The REFLECT model
The model comprises seven stages:
· R – RECALL the events (stage 1) – Give a brief overview of the situation upon which you are reflecting. This should consist of the facts – a description of what happened
The patient was admitted to the mother and baby unit for oxytocin of labor secondary to postdates, she delivered her baby following a prolonged second stage. She contracted a second-degree perineal laceration during delivery and had been repaired. She recently visited the bathroom, and she was unable to void.
· E – EXAMINE your responses (stage 2) – Discuss your thoughts and actions at the time of the incident upon which you are reflecting.
I assessed the perineal, palpated the fundus of the uterus and I realized it was soft and boggy, so I performed fundal message. Since the patient was unable to void, I assessed the bladder status and performed straight catheterization. I checked for blood, lochia, and fluid on the bed and changed the pads. I gave the patient 100% of oxygen through non-breathing mask. I started oxytocin postpartum 500ml/hr., butorphanol tartrate 2mg and 500ml of lactated ringers. I also provided patient education and called the physician to discuss the patient.
· F – Acknowledge FEELINGS (stage 3) – Highlight any feelings you experienced at the time of the situation upon which you are reflecting
I was prepared from the beginning, after reading through the scenario, I realized that the patient does not speak English fluently, so I was not sure about the difficulties I would face knowing that I would have a language barrier but didn’t seemed to be an issue at the end.
· L – LEARN from the experience (stage 4) Highlight what you have learned from the situation.
I learned about the importance of postpartum care assessment, newborn mothers are at risk for infections, hemorrhage, and the development of a vein thrombosis (DVT), so performing this aspect of care will help identify any of these risk or complications.
· E – EXPLORE options (stage 5) – Discuss options for the future if you were to encounter a similar situation.
In the future, I will make sure I focus on the things that are needed to be done now to save the patient. During the simulation, I realized that if you follow the doctors’ orders and reading through the patient chart, you should be able to know how to provide care to your patients. And not just follow the orders throughout but make sure you understand the orders and it make sense for the patient. if my patient does not speak English fluently, I will include an interpreter during cares. I will also communicate constantly with the patient’s provider to let him/her know what is happening.
· C – CREATE a plan of action (stage 6) – Create a plan for the future – this can be for future theoretical learning or action.
Know what medications is needed for managing bleeding after delivery and what the nurses should look
Learn about priority nursing intervention for managing bleeding after delivery
Review of postpartum hemorrhage
Learn about management of postpartum
· (stage 7) – Set a time by which the plan outlined in stage 6 will be complete
The plan should be complete within two-three weeks.