Clinical placements

Do not hesitate when you’re faced with a deteriorating patient

Don't be afraid to put theory into practice as a nursing student – your patient’s life may depend on it
clinical team works on a patient

Don't be afraid to put theory into practice your patients life may depend on it

My final placement as a first-year adult nursing student was on a urological surgical ward. I was on my sixth week of the placement when a woman in her early eighties, who had been admitted for surgery to form a urostomy, became acutely unwell.

The patient had recently returned to the ward after her operation and when I went to do her observations, I realised straight away that something was wrong.

Her breathing was erratic, she was dripping with cold sweat and was feeling nauseous. I asked the healthcare assistant (HCA) I was working with to go and get the nurse, and continued with the observations while doing my best to reassure the patient.

The nurse quickly arrived and assessed the patient and looked

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Don't be afraid to put theory into practice – your patient’s life may depend on it 


Picture: iStock

My final placement as a first-year adult nursing student was on a urological surgical ward. I was on my sixth week of the placement when a woman in her early eighties, who had been admitted for surgery to form a urostomy, became acutely unwell.

The patient had recently returned to the ward after her operation and when I went to do her observations, I realised straight away that something was wrong.

Her breathing was erratic, she was dripping with cold sweat and was feeling nauseous. I asked the healthcare assistant (HCA) I was working with to go and get the nurse, and continued with the observations while doing my best to reassure the patient.

The nurse quickly arrived and assessed the patient and looked at the observations I had written down. She then asked me the two questions every nursing student dreads: ‘What do you think is wrong and what do you think we should do?’

The patient's symptoms showed rapid deterioration following her surgery

I told the nurse I thought the patient was showing symptoms of sepsis, likely related to the urostomy; she had a route of infection, a high respiration rate and high blood pressure. I said we should start treatment for sepsis straight away.

The patient was given a fluid bolus and started on oxygen. The doctor was informed of the situation and that we needed intravenous (IV) antibiotics prescribing immediately and blood cultures taken. The patient also had an electrocardiogram and was put on regular observations every 15 minutes.

‘You may be screaming inside and your heart will be racing but try to keep calm’

When the doctor arrived, the nurse let me do the handover under supervision. The doctor listened as I described what had happened, then ordered the blood tests and prescribed IV antibiotics, fluids and oxygen.

It was only then that I realised the importance of the swift actions of myself and the HCA, and how we may have helped save the patient’s life. All my training up to that point – in university and on clinical placements – came together and everything quickly fell into place.

All the interventions had the desired effect and the patient was discharged 72 hours later.

What to do if a patient suddenly deteriorates

  • Stay calm You may be screaming inside and your heart will be racing but try to keep calm. Take a deep breath to steady your nerves. This will also help you think more clearly.
  • Ask for help calmly It is likely your patient will already be worried so don’t add to this by shouting and making them panic. Speak clearly and firmly but try not to raise your voice.
  • Carry out observations These help paint a picture of what is happening to the patient at that time and are needed for the patient’s national early warning score (NEWS). You will also need them when handing over to another member of staff.
  • Document everything Keeping a record of events is vital – we are told all the time that if you haven’t documented something, it hasn’t happened.
  • Have confidence in your abilities You have been taught how to care for a deteriorating patient in theory and likely practised this through simulation. This is your chance to put the theory into practice and demonstrate your skills and knowledge.

 

Swift action relies on effective teamwork

This was the first time I had cared for a deteriorating patient, using the skills I had gained over 14 weeks of placements and numerous university lectures and simulation exercises to deliver timely and effective interventions.

As well as the importance of acting fast when a patient’s condition is deteriorating, this experience taught me about the importance of effective teamwork. The HCA, nurse, doctor and myself worked together to ensure the patient quickly received the correct diagnosis and treatment, and that she was supported throughout her hospital stay.

This was my first experience of caring for a patient with sepsis, and I felt a great sense of pride when she was discharged home safely only a few days later.

Don't shrink away from putting theory into practice – even in an emergency

The outcome for this patient could have been much worse had we not acted quickly, so another important lesson I learned was to believe in myself. As nursing students, we go through three or four years of intense training. It’s only when you encounter situations such as this that you realise why nurse education is so rigorous, and why we have to be prepared to always act in the best interests of our patients.

Caring for a deteriorating patient can be daunting as a nursing student, and it is tempting to take a step back when a situation like this occurs. But this is a valuable opportunity to put our observation and problem-solving skills to good use while under supervision from qualified staff, and learn how to communicate assertively and effectively using SBAR – situation, background, assessment and recommendation.

So if you are caring for a patient who suddenly deteriorates, be brave and get involved as much as you can. This is a vital learning experience and your actions could save your patient’s life.


Scott Doughty is a second-year adult nursing student at the University of Sunderland  

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