Reflective_Account_on_Diabetic_Patient

(GIBBS 1988) REFLECTIVE ACCOUNT MONITORING A DIABETIC PATIENT DESCRIPTION: During a day shift I was part of a staff team of six. In the morning report we were all given a rundown of each patient from a night shift member. One of the patients is an elderly lady with dementia and diabetes. We were informed she had slept well and that her morning blood sugar level was reading high however she had received her insulin for this. No other information was given and the reporting nurse continued onto the next patient. After report I came out onto the ward floor and done what I usually do which is make beds and carry out our usual routine. At approximately 9.00am it was discovered by another staff member that the female elderly diabetic patient was laying on her bedroom floor. Four staff members, including myself, went to attend to the patient where we found her responsive but drowsy. I took a blood sugar reading and found her levels to be low at 2.5. We moved her onto her bed and administered Hypo stop as the patient, although responsive, was too drowsy to administer sweet fluids as a potential to choke. On call medical doctor was informed, patient was monitored throughout, continual blood sugar levels were done at intervals, physical recordings taken and routine checks of patient’s responsiveness /orientation was carried out. It became clear to us that the patient had not received breakfast following administrated insulin earlier that morning. No breakfast tray or signs of any meal was evident. The patient slowly improved with our interventions and by afternoon was back to her usual self. FEELINGS: Initially I was quick to lay the blame on the night staff. They had administered the insulin therefore it was their responsibility to ensure the patient had breakfast to prevent a hypoglycaemic attack. The night staff was an easy target, I felt they had contributed to a breakdown in continuity of care through lack of communication. I suppose, dealing with clients every day we get used to seeing, predicting and expecting different certain patterns from each individual therefore I assumed the patient would be fine going on previous days. I also felt we were getting no further ahead dealing with the patient’s erratic blood sugar recordings. Was I contributing to neglecting the patient which was leading to mismanaged diabetes' I almost thought we were back to square one, back to where we started which meant previous input was now wasted. EVALUATION: The experience has highlighted how I along with the rest of the dayshift worked as a team without making accusations towards one another and dealing with the situation there and then. It showed the ability of us working as a team, good communication ant putting the patient’s health first. However as I have learnt, we must not presume we know what is happening by going on our own experience and previous days when the patient has come to no harm. The patient often presented as confused and blood sugar levels had often been reading high therefore it was easy just to put the confusion down to the patient’s mental state rather than their physical state. The patient was not able to manage their own blood sugar monitoring or let their concerns known to nursing staff therefore subsequent actions may put the patient’s health in danger and lead to more problems. ANALYSIS: The event has highlighted to me that every patient we deal with is an individual with a unique set of circumstances and if we jump to conclusions which we think is reasonable at that time without taking the time to understand each individuals situation then we risk miscalculating the input and care each individual patient requires. Although earlier I stated I was quick to point blame at the night staff, I believe that challenging the way we reflect on our practice can hopefully provide the potential for better and improved care. CONCLUSION: I can now consider how events could have been avoided, overcome or improved. I am aware we all get used to using our judgement to assess situations and rely on our experiences to build up a picture of what warning signs and outcomes to expect however sometimes regardless of all our experiences we must remember to stop and assess just what is happening at the here and now. In hindsight better communication between shifts, closer monitoring of not only diabetic patients but diabetic patients with confusion related to their mental state and inability to monitor their own physical needs, and adhering to the Diabetic Protocol will all help and ensure safer practice for myself, colleagues and patients. Although this can be time consuming and repetitive, we all have to remember the easiest option is not always the safest.