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Portfolio Essay

3396 words - 14 pages

This reflective account demonstrates an ability to critically reflect on experiences within my nurse training, particularly within my third and final year. The reflective model selected is Gibbs (1998) (appendix 1) which incorporates description, feelings, evaluation, analysis, conclusion and an action plan which is divided into sections for ease of reading. All names have been changed in accordance with the NMC (2008a) guidelines regarding confidentiality. This piece includes reflections on my own learning using the NMC proficiency, managing care. As this covers a vast array my focus is primarily on medicine management, managing risk and delegation.

Description of events
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1ml/kg of 1:10000
Glucose = 5ml/kg of 10% dextrose

I had recently been taught this at university therefore I was familiar with the system.
With a score of ten in mind the registrar, Rob, was informed and came to assess Jay. Initially, Rob prescribed 2mg Budesonide which was given via nebulisation in accordance to British National Formulary for Children (BNF) (2008). Dykes (2005) suggest Budesonide helps to suppress the inflammatory process and agrees with many who suggest that glucocorticoids such as Budesonide are beneficial in treating croup, (Ausejo et al 1999, Moyer 2000, Russell et al 2004). However on this occasion, Budesonide proved to have little effect as Jay was still having breathing difficulties. Consequently Rob suggested that Jay be given adrenaline which many agree is often used for children with severe upper airway obstruction (Barnes 2000, Lissauer and Clayden 2001, Roberts et al 1999, Taussig and Landau 1999). Rob suggested a dose 1:10000 (0.1mg) of adrenaline which Schmidt and Smith (2005) agree is the general emergency drug calculation.
On hearing this dose I asked if I could speak with him privately as I believed that the dose was incorrect for croup and thought it unprofessional to suggest this in front of Jay's mother. On exiting the room I suggested that the adrenaline dose that he was prescribing was incorrect.
Rob informed me that he had been working in A&E for over ten years and knew the drug dose and indicated that I was merely a student nurse. According to The Nursing and Midwifery Council (NMC) (2008a) nurses must be willing to share their skills with their colleagues therefore emphasized that I was a paediatric student nurse in the final year of my training.
I proposed that I show him the BNF (2008) as I was certain of the dose. Rob suggested if it made me feel better that he was fine with it, which I found a little disrespectful. During this Sue remained with Jay and his mother and was unaware of any discrepancy.
After providing evidence of the correct dose as stated in the BNF (2008) and administering the adrenaline 1 in 1000 (1mg/ml), Rob stated that not many student nurses would have challenged senior members of the team and was glad that I had as Jay's condition could have rapidly deteriorated as the adrenaline dose of 1:10000 would have been insufficient. Whilst I appreciated that Rob had apologised, I suggested that although I am a student nurse I am also the advocate for the patient and there to provide and deliver the best care available in accordance with NMC (2008a) guidelines. Furthermore, I was working within the NMC (2008a) guidelines which states that nurses must act without delay, if a patient is being put at risk. Many suggest that in the past, nurses were perceived by doctors as subordinates, (Buckenham and McGrath 1983, Coeling and Cukr 2000, James 1989 and Watson 1990), perhaps Rob's apology signifies that history may be changing and that equality was increasing.

Sue and I...

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