Reflection plan of care
Patient Safety and Clinical Quality in Complex Nursing Care Reflection plan of care
Assignment 3 Reflection plan of care
ASSESSMENT TASK 3: Patient Safety and Clinical Quality in Complex Nursing Care Reflection plan of care
Word Count: 1200 words (+/- 10%) for a reflection plan of care AND a plan of care or shift planner (in the appendix) could be 20 words less or more, it is up to you and/ your case such as 8am Obs. 9am Medication and 10am CT scan….for total 8 hours.
When caring for patients, nurses often complete an 8-hour shift plan for all patients in their care for that shift.
Please (construct) and submit your plan of care for your patient in the appendix (this is not counted towards the word count) and use this to base your critical reflection on. A plan of care or shift planner could be 20 words less or more, it is up to you and/ your case such as 8am Obs. 9am Medication and 10am CT scan…. for total 8 hours. The patient chosen is Mrs. Betty Graham (see page 6-8 for Mrs. Graham case scenario and 2 separate PDF files for Mrs. Graham progress note and med charts etc.
Your reflection would only be based on your planned actions, not your practical actions.
Your task for Assessment Three (3) is to use John’s Reflective Model to reflect on your plan of care for your patient, identify strengths in your clinical reasoning, limitations in your critical thinking, and an action plan for how you will address your future learning to improve the areas where you did not perform as well as you wish. John’s reflective model requires you to address the following:
• Describe what you did, how you feel that you performed, what information you used to develop your plan of care (this may be formal research or it may be personal experience such as working on a ward, or it may be that there was very little thought applied at all – note all of this here).Reflection
• Did you have clear goals for each patient? What were you trying to achieve for each patient? Would your plan of care achieve these goals? Would you have caused any harm to your patient by doing things that should not have been done? Would you have caused harm by omitting care that should have been done? Did you consider the legal and ethical implications of your actions?
• Did you consider the specific individual needs of this patient, or were you developing your plan of care based on routine things that should be done for everyone regardless of what the patient needs or wants?
• Was your plan of care evidence-based – did it align with current clinical policies and guidelines? If there are no policies and guidelines around what you did, then consider what the evidence says in terms of what you did and the associated outcomes of patients here.
• Would your plan of care for this patient affect anyone else (other staff, other patients, family members, public health resources), and is this impact reasonable to provide care for this patient?
• In developing your plan of care did you use high-quality evidence to inform your clinical decision making (i.e. clinical guidelines, policies, systematic reviews of high-quality evidence), or did you use lower quality evidence such as individual studies in journals or textbooks? Or was your evidence from dangerously low-quality sources such as nursebuff.com and nurselabs.com or other resources written for average consumers, not health professionals? Would you be happy to have your nursing plan of care developed from these sources?
*** At least 7 high quality sources of evidence are used to support this part of the reflection. High quality sources include clinical practice guidelines, policy directives, and large systematic reviews of high level evidence).Influencing factors
• Thinking about areas in your care plan which you did well, or which you did not do well, what were the factors that influenced these decisions? Consider internal factors (personal thoughts, limitations, confidence, and knowledge) and external factors (time, peers, and resources available).
• Did you use past experiences to help you, did you use EBP? Was time an influencing factor for you in developing the plan of care? What else influenced your decision-making processes.
• Would these influencing factors play a role in the enhancement or hindrance of patient care in a real-life clinical setting? Improvement
• What could you have done better for these patients in developing this plan of care? How will you improve the patient’s outcomes?
• What would the consequences be of your suggested improvements and do the benefits outweigh any potential risks (eg. Is it too expensive with very little evidence-based improved outcome?).
*** This is supported by at least 1 high quality source of EBP (clinical guidelines or policy directives) per change Learning
• What will change because of your experience in writing these care plans?
• What have you noticed is an area that you would like to improve your knowledge and skill-based on what you have reflected on?
• How will you go about improving this? This should address 3 clear, specific, and measurable action plans (SMART goals).
• Do not write ‘read hospital policy’ as there are thousands, identify which exact policy you will read and reference it. The same goes for books, chapters, youtube videos, conferences, in-services. Do not write that you will vaguely attend these – these must be ones already scheduled/attended which you can reference.
• It must be an action that specifically addresses your ability to critically think, clinical reason and improve care for medical surgical patients
• It may be something you should already know but has been highlighted in this assessment as an area of weakness (such as medication administration errors), however, it should not be something you are already expected to know and this assessment has not highlighted any limitations in that area. Marking Criteria for Assessment Item 3 – Patient Safety and Clinical Quality in Complex Nursing Care Reflection
Criteria (% are indicative) High Distinction Description The student is able to provide a concise, specific and effective description of the case studies and how they went about developing the associated care plans.
The student is able to demonstrate an awareness of their own feelings with regard to the case studies and ability to maintain Patient Safety and Clinical Quality (15%)There is a concise and specific, yet effective description provided of the case studies and how the student went about developing their care plans.
Personal reflection is articulate, shows a high level of insight regarding the student’s own feelings regarding the case studies, ability to develop a holistic care plan with MDT engagement and student’s ability to maintain Patient Safety and Clinical Quality.
Minimal spelling and grammar errors. Marks (10/100) 8.5-10ReflectionThe student is able to identify the intended goals that they had in mind for their patients, the impact their plan of care will have and the safety of their plan of care as it relates to current evidence based practice, the specific needs of the individual patient and high quality evidence is used to support the student’s justification that their plan of care was appropriate or inappropriate for this patient. The student is able to analyse their care plan along with suggested improvements to safety and quality in regards to complex care needs of the patient. The student can identify aspects of their plan of care which are supported by policy, guidelines and EBP.
Support from the literature is expected in this section (30%)There is strong, well developed evidence of evaluation of what the student did well, aspects of care they overlooked and areas where patient safety may be upheld or compromised in their plan of care.
There is well developed and clear evidence of analysis of the care plan. Analysis identifies what aspects of care are supported by EBP/considered dangerous or poor practice in EBP/not adequately researched in EBP. The student demonstrates awareness of the impact that their plan of care will have upon their patient, other patients, healthcare workers and the public health resources. The student identifies what tools and resources were beneficial for them to develop their care plan and which were unhelpful or hindered the care plan. At least 7 high quality sources of evidence are used to support this part of the reflection. High quality sources include clinical practice guidelines, policy directives, and large systematic reviews of high level evidence).
Consistent and correct use of APA referencing style, incorporated effectively to support the reflection/commentary.
Minimal spelling and grammar errors.
Marks (30/100) 25.5-30Influencing Factors Students are able to identify internal and external factors which influenced their clinical decision making and consider how these would affect patient care in a real-life situation (10%)Internal and external influencing factors are clearly and concisely articulated. The potential impact of these factors on patient care is explored with specific outcomes for patients hypothesised.
Minimal spelling and grammar errors.
Marks (10/100) 8.5-10ImprovementThe student is able to identify what should be improved in their care plan. The student can predict how these improvements may benefit the patients as well as consideration of risks of any changes in clinical care. (25%)Suggested changes to the plan of care are concisely and clearly articulated. There is a clear rationale for the suggested changes which identifies predicted benefits to making this change. This is supported by at least 1 high quality source of EBP (clinical guidelines or policy directives) per change. Consistent and correct use of APA referencing style, incorporated effectively to support the reflection/commentary.
Minimal spelling and grammar errors. Marks (25/100) 21.5-25LearningThe student is able to indicate what they have learnt about their current knowledge and level of and understanding of patient safety and clinical quality. The student is able to provide three targeted action points that will continue to develop their awareness of patient safety issues. Rationales are included, supported by evidenced based literature. (25%)Reflection is carefully considered and specifically describes what the student has learnt about their knowledge and level of and understanding of patient safety and clinical quality. There are some insightful commentary in this section which identify progression of learning at the level expected of a third year BN student. There is clear, insightful evidence that the student is able to identify ongoing learning activities with 3 specific actions identified and rationales for these are identified and supported by evidenced based literature Consistent and correct use of APA referencing style, incorporated effectively to support the reflection/commentary Minimal spelling and grammar errors. Marks (25/100) 21.5-25
———————————————————————————————————————————————————————————————Mrs. Betty Graham Case scenario summary
Mrs. Elizabeth Graham is an 83 year old female who was admitted to the UTS Hospital Emergency Department via ambulance, following a fall at home. Reports being in bathroom about 8 am, when she slipped and fell. She was able to call her next door neighbour who came to Mrs. Graham’s aid and called the ambulance.
On examination: Short of breath, complaining of pain in her left side of her chest. Small laceration/haematoma evident – left side of her forehead – tender but not too painful. Nil other complaints.
PMHx: – PMHx hypertension, managed well with metoprolol, history of vertigo – but no current medications and regularly takes Panadol for arthritic type pain in her hands. Previous admissions – hospital to have her children and to get a BCC removed surgically in 2010. Otherwise reports general good health.
PLAN: For urgent CXR, pain relief and Head CTA
10.00am Chest X-ray identified fractured ribs (5th, 6th and 7th) with a haemo-pneoumothorax. A basal intercostal catheter (ICC) inserted under local anaesthetic and an underwater sealed drain (UWSD) attached. Observe for 1 hour in ED and re-evaluate. A CT of brain – report NAD. Head wound cleaned and Steristrips applied to laceration. 8mg of morphine IV given. S/C Morphine PRN for further pain relief is charted
Social Hx: Mrs. Graham is a widow and lives on her own. Two children: daughter in WA, son lives locally but currently overseas. Usually independent, holds a current drivers licence, Independent for ADLs with some support for heavier housework. Neighbour close support.
PLAN: Admit. For observation
Observations ON ADMISION to ED
HR 90 BPM
Resps. 24 BPM
O2 Sats. 92% 3L via NP
LOC Alert and orientated to time, place and person. GCS 15/15
Pupils Equal and reactive to light
Pain Self-report a pain level of 8/10 in the left chest
Wound Small laceration to her forehead with small amount of bleeding. Tender but not too painful
A chest X-ray revealed fractured ribs (5th, 6th and 7th) with a haemo-pneoumothorax. Betty was administered of 2mg of Morphine IV every 5 minutes to a total dose of 8mg for pain relief. Doctors then administered local anaesthetic and inserted a basal intercostal catheter (ICC) with an underwater sealed drain (UWSD) attached. Betty was observed for an hour in ED and it was noted the ICC and UWSD was having the desired effect and no other injuries were found. A CT of her brain had NAD. Betty was then made ready for transfer to ward 1A.
Betty’s condition after the ICC insertion (10.30 am) was documented as:
HR 70 BPM
Resps. 20 BPM
O2 Sats. 98% 3L via NP
LOC Alert and orientated to time, place and person. GCS 15/15
Pupils Equal and reactive to light
Pain Self-report a pain level of 3/10 in the left chest
Wound Small laceration to her forehead approximated with steri-strips with a combine secured with tape over the top. This wound had a small amount of bleeding.
UWSD Stitched insitu. Connections secured with tape
Bubble and swing present. 80mls of haemoserous fluid in the collection chamber.
————————————————————————Assessment 3 FAQs
Is it 1200 words including the care plan or 1200 words total? It is 1200 words and the care plan (which may only be a few words or abbreviations etc). Consider the care plan as 1 activity, and then reflect on this as a whole. Maybe you made the same mistake in your care plan, which means you need to improve your knowledge in this area. Or maybe you have made one mistake in your care plan but you improved your performance of the same task/care for a different patient in class, then you may reflect on why your practice is inconsistent and what triggers you to remember in one case but not the other (for example).
Do I need to include references in my reflection? If you follow the marking rubric you will see that you need several sources of high quality evidence in your reflection. The idea is that you are checking what you have done with best practice guidelines/policies/high level evidence to determine if that is the most appropriate thing you should have done. In the learning section, if you decide part of your plan involves reading policies/articles/documents then you will need to reference what exact, specific article/policy or document. Just writing “read NSW Health policy” will not be adequate. You do not need to reference your personal insights. Explanation from tutor on Microsoft team. Extra Q and A
Question: Assessment 3…….. please explain it to me?
It’s a structured reflection (using John’s) on your CNCMS learning.
You need to choose one patient
You will reflect on what you did in class but also what you would have done if you had time in a real shift etc. If you were too scared to prime a line, you can discuss that, if you didn’t’ get to prime a line because there were no more lines left, there’s not much for you to personally reflect on so you should just discuss as though the line got primed and move on.
Basically just structure it as the same in the assessment information (you don’t have to use headings but you definitely can).
And more or less you will just (in your discussion) answer the questions put to you in the example in the assessment information (although you don’t need to include the questions in your submission, you would do better to make a sentence out of it, but you can include the questions if you really must but it is unlikely to earn you an HD.
So if the question says :
What could you have done better for these patients in developing this plan of care?
Your answer should be:
In developing this plan of care for this patient, I could have done XYZ which would have been better for them because blah blah blah (reference, date).
You can reflect on stuff you actually did in class but you should consider your ‘plan of care’ as an ideal plan you created in the lab.
The practical part of the lab class is supposed to be like a shift.
Obviously, you don’t do all the things that would be done in a shift but it’s important that they are all considered.
When would you offer the patient a shower?
(Had you considered that in your class or first reading of that patient information?)
How often does this patient need obs?
(What had you thought in class about this and have you changed your mind since you have attended more classes and because of your research for your first assignment?)
What can you do for this patient, what do you need a physio/ doctor/ radiologist/ phlebotomist etc to do for your patient etc.
If you didn’t get to do the ECG just because everyone else in class was using the machine, it would not make sense for patient care for you to say that you wouldn’t do the ECG.
We couldn’t actually do ABGs because my ABG machine was a piece of paper stuck to the wall but we can still interpret ABGs and discuss the patient condition in relation to various ABG readings.
All the patients would need obs periodically but no one actually did any obs on most of the patients in the lab class (but your care plan should include obs/BGL/neurovascular obs/neuro obs as necessary and why that patient should have that frequency).
Basically, if you had time and resources available like a whole shift, what would you do and in what order and was that your initial plan and what would happen if you just followed your initial plan.
For example, when I used to play doctors and nurses with my niece Allegra and nephew Dominic when they were 3 and 5 years old, we just bandaged all the dolls from head to toe and then we did CPR on them.
That was their understanding of patient care.
Because you know more about patient care than a 5 year old, you know that not every patient needs to be bandaged head to toe and CPR for all patients is also a terrible idea. Also this sort of care misses out on a lot of stuff that nurses need to do for our patients on a daily basis like hygiene and meals and meds and obs and communication etc.