Introduction
Self-reflection allows nurses to analyze their experiences in practice and incorporate changes in the current and future practice to improve the outcomes. Reflective nurses are resilient, have improved wellbeing, and are professionally committed. Healthcare providers require encouragement to provide evidence-based care to patients, which relies on experience and prior studies. Self-reflections aid in the advancement of the nursing profession through the change of individual goals.
Confidentiality is critical in the disclosed or published case studies (Gogo et al., 2019). The paper provides a self-reflection analysis based on a case of an elderly patient who presented to the nursing home where I worked with the signs and symptoms of urinary retention.
Mrs. X, a 70-year-old patient presented with the inabilities to urinate, a distended abdomen, and discomfort on the lower abdomen. The patient also had diabetes and had been on medications for three years. For three months, the patient had been having problems with urination.
She was unable to empty her bladder by voluntary micturition and was experiencing overflow dribbling of urine due to bladder distention. Additionally, from an ultrasound done to estimate the amount of urine retained, the nurse identified that the woman had a high post-void residual. The patient also had a history of an injurious fall that immensely affected the pelvic function and had physiotherapy sessions for three weeks.
Mrs. X’s medical problem with voiding started days after experiencing the fall and is currently using crutches to maintain stability. A review of systems indicated positive findings on the genitourinary system and the musculoskeletal system. All vital signs were within the normal range. Generally, the patient was rather anxious and stressed due to her inability to void. The initial management aimed at helping the patient void the retained urine.
The priority was the use of non-invasive treatment methods for fear of hurting the anxious patient. The remaining option was treatment with the use of muscle relaxants to help the urinary sphincter muscles relax. The medication prescription was also meant to lessen my work of going through an aseptic procedure to save time for the overwhelming number of patients.
Since the physicians in the nursing home were busy, I decided to prescribe drugs to the patient. The medication of priority was 0.4mg of tamsulosin taken once daily for seven days and dutasteride 0.5mg taken once a day for seven days. After 48 hours, there were no signs of improvement, which initiated the need for another treatment therapy.
Furthermore, the patient got diagnosed with a urinary tract infection due to prolonged retention of urine. The patient got subjected to more stress and the family members were getting agitated and were losing trust in the healthcare providers. During this time the patient together with the family members were involved in making appropriate patient care decisions. A Foley catheter was inserted to remove the urine. Prolonged retention of urine can have effects on the kidneys.
The main issue of concern in the case scenario was the provision of care without patient and family involvement. The decision to prioritize medication over other treatment therapies such as the use of a catheter to drain the retained urine before advancing to other treatment therapies only involved one individual. Medications take longer to bring the desired effects on patients (Krueger et al., 2020).
The patient and the family lacked knowledge of the condition and the complications that could be associated such as urinary tract infections. Therefore, adequate patient and family education was critical before setting the goals of care and collectively developing strategies for their achievement. Patient and family involvement brings a feeling of trust in the care provided and makes them own the outcomes of care.
Another issue of concern lied on the inability to involve other healthcare workers in the management of the patient. Currently, the healthcare system advocates for patient care using interdisciplinary approach and teamwork approach (Gogo et al., 2019). A correct determination of providing early care to reduce the patient waiting time was prudent but a wrong decision was made on the priority treatment therapies. Even though the physicians were busy, a consultation could have contributed to making a correct choice.
Proper consultations could have solved the problem early and prevented the establishment of a urinary tract infection. The main goal of primary care was to reduce the symptoms and preclude the development of complications. Thus, a catheter to drain the urine could have been the first option.
Reflection of the Case Study
A quick intervention was required to relieve the symptoms that accompanied the urinary retention. A non-invasive therapy was preferred to an invasive therapy for fear of the effects on the patient. The client presented with stress and the introduction of a catheter into her urethra was presumed to increase the depression. Diabetes causes strengthening and contraction of the bladder muscles to prevent voluntary muscles (Billet & Windsor, 2019). To avoid trauma, discomfort, and increasing the risk for urinary tract infections, removal of an invasive catheter was recommended. The medication was anticipated to bring muscle relaxation within the first twelve hours but it took two days without success.
As a result of making decisions without consultations and poor priority of interventions, the patient and her family members were subjected to stress. From the observations, they lost trust in the care provided in the nursing home. The patient remained in discomfort for the period before further actions. The facility aims at providing care that is patient and family-centered but for this case, the actions made were contrary to the expectations.
My colleague health workers were disappointed because I failed to involve them in patient care. On consultation with other healthcare workers, patients, and the family, better interventions were made. The actions negatively affected the performance appraisal and facilitated my transfer to another ward.
I experienced a sense of guilt and self-blame for the wrong decisions that greatly affected me, the patient and family, and the colleagues. The shame decreased my self-esteem and it was difficult to cope with the situation. I acknowledged and accepted the mistakes and apologized for the situation that could have spoiled the image of the organization, which works on set standards. The patient and the family members became dissatisfied with the care provided.
The care received did not meet their expectations and even requested for a transfer but after assurance, the transfer was canceled. Since then, the client asked many of questions whenever a healthcare provider was attending to her. Furthermore, she demanded care from another nurse other than me. The situation initiated a change on the limits to which caregivers practice in the organization, an action which hinders the achievement of the future of healthcare goals.
Factors Influencing Actions Made
Unclear hospital policies and guidelines contributed to the development of the situation. Policies that define the roles of each healthcare provider are critical in the elimination of errors in care. In some organizations, nurses are prohibited from reviewing patients, prescribing drugs, and ordering tests without supervision from doctors. However, the nursing field is evolving at a high pace and it is aimed at eliminating the barriers that hinder nurses from exercising to their full potential.
In the discussed case, the nurse was supposed to review the patient in consultation with the physician on duty before determining on the actions to follow. Critical thinking is key when deciding the priority interventions of care (Billet & Windsor, 2019). A policy that puts surgery and medical treatment as the last therapies of care is required to minimize their effects on patients. In the nursing home, a clear policy, which indicates the protocols in patient care, is required.
The hospital culture discourages the use of invasive urine catheters because they increase the risk of urinary tract infections. Besides, shortages of non-pharmaceuticals such as catheters and lubricating gels in the facility influenced my decision.
The management of the nursing home failed to organize continuous medical education to keep the healthcare providers updated on the current trends of patient care. Understaffing of physicians significantly contributed to the wrong actions. The adequacy of physicians encourages teamwork and minimizes errors due to increased supervision (Krueger et al., 2020). Furthermore, the facility was overwhelmed with patients and I had to save time to attend to other patients.
External factors considered included the general condition of the patient. Urine retention is associated with an increased risk of infections, thus, insertion of a catheter multiplies the risk. Evidence from research indicates that catheters increase the risk of infection, especially in female patients who cannot use a condom catheter.
Furthermore, a catheter does not permanently solve the problem unless the patient agrees to use it for a long period. Indwelling catheters predispose patients to stigmatization, which affects their self-esteem (Billet & Windsor, 2019). The patient came from a poor socioeconomic background and was not insured hence could not afford surgery.
In the clinical setting, consultations and experience act as the best sources of knowledge for healthcare providers. Throughout practice in hospitals, I had not managed an elderly patient with urinary retention to gain experience in managing the condition. Besides, I was a new nursing practitioner who had just graduated from school.
Even though I was uncertain about my actions, I never consulted my colleagues, seniors, and online materials that are vital in the provision of evidence-based practice. After the incident, the team manager showed me a poster on the wall that had guidelines concerning the management of urinary retention. All the time of my hospital experience, I had never bothered to read the posters on the walls.
Given another chance, I will employ an inter-professional approach in the provision of patient and family-centered care. At first, I never involved the patient and the family in the care, an act, which had negative impacts on my therapeutic relationship with the patient. The patient lost trust in me and requested a change of the care provider.
I had the choice of discussing the available treatment options with the patient and her family and together decide on the best intervention based on the goals of care. After the prescription of drugs, the physician could have been informed to evaluate the management and suggest therapy change if necessary. Since the goal of primary care was to reduce the symptoms, a catheter could have drained the urine within the shortest time possible as compared to drugs, which take longer to act and sometimes get accompanied with interactions and side effects.
Learning from the Experience
As the saying goes, the experience is the best teacher in learning. The situation discussed above-provided lessons for use in future practice. I realized that patients and the family need to take the center in healthcare delivery actions taken should be based on their emotional wellbeing. Also, healthcare delivery needs to be based on an inter-professional and teamwork approach. I have discovered that all human being make errors and through the errors, they learn.
I actively involve myself in research and continuous learning to keep myself updated with the current trends in patient care. I have explored the various strategies of involving patients and their families in care.
Currently, I am an advocate of patient-centered care and I encourage my colleagues to be ambassadors of multidisciplinary and teamwork approach in care. Mrs. X’s case has significantly influenced my way of practice. My actions are based on consultations and whenever I am not sure about something, I do not do it.
I aspire to provide quality nursing care in collaboration with other healthcare providers with the consideration of the emotional, social, and cultural wellbeing of the patients and their families. Additionally, I am committing myself to long-life learning and continuous research to aid in the provision of evidence-based care.
Conclusion
Self-reflection is a critical aspect for nursing practitioners to help them use their experience to shape their future experience (Vicdan, 2020). In the clinical setting, errors occur and should be used to effect positive changes that improve the care outcomes. Actions need to be done with rationale and ought to consider the emotions of self and others. Individual goals should translate into the general nursing goals that define the future of nursing. I recommend an increment in the publishing of self-reflection studies of nursing practitioners to be used as evidence for present and future practice.
References
Billet, M., & Windsor, T. A. (2019). Urinary retention. Emergency Medicine Clinics, 37(4), 649-660. Web.
Gogo, A., Osta, A., McClafferty, H., & Rana, D. T. (2019). Cultivating a way of being and doing: Individual strategies for physician well-being and resilience. Current Problems in Pediatric and Adolescent Health Care, 49(12), 100663. Web.
Krueger, R. B., Sweetman, M. M., Martin, M., & Cappaert, T. A. (2020). Self-reflection as a support to evidence-based practice: A grounded theory exploration. Occupational Therapy in Health Care, 1-31. Web.
Vicdan, A. K. (2020). The ways of knowing in nursing/hemsirelikte bilme yollari. Journal of Education and Research in Nursing, 17(S1), 110-115. Web.