• Subject Name : Nursing

Nursing Reflection on Patient Care in Hemodialysis

Introduction to Workplace Clinical Assessment

Patients, who are in the final stages of renal failure, generally require dialysis for the treatment purposes. This can be done in the form of hemodialysis or peritoneal dialysis. The following essay will highlight the nursing care reflection based on Gibb’s reflective model in a dialysis setting (Markkanen 2020, pp. 46-62). Recently our department has introduced a new machine for hemodialysis. Automatic Monitoring of Blood Volume in Fresenius 5008 Machine is a new modeled machine engineered specifically incorporated for dialysis patients (Antlanger 2017, pp. 238-241). This machine makes use of ultrasonic velocity changes to help in deriving total protein concentration, which is a sum of total plasma proteins and hemoglobin. This machine can be quite effective in managing the patients requiring dialysis on an urgent basis.

Description of Workplace Clinical Assessment

I have been working in the dialysis unit for a long time now. Generally, the patients being admitted to the ward are critically ill and require on-spot attention for their condition. I have keenly observed that patients, who come in for the sessions, are shown to express severe anxiety (Cohen 2016, pp. 2250-2255). Usually the patients are aware of the process of dialysis and they might not have an underlying fear for the situation. I have observed that patients who are new to the process of hemodialysis generally have high levels of anxiety prior to the procedure. This might be due to low levels of perception for the underlying situation and thus, have a fear of developing underlying complications from the procedure. I usually try to involve the family of the patient in the process. By having someone known to, by their side, the patient might be less anxious and less reluctant for the treatment. The hesitation in the patients can sometimes be due to the hospital environment, which is not quite often perceived in a positive manner by the patient and their families (DePasquale 2019, pp. 171-179). I strongly believe in providing direct attention to the patient in such given case scenarios.


From my previous clinical experiences as a nurse I have learnt that to best way to deal with the patients in any healthcare setting is through a planned care and approach method. This care plan should be devised in accordance with the individual’s needs and requirements. Dealing with patient having stress and anxiety can be a bit challenging situation to deal with (Enger 2018, pp. 186-194). It is imperative that the patient is listened to carefully for his concerns and should be given utter respect. In order to get the patient acquainted with the clinical settings and the procedures, the healthcare professionals should spend a quality amount of time, trying to impart education to them. By connecting with the patient on a personal level, smooth facilitation of care services can eb rendered to the patient. This will also be helpful for the patient to get adapted to the clinical settings and will have comparatively less anxiety for any interventions to be executed.

Evaluation of Workplace Clinical Assessment

Such situations can have both positive as well as negative impact on the clinical management of the patient. The main positive impact of this process is that it enables regular follow-ups of the patient to the healthcare setting (Ryba 2017, pp. 648-656). It is crucial from the point of view of continuity of treatment for the patient. Patients are also usually depressed in a way for accepting their fate of having kidney failure. However, with the help of good family support and positive reinforcement for the treatment therapy, the patient can be motivated to stay afloat for continuing the treatment. The negative aspect associated with the process is the patient having anxiety and a difficultly to adjust to the new normal pattern in his daily routine. The initial few sessions are always stressful for the patient as well as for the nurses, as it is unknown how well the patient will react to the treatment. The patient, along with dialysis has to be treated from a holistic point of view. This can be inclusive of medical management, dietary management, psychosocial support and so on (Haris 2018, pp. 347-357). All these aspects have to be taken into close consideration while managing care for the patient.

Analysis of Workplace Clinical Assessment

I believe in the concept of noting for my individual strengths and weakness. The situations like these can be quite stressful for the patients as well as the healthcare workers. However, by working closely with the family members the underlying conflicts can be easily resolved and better healthcare services can be rendered for the patient. Most of the times, it is seen that patients are quite anxious before the intervention. However, with proper time and comfort provided to the patient through one-on-one interaction, can lower down the anxiety and can thus, help the patient in adapting well to the situation.

Conclusion on Workplace Clinical Assessment

With my overall experience I have come to learn that we should not rush into any given situation. As a nurse it is our duty to not only educate the patient but also help in understand the procedures well for helping in the transition process. Hospital environments can be quite troubling for the patient (Yeh 2020, pp. 1-14). Having someone close one by their side, not only makes it easier to interact with them, rather helps in lowering their anxiety as well. I will always be engaged in the care delivery process, by encouraging my patients to continue with the treatment, irrespective of the any underlying issue. Team work can help in resolving conflicts and ensuring smooth facilitation of healthcare services delivery to the patient.

Action Plan

In case I will be subjected to any such scenario, I would to like to include a different approach for future inferences. I would arrange a meeting with the patients and their families, to help them understand the concept of dialysis and what benefit it might reflect in the patient. This will allow my patients a chance to pay a visit to the unit and see how things work. Thus, enabling them with a chance to settle in the system well. I would also work along with the patients, to provide them assistance with support groups where patients will be able to discuss their current issues and concerns in a safe environment. Health education will be an integral part of the process, ensuring a way for one-on-one sessions with the patient and allowing them a medium to know more about their condition (Snowdon 2017, pp. 786-792). This will also be helpful in lowering their anxiety for their clinical condition and its pertaining treatment.

References for Workplace Clinical Assessment

Antlanger, M., Josten, P., Kammer, M., Exner, I., Lorenz-Turnheim, K., Eigner, M., Paul, G., Klauser-Braun, R., Sunder-Plassmann, G., Säemann, M.D. and Hecking, M., 2017. Blood volume-monitored regulation of ultrafiltration to decrease the dry weight in fluid-overloaded hemodialysis patients: A randomized controlled trial. BMC Nephrology18(1), p.238-241. https://doi.org/10.1186/s12882-017-0639-x

Cohen, S.D., Cukor, D. and Kimmel, P.L., 2016. Anxiety in patients treated with hemodialysis. Clinical Journal of the American Society of Nephrology11(12), pp.2250-2255. https://doi.org/10.2215/CJN.02590316

DePasquale, N., Cabacungan, A., Ephraim, P.L., Lewis-Boyér, L., Powe, N.R. and Boulware, L.E., 2019. Family members’ experiences with dialysis and kidney transplantation. Kidney Medicine1(4), pp.171-179. https://doi.org/10.1016/j.xkme.2019.06.001

Enger, R. and Andershed, B., 2018. Nurses’ experience of the transfer of ICU patients to general wards: A great responsibility and a huge challenge. Journal of Clinical Nursing27(1-2), pp.186-194. https://doi.org/10.1111/jocn.13911

 Haris, Á. and Polner, K., 2018. Care for chronic renal patients–Role of multidisciplinary education. Physiology International105(4), pp.347-357. https://doi.org/10.1556/2060.105.2018.4.26

Markkanen, P., Välimäki, M., Anttila, M. and Kuuskorpi, M., 2020. A reflective cycle: Understanding challenging situations in a school setting. Educational Research62(1), pp.46-62. https://doi.org/10.1080/00131881.2020.1711790

Ryba, M.M., Brothers, B.M. and Andersen, B.L., 2017. Implementation of an evidence-based biobehavioral treatment for cancer patients. Translational Behavioral Medicine7(4), pp.648-656. https://doi.org/10.1007/s13142-016-0459-8

Snowdon, D.A., Leggat, S.G. and Taylor, N.F., 2017. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review. BMC ealth Services Research17(1), p.786-792. https://doi.org/10.1186/s12913-017-2739-5

Yeh, J. and Ostini, R., 2020. The impact of health literacy environment on patient stress: A systematic review. BMC Public Health20, pp.1-14. https://doi.org/10.1186/s12889-020-08649-x

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