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I was in second year and at that time; I got a placement on a general ward to understand importance of oral medications. I was assisting my mentor. Under my mentor’s supervision I took care of a 75 years old lady, named Mrs. Mathew. She was suffering from Acute Renal failure. She was admitted for her dialysis, by the time she had diagnosed gastric ulcer. I had been asked by my mentor to take care of her very sincerely and when the doctor came for the ward round, report him thoroughly As other patients were there and my senior should take care of them, so she was not with me all the time.
I have noticed that the doctor was in a hurry to treat her complications. Then doctor came straight to Mrs. Mathew. He checked the prescriptions, asked me about Mrs. Mathew’s Blood Pressure, glucose level, Pulse rate. I informed everything and I said that Mrs. Mathew’s gastric ulcer problem was increasing for which she felt devastated. Doctor prescribed a new dose of medicines for a time being.
I checked the prescription for her oral medications. I noticed that the new dose of medicine which was prescribed by doctor for gastric ulcer, can affect renal condition which is in bad condition already. I was in a dilemma what to do or what not to. However, the doctor has already left.
I was shocked to see that the doctor was completely overlooking the acute renal diseases matter of the patient. At the same time, I did not want to Mrs. Mathew got tense after listening to all this. So, I decided to talk to my senior-mentor about the incident. After seeing this, my senior suggested that we speak to the doctor together about it.
My mentor took the doctor aside and explained the whole scenario and showed him Mrs. Mathew’s case history. Doctor said that he was in a hurry and overlooked some issues. Doctor apologised and prescribed another dose of medicine. My mentor explained that no matter how much we are in a hurry, this kind of mistake we cannot afford. Doctor assured that he would remember these things for further.
I regret that I did not gather that much courage to speak about this matter then and there. As per the viewpoint of Takahara et al. (2017), communication with peer nurses and doctors is one of the major accountability tagged with the role of caregiver as this helps in the proper conducting of clinical information of the patient and in the enhancement of the quality of nursing. In this case, was not able to perform the same which has been rectified by my supervisor. However, I am happy that the doctor accepted his fault and responded positively to my mentor. I learned from this incident how to respond positively in a sensitive manner with your colleagues in the matter of safety and well-being of patients. As per the idea of Lee et al. (2017), it is the responsibility of the caregiver to provide all information regarding a patient to the responsible doctor. However, in this case, the doctor was in hurry which has triggered such mistake. This experience has taught me about the management of the safety issue and importance of active interaction with doctor. NMBA (Nursing and Midwifery Board) standard 2.2 always prioritises effective communication in nursing for the management of patient safety (Nursing and Midwifery Board Aphra, 2017). However, I have not able to maintain the same in the professional sphere.
Pharmacological aspect is one of the major domains tagged with nursing and the nurses have to have knowledge in the same filed. As per the idea of Linder et al. (2019), in terms of oral medication, there are some pros and cons which should be maintained by analysing the factors like half-life, clearance and intermolecular interaction as well. Additionally, van der Vossen et al (2019) has further stated that drug may irritate the body because of side effects. A patient with more than one disease should take drugs with proper diagnosis as one drug can be the cause of another disease. This is applicable to the context of Mrs. Mathew. NMBA standard 6.1 is focused over the comprehensive high-quality and safe clinical support to the patients. Hence, this should include the issue of medicine administration (Nursing and Midwifery Board Aphra). As a student of nursing under my mentor’s supervision I always try to do this to my own practice.
Recalling the incident, I feel that I should have told the doctor then and there immediately. I can now realise that my dilemma might put Mrs. Mathew in danger. I realised that I need to develop my confidence, be more supportive to my colleagues.
I will try to develop my confidence level toward my work and develop assertive skills. I will make sure that, in my next placement, definitely set this as a goal. I will be more concern and interactive for the well-being of my patients and will take help from my seniors.
From the single learning experience, I have learnt how to be assertive with colleagues for the well-being of patients. I will try to apply all these learning experiences to my development in the professional field. Next time when I will be in a similar situation, I will definitely deal properly.
Lee, C. S., Tan, J. H. M., Sankari, U., Koh, Y. L. E., & Tan, N. C. (2017). Assessing oral medication adherence among patients with type 2 diabetes mellitus treated with polytherapy in a developed Asian community: a cross-sectional study. BMJ open, 7(9), e016317. Retrieved from: https://bmjopen.bmj.com/content/bmjopen/7/9/e016317.full.pdf
Linder, L. A., Wu, Y. P., Macpherson, C. F., Fowler, B., Wilson, A., Jo, Y., ... & Johnson, R. (2019). Oral medication adherence among adolescents and young adults with cancer before and following use of a smartphone-based medication reminder app. Journal of adolescent and young adult oncology, 8(2), 122-130. Retrieved from: https://www.liebertpub.com/doi/pdfplus/10.1089/jayao.2018.0072
Nursing and Midwifery Board Aphra, (2017), Registered nurse standards for practice. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx
Takahara, M., Shiraiwa, T., Ogawa, N., Yamamoto, M., Kusuda, Y., Shindo, M., ... & Shimomura, I. (2017). Patient perspectives on combination therapy of a once-weekly oral medication plus daily medication for lifestyle-related chronic diseases. Internal Medicine, 56(6), 615-620. Retrieved from: https://www.jstage.jst.go.jp/article/internalmedicine/56/6/56_56.7583/_pdf
van der Vossen, A. C., Al‐Hassany, L., Buljac, S., Brugma, J. D., Vulto, A. G., &Hanff, L. M. (2019). Manipulation of oral medication for children by parents and nurses occurs frequently and is often not supported by instructions. Acta Paediatrica, 108(8), 1475-1481. Retrieved from: https://onlinelibrary.wiley.com/doi/pdf/10.1111/apa.14718
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