Reflective Account Of Working At Day Care Units

This account is taken from my diary after working at the Day Care Unit. This unit, as the name denotes, is doing day surgeries and endoscopic day procedures. It has also a number of medical patients. In the first day of meeting with the Nursing Officer, we were given an explanation of the ward and the learning opportunies we could get from the ward. We were also told that the ward would facilitate us in observing some operations in theatre. After we had finished the orientation by going around the ward, the Nursing Officer told us to work according to our assigned roaster , because we were seven students. This made us to practice routinely from basic nursing task and observe procedures in the theatres.

Mr. Branco was a 58 years-old man with Left Inguinal Hernia. He was received from Day surgery Unit, after an inguinal hernia repair. He was stable, fully awake and in a good condition. After I took his parameters, I started discussing with him about the advice given by the consultant. He was advised not to drive and lift heavy objects for a limited period of time. He fully understood and was ready to adhere with the information. As I was talking, another patient interrupted us by asking me to give him some sips of water. Since I was alone in the room, I had to go to the kitchen to bring water. After the patient was given sips of water, I kept talking with Mr Branco until I saw two visitors looking and reading the file of Mr Branco to whom I was talking. They were Mr Branco’s wife and daughter. I immediately responded to the way they were acting. I was conscious of the way I spoke to them asking them to stop looking at the patients file without being intrusive. I tried to be polite and asked them that were not allowed without being given permission. But, Mrs Branco replied “I have a right to see the file, because he is my husband”. I continued, “first of all I didn’t know that you are his wife. Even though, if you are his wife, you must get a permission from a person who is in charge.” She then said some thing, which made me feel uncomfortable. “You know, I am a staff nurse, and I have been working as a nurse trainee in England for ages, so I know what I am doing.” I sensed her irritation with me. Did she want me to keep quite? Should I accept her action and approach that seems she had the right to search the patients’ file? I picked up the file, not wanting to irritate her but recognizing she had to realize she was completely wrong and hadn’t permission to get access. The Maltese code of ethics for nurses and midwives, issued by the Nursing and Midwifery board in 1997 states clearly that “The patients’ notes or file should be kept in a safe place and only authorized persons should have access to them”.  As a registered nurse in the U.K with an experience of more than 20 years, she would rather reflect her professional responsibility even out side her work place. The Maltese code of Ethics for Nurses and Midwifery also indicates about the professional responsibility of the nurse that..

“The nurses and midwives must be, and be seen to be, exemplary upright citizens not only during the execution of their duties, but also generally in their public lives. They should consider themselves as ambassadors of their profession, as the public will judge nursing and midwifery by the behavior of nurses and midwives”

We should realize that nurses must have to act professionally wherever they are. She must be aware that nurses have a duty to maintain confidentiality of a patient at all times and the nurse safeguards the patients right to privacy by protecting his information.

I started thinking the way she responded to me. And how else might I have responded? Why did I feel uncomfortable? I can’t say that she was not aware of her professional responsibility, but what made her act in such a way? Was she so eager to see the outcome of her husband? She might be in a bad mood? Stressed? I felt a bit irritated with my self, because I needed to solve the tension made between us. I never felt uncomfortable since I started on my placement, but today…………..? The patient (her husband), didn’t speak out a single word all day long. He just was moving his eyes around in the room. Suddenly, I realized that I am in a best position to make the gap narrow. I struggled to manage my feelings. Fortunately, the patient asked me to give him water. This created the opportunity to start talking with the family. I told the patient it would be preferable to stay half an hour, because the surgeon advised him not to take any fluid 2 hours post-op. Then, the wife asked me to get him some sips of water. I agreed, as this was allowed. How long have you been working in England? I asked. To find a way talk to her. “More than 20 years”. She replied. Before asking her the next and important question, the security came and told the visitors that the visiting hours were over and that they had to leave. I felt upset as the conversation was interrupted due to intervention of the security and time. I then spoke to the ward nurse about the situation when she came back from break, however she didn’t comment on this event. Soon I was sent for break. I went for break thinking how she could have shared her experience to me if the tension hadn’t arisen.

To avoid such a problem with the family members, the patients file could have placed apart from them. In the ward the files are left near the patients so that when parameters are done the file is near. In conclusion, to act professionally to which someone represents is an important factor that should be maintained at all times and everywhere. Mrs Branco was not professional in seeing her husbands file without asking permission, professionally she should have asked the nurse in charge of Mr Branco if she could see the file. There are hospital rules with concern to patients files and Mrs Branco, being a nurse herself, should adhere to these rules