490 SelfRef

Michaela Campos
NURS 490
May 6, 2024
Self-Reflection
1. Discuss a conflict at work/clinical practice. What happened? How did you respond?
How did you attempt resolution?
During my 491 internship, I was at Hemet Global’s ICU. My nurse had two very high acuity
patients that required a lot of care. It was as though one patient was becoming stable, the other
patient’s oxygen saturation or blood pressure would tank and vice versa. It was my first day on
the unit and my first time meeting the nurse that is going to be precepting me for the following
eight weeks. It was crucial that I helped as much as I could to my availability and stay out of the
way and not slow her down. I told her that I would take over vitals and blood sugars so she did
not have to worry about that. I took one of the patient’s blood sugar and it was 17. I immediately
found the nurse and informed her of the dangerously low blood sugar and she stopped what she
was doing and got a glucose bolus. There was so much chaos happening between the two
patients, I can tell we were both getting overwhelmed, but it was crucial that we maintained calm
and focused and prioritized care. In situations where staffing levels are insufficient to meet the
demands, it is important to prioritize tasks based on patient acuity and safety. I would also
emphasize the importance of teamwork and mutual support among nursing staff. I noticed that
the charge nurse and many other staff nurses would volunteer to help with anything my nurse
needed and take over tasks for her. As a nurse, conflict will rise often in the workplace, but it is
important to be able to assess the situation and be able to communicate effectively. The patient
with the blood sugar of 17 ended up passing away later that afternoon. Her blood was very
acidic, and she was very malnourished and they placed a central line and she lost a lot of blood.
2. Discuss the most difficult patient you took care of during nursing school. Were they
aggressive, problematic, critically ill?
My first semester of nursing school, in fundamentals, we were at Menifee Global and they put us
on a step down unit because they did not have any other floors available to students. My first
patient was a problematic, combative older man who was blind and bed bound. He would refuse
everything- vital signs, assessments, and every medicine except for pain medicine. The nurse that
I was shadowing that day just told me the importance of documentation. She documented
everything he would tell her in quotes, including the profanities. The patient was stable for the
most part, so there was nothing that could have been done for him if he was refusing treatment.
The nurse informed the health care provider and the provider discontinued many of his orders.
The nurse handled this situation very well. It can be challenging to handle, but she remained
calm and assessed the situation. We assessed the level of risk and determined that since he was
blind and bed bound, he would not do any physical harm. If he wasn’t, it would be important to
ensure our own personal safety as nurses. And to maintain a safe distance from the patient and
having your back towards the door so you have a safe exit plan if tension would arise. The nurse
also attempted to establish a rapport with him by using active listening. However, the patient just
wanted to sleep and get pain medication and nothing else. By approaching the situation calmly
and setting boundaries, we were able to manage this aggressive, non compliant patient.
3. Discuss a time you went above and beyond for a patient.
During my 491 rotation at Hemet Global, I had a patient that was anxious and overwhelmed
about being admitted and receiving treatment. She was in for Diabetic Ketoacidosis because of
her non compliance with checking her blood sugar as a type 2 diabetic. Despite receiving the
medical treatment, she was struggling emotionally and mentally and she was having a hard time
to cope with her diagnosis and the challenges of being hospitalized. She was my only patient that
day so I was able to give her my full undivided attention. I was able to create a supportive
environment by taking the time to sit with her and actively listen to her concerns and offer
empathetic support. I was able to acknowledge her emotions and validate her feelings. I was also
able to anticipate her needs like providing extra blankets, pillows to create a calm environment
so she is able to heal. I was able to facilitate communication with their family members and
loved ones who weren’t physically present and were not able to be at the hospital. Allowing the
communication between the family members was important because she needed all the support
that she could get. I allowed her to rest, and I checked in on her regularly. I understand that this
usually isn’t the case when you have two patients to be fully involved with one patient, but I
could tell that she was very appreciated and she expressed to be at the end of the day that she was
feeling a lot less overwhelmed and she can focus on healing and recovering.

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Michaela Campos

aggressive, problematic, critically ill?

3. Discuss a time you went above and beyond for a patient.

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