1-10. Web.
Chiariello, G. A., Bruno, P., Pavone, N., Calabrese, M., D’Avino, S., Ferraro, F., Nesta, M., Farina, P., Cammertoni, F., Pasquini, A., Montone, R. A., Montini, L. & Massetti, M. (2022). Bleeding complications in patients with perioperative COVID-19 infection undergoing cardiac surgery: A single-center matched case-control study. Journal of cardiothoracic and vascular anesthesia, 36(7), 1919-1926. Web.
Clarke, V., Lehane, E., Mulcahy, H., & Cotter, P. (2021). Nurse practitioners’ implementation of evidence‐based practice into routine care: A scoping review. Worldviews on Evidence‐Based Nursing, 18(3), 180-189. Web.
Edgman-Levitan, S., & & Schoenbaum, S. C. (2021). Patient-centered care: Achieving higher quality by designing care through the patient’s eyes. Israel Journal of Health Policy Research, 1-5. Web.
Elassal, A. A., Al-Ebrahim, K. E., Debis, R. S., Ragab, E. S., Faden, M. S., Fatani, M. A., Allam, A. R., Abdulla, A. H., Bhukary, A. M., Noaman, N. A. & Eldib, O. S. (2021). Re-exploration for bleeding after cardiac surgery: Revaluation of urgency and factors promoting low rate. Journal of Cardiothoracic Surgery, 16, 1-11. Web.
Gerdessen, L., Meybohm, P., Choorapoikayil, S., Herrmann, E., Taeuber, I., Neef, V., Raimann, F. J., Zacharowski, K., Piekarski, F. (2021). Comparison of common perioperative blood loss estimation techniques: A systematic review and meta-analysis. Journal of Clinical Monitoring and Computing, 35(2), 245-258. Web.
Kuipers, S. J., Cramm, J. M., & Nieboer, A. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Services Research, 19, 1-9. Web.
Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3), 835. Web.
Seidelman, J. L., Mantyh, C. R., & Anderson, D. (2023). Surgical site infection prevention: A review. JAMA, 329(3), 244-252. Web.
Shah, A., Palmer, R., A. J., & & Klein, A. A. (2020). Strategies to minimize intraoperative blood loss during major surgery. Journal of British Surgery, 107(2), e26-e38. Web.
Vaismoradi, M., Tella, S., Logan, P. A., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health, 17(6), 2028. Web.