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The involvement in reflective practice is important as it allows nursing practitioners and health practitioners manage their personal as well as professional effect on addressing fundamental health well-being of patients (Jacobs, 2016). In this study, reflection regarding use of Sepsis management skill is to be made. For this purpose, rationale of selection of the clinical skill is to be presented along with Gibb’s reflective cycle is to be used as model to present the reflection of the skill in a systematic way.
In the UK, each year nearly 48,000 deaths occur as a result of sepsis in the in-patients (BBC, 2020). Thus, it means that sepsis is a vital clinical condition in the UK and the management skill for the clinical condition as a nursing associate is important to be reflected in practice so that strength and weakness faced in the implementation of the skill at work can be determined. In the placement, I was allocated to look after M who was suffering from pneumonia. According to NMC Code of Conduct, personal information of the patients is to be kept private and confidentiality is to be maintained (NMC, 2018). Therefore, the patient is mentioned with the pseudonym M to maintain confidentiality and privacy. The people with pneumonia, bacteraemia and infectious blood are found to be prone to develop sepsis (Ranzani et al. 2017). Thus, the specific skill for its management is being discussed. Sepsis is extreme response of the body towards any infection and it is caused when the infectious agents enter the blood, lungs, urinary tract and others of the body.
The Gibb’s reflective cycle is used because it provides opportunity to systematically present the reflection in an easier way and it provides ability to develop learning over-time on the basis of personal experiences (Martin, 2018). Thus, the use of the model for reflection is effective as it provides time for making balanced along with accurate judgement. The six steps of Gibb's reflective cycle are description, feelings, evaluation, analysis, conclusion and action plan.
The patient named M who is a 72 years old individual was admitted to the hospital with severe pneumonia. On admission, sign of patched discoloured skin and temperature of 34˚C as identified by measuring through thermometer. Since pneumonia is an infectious disease which has ability to cause sepsis, I performed assessment of M accordingly to avoid septic shock which is often fatal. According to NICE guidelines, body temperature less than 36˚C with raised respiratory rate and patches on skin indicates moderate to high risk of sepsis (NICE, 2019). The body temperature and skin examination made me suspect that M is suffering from risk of sepsis. I ignore taking respiratory measurement as I thought it would not be normal since M already has pneumonia of severe form.
On the basis of examination reports provided by me regarding M, nurse asked me to administer antibiotics to M for coping with sepsis and ensure the oxygen saturation of M does not fall below 94% by taking reading through pulse oximeter. After 10 minutes, the nurse took blood sample from M for culture and serum lactate measurement. After this, within the next 15 minutes, the nurse provided intravenous fluid to the patient as asked me to monitor M’s skin colouration, urine output and body temperature to determine if the fluids are working to control sepsis. However, the emergency situation led me to get scared and confused regarding the way to effectively monitor M’s health. This led me to measure a wrong body temperature of M and urine output amount indicating that the fluids are not acting to lower sepsis so that her body temperature and fluid balance is restored.
The the issue was resolved when the registered nurse personally checked the temperature along with urine output amount and ensured that the fluids are working. The registered nurse instead of the error was polite to me and assured that if I try I would be doing great. It led me to get confidence in effectively monitoring the health of M regarding sepsis at 50th minutes since admission of M it was seen that the urine output of the patient was normalised to some extent mentioned the sepsis is effectively being controlled.
According to Nursing Associate Standards, the professionals are to remain accountable in care, promote health and prevent deteriorated health, monitor and deliver care, work in team, improve safety and care quality and contribute in integrated care (NMC, 2018a). During the activity, I felt that I was able to follow all the mentioned standards of proficiency for nursing associate except executing enhanced health monitoring of M. This is evident as from the time of admission I worked as a team with the registered nurse and remain accountable in caring for M along with expressed integrated and monitored M's health progress throughout the phase of 1 hour which is most critical hour in case of sepsis patients. Moreover, I supported the registered nurse and initiated Sepsis Six Bundle implemented for M so that M does not enter sepsis shock, in turn, preventing deteriorated health. However, I failed to effective measure the urine output and body temperature of M in the first attempt after the IV fluids was provided by the nurse which made me to interpret a wrong result. Since the nurse rechecked the data, thus to some extent the safety of the patients was not compromised and wrong directed treatment was avoided.
The evaluation of the experience led to interpret that taking immediate action to measure body temperature and examination of skin to detect the patches was a good approach. This is because NICE mentions that body temperature, respiration rate and blood pressure measurement are initial actions to be taken to determine suspected sepsis (NICE, 2014). However, failure to check the respiration rate of M on admission and with suspected sepsis was violation of one of the activities mentioned by NICE for sepsis management. Thus, the experience indicates that all the NICE guidelines in providing care to M was not effectively followed as I missed checking M’s respiration rate which is one vital parameter in sepsis detection. The other good aspect was that I followed Sepsis Six Bundle after suspecting sepsis in M with the help of registered nurse. This is because Sepsis Six Bundle is mentioned by the NHS as the universal management action to be followed for treatment of sepsis and prevent them from facing septic shock which is often fatal (NHS England, 2014).
The immediate administration of antibiotic to M on suspected sepsis was another good approach. This is because intravenous antibiotics in sepsis help individuals effectively fight the infection and protects organs from getting damaged (Liu et al., 2017). The measurement of serum lacate level after antibiotic administration by the registered nurse was also a good approach. This is because in sepsis patients the serum lactate level indicates the severity of infection in the blood (Cheng et al., 2018). Thus, assessment after antibiotic administration to M led to determine the condition of sepsis intensity in M.
The working as a team with the registered nurse to care and monitor M was an effective approach according to me as it led me to create coordinated care towards M. The IV fluid administration in sepsis patients helps to avoid sepsis shock as it assists to normalise the fluid concentration in the body that is lowered due to the action of the infection (Puskarich et al., 2016). Moreover, urine output monitoring indicates whether or normal amount of urine is produced by the patient. The normal output of urine in sepsis patient indicates that body has attained fluid balance and damage from the infection on the kidney is prevented assuring effective filtration of waste and infectious agents can perform (Bellomo et al., 2017). However, it was seen that failure occurred regarding monitoring of health progress of M as her body temperature and urine output are wrongly assessed. This is because I was unable to remain calm during emergency care and executed hindered action and health measurement.
The analysis of the experience led me to determine that the actions that went well was because I along with the registered nurse with whom I team to provide integrated care to M were having effective knowledge and skill in managing sepsis. The action of hindered care monitoring and failure to abide by NICE guidelines occurred because I was frightened of the situation and was unable to control my emotion in emergency situation. I think I require taking action in enhancing my knowledge to control my emotions and way to remain calm during an emergency situation.
The experience led to the conclusion that five aspects of nursing associate standards are effectively fulfilled but I required to improve my standard in monitoring health and care of patients. Moreover, I required working on controlling my emotion and patience in an emergency situation.
In future, I as the nursing associate will be going to execute breathing exercise to be calm and patience in an emergency situation. This is because it would help me to focus on my actions and avoid getting frightened out of lack of patience in the emergency situation related to sepsis. Further, I will try to remember all the NICE guidelines for sepsis management so that no further non-assessment of vital health parameters occurs which has led to wrong detection of sepsis intensity.
The above discussion informs that sepsis is a common infectious condition faced by people in the UK which is fatal among 1 in 5 inpatients. The reflection on sepsis management led to inform that I as the nursing associate can take proactive actions in suspecting sepsis in patients effectively. However, I have to work on improving the monitoring of health of patients and assessing their health parameter for suspecting sepsis intensity along with remaining calm in an emergency situation.
NICE 2019, Sepsis Assessment and Management, Available at: https://www.nice.org.uk/guidance/NG51/chapter/Recommendations#identifying-people-with-suspected-sepsis [Accessed on: 2 September 2020]
NHS England 2014, Sepsis Six Bundle, Available at: https://www.england.nhs.uk/wp-content/uploads/2014/02/rm-fs-10-1.pdf [Accessed on: 2 September 2020]
BBC 2020, 'Alarming' one in five deaths due to sepsis, Available at: https://www.bbc.com/news/health-51138859 [Accessed on: 2 September 2020]
NMC 2018, Professional standards of practice and behaviour for nurses, midwives and nursing associates, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 2 September 2020]
NMC 2018a, Standards of proficiency for nursing associates, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/nursing-associates/nursing-associates-proficiency-standards.pdf [Accessed on: 2 September 2020]
Jacobs, S., 2016. Reflective learning, reflective practice. Nursing2019, 46(5), pp.62-64.
Ranzani, O.T., Prina, E., Menéndez, R., Ceccato, A., Cilloniz, C., Mendez, R., Gabarrus, A., Barbeta, E., Bassi, G.L., Ferrer, M. and Torres, A., 2017. New sepsis definition (Sepsis-3) and community-acquired pneumonia mortality. A validation and clinical decision-making study. American journal of respiratory and critical care medicine, 196(10), pp.1287-1297.
Martin, P.J., 2018. Going Green–A Toolkit to Support Sustainable Practice. Coping and Thriving in Nursing: An Essential Guide to Practice, p.152.
Cheng, H.H., Chen, F.C., Change, M.W., Kung, C.T., Cheng, C.Y., Tsai, T.C., Hsiao, S.Y. and Su, C.M., 2018. Difference between elderly and non-elderly patients in using serum lactate level to predict mortality caused by sepsis in the emergency department. Medicine, 97(13).
Liu, V.X., Fielding-Singh, V., Greene, J.D., Baker, J.M., Iwashyna, T.J., Bhattacharya, J. and Escobar, G.J., 2017. The timing of early antibiotics and hospital mortality in sepsis. American journal of respiratory and critical care medicine, 196(7), pp.856-863.
Puskarich, M.A., Cornelius, D.C., Tharp, J., Nandi, U. and Jones, A.E., 2016. Plasma syndecan-1 levels identify a cohort of patients with severe sepsis at high risk for intubation after large-volume intravenous fluid resuscitation. Journal of critical care, 36, pp.125-129.
Bellomo, R., Kellum, J.A., Ronco, C., Wald, R., Martensson, J., Maiden, M., Bagshaw, S.M., Glassford, N.J., Lankadeva, Y., Vaara, S.T. and Schneider, A., 2017. Acute kidney injury in sepsis. Intensive care medicine, 43(6), pp.816-828.
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