1.4 Reflective practice in health – nursing journal entry transcript

Description

This week during my professional placement I was faced with a significant and unexpected event that made me more aware of the unique challenges and responsibilities of a remote area nurse (RAN). The event occurred during the evening when I was on-call. A local farmer had been involved in an accident and severely injured his upper arm.

The area does not have paramedic staff, and the local doctor was in another town, so my placement supervisor, an experienced RN, was called upon to retrieve the farmer from his home and provide care. We attended the patient’s location and my supervisor provided emergency care on-site with me attending. We then relocated the patient to the center for further treatment. My supervisor determined that the patient needed surgical intervention and took action to arrange air transport to the nearest hospital.

We have received news that the patient’s arm did not require amputation due to the initial care he received and his quick transfer to the hospital, where he was treated by a surgeon. He is expected to recover the use of his arm.

Feelings

When I heard the news of the accident and realised that my supervisor and I would be the sole healthcare professionals on the scene, I felt very overwhelmed and anxious. At first, I didn’t believe that there wasn’t anyone else who could go to retrieve the patient and was completely shocked that we were going. My supervisor acted quickly, but for a few seconds I was frozen and felt terrified that we could not provide this man with the care he needed without medical specialists.

When my supervisor gave me instructions, I felt adrenalin rushing through me in addition to feelings that I was completely out of my depth. My supervisor was calm and confident in response to the situation, which made me feel slightly better, but also quite inadequate because I felt so far away from matching her competency in the situation.

Afterwards, I felt proud that I had been able to help my supervisor carry out the patient’s treatment, but I still felt a sense of disbelief that as a nurse, this was my responsibility and anxiety that I would be met with more unfamiliar situations.

Evaluation

This event was challenging for me and highlighted the difference between urban and remote nursing work – in remote areas, nurses are required to take on responsibilities that nurses in cities or larger towns never would. The anxiety and insecurity I felt during this event made me question whether I was cut out for a remote nursing role.

The patient was losing so much blood that without immediate care, he may have lost his arm or even died. That is a very sobering and humbling thought. Nursing here may sometimes require the ability to make autonomous life and death decisions, which isn’t something I thought I would be doing. I am disappointed by the fear and hesitancy I felt when I heard of the accident, when really there was no option but to provide care.

The patient received excellent care from my supervisor, and I did my best to follow her lead despite my anxiety. She made him feel as calm and comfortable as I believe possible under the circumstances. I was in awe of her interaction with him. She spoke to him calmly and was familiar with him from her work in the community. She asked him about his children and job, and this calmed him immensely. I could tell that he trusted her and was willing to be in her care. Her decision-making in discerning that a surgeon was needed and calling for transport to the hospital also made a big impression on me. My supervisor didn’t falter in such a high-stakes situation, even though it is something a nurse would not be responsible for in an urban health setting.

I think it was important for me to have this experience because I became truly aware of the lack of specialist support in remote nursing. Feeling out of my depth was a wake-up call for me to fully understand the responsibility RANs hold and how important they are in this community.

Analysis

McCullough et al. (2022) note that remote nurses are often unprepared for the generalist scope they must take on after their specialist nursing courses. Because there is a lack of access to other health professionals, remote nurses need to deal with any potential emergency and do what is necessary. Nurses interviewed for the study described feeling ‘scared’, ‘nervous’, and ‘frightened’ in moments when their skills and training did not prepare them for what they were facing. They expressed concern about the scope of practice and the responsibility of being the only ones in the community with health knowledge and resources, and therefore needing to do things they had never experienced.

This is very much something I felt during and after the event this week. This was not a situation I have experienced in an urban health setting, and it is not something I have been trained for. In cities and larger towns, there’s a sense of security knowing that there’s specialised support and healthcare roles are well-defined. In remote areas like this, specialist staff aren’t always available. My supervisor had mentioned this type of scenario as a possibility, but I hadn’t considered it likely or given it enough weight. During previous shifts, the regional doctor had either been in the clinic, or the patients we were seeing hadn’t required treatment from a doctor, so I hadn’t fully considered what would happen without a medical practitioner available. The experience also highlighted an element of a RAN’s role that I hadn’t fully appreciated before – the need for immediate action and decision-making in the absence of specialised support. While my training has prepared me to be a critical thinker, I did not and do not feel prepared to make independent decisions in emergency situations yet.

Reflecting on this event, an aspect that stands out is the trust the patient had in my supervisor despite her not being a paramedic or doctor. Aside from her obvious clinical competence in her role, I believe this is a result of her engagement with the community and his familiarity with her and her skills. It’s clear that community bonds are much more important in remote areas than in urban settings. RANs like my supervisor don’t just need to have clinical expertise, but also the ability to build relationships and rapport within the community.

Finally, I’m trying to remind myself that my supervisor has over ten years of experience in rural and remote communities, and that I cannot expect myself to perform at her level. Through better awareness of what the role entails, and on-the-job experience, I believe I can improve my practice and build my confidence and connections within the community.

Conclusion