Student nurse dissertation

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This essay is going to demonstrate the purpose of the Scottish Patient Basic safety Programme (SPSP, 2008) in relation to early intervention in a showing signs of damage patient, through reflective practice. Using Gibb’s (1988) refractive model the writer is going to analyse and appraise an individual experience about placement although demonstrating the abilities and understanding based theory (Jasper, M., 2013), according to SPSPs’ suggestions; monitoring of Early Caution Scoring (EWS) system as well as the use of the SBAR (Situation-Background-Assessment-Recommendations) tool and safety rassemblement in relation to affected person safety. The six stage account includes: a description of events, can certainly make money felt, analysis, analysis, conclusion and action plan for upcoming practice.

As a result of (Data Safety, 1998) Work, the patient will probably be referred to as Mister Smith.


Whilst monitoring patients by using an acute medical ward using the EWS system, on a busy Friday morning, I came across Mister Smith who had been complaining of abdominal discomfort. I noticed his skin colour was really pale and he was irritated. I proceeded to check his vital indications.

His Blood pressure (Bp) determined having been hypotensive (low blood pressure) 79/49 and he was tachycardic (increased heart rate) 123 beats each minute (Bpm). His temperature, breathing rate and oxygen saturations were inside normal range. I documented his vital signs and on checking the EWS score (4), this brought on me to alert the nurse in control and medics on the ward, in accordance with SPSPs driver picture on what action should certainly follow.


I sensed relieved to obtain had the observational abilities and understanding which gaveme an understanding that Mr Cruz was going down hill. Having direction and protocols such as EWS driver plan gave me the confidence and support required to take the relevant action. Mr Smith was examined by simply medical staff within 10 minutes of me notifying them and appropriate action taken. Now it was realized by a clinician who examined his medical notes, that Mr Jones had a new previous incidence of a gastrointestinal (GI) Haemorrhage (bleed) although this information was not passed on throughout the handover survey which I sensed was vital in this case and could have been bad for his end result.


GI haemorrhages account for 7% of deaths in Scotland (SIGN, 2008). SPSP together with HIS created a tool set; The Hospital Standardised Mortality Level (HSMR) to link study regarding mortality costs and health care improvement in Scotland; the goal being to minimize mortality costs and adverse harm, which includes near misses to people in serious wards, (HIS, 2011).

Strategies such as SBAR and EWS are promoted by SPSP and Wellness Improvement Ireland (HIS) to recognize any potential risks to patients and let for early intervention. Conversation between staff regarding patient’s condition including relevant past medical history is important if individuals are to acquire specific attention and treatment required. The SBAR device was adopted from the ALL OF US Navy and the aviation industry by Dr M Leonard (2000). It absolutely was adapted to get the health-related setting, to permit all experts to speak concerns and risk to patients’. (NHS, Institute intended for Innovation and Improvement, 2013). EWS originated to assess patient’s physiological level of health issues and identify clinical degeneration using a rating system. This really is calculated by totalling malocclusions of vital signs which can be below or perhaps above usual parameters. Scoring, triggers healthcare professionals to take suitable action and referrals to doctors, (Odell. M., 2010). Nonetheless it has been suggested there is opportunity for problem using EWS if credit scoring is certainly not carried out correctly and factors such as the actual patient and pattern; recognising deterioration; appropriate referral; time and day time of the week may be triggers for error, (Odell ainsi que all, 2009).

Following study on the use of SBAR in a healthcare placing, communication problems were reduced by 50%, (NHS, Start for Advancement and Improvement, 2013). However the SBAR tool is not always followed correctly and can bring about communication mistakes, increasing likelihood of harm to sufferers (Royal School of Breastfeeding, 2013). Mr Smith had been admitted through Accident and Emergency (A&E) during the night with acute stomach pain and transferred to the acute medical ward. It had been unclear if history of his previous GI haemorrhage have been known now but it was not highlighted on the hand over survey. By the time I had reached Mister Smith, while carrying out routine vital signs on people, it was clear by seeing a routine of his vital symptoms, EWS report, pallor and pain level that he was deteriorating.

Even though the EWS program triggered the immediate care and intervention which Mr Johnson required, the SBAR application could have eliminated the degeneration earlier. The aim of the SBAR and basic safety briefing should be to identify potential risks, taking into consideration the patient’s qualifications, assessing the patient and promoting a plan of care. Got Mr Smiths’ background been communicated correctly then the suggestions of regular assessing and ideal procedures might have been implemented previous; such as monitoring his essential signs by the hour, risk rating, haematology (Blood) screening and endoscopy, in accordance with the Scottish Intercollegiate Rules Network (SIGN 105, 2008).

The appropriate activities were integrated immediately following the realisation with the patients’ destruction, confirmed by a medical practitioner who have suspected one more GI haemorrhage. The patient have been referred to radiology for a great abdominal ultrasound scan before but was then simply referred once again as ‘urgent’. The medical team had been informed, and blood was sent to haematology. Mr Smith’s haematology benefits showed having been hypovolemic (had lost blood) and essential a blood vessels transfusion which has been prescribed and infused quickly. All needed documentation was followed using the blood transfusion pathway, (HIS, 2010); approval obtained, patients’ identity confirmed, blood inspected by two trained rns, labels created clearly, reasons behind administering and countersigned by simply nurses andprescriber, (HIS, 2010). I was asked to check and document Mister Smiths’ essential signs prior to the infusion of blood and thereafter every single 15 minutes throughout one hour, in adherence while using blood transfusion pathway, (HIS, 2010). The EWS system allows for any adverse reactions to get detected early on, as extreme reactions are more likely to occur within the first a quarter-hour of infusion and in the truth of an unfavorable reaction the infusion would be stopped; medical staff and haematology educated (Ackley ain al, 2008).

I remained with Mr Smith and monitored his vital indicators closely, examining for improvements. He was becoming more and more agitated as they wanted to end up being left alone. Within around 45 minutes Mister Smiths’ vital signs acquired improved (scoring 2). A moment later personnel came from radiology to escort Mr Cruz for his ultrasound check out, he was (scoring 1), although his abdominal was very distended and painful.

To be able to improve basic ward outcomes the SPSPs’ aim should be to deliver trusted and well-timed evidence structured care to patients through early affluence in showing signs of damage patients with effective inter-professional communication; SBAR, safety briefings and EWS. Although in a news-letter from SPSP’s conjecture was that the creation of the general keep package would be more complicated in busier settings and EWS would be a even more ‘opt out’ solution, (SPSP, 2010) A write-up from the Universe Health Organisation also shows that sufficient given time end up being awarded at hand over reviews without interruptions, if so then repeat-back and read-back steps must be put in place, (WHO, 2007). The Scottish Federal government established goals which aim to reduce preventable harm to individuals. One of the important elements is to improve communication expertise between inter-professional practitioners in all departments, through education, (Scottish Government, 2010). The SPSP in partnership with NHS education for Scotland (NES) have developed Inter-professional Learning (IPL) courses to further improve communication expertise collaboratively; endorsing patient safety, (NES, 2013).


The essence the SPSP (2008) and HIS (2011) is usually to reduce trouble for patients bydeveloping protocols such as improved communication inter-professionally and driver deals; EWS to distinguish patients vulnerable to harm, as a result triggering early intervention and good effects. Mr Jones could have been classed as a ‘near miss’ because of poor interaction of his past medical history. However with the use of the EWS system his destruction was recognized and protocols were used accordingly, lowering further injury. Although there has not been a diagnosis intended for Mr Johnson initially, his symptoms in admission should have triggered standard observations using the EWS system, checking his past medical history and the make use of effective clinical judgement.

Plan of action

Reflecting within this personal experience has presented me a very good understanding on the importance of communication in relation to the care brought to patients. I possess learned that it is crucial to have all the background information regarding patients as it can influence decisions regarding ideal care planning. I have discovered that importance should be positioned on patients with no diagnosis and closer declaration given. Writing important information and concerns relating to patients with relevant multi-disciplinary team members is important for patient outcome and also for my own learning. I have a good comprehension of the EWS system as well as the benefits it has in determining deterioration or improvement of patients, nevertheless I have discovered observational expertise are also an excellent tool in clinical judgement, which I will use. Documentation is a legal necessity in nursing but it is additionally very important as it allows for earlier and current comparison of a patient’s health, which I discovered from this knowledge.

Overall I’ve learned to be able to deliver safe practice I have to use a mixture off every one of the skills I’ve learned. It has taught myself that although practical abilities such as observing vital indications is important, observational skills, conversation skills and clinical reasoning must be regarded for sufferer safety. I discovered by highlighting on this personal experience I use learned the value of reflection and decide to use it in future practice since it has allowed me to gain regarding how to develop all my skills additional in the nursing role. It includes helped me to determine weaknesses and strengths from this experience, which will guide me with mypersonal learning.


Ackley ain al (2008), Evidence-Based Breastfeeding Care Guidelines”Blood Products Government. Canada: Elsevier Pp 107-110.

Data Safety (1998) Work [Online]

Available: [Accessed 04/07//2013]

Healthcare Improvement Scotland (2010) Blood Transfusion Pathway [Online] Available: [Accessed 18/06/2013]

Health Improvement Scotland (2011) Using the Hospitalised Mortality Percentage to help improve affected person care [Online] Available: Hospital Standardised Mortality Costs [Accessed 27/06/2013]

Information Companies Division (2013) Hospitalised Standardised Mortality Proportions [Online] Readily available: [Accessed 28/06/2013]

Jasper, M., (2013) Beginning reflective Practice- Gibb’s reflective pattern 2nd Impotence. Hampshire: Cengage Learning. Pp. 79-82

NHS Education pertaining to Scotland (2013) Patient protection [Online]

Available: [Accessed 26/06/2013]

NHS Institute for Development and Improvement (2013) SBAR:

Situation-Background-Assessment-Recommendation [Online] Offered: [Accessed 20/06/2013]

Odell. M., (2010) Are early on warning ratings the only way to rapidly find and take care of deterioration [Online] Available: [Accessed 30/06/2013]

Odell ou al (2009) Detecting Destruction [Online] Available: [Accessed 30/06/2013]

Hoheitsvoll College of Nursing (2013) Patient protection: Human Factors-Communication [Online] Obtainable: [Accessed 30/06/2013]

Scotland Patient Protection Programme (2008) General Ward Driver Plan [Online] readily available: [Accessed 18/06/2013]

Scotland Patient Protection Programme (2008) SBAR Guidebook [Online] Obtainable: [Accessed 18/06/2013]

Scotland Patient Protection Programme (2010) News Page, Issue several: What’s Happening Locally? [Online] Available: [Accessed 26/06/2013]

Scottish Federal government (2010) The Healthcare Top quality Strategy [Online] Available:


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