Clinical placements

Escalating concerns boosted my confidence and helped save a patient’s life

When nursing student Christine Urum used her initiative to identify a problem and then escalated her concerns, she helped save the life of a seriously ill patient.

When nursing student Christine Urum used her initiative to identify a problem and then escalated her concerns, she helped save the life of a seriously ill patient 

escalate
Nursing student Christine Urum learned the importance of escalating concerns
about her patients. Picture: iStock

In my second year of training I was in placement on a cardiac/respiratory ward where I was I caring for a bay of four patients under the supervision of my mentor. 

I was assisting the patients with their personal hygiene when two of them asked for the commode. After they had been to the toilet, I discovered they both had liquid stools. Patient A's was brown and patient B's was a deep coffee colour. 

I reported this to my mentor, and patient A had a urine sample sent to the laboratory for investigation. He was found to be MRSA positive and was barrier nursed. A stool sample from patient B was also sent off for analysis.

Asking and reporting

Patient B had about four more episodes of liquid stool, and with each episode the stool became bloodier. I was concerned about this, and when I asked the patient how he felt, he said he had pain in his stomach, difficulty in breathing and felt sweaty.

I escalated my concerns by reporting this to the nurse in charge and the doctors on the ward, and following a CT scan, the patient was diagnosed with a gastrointestinal bleed. When the doctors checked his drug chart, they found that he was taking Aspirin and Clopidogrel – both anticoagulants – without any proton pump inhibitors for gastro protection. 

He was immediately catheterised and a nasogastric Ryles tube was inserted to empty his stomach contents in preparation for an operation to repair his ulcerated intestines. 

Learning to stay calm

Through this experience, I learned new skills and was able to enhance the skills I already possessed. I learned how to work calmly and efficiently in an emergency situation, observed the insertion of a Ryles tube for the first time and witnessed male catheterisation. 

I also learned the importance of accurate record-keeping, particularly with the stool chart, which enabled me to monitor the frequency, colour and type of stool to identify any problems. 

Barrier nursing the patient with MRSA also improved my infection prevention and control skills, underlining the importance of handwashing, the proper disposal of clinical waste and the use of adequate personal protective clothing when dealing with bodily fluids.

Observe, communicate

My observation skills were improved, and I gained more experience in communicating effectively, which enabled me to form a therapeutic relationship with my patient and deliver person-centred care. 

I was glad that I had communicated well with the patient and the multidisciplinary team, helping to identify the problem and solution, which saved the life of the patient.

Escalating my concerns by reporting them to the nurse in charge and the doctors on the ward also boosted my confidence. I was so relieved that the patient's life was saved, and was commended by my mentor, who praised me for using my initiative to identify a problem and escalate my concerns accordingly.


Christine Urum is a second-year adult nursing student at City, University of London

This article is for subscribers only

Jobs