In this assignment I will be reflecting on a particular scenario that I have experienced during my time in a female only surgical ward (SW). In order to reflect in a methodical manner, I will be using Gibbs' model of reflection (Gibbs, 1988).DescriptionWhilst on the SW, I was placed at the Early Pregnancy Assessment Unit (EPAU) and had the opportunity to observe transvaginal scans. This method of examination is very thorough, the entire true pelvis can be surveyed in various angles by raising, lowering and moving the probe from side to side (Merz, E.
1997). It can be used to diagnose many gynaecology problems, such as polycystic ovaries.I came across a woman – Patient A (who will not be identified due to confidentiality as per the NMC 2008 code of conduct) 28 years old, 6 weeks gestation. I introduced myself and ensured that, by consent, she was happy for me to be present.
The patient was referred to EPAU by her GP and explained that she wanted to terminate. She was very upset and was not sure why she was having the scan. The Nurse Sonographer (NS) explained that patient A was referred because she had been experiencing severe pain and excessive bleeding and the scan would determine whether she would be suitable for the termination. The NS continued with the scan and explained what she was doing and pointed to the gestational sac which was within the right fallopian tube. It was identified that she had a live ectopic.
Patient A broke down and I immediately went to comfort her. The nurse explained that patient A would have to come back the next morning for her operation and to be nil by mouth after midnight. I stayed with her outside to comfort her.The next morning I was placed back in SW, the nurse and I had her under our care.
The nurse allowed me to prepare her for surgery; she was to have a laparoscopy and a salpingectomy to remove the ectopic sac. I used my previous experience of preparing women for caesarean sections to prepare her. She seemed agitated and I asked her how she was and if she wanted to talk. She explained that she was nervous and hated being in hospitals.
I reassured her that she was in good hands and to try not to worry. When she was ready and was feeling better, I left to read through her notes and familiarise myself with her history, the first thing I identified was that she was HIV positive.I immediately informed the nurse, who also read the notes. The situation was difficult to compare to midwifery, where the first thing that is checked are the blood results. I was shocked that this vital information was not shared by the doctors or even at the scan until the notes were checked.
When the theatre was ready, we accompanied her down, reassuring her and conversing en route. In the afternoon she was transferred and I was given the responsibility to continue her postoperative observations, I had gone through what we do in labour ward after caesarean sections with the nurse. The nurse explained what needed to be done and was happy for me to start the observations. I monitored her respirations, heart rate, blood pressure, temperature, oxygen saturation and the mean arterial pressure (MAP). I ensured all the outcomes were kept within normal range.
Patient A recovered very well and was able to eat soon after.FeelingsPrior to the start of the module I had limited knowledge of gynaecology outside of midwifery, i.e. the surgical procedures like hysterectomies, laparoscopies due to ectopic pregnancies. I did not understand why such procedures were carried out, what they involved and how these procedures affected women. I was nervous as I did not know what to expect.
I was completely out of my comfort zone on my first day on EPAU. I felt uncomfortable not knowing what I could do as a student midwife. I discussed this with the nurse who was very understanding and supported me when caring for patients. However, I was eager and very intrigued to learn more during my time.Throughout the scan, I felt a little anxious as I found patient A to be a little abrupt.
She made me feel conflicted as she seemed very reluctant to have the scan to begin with but was very intrigued with the images as the NS was scanning. Ultrasound scans facilitate prenatal bonding and have positive psychological effects on women. (Van Diick, J. 2005).I felt very confident when caring for the patient, especially when she needed emotional support as the decision to terminate can have a huge impact on ones psychological state.
However, I also felt that I was in the dark in terms of being aware of the patient’s history. I believe that due to her HIV status she was not open to us and did not want to communicate her concerns and queries.I felt that if I had known her medical, obstetric and mental history I would have dealt with caring for her better, ensuring that she received appropriate care. From past experience, pregnant HIV positive women require extra support such as reassurance and being well informed concerning their status.
They also receive extra support from HIV specialists. Patient A would have gained much from this if she had access to it. I wanted to understand how women felt experiencing early pregnancy losses, reading about the experiences and accounts, opened my eyes to the level of emotional support such women need.Due to my personal beliefs I am against terminations and I found the environment to be eye opening and difficult during the scan.
However, I am also a very strong believer of not judging others and have a duty of care. Therefore, I felt obliged to give the woman the support she required. Professionals must not discriminate in any way shape or form and must treat all under their care with dignity and respect (NMC 2008). I felt that I did not treat her any different to all the other women I have cared for.EvaluationI researched more about early pregnancy losses such as miscarriages and Ectopic pregnancies before starting my placement see appendix.
I found that women with a history of infertility and exposure to diethylstilboestrol in utero were at risk of ectopic pregnancies (Jurkovic,D. 2012) see appendix. Furthermore, women who have had a previous ectopic are at greater risk of another occurring (Danforth, D. 2003)Initially, I did not understand why women who were early on in the first trimester had transvaginal scans rather than abdominal.
Relating to my experience, signs and symptoms of ectopic pregnancy are pelvic/abdominal pains, vaginal bleeding or spotting if the individual is confirmed to be pregnant (Danforth, 2003).I have taken advantage of the learning opportunities and the support given by the nurses and doctors. I learnt a great deal and was able to take note of information and research it, i.e. Salpingectomy, defined by Danforth (2003) ‘a resection of involved fallopian tube segment with implanted trophoblastic tissue’. This helped my studies when revising my A;P and understanding more about the procedures that are not exposed to midwives, for example evacuation of retained products of conception, (ERPC).
I now appreciate that as a professional, care must be provided regardless of a patient’s history, personal circumstance or decision. A termination is a life changing decision and supporting women who have had to go through that, ectopic pregnancies and miscarriages has developed my attitude towards them. They are losses suffered by the women respectively and they require us as professionals to provide appropriate care holistically. I will use these valuable experiences to be more empathetic towards the women as it can be a traumatic experience physically and emotionally.
Analysis Reflecting back on this scenario, I learnt that the surgical ward admitted many Gynae patients and others with different medical problems and procedures. This contributed to expanding my knowledge and experience outside of midwifery. (RCN 2006) found out that this kind of opportunity allows students to increase their knowledge and understanding of other professions and their roles in contributing to patient care.Before starting I began to research on what I could possibly take away from my experience at the surgical ward. As I did not have one particular goal I was able to divulge further into the role of a nurse. I used the SWOT analysis (strengths, weaknesses, opportunities and threats) to identify my strengths and weaknesses of Gynaecology, women’s health and surgical care.
I used it as a basis to facilitate in setting out my objectives and identify learning outcomes, see appendix 5. This technique contributed to my reflective writing skills.ConclusionTo conclude, overall, this experience has allowed me to understand the procedures women experience, and to recognise how they may have felt and what they have gone through. This can be incorporated when booking women in, prior to the surgical placement I did not know how such procedures can affect women not only physically but emotionally, allowing women to be cared for in a holistic manner. This experience has encouraged me to adapt and gain invaluable skills for future practice.
