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Reflective Journal Med Surg, Ridge Meadows, Maple Ridge.

Student Name Dermot Connolly Stenberg College

Sunday March 24th 2013 I enjoyed the set up to our first day of clinical. The opportunity to job shadow gave me the chance to settle my nerves and watch the flow of the unit before being handed my own patient. I shadowed Waylon for the day and I thought he was a great guy to hang out with. He was very knowledgeable and explained everything from how to read the Kardex, to where to get all supplies. Through Waylon, I got to experience what it would be like to handle a caseload of four patients on a busy hospital ward while also interacting with family members, doctors and nursing staff. By the time I had chosen my patient for the next day, I was already feeling quiet comfortable and Waylon was more than happy to let me help as much as I was comfortable with. For my patient, I picked S.J., a palliative patient awaiting a bed at Maple Ridge Hospice. S.J was an interesting patient for me as he had feeding tube and a Foley catheter, so I was excited to get trained in on their care and maintenance. Before we administered any medication, I also assisted Waylon with the taking of four of the patients vitals. Waylon was particularly good at explaining how to correctly administer S.J.s feeding tube medications and how to ensure the complete dose was administered correctly. The personal care was a welcome refresher from semester 2 and I was particularly comfortable with doing it. As the morning wore on, Waylon and Don both allowed me to take patients glucose readings, give insulin shots and assist in the performance of enemas which also helped to relax me. By the time my first day ended, I was no longer nervous about my second day, in fact I was looking forward to it. Monday March 25th 2013 Today was a busy day filled with mixed emotions. I could sense a different vibe among the nursing staff this morning and Im not sure if it was because it was Monday morning, the

start of a new week or just the fact that it was a different set of staff on duty. It was a bit of a slow start as my assigned nurse arrived late at 7.30am. She had a more hands off approach when compared to Waylon which I was OK with as I was confident I could handle whatever the day threw at me. The day started out well, I checked up on my patient, did a head to toe assessment and took his vitals without any problem. Listening to lung oscillations and bowels movements was again a welcome refresher from my second semester. I had noted from talking with my patient and my subsequent check in his MAR that not all the PRN medication he received during the night and early morning was charted which made me a little anxious prior to administering his medications in case of complications. Having cleared my concerns with Don the rest of the morning was pretty straightforward and I was quiet enjoying the busy pace of the unit. Then the pace of my day and indeed the unit kicked up a notch. In the space of what seemed like five minutes, I had just realized that my patient hadnt had a BM in four days, he had received a hospice bed, he requested a PRN for pain and I was asked to arrange his discharge. While I didnt panic, I was certainly aware that I had a lot to do in a short period of time. The first thing I took care of was his request for a PRN medication and because I had just given him 2mg of Hydromorphone as part of his scheduled medication, I had a lapse of concentration and dispensed another 2mg Hydromorphone as his PRN. Luckily I remembered that I hadnt checked the MAR because his Hydromorphone PRN was 1Mg not 2Mg. I got a bit of a scare with that near miss and I can honestly say I will never forget to check the MAR first again. On the positive side, my training and experience to date meant that I caught my error before any medication was administered. While the remainder of my afternoon was extremely busy and at times a little stressful, I enjoyed it and Im especially proud that I was thrown in at the deep end on my first day and I

think I did OK. I found it a little unnerving however trying to report on my patient to the hospice without any real idea what they were going to ask me. Don helped me out here again and I ended up making the call using just the patients Kardex as both his MAR and file could not be accessed. I also notified the patients next of kin of his transfer and arranged for the porter to come and collect him. In the meantime, I performed a rectal examination on the patient to detect for the presence of stool. Under hospice bowel protocol, my patient should have being administered a stool softener but his discharge to hospice took priority and in the end I was able to get my hands of his chart for just long enough to chart his final entry before his discharge what a day.