Rational: "Self-reflection is a necessary foundation for meaningful nursing practice that allows for feelings of satisfaction and empowerment. As such, it is a critical nursing skill with the potential for enormous benefit. And while we call it “self” reflection, those nurses who have had a lifetime of experience in practicing this discipline and looking inward are the very nurses who, by sharing the insights they have gained, can help less experienced nurses improve practice, avoid burnout, and find solutions to problems they face" (Olsen, N., 2014)
Acute care at Scone Memorial hospital for 160hrs
Scone was small regional area. As compared to Multipurpose service, it is slightly bigger and more like hospital. But it is smaller than Bathurst base hospital and total population in Scone is also much less than Bathurst. Emergency is rarely seen because the lack of resources. Most of serious and emergent cases transferred to either Maitland hospital or John Hunter Hospital.
The main tasks of RNs are responsible for documentation. This hospital still uses paper chart and nurses check patient’s detail such as Medicare, pathology slip and triage. Secondly, this hospital plays a role as a bridge between a GP clinic and tertiary health care. Aside from real patients, some visits are to collect their drugs, get blood test and injection. Thirdly, ED nurses need to provide help for general ward and maternity unit.
The day my preceptor was Erin. Her role on the day was discharge planning. She explain her role as well as shared her experience as a nurse. She started her career in Scone with New graduate program and worked in Musselbrook as an AIN. Discharge planning is the preparation process before a patient’s discharge. To do her job, she went to the patient, and asked many questions in regard to financial, physical and psychological issues. One patient with colostomy bag needed education before discharge, so she assess his health literacy and his coping skills. Also, Erin went to Strathern Nursing Home as she needed to assist one resident with a perc drain. I was able to see the public hospital collaborated with a private nursing home if the private nursing home needed resources and education.
During placement, I feel like I need confidence. I was uncomfortable working with the RNs who rarely speak to me. In that case, I could have been asked or engaged actively patient care with her, but I was a bit passive and quiet . But an Indian nurse that I met in Scone encouraged me. She kept telling me you were okay and doing so well. I started to feel valued. What I need is to get relaxed and focused on patient care and safety. Even if the staff members are not so gentle and kind, I should speak up if a patient left untreated and try to communicate one another.
Paediatrics at Bathurst Base hospital for 80hrs
I met a patient with an eating disorder who was admitted to the paediatric ward in the hospital during my fourth placement. Her main problem was refusing to eat food and also recently she disclosed that she heard voices saying that she needs to lose weight. Her speech was soft, passive, but also very adamant if I asked her to have a bit of food. Harken et al. (2017) found that adolescents with eating disorders can react in this way, so communication can be difficult. I felt like helping her in a warm manner using therapeutic communication that I’d learned, but I did not know where to start. She had a long history of mental health issues, and approaching her was not easy for me.
The paediatric unit in this hospital has limited resources to help her aside from feeding nutrition via nasogastric tube. Transferring her to ED in The Children’s Hospital at Westmead may not be the best way, but mental health service needs at least three months to book. Eating behavior therapy is not available as a doctor in Bathurst moved to another hospital. She continues to refuse food and relies on being fed. The second problem is self-harm; chances are she takes off her feeding tube when she goes back home. Carers are not able to feed her by using NG tube, which needs training even though she has received 24-hour care. It is undesirable that no medical care is given and she receives negligible care. In a realistic way, I think she needs to go school to make friends as she hasn’t been to school in her life. She even hasn’t been to the beach, so I want to take a walk or exercise while holding her hand. She needs attention from people and to improve ability to control her emotion without shaking from outside pressure.
I would like to improve my communication skills, so the first thing that I did was I observed how the nurses and doctor approached her, how they made a care plan for her and what they thought the best care for her would be. I will start with general questions to stimulate her interests rather than thinking and questioning her too seriously.
Mental rehabilitation at James Fretcher hospital for 80hrs
Honestly, I was interested in physical rehabilitation. But when I got these preference lists, my eyes went to Newcastle. One reason is it is not only close to my house, but also easily finding accommodation. Mental rehabilitation is the place where I can connect the patients to the community. Most of my patients have a dysfunctional family, poor childhood and genetic susceptibility. Then, the patients with Schizophrenia are likely to have experienced taking illicit drugs.
I understood, they are vulnerable. They need someone to help. Hence, the mental rehab seemingly exists for them. I visited one man who killed his mother, but due to the section 32, he was released from jail and stayed in a group home. However, it was a single unit. When I visited the place, it was very warm because he kept the heater on. Apparently, he didn’t worry about his electricity bill. Almost 8 out of 10 houses are filled with smoke. Where does the money from? They got a DSP and even NDIS. I knew they might not be able to live their life if there is no government support for them. It is a shame to see the people who have mental health problems like the one who has diagnosed cancer inadvertently. I need to have eyes that can see their life without judgement.
Dynamic supports and rehabilitation programs would be a reasonable way to help their recovery. The flowers and plants can grow with some amounts of water, but their ideal amount of water is different. It might be able to be measured by the experts. What if the supply is excessive? What if there is a fundamental defect? Could physical resources be helpful to their issues? It would be too subjective to provide an individual care plan. How should we help people with mental health problems to some extent?