ASSIGNMENT

STUDENT NAME

COVER

SHEET

THANDEKA N. MSWELI

STUDENT NUMBER

21111201

DUE DATE
SUBJECT
SUBJECT CODE
TITTLE OF ASSIGNMENT
LECTURER

11 MAY 2015
CLINICAL NURSING PRACTICE
CNPA201

REFLECTIVE JOURNAL
Mrs. T. J BHENGU

DECLARATION

1. I know and understand that plagiarism is using another persons work

and pretending it is ones own, is wrong.
2. This assignment/report/project is my own work.
3. I have appropriately referenced the work of other people I used on text
and at the end.
4. I have not allowed, and will not allowed, anyone to copy my with the
intention of passing it off as his or her own work
STUDENTS SIGNATURE: ___________________
COMMENTS:

FINAL MARK/PERCENTAGE: ___________________________

LECTURERS SIGNATURE: ____________________________

INTRODUTION

Reflective journal is whereby the person is reflecting on his/her experiences after the
practical or particular event. According to Callison (2012: 37) reflective journal is means
recording ideas, personal, thoughts and experiences as well as reflection and the
understanding a student have in the learning process of a course. It must tell the person
reading it more about what was happening, what was your thinking and feelings, what went
bad and right during your experiences, what that experiences contributed on your knowledge
and profession, and what should you do to avoid or improve if you face this experience in
future.
In this my reflective journal, I will be reflecting on my experiences during my practical that I
was started on the 25th of March 2015 in Midlands Hospital. It will include all six steps of
Gibbs (1988) reflective cycle such as description of the event, feelings, evaluation on
experiences, analysis, as well as conclusion and action plan. The last part on this assignment
will be the reference lists which are the sources I used to write the assignment in a proper
way.

Description

I was allocated in the Midlands and Medical Centre, which is the private Hospital that is
located at Pietermaritzburg town on East Street. I started my practical on the 25th of March
2015. We were two students from Durban University of Technology that were placed in
Medical ward C to work on. We were working only Wednesday and Thursday per week. On
the first day we came and being oriented about the ward. Sister told us the routine of the ward
that they did, when came on the morning, first is the hand over from night staff, checked the
blood glucose level (HGT) on the diabetic patients, dam dusting and sometimes will be
depending on where you are located.
It was my third day on the ward, the second Wednesday, in the morning. The ward was very
busy. I was allocated on the monitoring of the patients observation. I was busy checking the
blood glucose level on the diabetic patients in cubicle one, when I heard sister called me in
cubicle two. I leave what I was doing there and attend sister. There was the patient which was
unconscious with no response, sister asked me to checked that patients HGT, I checked it and
it was 1.8mmols which is the abnormal low blood glucose level, because Hinkle et al. (2014:
1420) states that the normal blood glucose level is between 4.5mmols and 8.3mmols. I
reported to sister and recorded to patients file. Sister called patients doctor about the
condition of the patient.
The patient was 75 years old and known diabetic patient which was on the sliding scale. He
came with the diagnosis of Osteoarthritis, which is the degenerative disorder of the joints
(Hinkle and Cheever 2014: 1075). All vital signs were checked and noted abnormalities such
as BP 84/56mmHg, pulse 56mmHg, respiration 7beats per minutes, temperature 32.5 degrees
of Celsius and Oxygen saturation 32%. When I was observing him I saw that his face
muscles were started to relax, his finger and toes were inflamed. Sister administers the
oxygen 100%, and the patient was given Glucagon injection, which is the glucose elevating
drug as was prescribed by the doctor that was going to bring his blood glucose to normal
level. Sister asked me to monitor his blood glucose half hourly and report.
On the second half hourly of monitoring that patients blood sugar level, it was better
4.2mmols and I changed time of monitoring to hourly, because HGT shows the improvement
and the patient was started to open his eyes, respond when you talking to him. I asked him
how did he feel now and said he is ok. I also monitored his level of consciousness, voice/
response and movement (Glycoma Scale). When I was reading the patients file I found that
the patient did not ate his lunch and supper of the day before. I think the main cause of this
hypoglycaemia was hungry, because if the person does not eat the blood sugar level in the
body decreased and that is exactly the leading cause of unconsciousness.
It was on the mid-day, around 12H00pm when I monitored all patients vital signs and they
were HGT 6.7mmols, pulse 70mmHg, BP 100/60mmHg, respiration 10breaths per minutes
Oxygen saturation 89% and temperature 35.5 degrees of Celsius which are the normal
values. I reported to sister and recorded on the patients file. It was already the lunch time for
the patient and doctor said he must eat the porridge or light food for now because he does not
like food I asked for his food to kitchen people and I started to feed him and he was eating
very well. I was very happy too that my patient was fine feeling better. When I came back in

the ward the next day morning, sister told me that my patient died last night. It was the bad
day to me.

Feelings
All what I can say about my feelings and thoughts on that events, is that to be honest I was
too shocked when I found the value of 1.8mmols in patients blood glucose level and it was
my first time. I felt ashamed to the patient the way he was looked like, with the inflamed
foots and fingers, unconsciousness for almost three hours. I felt angry to the nurses were
working on the day before because I thought it was their fault that the patient is like that, as
he was did not ate his food. I thought that sometimes we as the nurses we do not taking a
good care of our patients. I was also angry to us as the nurses that may be the patients are
dying day by day because of our faults.
My thoughts related to the patients conditions on that time were very bad. I was thoughts
that may be the patient is going to die now because we have been tried everything but he is
not responding to anything the sister gave to him, such as administration of oxygen,
medication linked to his condition. I was always there for the patient, looking after him,
monitoring his vital signs until I noticed the change. Afterwards I felt better when the patient
showed recovery and his vital signs back to normal and his condition looked well than before.
I went home happy that patient was feeling better and even able to talk to his relatives and us
as nurses. I prayed at home for the speed recovery of my patient. I was too shocked again
when I came the following day morning and heard that my patient died last night. I felt very
angry for myself that I failed to take a good care of the patient and I was nervous to patient
relatives that they going to blame us, the day staff as failing to help and care for his family
member. Afterwards I realised that sometimes as a nurses we are caring for the patients but
he/she is about to die, we are not able prevent or stop that. If God say yes nobody can say no.

Evaluation
To evaluate on my experience, I think nothing went badly because we have tried all our best
as the day staff and patients doctor to help this patient, but the outcome become negative as
the patient died at the end. It is even worse because Midlands is the private hospital where the
patient or relative need to comment when the patient being discharged. It was my first time
on that type of experience but I make sure that I did all my best as I was taught at school.
I think when I heard the news that my patient died last night, is where I realised that may be I
have done something bad to him that why he loosed his life now. The sister I was working
with was very supportive and I think she played a big role on helping to coping with this
situation until I am sure that it come to an end.

Analysis

The situation went very good, only the death of the patient that was made it sound like
something went bad about it. McCulloch (2015: 3) agreed with me that the diabetic patient
may present hypoglycaemia but because of causes such as do not eat enough food, waits too
long between meals and taking too much insulin. As my patient in this case did not ate his
meal the day before I think that was the possible cause of his severe hypoglycaemia that
results to unconsciousness, as McCulloch (2015: 4) states that the severe hypoglycaemia lead
to unconsciousness.

Conclusion
In my conclusion I think nothing I should have done differently in this situation, because we
have tried everything with the sisters and other staff to ensure that the patient feel better. I
think sometimes you should do right thing but the outcome may be negative, especially in
persons life because there is God who is looking after the souls of His people. Only thing I
think we as the nurse we have to do to prevent this to happen again, is that we have to make
sure that all the patients need are met all the time, especially the physiological needs which
comes first according to Maslow Hierarchy of needs.

Action plan
Although my experience did not went bad, but I saw some areas or skills I have to improve
on, in order to react in the better way when I face this situation in future. I have to listen
carefully to my facilitators during my study time and ask questions, because some of the
things or problems we come across with in our practical as the student we have been studied
about it before placement. I will ensure that I caring for my patients emotionally, physically
and psychologically. I will make that all the patients needs are met all the time such as to
encourage the patients to eat their foods. I will also make sure that I do not blame anyone for
patients death without a reason.

References
Gibbs, G. 1988. Learning by doing: a guide to teaching and learning methods. Oxford:
Further education Unit.
Hinkle, J. L. and Cheever, K. H. 2014. Brunner & Suddarths Textbook of Medical-Surgical
Nursing. 13th ed. China: Lippincott Williams & Wilkins.
McCulloch, D. K. 2015. Patient information: Hypoglycaemia (low blood sugar) in diabetes
mellitus (beyond the basics) (online). Available:
http://www.uptodate.com/contents/hypoglycemia-low-blood-sugar-in-diabetes-mellitusbeyond-the-basics (Accessed 18 April 2015).