Running head: REFLECTION 1 1

Reflection 1

Alicia Jeffery

Trent University

NURS3021
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Reflection 1

Look Back:

One clinical shift, I was assigned to administer medications. Under supervision of my

instructor, got the medications out of the ADU. The patient had two tablets and Lax-a-day due

for 0800hrs. I did my last medication check outside of the room because this patient was on

contact isolation precautions. I also put the tablets whole into applesauce, as ordered. When I

entered the room, I found that my patient was very drowsy. He was barely able to open his eyes

in response to physical touch. I was not able to rouse my patient even by sitting him up, nor by

putting the lights on, nor by opening the blinds. My clinical instructor and I decided that the

patient was unable to take the oral medications and instead, I discarded of them and recorded in

the MAR that I had done so. Later on, before doing the AM care for this patient, I administered a

PRN subcutaneous injection of 1mg of Dilaudid.

Evaluate:

This was my first time administering medications to a patient on this unit and so I was a

bit nervous. I had researched the medications the night before and I knew the uses for each one.

Although I have seen and done care for many patients who are heavily sedated, it still sometimes

makes me a little uncomfortable. In palliative care, the main goals are to comfort the patient,

maintain their dignity and relieve pain (Home Care Ontario, n.d.). Thinking about this and how

the sedation would have helped to calm the patient, relief some pain and keep the patient safe if

he was restless, helps to make me more comfortable with sedated patients. Having my instructor

with me to guide me also helped to calm my nerves. Being reflexive and acknowledging my

feelings about it can also help me to become more comfortable and/or not let it affect the care

that I provide.
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When I had checked in on the patient earlier in the morning he was still asleep and did

not arouse spontaneously. I had also been told by a nurse that this patient had frequently refused

medications. Since I knew both of these things, I was expecting to have difficulties administering

oral medications to this patient. This helped me to not be as overwhelmed when the patient was

unable to take the medications.

Having to sort my medications and do my med checks in the hallway because of the

isolation precautions made this situation a bit harder. I am glad I had this experience so that I

will know how to give medications to a patient on isolation precautions in the future. Since I

have administered subcutaneous injections in the past, and have written a reflection about it, I

was not as nervous performing this skill.

Analyze:

The outcomes of this situation were positive. The patient was not harmed in anyway. By

holding the medications, I ensured that the patient did not choke or aspirate while trying to

swallow in his drowsy state. The patient had a bowel movement the day before and was

supposed to receive more laxatives throughout the day, so by holding the morning laxative, he

was not harmed. The patient was also not in any pain so holding the pain medication also did not

negatively affect the patient’s wellbeing. This relates to the ethical principle of non-maleficence.

Non-maleficence involves ensuring you are not doing harm to a patient even if it involves not

doing an act that could be considered useful or beneficial (American Nurses Association, n.d.).

I also told the nurse who was assigned him for the shift what I did so that she understood

and was aware of this. Later, after I administered his PRN pain medication, the patient stated he

was in no pain and I was able to complete his AM care while ensuring he was comfortable. I

think that if I had tried to do the patients AM care while he was still super drowsy it may have
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been confusing and scary to him. Although it may have also helped to awaken him, I think that

he was too sedated for it to do much. I think that giving it some time to let the sedative wear off

was the best solution, although, in nursing, there is not always time to do this.

This patient also had dysphagia and right-sided weakness which also puts him at risk for

aspiration. According to Santos, Poland, Kelly and Wright (2012), “patients with dysphagia are

more likely to suffer medication administration errors…”. Tablets and capsules are designed for

people who are able to swallow properly (Santos, et al., 2012), so it can be dangerous to

administer these medication formulations to patients with dysphagia. Mixing the whole

medications in food, such as applesauce in this patient’s case, can help to prevent aspiration

(Santos et al., 2012). Santos et al. (2012) recommend that nurses should receive specific training

about this.

Revise:

In the future, I will be more confident and I will know what to do when this situation

occurs. Overall, I would not change about my approach. Since this patient had more than one

risk factor for aspiration or chocking, I am confident that not administering the medication was

the right thing to do. The only thing I would change would be to not open the medications and

put them into applesauce before I am sure the patient is able and willing to take the medication.

Since I had opened the medication and put it into applesauce this time before I knew the patient

could not take it, I wasted medications.

New Approach:

In the future, I will assess the patient’s level of consciousness and swallowing ability

before opening the medications and bringing them into the room on isolation precautions. This

will allow me to put the medications back into the ADU instead of disposing of them. I will also
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be conscious of the difficulties and risks associated with administering oral medications to

patients who have dysphagia.

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References

American Nurses Association. Short Definitions of Ethical Principles and Theories. Retrieved

from

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-

Definitions.pdf

Home Care Ontario. Palliative & Hospice Care. Retrieved from

http://www.homecareontario.ca/home-care-services/about-home-care/hospice-palliative-

care

Santos, J., Poland, F., Kelly, J., & Wright, D. (2012). Drug administration guides in dysphagia.

Nursing Times. 108(21).