¶ … placement practice I discovered a great deal about pressure ulcers that occur following perioperative care. I am normally community based and I treat patients that have been discharged from hospital that have developed pressure ulcers following an operation. During my complementary placement on a short stay ward I was involved in the care of patients through their perioperative period. I was amazed how quickly one patient developed a pressure ulcer. The experience and subsequent investigation produced several facts concerning the reasons why such ulcers develop, how to prevent them from occurring, treatment and the emotional, financial and physical hardships that having these ulcers produce in patients. To evaluate my experience, I have chosen to use Driscoll's model of reflection. Driscoll's model was chosen because of the simple but reflective manner in which it concentrates on questions that are pertinent to the care of patients. The model is divided into three parts: What, So What and Now What. The "What" aspect of the evaluation requires returning to the situation and reflecting on the facts and feelings associated with the situation. The "So What" part of the reflection considers the context of the situation in terms of feelings and actions while the situation was occurring. The final part of the reflect ask "What Now" and focuses on modifying future outcomes. This aspect of the reflection will assist me in determining how I will handle these types of situations in the future as a medical professional. The answers to all of these questions are important and will assist me as a nurse in treating patients in the appropriate manner. Overall this type of reflection was chosen because of the simplicity with which it details and records how various situations in the medical field can be handled. Through the observations made I will be able to determine the steps I need to take in the future to be the best medical professional that I can.

What: Returning to the situation

What is the purpose of returning to this situation?

The purpose of returning to the situation involving Pressure ulcer risk during the Perioperative period is to examine the ways in which such ulcers can be avoided and how to treat these ulcers when they do occur. The presentation provided the opportunity to focus on the serious problems that occur during the perioperative care period. Overall the purpose of returning to this situation was to acquire the evidence base that can enhance my practice and reduce the negative impact pressure ulcers can have, for patients and the NHS.

What exactly occurred?

During placement practice a patient experienced a pressure ulcer on the sacrum following hip surgery. The patient was a bit depressed because she had to stay in the hospital for a longer time than she had anticipated. She was also expressive about how vulnerable she felt as a result of where the ulcer was located. This particular experience affected me because the patient's stay in the hospital was extended as a result of an ulcer that could have been prevented.

What did you see?

I saw the ulcer right above the buttocks and the discomfort that is caused the patient. Additionally the patient was devastated she needed to stay in hospital longer and was experiencing what should have been preventable pain and low self-esteem. Both the pain and low self-esteem caused by the ulcer really impacted that morale of the patient and it is likely that is also impacted her recovery.

What did you do?

I repeatedly made sure the patient was comfortable and re assuring her. I encouraged her to drink and eat and explained that this would help in the recovery of her operation and ulcer.

What was your reaction?

I was anxious to assist in helping the patient as it related to relieving the pain and finding and remedy for the ulcer so that the patient would be able to concentrate on regaining mobility after the hip transplant.

What did other people do? E.g. colleague, patient, relative

My colleagues went into action immediately to treat the pain and to position the patient in a manner that would assist in healing the ulcer. The family was concerned about the ability of the patient to recover from both the ulcer and the hip replacement. They were also concerned about the extended hospital stay because longer stays in the hospital during the perioperative period increases the risk of getting other...

These infections can be fatal and as such the family wanted the patient to have a short stay in the hospital.
What do you see as key aspects of this situation?

This situation indicates that greater care must be taken to prevent such ulcers from occurring. The research and my experience in this area indicate that while anyone can be vulnerable to developing pressure ulcers following surgery, there are several factors that can be addressed prior to surgery that will reduce the likelihood of developing an ulcer. This means that preventative measures are a key aspect of ensuring that patients will not experience this complication.

So What: Understanding the Context

What were you feeling at the time?

At the time I wanted to relieve the stress and the pain that the patient was experiencing as a result of both the operation and the ulcer. I was also somewhat upset that more hadn't been done to prevent the ulcer. I did my best to attend to the physical and emotional needs of the patient as she was really looking forward to having a shorter stay in the hospital but the ulcer prevented her from doing so. Additionally Even though I had not completed the assessments I did feel guilty that she had come in to hospital for a hip replacement and ended up developing a ulcer. Therefore I wanted to gain the knowledge, skills and understanding of what can be achieved to prevent ulcer development. this is why I choose the topic I did for the presentation, to raise awareness on how quickly ulcers can develop the affect they have on the patient and to raise the awareness of everyone to the importance of prevention. When I talked about ulcers on the ward not many staff seemed to be aware of the impact ulcers have on the patient. Everyone knows what an ulcer is but unfortunately a high number of patients still develop them.

What are your feelings now? Are there any differences and, if so, why?

I still a vbit of frustration in the manner in which the situation was handled by the medical staff and their inability or unwillingness to act soon so that the pressure ulcer did not develop. I also feel some relief for the patient because I was there to comfort her and reassure her that the ulcer would heal and she would be able to go home. I still feel some sadness for her because of how vulnerable she felt when having to get the ulcer dressed. As a medical professional I always want to help patients to maintain their dignity. In some ways I feel as though I was not fully able to do this with the patient. I also feel empowered in some ways because after researching this issue I know that in the future there are many steps that can be taken to ensure that many of my peri-operative patients do not get pressure ulcers. In addition if these ulcers do occur I will know how to address the issue with compassion and sensitive as it pertains to preserving the dignity of the patient.

What were the effects of what you did (or did not do)?

My efforts to reassure the patient that the situation would be resolved and she would get better seemed to affect her mood. OI wanted her to know that the medical staff was working to treat the ulcer. I also wanted her to know that she had an advocate and that I understood her feeling of vulnerability as a result of where the pressure ulcer was located. As an effect of my efforts I do believe that the patient was able to cope with the situation and not feel shame. Overall I think I did a good thing in regards to the patient's well-being and encouraging to get well so that she could return home and fully regain her strength.

What good emerged from the situation e.g. For self, others?

The good that emerged from this situation included my own personal ability to better understand how to treat preoperative ulcers. I also learned how to maintain my composure when treating people in distress. In addition, as a result of the experience I learned about the healing process and the extra financial burden that is placed on patients and their families when ulcers occur. I also learned that I have the ability and responsibility to educate others concerning ulcer prevention in patients.

What troubles you, if anything?

The primary issue that I find troubling is that an estimated 95% of pressure ulcers can be avoided (NICE, 2005) when the proper precautions are taken. Failure to take precautions complicates the ability of the patient…