Attending a dance class. Feels challenged and tired.

Reflection -

After the class ends, I feel

Motivated as I am able to remember and enjoy the fun of the choreography.

Action - don stress too much and enjoy at the moment. Let Things happens and I just tackle whatever it happens

Experience - child had high fever, Wife was the only one at home. Child developed fits and wife did not know what to do. Called me (was working) just saying “child was unconscious” and put down the phone.

Reflection - remember feeling very frustrated with wife because of the lack of information. Upon reflection, realised that it was a traumatising experience and as she is not medically trained, panicked and did not know what to do. Also realised that I should have been more empathetic.

Action - encouraged wife to share how she felt and also decided to share with her what to do if child has fits again. Had standby rectal diazepam in the fridge and encouraged wife to learn how to administer.

Reflection- in a hurriedly manner, vocal tone might sound harsh to her. Told her that i was not angry and that it was already well pass the time of breakfast and that we needed to quickly serve patients their medication. So maybe when rushing my tone was loud to get her attention to the situation.

Action- Watch my tone and manner in which I speak. Singlish sometimes may sound harsh to foreigners so speak proper english.

Last year, i took a group of 6 students from NYP for their posting. All students(being affected by majority) appeared disengaged, showing minimal participation and reluctance to ask questions despite demonstrations and prompt.

So What?

So i was thinking maybe their lack of interest could be due to anxiety, unfamiliarity with the settings, or they are just use to passive learning approach or maybe not interested. Simply demonstrating skills may not be enough.

Maybe hands-on most of the time.

Now What?

I may try to incorporate hands-on practice and real-case discussions after they have experienced. This may encourage students to take active roles and relating what they see to what they have learnt and enhance their interest.

after our Go cart activity we decided to do ATV and unfortunately 1 colleague encountered an accident fell off and had cuts and bruises on her upper limbs.

We aid the wounds and cuts with whatever resources we have and waited for a transport to bring her to the nearest emergency facility.

waiting for the initial assessment of the doctor to decide whether to transport to JB or stay warded in Jb hospital

i felt overwhelmed thinking of what could get worst and what to do . How to explain to the mgt and stuff

-what not good happened - the acccident happened caught unprepared ..the rest of the activity was cancel off

-what good happened - she was fit to tranfer back to SG by car ...

-action: plan ahead , and anticipate in advance of things that could happen and prepare for it,

orientate all members of the group before the activity ..

What: I had one preceptee that had issue with new AVF cannulation. The staff missed cannulation of the V site of the AVF resulting to infiltration. The staff did not use torniquet during cannulation of the new fistula. This caused the patient to complain of pain over the AVF and deferred using the AVF for that day. Instead used permanent catheter for dialysis treatment.

So What: the staff learned the importance of using torniquet during cannulation and ask for assistance especially in doing cannulation for new fistula. She also learned that for new fistula cannulation this should be done with care and guidance from senior staff.

Now What: the staff realised that she needs to practice on her cannulation skill and follow the protocol to prevent complications. She needs to have someone beside her to guide especially in doing new fistula cannulation.

Reflection - The team and myself felt very disappointed and frustrated as majority of the staff are not familiar at all. But we also acknowledged that the last exercise was 9 years ago and many senior staff have left + we did not provide a good outline of information and resources for everyone to refer

Action - We created quick guide and action cards as well as designated roles in our daily assignment sheet and pasted around office and pantry as well as clinical area to remind everyone on the crucial actions during CE activation

Negligence - Nurses started patient on dialysis treatment with BP 220-230/113 without consulting doctor. Patient collapsed within 5 minutes. And deceased in hosp after 3 days.

On investigation. Patient meds was out of stock for 3 days.

So What

Do not assume. Do not take medical conditions for granted despite patient showing no symptoms. Instead, Nurses should anticipate potential complications that can occur with hypertensive urgency.

Now What

Do thorough assessment on patient. Discuss with doctor on special cases that is not within nurses’ control in decision making.

Refresh knowledge on ESRD & Hypertension.

Went oversea shopping last week.

Saw something that i wanted but hesitated to buy. Think alot the whole day and end up not getting it. Now regretting not buying as its more expensive in SG

So what

When going overseas dont hesitate on buying as you may not get the chance to buy again.

Now what

In the future make alist of what i want and compare price to SG on the spot if worth it dont hold back just buy or else you will regret.

Nurses were unsure about how to respond when a patient’s tracheostomy tube  was dislodged. They were occupied with searching for SWIs and protocols, leaving the patient unattended.

So what?

o   A lack of knowledge among nurses regarding emergency tracheostomy management.

o   SWIs and protocols are not easily accessible when needed.

Now what?

o   Conduct in-service training within the department

o   Develop an advanced tracheostomy course

o   Introduce new initiatives to ensure resources are readily available, such as QR code on tracheostomy kit

When the participant was struggling with the technique, the CI demonstrated the procedure. One of the ward preceptors then mentioned to the participant that they can do it their way and praised the participant for doing well.

Feelings:

The staff should reinforce the aseptic technique rather focus on the the participant's feelings and motivation.

Being there to guide and support the participant is already demonstrating "support and encouragement".

Evaluation:

The staff will need to be clear of the standards and be sure of the appropriateness of when to use words of encouragement.

Analysis:

E learning video for refresher.

Conclusion:

Staff to refresh the procedural steps.

Action plan:

Keep the E learning open for new staff for 1 year.

-probation staff with almost >6month, slow leaner, unable to retain information and no initiative. He unable to perform EVD care on patient as he verbalised he did not hands on or encounter patient with EVD. He just increased the level of EVD without clamp it. he mention that he need to measure the level of the EVD.

-but there is EVD case past month in the ward and patient is long stayer.

Reflection

-stop immediately his action, show him proper care of patient with EVD. asked him what is the rational why he increase the EVD level prior to measure it.

-I should show him before ask him to hands on.

-have a talk with him, asked him to reflect the whole situation.

-Asked him to find out how to do better next time for patient with EVD

• New staffs verbalized that she don't want to assist the doctor in doing procedure

Reflection (Reflect on what happened)

• Reflect on the procedure that the doctor want to perform (insertion of chest tube) which she might not be experience before

Action (taking an action)

• Go through the steps with the new staffs before she assisting the doctor and guide her while the doctor inserting the chest tube

Out of 9 students (6 NYP, 3NUS) on AM shift, 7 (6 NYP, 1 NUS) students are on break together. After gathering details from 2 students, I got to know that the NYPians planned to go break together.

I as the covering CI for that day instructed all 9 students to write reflection on communication and teamwork. All 6 NYPians were very unhappy and complained it to main CI and my bosses.

So What?

I need to put myself into the students' shoe. They may feel penalized and not fair as this is their first time. What they need to understand is the potential consequences and how to prevent it in future. These pointers could be shared across in other ways.

Now What?

I will give benefit of doubt for this type of non-critical event where no patient/ self safety is implicated. Other ways of activities could be adopted to bring the learning pointers across.

So what: I should not waver in correcting their practices cause as a result, these incorrect practices will set wrong examples for the new nurses

Now what: I will read up and practise communicating in affirmative style to emphasise on right practices

Action: instruct student to follow the schedule to have their meal break. And reinforce to them the reflection is required if same thing happens again next time .

So what: It was a learning experience for vigilance in patient safety. Patient will be expose to potential risk such as infection, bleeding, or accidental dislodgement outside. It also highlights the importance of double-checking before patient discharge, to ensure all necessary steps are completed before a patient leaves.

Now what: To prevent reoccurrence, staff will double check that a necessary steps were taken before discharging patient. Education was also provided to patient to raise their awareness and empower patient to take ownership to their own health.

I was conducting a Code Blue drill for staff, but despite multiple attempts, she kept making the same mistake. As the situation progressed, I became very frustrated and asked her to repeat the drill again.

So What?

I felt frustrated because Code Blue scenarios are critical, and mistakes in real life could have serious consequences. I wanted to ensure that she mastered the correct steps, but my frustration may have affected the learning process. Instead of helping her improve, it might have increased her anxiety, making it harder for her to retain the correct procedure. This experience made me realize that repeating the drill without addressing the root cause of the mistake was not the most effective approach.

Now What?

Moving forward, understand the root cause of mistakes: Instead of immediate repetition, I will assess whether the issue is due to misunderstanding, stress, or lack of confidence.

I will break down the steps and use a hands-on demonstration or guided questioning to reinforce learning.

Encouraging staff and providing constructive feedback can improve confidence and retention.

1. Description

   PAtient had a fall during my shift. Patient had dementia and history of fall. He climed out of bed and fell head first. What i heard a thud me and my colleauges quickly ran to assess patient and bring him back to bed.

2. Feelings

   I Felt mixed of shock, concern, and guilt. I was worried about the patients well being. I could have more to prevent the fall.

3. Evaluation

   Positive:

   • The rapud response of my team ensured patient received immediate care.

   • Incident led tobreview of fall prevention strategies to improve patient safety.

   Negative:

   • Fall could have been prevented if rhe bed alarm was on at all times.

     
     

   4.Analysis

   Incident higlighted the importance of fall risk assessment and encouraging family members or caregiver to stay and be with the patient to alleviate anxiety for the patient.

   5. Conclusion

      • IF i were to face similar situation again, I would

      • Ensure high risk are places lld near to nurses counter.

      • Reinforce to family to stay as patient has dementia.

      6. ACTION plan

         • Advocate for additional fall prevention strstegies in the work place.

   
   

I took the initiative to observe and question the practice, showing critical thinking and a commitment to maintaining high standards of care.There was a discrepancy between my observation and her statement regarding hand hygiene. This suggests a potential gap in either practice or understanding of infection control protocols.She may have misremembered or assumed that earlier hand hygiene was sufficient or she believed that she had performed it. Inadequate hand hygiene increases the risk of healthcare-associated infections (HAIs), compromising patient safety.Provide constructive feedback to the nurse, emphasizing the importance of performing hand hygiene immediately before injection preparation. Reinforce the 5 Moments for Hand Hygiene recommended by WHO, especially before aseptic tasks. Implement regular observation and feedback sessions to support the ongoing development of safe clinical practices.

CNY day 11, I was very excited to attend the Chingay show as this year theme include SG60 celebration. However, I didn’t manage to fully enjoy the performance due to the view and bad sound.

Feeling

Disappointed ☹️ because I can’t see the whole performance from where I was sitted (section) and I can’t even hear clearly what the emcees were speaking/singing due to the poor sound system & multiple echo.

Evaluation

Experience was not totally bad as I still get to wave at the Mr president & Ms President when they first enter in (transported) via the flower car & got to watch the live fireworks.

Analysis

I can’t do much in the situation.

Conclusion

Next time I will purchase ticket early and choose a better seat with better view.

Action plan

Make full use of the current situation and still enjoy myself.

Reflection: The passive attitude showed by the senior staff makes it frustrating because she has been trained to perform the skill but refuses to try to do it. “I don’t know” felt like a convenient excuse that she could use to get herself out of the situation.

Action: Encouraged her to perform the skill under guidance of another staff. Spoke to her afterwards to find out the challenges she faced, and the barriers or fears that she has that resulted in the perceived passiveness. Also asked her how we could better support her in her learning.

Daughter being mischievious during meal time. She only ate 1/4 portions and play with her food afterwards.

Reflection:

I was very upset with her and scolded her. She then threw the food on the floor and created a mess. She cried for very long and I get annoyed cause she does stop despite coaxing.

Action:

I later learned that she actually is not hungry as she just drank her milk and she is sleepy as she missed her afternoon nap. Thus she is not interested in eating her food and already over stimulated. In the future I would have do it better by being more calm given such situations