Reflection 1

Student: Haley Patterson Faculty: NURS 2021
Topic: Maternal Assessment
Look Back: A meaningful event from my clinical experience is assessing the for a mothers
fundus postpartum independently. The nurse instructed me to preform fundal assessment to make
sure the mother’s fundus was firm and midline before getting discharged to go home with her
baby.
Elaborate: In first shift in maternal child, the charge nurse had demonstrated a fundal check
with me, and the patients fundus was deviated up and to the right upon palpation (vaginal birth).
The nurse told me to palpate for a ridge in the fundus, which I was able to feel for and was very
excited about it because I had only felt a simulated fundus in lab, and not on a human being. The
nurse informed me that her fundus was not as firm and midline because her bladder was full, and
we would check again before she was getting ready to be discharged, and after she had gone to
the bathroom to void. A couple hours later, the nurse instructed me to palpate her fundus for
firmness and that it was midline with her umbilicus so she could be discharged. Going into the
patients room I felt confident for the fundal check because I had gone through it with the nurse a
couple hours previous. However, I felt nervous that the patient or her partner would begin to ask
me questions that I couldn’t answer and get mad that a student was allowed to perform this
assessment/not able to answer their questions. I instructed the patient to lay in her bed, but was at
first unsure if the patients bed was to be completely horizontal for a proper fundal check, so I put
the head of the bed down just in case with the patient permission. I began to palpate the patients
upper abdomen because that is where the nurse had located it before, but couldn’t feel the
fundus. I then felt very unsure in myself and embarrassed that I couldn’t find the fundus because
both her and her partner were looking at me waiting for me to locate it. I explained to the patient
that it was my first day and I was having troubles finding the fundus. The patient directed me to
where the fundus was previously found by other nurses on her, and with that information I was
able to palpate the fundus. The patients fundus was firm and was midline and located 1
centimeter below the umbilicus, which I knew was normal for a mother who was one day
postpartum. I felt more at ease with the patient after she helped guide me, as she was very
understanding that it was only my first day and did not appear to be irritated that I did not palpate
for the fundus right away. I felt more confident in myself because I was after all able to feel for
the fundus after one day postpartum in the correct position which we had learned in lab the week
before. I was very excited that I was able to apply my theoretical knowledge which I learned in
lab, to a clinical setting with an actual postpartum patient. I also felt more confident I would be
able to locate the fundus more accurately the next time I preform a fundal assessment. After
preforming the assessment I told the charge nurse of the location and the firmness of the fundus.
Analysis: The key issue in this experience I had was that I did not stop and think before I
preformed the assessment of where the fundus anatomically should be one day after postpartum.
I also should have brought either the nurse or my preceptor into the patients room with me to
ensure I was doing the assessment correctly. I immediately assumed the patients fundus would
be in the same location it was when the nurse and I checked a couple hours previous, although I
knew it was pushed upwards and to the right because her bladder was full. What is known from
nursing theory is that normal findings within the postpartum fundal assessment is that the fundus
should be firm and central, either one centimeter above or below the umbilicus (Perinatal
Services BC, 2011). The fundus can feel boggy and obstructed by a full bladder (Perinatal
Services BC, 2011). I should have used my critical thinking during this assessment, especially
using my knowledge from lab and with the nurse that after a full bladder the fundus recedes back
to normal positioning. With the guidance of the patient, I was able to palpate the fundus in the
correct position. However I was embarrassed that I was not looking in the correct abdominal
location in which I should have been palpating in, and knew from theory in lab in which I should
have used while doing the assessment. During a postpartum assessment, the patient must be in a
supine position with the legs slightly bent, with the head of the bed flat, with one hand palpating
the fundus while the other stabilizes the uterus (Perinatal Services BC, 2011). The nurse must
also be looking at the lochia flow and colour while palpating for the fundus for signs of
postpartum hemorrhage which can be life threatening for the patient especially if not caught
early (Perinatal Services BC, 2011). These are to be done before palpation of the fundus to
correctly locate the fundus, and to make sure any other organs are not obscuring the location
(Perinatal Services BC, 2011). Looking back on the assessment I did for this patient, I did not
ensure all these were met. I did lower the head of the bed for the patient, but failed to support the
uterus with my other hand while looking at the lochia which is very important to assess for
postpartum hemorrhage (Potter & Perry 2014).
Revision: From this situation, it is important that I follow all the steps during a fundal assessment
because I am only learning and I am not an expert. I should have gotten the nurse or preceptor to
observe the assessment done on the patient to ensure patient safety and that I am correctly
preforming postpartum assessments. For the future, I would preserve my ability to admit to
patients that I am learning so we can help each other. However, I would change for next time to
stop and think about the anatomy of the body, and critically think about what I am doing and to
translate theory to practice. I would also ask that my assigned nurse or my preceptor shadow me
while preforming the assessment for optimal learning.

New Perspective: For future situations similar to this one, I will make sure to use my resources to
ensure I am hitting all the patient assessment requirements (ex. looking for lochia, supporting
uterus) before I go into the patients room. I will also call in the nurse or my preceptor to shadow
me in case I miss anything, or am unsure.

References:
Perinatal Services BC. (2011). Obstetrics Guideline 20: Postpartum Nursing Care Pathway.
http://www.perinatalservicesbc.ca/Documents/Guidelines-
Standards/Maternal/PostpartumNursingCarePathway.pdf
Potter, P. A., Perry, A. G., Ross-Kerr, J. C., Wood, M. J., Astle, B., & Duggleby, W. (Eds.).
(2014). Canadian fundamentals of nursing (5th ed.). Toronto, ON: Elsevier. Chapter 31

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What challenges did the student face during her first fundal assessment?

What steps should the student have taken during the assessment?

Student: Haley Patterson Faculty: NURS 2021

Topic: Maternal Assessment

postpartum hemorrhage (Potter & Perry 2014).

while preforming the assessment for optimal learning.

me in case I miss anything, or am unsure.

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