Reflective Journal Patient Narrative

Patient Narrative Patient KM is a 26-year-old woman who presented to the emergency room at 0940 today in labor at 39 weeks and 2 days. She was admitted at 6 cm dilated and 70% effaced. Her husband and mother were both in the room as her support system. This is the patients first child, and she claims she has had a relatively easy pregnancy, although she has been on bed rest for the past week due to dizzy spells and an altered LOC. She is alert and oriented and claims to be in moderate pain. Today I felt like I applied my nursing knowledge when I had the opportunity to provide patient teaching in regard to different methods that could help naturally aid in dilation and effacement. I recommended changing positions and utilizing the peanut ball to support the labor process. With the assistance of my nurse preceptor, we assisted the patient into a left side lying position with her right leg elevated onto a stirrup and informed that after an hour we would come assess her progress. Before I began patient care today, I was most concerned about how the laboring mothers would respond to a student nurse. I found that all of the mothers I had to opportunity to care for welcomed me with open arms. I was very proud and privileged to be a part of their care. Nursing Process Narrative With the information presented, it was evident that delivery would occur within the next few hours. We were able to monitor the mothers’ contractions and the mother and fetuses heart rate using a continuous fetal monitor. With this we were able to see the mothers’ contractions were occurring more frequently and growing stronger. We also continued assessing the mother every hour for dilation and effacement to determine if the mother was ready to begin pushing. KM required assistance with positioning in bed due to her pain level. It is important to make a goal of showing progress of labor. This is measured by monitoring contractions, heart rates or mother and fetus via a continuous FHM, assessing dilation, effacement, monitoring the urge to push, etc. Clinical Experience Narrative During my clinical experience I was able to assess patient KM while she progressed through the stages of labor. This included obtaining vital signs, assessing bowel sounds, palpating the fundus, monitoring mother and babies heart rate, assessing dilation and effacement vaginally and preforming continuous pain assessment checkups. Within 1 hour of changing KM’s position, we preformed another assessment to measure dilation and effacement within 1 hours of changing KM’s position and found that she was 9cm dilated and 90% effaced. We then assisted KM in another position change, the bed was put at a 90-degree angle and KM was assisted into a “sitting” position in bed. The patient expressed concern as to why we had her in this position, and I was able to explain to her that in this position gravity would be able to naturally aid in achieving complete dilation and effacement. Our clinical unfortunately ended before I had the opportunity to aid mom in delivery, but I was very thrilled with my experience, nonetheless. Communication and Diversity Narrative It is critical to understand the importance of cultural competence while dealing with different cultures and knowing if they have any beliefs that could affect the quality of care I give to them, as well as if there is anything I need to treat differently or abstain from doing. It was not stated that KM had any cultural qualities that would affect care. Had thr been any, we as a team would have taken the time to respect and follow them to make our patient feel comfortable and confident with her care. Personal Growth Narrative After completing this clinical, I am more skilled as a nursing student to know what is required of me during the labor experience. I have a better understanding of dealing with mothers in active labor. I also feel much more knowledgeable about how to teach patients about the how and whys of the birthing experience as well as preforming patient education. During this clinical there were protocols and steps that I didn’t know were necessary to complete, such as talking with the nurse manager and team to inform them about how far along our patient was. I did not realize that it was indeed a true group effort when working on a maternity floor. I am so glad to have this clinical experience because not only was I able to practice. I learned it is important to take my time and make sure all steps and education has been completed, as well as making sure task are completed in a timely manner. I also learned the importance of sensitivity when addressing patient who are in a vulnerable state during labor. I will be able to take away the aspect of sensitivity and utilize it as a nurse. My patients concern and worries about how to manage life and family after birth is a concept that I will remember for my future patients. As I left, I felt good about having a role in helping mom during labor.