NURSING STUDENT’S REFLECTIVE JOURNAL DURING THE CLINICAL PLACEMENT AT OPERATING THEATRE

Nursing Student’s Reflective Journal
Name
Institution
Nursing Student’s Reflective Journal
A very good, positive and supportive learning environment
Description
One of the requirements of an ideal working place is that it should foster learning amongst students. Students need to feel safe, relaxed and willing to take risks especially if they have undergone previous negative experiences in the classroom set up (Chesser-Smyth, 2005; Bradbury-Jones, Sambrook & Irvine, 2011). Moreover, an ideal learning environment enables students to have a unique experience away from class because it entails the differentiation of theoretical and practical work. One of the benefits of the student placement is that it offered an ideal learning environment for any willing student. The multidisciplinary team was committed to imparting students with ideal skills for their positions. The surgeons, radiographers, technical staffs and nurses were all supportive and always willing to respond to questions regarding the practice. Working with the team played a primary role in strengthening the nursing knowledge that had previously been attained in the classroom environment (Andrews, Brodie, Andrews, Wong & Thomas, 2005; Saarikoski & Leino-Kilpi, 2002; Lioba, 2016).). Moreover, the team ensured that it boosted my knowledge and skills in communicating regarding the anatomy and physiological knowledge gained from the class environment
Feelings
The provision of an ideal working environment was a deal breaker for the nursing placement.

Most importantly, I was overwhelmed with positive emotions on the commitment of the team to ensure that all student nurses are equipped with a variety of skills to ensure that they can tackle a host of issues in the medical field. Most importantly, I was always grateful for the commitment of the team in boosting my responses to critical issues and hence my self-esteem in responding to several patient and organizational needs while in the work environment.
Evaluation
I would award the hospital a score of 9/10 given the chance to explain how its facility worked to ensure that all student nurses had an ideal experience and were given the chance to learn. According to Andrews, Brodie, Andrews, Hillan, Thomas, Wong and Rixon (2006), one of the tenets of an ideal working environment is the commitment by senior employees to work towards fostering the growth of junior employees. The supervisors assigned to work with were also committed to their tasks. I was particularly impressed that they were willing to give students a chance to demonstrate their capabilities before they could intervene. Thus, the tam was influential in imparting us with critical skills to work in the operating theater
Analysis
While the help accorded by the team was critical, it was evident that previous knowledge and skills were also influential in enabling me demonstrate my prowess and capacities in the working environment (Brown, Nolan, Davies Nolan & Keady, 2008; Last & Fulbrooke, 2003). It was critical that an individual translates theoretical information as well to attain excellence. Poor understanding of theoretical knowledge gained from school would compromise individual ability to respond to the new tasks and responsibilities given in the working environment.
Conclusion
The creation of a supportive working environment is critical in enabling learners to gain relevant skills to boost their knowledge and the understanding of key concepts. A supportive working team was a major deal breaker for me because it provided the chance to respond, enquire and practice new concepts that I was previously unaware of.
Action plan
The provision of a supportive working environment is a key instrument for nursing students. Based on the outcomes of researches explaining burnout as a major constraint for most nurses, I believe that the creation of a flexible working time and environment in general would improve the abilities to respond to the needs of my job even in the future (Levett‐Jones, Lathlean, Higgins & McMillan, 2009).
Incompliance to proper counting of surgical items
Description
On the second of my placement at the operating theater, I experienced a strain that would have put my career in jeopardy. The staff nurse assigned to work with had not counted the surgical items prior and throughout the operating procedure. I asked of the same but I was shocked to receive a strange reply from her. She mentioned that the process was a minor one and thus did not require a comprehensive process in preparation such as counting of instruments. The nurse explained that the scrub nurse was responsible for the surgical instruments and would thus be aware of the specific instruments that she had assigned the team.
Feelings
I was perplexed about the attitude of the nurse regarding critical procedures for the operating theater. As we had initially been instructed, it is imperative that nurses take into account the number of instruments being used in the surgical room for various processes (Vogts, Hannam, Merry & Mitchell, 2011). Counting the devices is good for purposes of accountability as well as preparing for other procedures in the event that an emergency occurs (McGain, McAlister, McGavin & Story, 2010; Cima, Kollengode, Storsveen, Weisbrod, Deschamps, Koch & Pool, 2009). It would be difficult to determine whether all the relevant instruments are prepared for another process when the process of record taking is improper.
Evaluation
As is known, students learn from their leaders and superiors at work. They follow the instructions and trends set by their leaders in the working environment. In this case, the nurse did not demonstrate a good example. Instead, she should have admitted the mistake and instead cautioned me on the importance of counting instruments before such a procedure. A count is essential to enable the team in charge be assured that no instruments are retained in the patient’s body after the surgical procedure (Adler, Scherrer, Rückauer & Daschner, 2005; Dowson, Gage, Jackson, Qiao Williams & Rockall, 2012). While it is true that there are procedures that do not need a count, the nurse should have informed me prior to the process such that we are in tandem if the surgical doctor enquires.
Analysis
The count of instruments would have been fatal if the process involved was major surgery. In fact, experts emphasize that the two nurses in charge of a process must account for the number of counts done and recorded to ensure that no mistakes take place. Lafrenière, Bohnen, Pasieka and Spry (2001) emphasize that health care organizations must have a sequence with which the counts are conducted. The use of a consistent methodology plays a vital role in eliminating doubts regarding leaving any instruments in a patient’s body after surgery (Ram, Kaushik, Brar, Taneja, & Gupta, 2001).
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Conclusion
Future incidences of not counting instruments before and after a surgical procedure should be treated with a lot of care. The sequence with which individuals conduct a count is also essential. There are incidences when devices may get lost in the facility. Thus, the use of such instruments is critical in enabling those in charge remain accountable.
Action Plan
The health care facility should introduce an ideal plan whereby burses are prompted to conduct a count before any process. The facility must have a sheet that accompanies all processes to ensure that nurses remain responsible for all their actions. In the event that counting is not essential, the doctor in charge should also sign the document as proof that there was no need for counting instruments (Sridhar, Boopathi, Lodha & Kabra, 2004; Fourcade Blache, Grenier, Bourgain, & Minvielle, 2011). In such cases, there will be greater accountability and responsibility from all the respondents.
Preoperative patient hygiene preparation
Description
In several instances, I identified that some patients were taken for surgery without conducting a proper pre-operative hygiene. Some of the elderly would even be taken for processes without a change of diapers. There are instances when patients complained of being in the facility without receiving proper care up to 3 days after they were admitted because of road traffic accidents. Such incidences are known to have profound effects on the patient’s healing capacity as well as lead to infections.
Feeling
It is the responsibility of nurses to look after the care needs of patients once they are taken to the health facilities. The only way to avoid infections in the course of treatments. There should also be a formal guideline indicating the actions that should be undertaken by the nurses during the pre-operative phase (Kasatpibal, Senaratana, Chitreecheur, Chotirosniramit, Pakvipas & Junthasopeepun, 2012).
Evaluation
Patients who render themselves dependent on the integrity, knowledge and skill of the health care team. The health care team is obligated to offer an ideal recuperating environment for the patient (Eiselt, 2009; Boyce, & Pittet, 2002; Lioba, 2016).). It is the obligation of the nurse to ensure that the welfare of the patient is well taken care of before an operating procedure takes place. Ivarsson, Larsson, Lührs and Sjöberg, (2005), emphasize that it is imperative that the nurses offer relevant pre-operative care to patients. Patients should be taken for a bath, shower and the removal of excess body dirt and oils that may contribute to re-infections after a surgical process (Seal & Paul-Cheadle, 2004; Widmer, Rotter, Voss, Nthumba, Allegranzi Boyce & Pittet, 2010). Thus, the facility failed in its mandate to guarantee the health and wellbeing of its patients.
Analysis
Pre-operation hygiene is critical because it ensures that further infections on the surgical site are eliminated. Moreover, the process offers an ideal environment for faster healing of the surgical wound. A study conducted by Kamel, McGahan, Polisena, Mierzwinski-Urban & Embil (2012 identified that when pre-operative healing is well done, it reduces the chances of infection by up to 50%. Thus, following the right procedures plays a critical role in making the operation processes successfully.
Conclusion
The preparation of a patient before the surgery takes place is a critical process of the operation procedure. The health care facility failed in its mandate to in several instances to ensure that adequate care was provided to its patients to avoid infections. It is imperative that the facility emphasizes the need to take care of the needs of patients as is recommended.
Action Plan
Early preparation of patients should begin on the night before the surgery takes place. Identifying an ideal preparation system may play a vital role in equipping organization employees with relevant skills to minimize incidences of infection after a surgical process (Kampf & Kramer, 2004; Lioba, 2016).). Efficiency can be attained when a reliable protocol is adopted to ensure the safety of patients.
Staff Safety Hazards
Description
The safety of the staff working in a health facility is critical for the health facility. Safety hazards that may lead to accidents in the organization ought to be eliminated. There were several extension wires on the floor of the facility that posed significant safety hazards for people within the facility. The wires risked the health of patients and staffs because some would trip almost to the point of falling. Moreover, rather than identifying an ideal methodology to eliminate the risk, there are instances when draping cloths were used to cover the wires, further complicating the situation and making it impossible for an individual to identify whether there are risks. Moreover, a significant number of the rooms did not give any information on the existence of sockets. Tangling cords and wire extensions throughout the room for machines with high voltages also posed significant health hazards
Feelings
The presence of electrical wires and cords poses safety hazards to all those in the health facility. It would be detrimental to the health of patients moving around the facility after surgeries or even the elderly. Thus, the floors of the health facility ought to be completely dried and all cords are attached to the wall next to them using appropriate tucks. I also felt that the management was inconsiderate because it did not make appropriate follow-ups to ensure the safety of its residents within the facility.
Evaluation
The role of nurse care and the medical acre is to improve the health and guarantee the safety of patients. Facilities that fail to put in place viable methods to protect their patients contravene the tenets of providing an ideal environment to boost the health and abilities of their patients to recover (Matern & Koneczny, 2007; Fasunloro & Owotade, 2004; Millar, Xu & Moore, 2002). Health and safety hazards principle emphasize that employees should be at the front line of communicating such incidences to enable their supervisors to respond amicably to situations that pose safety hazards for patients. To this effect, all individuals within the facility were at fault for not communicating in time
Analysis
The health and safety of workers are the responsibility of all people in their working area. Thus, employees ought to highlight issues or circumstances that pose safety hazards to their functions within the facility (Smith, Pearson & Rose, 2009; Sexton, Berenholtz, Goeschel, Watson, Holzmueller, Thompson & Pronovost, 2011). The required team should move swiftly to offer solutions by ensuring that the cables and labeling of sockets take place to guarantee the safety of workers. Statistic shave indicated that the health care and social assistance industry records the highest workplace related injuries (Blegen, Vaughn, Pepper, Vojir, Stratton, Boyd & Armstrong, 2004). To this effect, the only way to ensure continuity in the provision of services within the facility is by making sure that its health workers are also safe
Conclusion
Health workers put their lives in danger when at work. Thus, it is the responsibility of their employers to ensure that the working area for their staffs is void of any events that would lead to accidents. It is imperative that the concerned supervisors respond amicably to ensure that the health and safety of all workers are maintained at all times.
Action Plan
It is imperative that all the risks within the facility be identified. The details associated with all the hazards should also be documented (Timmel, Kent, Holzmueller, Paine, Schulick & Pronovost, 2010). Risk controls and labeling of areas whereby staffs are likely to be injured should also be done to give the management better control and hence the safety of its workers
Reuse of disposal items
Description
There are instances when the disposal endotracheal tube (ETT) such as laryngeal mask airway (LMA) & suction tube was reused though it had been sterilised. When I asked how many times they are going to reuse it, they said as many time as they think that the item still can be reused and not broken. No indications or records were notifying the number of times that the LMA or suction tube can be reused. It was based on personal judgment only. They attributed their actions to the fact that the equipment was quite expensive.
Feeling
It is evident that the health facility is more concerned about costs and not the needs of its patients. While the instruments may be reused and sterilized after use, it is imperative that the facility specifies how many times the device can be reused to avoid incidences of infecting other patients (Ram, Kaushik, Brar, Taneja & Gupta, 2001). As a result, I was not content with the way the facility handled the matter and were more concerned about cost saving instead of the health of the patient
Evaluation
Patient safety is paramount in any health facility. It is ideal that health centres put into the record the number of devices that they anticipate to use in a day to enable the management plan for the needs of their patients by investing in adequate equipment (Hausman & Johnston, 2010; Gibbs, 2005). At the facility, it is evident that the staffs were negligent and failed to observe the appropriate protocol regarding the use of disposable materials. Such incidences are known to trigger reinfections amongst patients
Analysis
The institution should conduct a budgetary needs analysis and document the number of times that the device ought to be used before disposal. Such disposable devices should be done away with because their physical properties make them unsafe for use or may lead to cross infections. Moreover, Gawande, Studdert, Orav, Brennan and Zinner, M. J. (2003) cite that the re-use of such devices makes them weak and prone to breakage or malfunctioning when using them thereby posing greater harm to the health of the patient.
Conclusion
Non-reusable devices ought not to be reused on patients at the expense of costs. It is essential that hospitals budget for such needs based on statistics and the number of patients served within particular periods. Official guidance stipulates that the number of reuse should not exceed two. Such would enable all the concerned parties practice care and remain accountable for the health of patients.
Action Plan
The facility should specify the number of re-uses that can be done using a single device. There should also be standard procedures used in sterilizing of equipment’s used within the facility hence avoid any form of cross infections (McGain, Cox, Cecchin, McAlister & Barach, 2012). Most importantly, proper budgeting of equipment ought to be done to ensure that there are adequate facilities to respond to the needs of patients.

References
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