Reflective Nursing Essay

Case Study OneIn this case study I leave use Gibbs (1988) beat of admonition to write a personal account of an abdominal mental test carried come to the fore in general practice under the supervision of my mentor, utilising the skills taught during the module thusly far.What happenedDuring morning r exposeine sick parade I was presented with a 21 year old male soldier experiencing severe acute, non specific, abdominal pain. nether the supervision of the medical officer (MO) I proceeded to carry out a full assessment and abdominal examination, apply Byrne and Longs (1976) model to structure the consultation. I requested the uncomplainings consent before conducting the examination, as is internal before commencement of any medical procedure, be it a corporeal examination or a critical surgical procedure (Seidal et al, 2006).The patient was quite agitated on arrival and appeared to be in a great plentitude of pain, and so before continuing with the physical examination I rea ssured him and made him comfortable in the treatment room. On examination his abdomen was soft, palpable with no tenderness, on auscultation bowel sounds where normal, springy signs normal, with cramping centralised pain.FeelingsI was determineing confident in my ability to deal with the patient and perform the examination effectively as I had skillful this several times previously using the university resources and mock OSCE with my facilitator. As I am often solely responsible for the care and management of patients during out of hours (OOH) I felt comfortable assessing and triaging the patient. However, under normal circumstances I would assess the patient and refer them to the MO if I was concerned approximately their condition, in wander for a determination to be made. I was to a fault being closely monitored throughout which did increase the pressure to deliver the chastise diagnosis and make appropriate decisions. However, by utilising the consultation model I feel I m anaged to keep a focused fire and crack the correct questions where asked.EvaluationI feel I gained a dependable history from the patient by using the SOLER principles (Egan, 1990) taught in the history fetching presentation. Thus allowing me to form a differential diagnosis and reign out sealed causes, such as constipation, and indigestion. Subsequently, the physical examination enabled me to confirm a diagnosis of acute abdomen. As the patient was not experiencing any worrisome (red flag) symptoms associated with abdominal emergencies, such as appendicitis or pancreatitis. However, I did impede certain aspects of the physical examination and had to be prompted by the MO. Although with to a greater extent practice such incidence would be reduced.AnalysisI was happy that I managed to rule out any distinct causes of the abdominal pain by performing the examination to collect data, analyse it, and use the results to make an appropriate decision (Schon, 1984). However, had I p erformed the examination without assistance I may not look at gained all the information required to confirm diagnosis, as I did forget some aspects.ConclusionThe MO seemed happy with my diagnosis and care plan, though he did highlight the importance of practicing the physical examination skills in order to get under ones skin a more competent practitioner. Overall I feel gaining knowledge and skills in translating a patients history and physical examination results, has enabled me to kick the bucket more confident in making a diagnosis and has improve my decision making skills.Action PlanIn order to become a more capable and effective practitioner I must continue to perform physical examinations under the guidance of a more senior practitioner, and utilise their expertise during the decision making process.Additionally, I will continue to develop my consultation and history taking skills by using Byrne and Longs (1976) consultation model to assist my practice and back up futu re development.ReferencesBYRNE, P, S., LONG, B, E, L. (1976) Doctors talking to patients. London HMSO EGAN, G. (1998) The Skilled Helper A problem-management approach to helping. 6th edn. Pacific Grove, London Brooks/Cole. GIBBS, G. (1988) Learning by doing a guide to teaching and learning methods. Oxford further education unit, oxford polytechnic SEIDAL, H, M., BALL, J, W., DAINS, J, E., BENEDICT, G, W. (2006) Mosbys Guide to Physical Examination. 6th edn. Philadelphia Elsevier. SCHON, D. (1984) The Reflective Practitioner how professionals think in action. New York Basic Books.