. What were your primary concerns related to patient care? What were you primary concerns as a senior nursing student preparing for your final simulation?

. What were your primary concerns related to patient care? What were you primary concerns as a senior nursing student preparing for your final simulation?

My primary concern about this patient is that he has chest pain related to acute coronary syndrome and the pain is unstable. If we dont intervene he might go into cardiac arrest.
As a senior nursing student Im anticipated what could be the worse situation that can happen to my patient in simulation. I try to gather more information as I could to figure out what was the caused that brought the patient to the hospital and how can I alleviate his symptoms so that he can get better and not worse.
2. Did you miss anything in getting report on these patients? If so why? Were you distracted? Did you receive too little information? Did you receive not enough or incomplete information? Were there environmental distractors?? What actions could you have taken to improve your patient report? What systems are in place that would assist you? (SBAR etc.) Describe them.
During report with the last shifts nurse I was pretty thorough and asked what I need to know about my patient. I was focus and listen to what the two nurses have to say. The information I receive was good but it wasnt enough tell me much about the patient and especially his current condition. We were inside the patients room while doing our turn over report. If I was to utilize the PASSMESAFELY report it could have been better.
3. Did you have the required clinical knowledge and skills to manage the patient illness? If not what concepts were you missing? Support your reflection with an evidence based reference from a peer reviewed journal (not greater than 5 years old). This information needs to be relevant to your patient the clinical scenario and your knowledge deficit.
I have the skills and clinical knowledge to manage this patient and prevent him from dropping blood pressure and going into heart attack. Treatment such as: (article) and I can based of hospital protocol and call ask the doctor.
4. How did you prioritize the patient information/data? On what did you base choice of intervention?
I prioritize the information/data based on the severity of his illness and the present symptoms. The patient has chest pain but no shortness of breath crackles on the bilateral lungs hypotensive tachycardia unstable O2 saturation. Airway breathing circulation are my top priorities. The patient airway wasnt compromised his breathing is normal (24 breath per minute). His circulation is diminished due to low blood pressure.
So I called the doctor to report about my patient dropping blood pressure and ask him for some treatment orders. The doctor ordered bolus normal saline (NS) and dopamine running at 5mcg/kg/min maximum 20mcg/kg/min. Titrate it to keep the systolic blood pressure above 90.
5. What were your strengths during the clinical scenario? What areas do you think you could improve upon? How did you utilize the nursing process to enhance your clinical reasoning?
My strength during simulation was teamwork assessment skill recognize the severity of symptoms/condition pick up on the necessary information from the patient and follow orders from the doctors chart.
I still need to work on my communication skills including verifying the doctor order by repeat or verbalize what the doctor just order to make sure I got the verbal orders correctly. My medication calculation was taken a long time before I decided to ask for help. I took a long time on setting up the pump to run the dopamine after I got the calculation. I didnt check the monitor and set the 15 minutes cycle for vital signs to be taken. I was solely depend on what the monitor to tell me what happen to my patient. No wonder his condition didnt get better. I assess my patient before I administered the dopamine drip but I didnt reassess him 15 minutes after to see if his condition improve.
6. How would you approach this clinical scenario if you had to do it over again? Which objectives were you unable to achieve?
I will have to practice on my pump setting skill drug calculation for drip and re-verbalize the doctor order when I communicate so that if I have to do it again I wont make the same mistake like I did in simulation.
I didnt:
o Incorporate assessment and critical/clinical reasoning skills to create priority interventions for patients who have complex multi-system health care needs
o Utilize effective communication skills in providing care to diverse patient populations and in collaborating with the interprofessional team.
o Integrate patient care technologies information systems and communication devices that support nursing practice.
7. How would you summarize this experience?
My experience in simulation allow me to begin to think critically overall the big picture about my patient.
Australian Critical Care 27 (2014) 111118
Contents lists available at
ScienceDirect
Australian Critical Care
journal homepage:
www.elsevier.com/locate/aucc
Timely treatment for acute myocardial infarction and health
outcomes: An integrative review of the literature
Lorelle Martin RN MNSc
a

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