Documente Academic
Documente Profesional
Documente Cultură
Critical Reflection
NURS 3020
Bethany Carr
Trent University
Critical Reflection 2 2
During my tenth shift at Ross Memorial I was assigned to work with an Registered Nurse
(RN) Jane (pseudonym). Jane was assigned four patients for her day shift; one independent
patient who is participating in medical assistant in dying (MAID), one patient one person assist
who was being discharged, one two person assist and one patient that required a Hoyer/ceiling
lift. I was assigned to the patient who was being discharged for the unit, so I helped Jane with all
of her patient load for the day. The patient which required to people’s assistance, Bill
(pseudonym) used the call bell which I answered and asked me if someone was going to help
him with his inhalers because he “hadn’t used them in a while”. When I approached Jane about
the matter she stated those were his 8 o’clock inhalers. She notified me that sometimes he can be
instructed to take them, and he will on his own, and other times he will not remember to take
them after being instructed. Jane instructs me to go remind him those are from this morning and
he can take 4 inhalations of his Atrovent and one inhalation of his Advair. He also had as needed
(prn) Ventolin on his bedside table with other inhalers. Bill uses an AeroChamber so that he can
get all the medication in more than one breath. I asked Bill to take a deep breath out then put the
mouth piece, which was a mask, to his face and press the inhaler once, I allowed Bill to take
three slow deep breaths and then allowed him to breath normally, I repeated his four more times
and took a one-two minute break between medications. I asked Bill to rinse his mouth with water
once we were finished. Bill then complained that I did not know the special and specific
technique that the respiratory therapists (RTs) usually do. I asked Bill what I did incorrectly that
I can approve on for next time, and he told me I “just didn’t have the technique that was
required”. I notified Jane that Bill had taken his required inhalations, and his statements about
my lack of technique, and she assured me not to worry about it that he was just use to a specific
routine.
Critical Reflection 2 3
After this situation on my tenth day, I was left feeling somewhat unsure and questioning
the technique I thought I knew and understood. This brought me to the AeroChamber website
where I looked at the instructions for use, the only step I seemed to be missing was holding the
breath for as long as possible after each dose (AeroChamber®, 2014). Knowing that I the correct
concepts in my learning but still feeling unsure I searched for journals which talked about
metered dose inhalers (MDIs) and correct/incorrect use by nurses. In the study is says the
baseline inhaler technique assessment ranged from 100% for specific and RTs to 20% for nurses.
After people had attended a workshop on how to properly use inhalers their post workshop
assessment was much higher for inhaler technique (Basheti, et al. 2014). I think based on having
one lab that does not have high focus on the use on inhalers could lead to incorrect inhaler use by
students. I myself have never used an inhaler and those rely on reading step by step instructions
and then gaining my own habit on how to use one, this can also make it more difficult for myself
to explain how to use an inhaler as I have never had the experience. Between sources I have
looked at to continue my learning, I am still unsure of whether to do the next dose directly after
holding the breath and returning to normal breathing or whether I should be waiting one minute
between puffs to allow it to better enter the lungs. I think a way to improve student comfort and
skill is to offer a more hands on lab like the study offered the participants, because learning
correctly once and lead to better management of symptoms for patients and less medication
errors in the long run. A small part of one lab I do not think facilitates a student’s learning
The reason I chose to reflect on this event is because it was again, one of the only things
that came to mind of what went “wrong” when I have been at placement. At the time, the patient
made me feel incompetent because I didn’t know what I was doing in his eyes, and then I tried to
Critical Reflection 2 4
assure myself that I wasn’t a RT, so I wouldn’t have the same technique as one. I do not think
this is a very good mind set though, because inhaled medication administration is very important,
and technique is most important part. I want to be “as good” as an RT when giving someone
inhaled medications. I also have not had the opportunity to witness or work with a RT, so I
believe that would be a valuable chance to get to enhance my skills and correct any bad habits or
misunderstandings before they form. As the patient was older and had previously experienced
being given inhalers by RTs, meeting me a young nursing student could be off putting to explain
what he experienced that he thought was wrong. I know people get into habits and you can’t
explain what was wrong, you just know that wasn’t the way you are used to. Though my nurse
assured me not to worry about my lack of RT technique, it made me feel better at the time, I now
want to increase my knowledge so that I could have good technique and be able to provide
proper medication administration. As stated above, I do not have a lot of experience with
inhalers besides in lab and seeing my boss (a pharmacist) briefly explain to patients how to use
their new inhalers. I think reflecting on this experience will only help me become a better nurse
because I will know how to better help my patients especially when using an AeroChamber.
Overall, this situation and reflection are ones that can help me become a better nurse as I
finish my Acute Illness placement at the Ross. I think an opportunity to leave the floor or
accompany patients to see different specialists such as RTs would be valuable to learning if
possible. It would help facilitate learning and lead to reduced errors by students and in turn, new
nurses. In the future I will continue to question my technique when patients make comments on
it, so I may reflect and see if I can improve in my own practice to help patient outcomes.
Critical Reflection 2 5
References
https://www.nationaljewish.org/treatment-programs/medications/inhaled-medication-
asthma-inhaler-copd-inhaler/metered-dose/aerochamber
Basheti, I. A., Qunaibi, E. A., Hamadi, S. A., & Reddel, H. K. (2014). Inhaler Technique