Critical reflection of my journey in PACU nursing

by Emma Malone, posted on:  05/10/14

Since my first placement I have done many weeks here and there; and managed to see a glimpse of a small picture of different clinical hospital settings. At times, I developed my own professional nursing style that suited that placement, but then only to move on again to a new setting.  However, things changed after I got a 4-week block in post-anesthesia care unit (PACU).  Working in PACU as a student nurse allowed me see the whole picture in the perioperative setting and the imperative integral role of teamwork; where everything is bounced of each other in sync – a bit like orchestra. Also, PACU at times was hectic busy; at first when I started it was easy to be consumed into the chaos. However, during the quiet times; I was able to reflect on what just happen and how, where I could systematically evaluate the nursing care plan; which heightened my skills in understanding of what and why.

Changing from placement to placement on short blocks, made me question my abilities and confidence in working in clinical settings; which then often made me feel disjointed about my career of which pathway I wanted to take. At times, I was often perplexed about nursing, but after my time in PACU I have new grown passion and desire to learn more for acute/critical care nursing. This new passion and skills learned have given me confidence and desire to work and learn the ins and outs of patients care plan and looking at the patient as a whole, not someone who is not just their illness.

At first I was treading in unknown territory within PACU; it was often busy and it was easy to get overwhelmed and caught up in the chaotic process needed to stabilize the patient. During my early times in PACU I spent my time just doing what the preceptor nurse wanted me to do. During quiet times, I reflected on the ins and outs that are needed to stabilize a patient from the operating theatre to their discharge to either a ward or day surgery. During these quiet times I broke the process down systematically into my own style of nursing; whereby growing my confidence which gave me the stepping stones to able to be an effective critical think on a practical level in more critical situations.

An insight developed in PACU was seeing the whole picture of a clinical setting; the different roles and teams that work in sync with each other: where I was made to feel part of a team; the fundamental importance of a clinical hospital setting. Whereby I felt a sense of responsibility which according Chesser-Smyth (2013); an imperative process needed to make the transition from a student nurse to registered nurse.  An negativity of my journey in acute/critical care nursing so far, is the perception of always expect the worse; but as a student I understand I have a knowledge gap of acute deterioration of a patient to make crucial judgment/diagnosis calls, however, in time my growth of knowledge will sync in with this process.

Nursing and Midwifery Board of Australia (2006) states that a competent nurse is one that seeks, considers feedback and critically reflects on their own nursing practice, my experience in PACU allowed me to practice within these domains. This has given me a sense of pride and feelings of accomplishment that I am on my way of transiting from student to professional nurse.

The skills I have learnt during this placement will help me transition into any future nursing pathway set in my direction. The valuable time in PACU was a learning curve on personal confidence; from my early time during placement; I was consumed into the chaos, but having the ability to critically think and break down systematically the process needed to care for patients is a provides a sense of accomplishment which gives me the confidence that I will be able to do this in future settings. with this new skill, in any setting, I will know to take a step back and break things down systematically, not allowing myself to get overwhelmed by any perceived chaos, not even for a moment.

From my experience in PACU I plan to take on my future placements and career with a new insight, of working systematically in the events of the nursing care plan that is needed to stabilize a patient. My ability to use critical thinking skills and reflection and use criticism to enhance my care was enhanced during PACU. These attributes are the underlying fundamental qualities needed for acute/critical care nursing (Evans, Bell, Sweeney, Morgan & Kelly, 2010; Lakanmaa, Suominen, Perttilä, Puukka & Leino-Kilpi, 2012). With understanding of how easy it is to get consumed in the chaos’s of busy ward with many events occurring simultaneously; it imperative that to step back reflect on action and be confident to break down the any situation in calm manner.


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Reflection on my first clinical experience                                                        
by Emma Malone, posted on:  20/05/14

My first placement was at St George Hospital; pediatric ward. Since starting the Bachelor of Nursing I have been practicing clinical placement skills and fundamental theories of nursing practices for adults. Being my first placement I enter an unknown environment; what’s this, where does this go and why ? I had no idea what to expect. Pediatric nursing is in a world of its own and has its own set of challenges and skills. I used this opportunity to learn and engage in my new environment, patients and other health care workers. This was a perplexing experience that was exciting and rewarding; resulting in new insights for the beginning of growth for my new career.

 I felt vulnerable for a few days, treading in unknown territory, as being new was not within my comfort zone. Not being in control is an unnerving factor for me – it heightened my anxiety. Not only was I getting used to be in a new environment, I was learning almost completely new skills as pediatric nursing is very different to adult nursing. These new skills were very challenging to me, thus creating more anxiety. Once I had overcame this anxiety I found placement to be a mentally stimulating and challenging, yet an exciting and inspiring experience.

 Anxiety was a negatively of my clinical experience. The positive of the experience was the journey of growth I achieved in two weeks of clinical placement. During the beginning of placement I was anxious and my nerves got the better of me, however, towards the end of my placement, I was in a routine of the environment and could spend more time thinking about the process of; how, what and why for my new clinical skills and further develop them with more confidence.

During this placement I have identified some of the complexities of pediatric nursing. An example of this is communication, it’s imperative to form a good rapport with the child and parents in a calming and soothing tone, thus this will allow parent-nursing communication to be more efficient, otherwise, the parents can become aggressive. Coyne, O’Neill, Murphy, Costello, and O’Shea, (2011) support the importance of effective communication; and how you must build a rapport and trust with parents by listening to their concerns.  This is one of many new insights that I have developed during placement. The whole concept of communication is simple, however, it is something that is commonly an after-thought. Considering this, it’s amazing how a simple skill like effective communication is an essential and important skill that I must work on developing to become person-centered and competent professional nurse.

Practicing within an evidence-base framework is essential – this is an attribute that coincides with the Nursing and Midwifery Board of Australia, which is the national competency standard for registered nurses (Nursing and Midwifery Board of Australia, 2006).  Being unfamiliar with pediatric nursing I used the best available evidence to familiarize myself with new skills needed in my quiet time during placement. I read the detect-manuals to increase my knowledge.  Asking questions can be daunting experience, as I feel they are possibility to simplistic (or stupid) for experienced nurses. However, I clarified my new knowledge with different nurses by asking questions, they were happy to mentor and share their advanced knowledge. The level of professionalism was an inspiration – they were the type of nurses that I inspire to be and this motivates me, as I would love to work in such a team.

My confidence needs further development for my next clinical placement. I need to be able to have faith in myself; each clinical placement will have a set of new challenges; but finding the extra time to keep up with evidence-based literature that is relevant to the clinical setting my skills will grow in time along with my confidence. To do this, not only will I read any available literature, I must also learn to stop hesitating to ask questions, the more informed I remain, the more comfortable I will be in the clinical setting. My role as a student nurse is to learn, and by opening myself up to all the experiences that placement has to offer, confidence with myself and my abilities will subsequently increase. Porter, Morphet, Missen and Raymond (2013) state that self-confidence is a key factor in performance, and as a student, to be confident helps create more effective nurses.


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