Diana Holowaychuk

Instructor: Cathy MacDonald

RAH REFLECTIONS SEPT. 14, 2015

Description: This week in clinical practice on Unit 53 I was caring for patient KC who was cooperative, agreeing to have his vital signs taken and a physical assessment done. I had also spent
time with KC encouraging him to take his honey thick apple juice and Ensure bottle, having
noticed that normal saline was infusing at 70 mL/hr. I praised him for making an effort for
trying to take in extra fluids. I noticed when helping KC to sit in the bedside chair, he was
having difficulty transferring due to an unsteady balance and lack of muscle strength in his legs.
I left for my supper break while KC was enjoying his supper, showing a good appetite. When I
came back on Unit 53, I was informed by my fellow student nurse JO that KC had fallen when
we were off Unit 53. JOs patient and my patient were both in room 53-4. JOs patient had
witnessed KC falling backwards as KC came off the toilet and started to move back to his bed
unassisted. I am uncertain which staff members responded to KC or what happened while on
supper break. When I came to the room to check how KC was doing, the patient was resting in
semi-Fowlers in his bed with a startled look on his face. KC reported he fell mostly on his bum
and that he hit the back of his head on the hard floor. When I asked KC why he did not pull the
call bell for help to go to the toilet or to get off the toilet, KC had no explanation. I said that he
would probably find some bruises on his body the next day caused by the fall. I then asked if he
noticed any lumps forming on the back of his head and he answered no. KC also said that a Dr.
had checked him out after the fall. I reminded KC to please use the call bell for staff assistance
when he needs to get out of bed and then I made sure that the call bell was within reach. The
bed rails were up X4 and the bed was in the lowest position. My role in this situation was to
reinforce with KC that he must rely on staff to help mobilize when getting out of bed.
Reflection: I felt shocked that KC had fallen and felt scared for the patient because there was a
possible concussion and bruising on the rest of his body. I started to realize that KC was very
vulnerable to injury and lacked good judgment of his own strength and physical ability. Now I
felt responsible for KC falling while going to the toilet on his own, since I had encouraged KC to
take in more fluids. This caused him to want to urinate more frequently, or so I thought. I felt
guilt because I thought that if I didnt leave him to go on my break, the fall could have been
avoided.
Analysis: A positive aspect of this situation occurred when I was able to encourage KC to take
in more fluids and have him realize that when he is feeling thirsty and has a drink he will feel
better. This helped the patient to feel more in control of his health. This situation was difficult
for me since it showed me that even with positive steps forward, my patient was very frail and
unstable. According to the text, Physical Examination and Health Assessment by Carolyn Jarvis,
an abnormal finding in a patients judgment or an impulsive action can be caused by Alzheimers
disease, schizophrenia or various psychotic conditions. The patient KC is on medication to treat
depression. At the age of 73 it is possible KC is experiencing dementia. I have learned to give
several reminders to the patient about keeping safety in mind by asking for staff assistance when
mobilizing. Problem solving with staff by encouraging the use of the commode instead of
walking to the toilet will minimize fall risks. In a more personal comparison, my father thinks he
is physically capable of climbing on a tall ladder to trim the branches of the neighbours trees.

Diana Holowaychuk

Instructor: Cathy MacDonald

This shows that he has a lack of good judgment of his physical capabilities at the age of 86 years
and can also be a sign of early onset dementia with impulsive actions.
Evaluation: I learned that I cannot always watch over my assigned patient and must rely on
other staff members to cover for me as I will also cover for them when they are on their breaks. I
will realize that what goes in must come out and that I need to offer to toilet my patients
regularly in the future. If this situation occurs again while I am on the Unit, I will follow the
policy and procedure manual and offer any assistance to staff members that I can. This means I
will be familiar with the standard policies and procedures to follow when a patient experiences a
fall, by reading and studying the manual located at the Unit main desk area.