Encouraging Reflective Practice

Workplace Supervisor: So Katy, how was your day today?

Nursing Student: Yeah, it was pretty good today. Except for one incident that happened this morning. When I was giving the medications this morning I was checking the vitals to see if they were all alright before I gave the medication and I noticed that one of my patients was having perindopril so I checked her blood pressure and it was already quite low - it must have been about 95 on 50. So I talked to my RN [registered nurse] who I was with and we went to the team leader for the day and asked her what we should do, and she said to give it anyway. So we gave it to her and we were told to check back a bit later and see what her blood pressure was. Just before lunch time at about 11 [o’clock], I checked the blood pressure again and it was about 80 on 40.

Workplace Supervisor: That is a low blood pressure.

Nursing Student: Yeah, yeah it was low.

So then we went and called the doctor, just to let him know so that he could review it. And then shortly after lunchtime, she was lying in bed and she decided to get up to go to the toilet and she had a fall and hit her head. She had to have stitches.

Workplace Supervisor: And she was the patient that you were looking after.

Nursing Student: Yeah, she was.

Workplace Supervisor: Pretty eventful day then.

Nursing Student: Yeah

Workplace Supervisor: How do you feel about that whole situation?

Nursing Student: Obviously I was worried when I found out that she had a fall. But I was glad at the same time that I had checked the blood pressure earlier on and seen that it was low and done something about it.

Workplace Supervisor: Why do you think she fell over? I mean, what knowledge are you drawing on there?

Nursing Student: Well, the perindopril is an antihypotensive and if she had a low blood pressure which became even lower when she was lying down [then] when she got up she was obviously at risk of postural hypotension and falling over.

Workplace Supervisor: Yeah I think that’s right. I mean, that she could have got postural hypotension, that’s probably something that you could have picked up on. What could you have done differently? I mean do think that there is anything there that you could change?

Nursing Student: Well I did speak to the RN and I’m glad I did that. But I guess the fact that she did get up without asking for help thinking “oh, they’re too busy” or something like that, well I could have educated her a bit better and said “listen, we’re never too busy to help you to get up”.

Workplace Supervisor: What do you feel good about in that situation?

Nursing Student: Well, I’m glad that we talked to the team leader to see if the drugs should be withheld. And then contacted the doctor. But it was not a good thing to happen obviously.

Workplace Supervisor: Yeah.

Nursing Student: I guess next time, I’ll definitely look into making sure she was aware that she definitely needed someone to be with her when she’s going to the toilet.

Workplace Supervisor: Okay. You’ve given some really good thoughts there. I mean, you’ve reflected on that situation, what I think is fairly well. Particularly the fact that you recognised about her blood pressure medication and the association there. And then you’ve gone on to be able to realise that there’s some further education you can give to your patient in the future.

Thanks for sharing with me. That was really good.

Nursing Student: Thanks.