Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion

Mid-Point Guide for Reflection

Tanner’s (2006) Clinical Judgment Model

Describe the most challenging moment or event you experienced recently. What actions did you
take and what would you have liked to do differently? What specific actions are you taking to
improve the outcome in future situations or to prevent recurrence of the situation? To answer this
question, use the guide for reflection using Tanner’s clinical judgment model (see below).
Interpreting

Describe the clinical judgment or clinical reasoning that you performed. The example should include alternatives
you considered, and rationale for your decision.

I recently had a patient that was a newborn, 36 hours old that was demonstrating some new symptoms (legs were
shaking/twitching erratically) while I was doing a weight check. I noticed the new onset of the symptoms as the
newborn had not demonstrated this behavior earlier in the night and not even 10 minutes earlier when I checked the
baby’s diaper before leaving the mothers room. I mentioned to another nurse that this was new and I didn’t know
exactly what it meant, I went to call my preceptor into the nursery and the other nurse informed me that I shouldn’t
have continued to weigh the baby but I should have immediately taken a blood glucose reading of the baby.
Personally, I knew that the baby had been feeding at regular intervals and had just fed less than an hour before this
situation. But being scared that something was wrong I performed a blood glucose check and it came back as a
normal level, I told my preceptor about the situation and she said I did the right thing by listening to the other nurse
but also agreed that she didn’t know what the cause of the baby’s legs shaking. I chose to listen to another nurse who
had no previous knowledge of my patient because she was experienced and had explained to me that the shaking
could be a neurologic response to hypoglycemia. I could have chosen to ignore this nurse until I spoke to my
preceptor, but I decided that checking the blood glucose and it being normal would be better than not checking and it
being low.

Responding

What written evidence have you drawn upon for the care of your patient in this example? Provide cites/references.

I used the knowledge of signs and symptoms of hypoglycemia in newborns as a rationale for performing the blood
glucose testing in addition to the recommendation of the other nurse. I knew that shaking is considered a sign of
hypoglycemia (Karakashain 2018, and decided that the risks and consequences associated with hypoglycemia in a
newborn were too severe for me to not check when suspected.

Karakashian, A. R. B. (2018). Hypoglycemia in the Newborn: Managing. CINAHL Nursing Guide. Retrieved
from http://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T922203&site=nup-live&scope=site

Reflection-on-Action and Clinical Learning

Based on your experience as a student nurse on a unit with a preceptor, reflect on the differences of working one-on-
one with a preceptor versus a student nurse in a group of students and one instructor.
Working with a preceptor has been an extremely different experience than being in a large clinical group with one
instructor. Working one on one I have had the opportunity to observe my preceptor’s assessment and she has been
able to observe my assessment and we have compared techniques and discussed how I can best improve. While in a
large group an instructor doesn’t have the opportunity to evaluate every time an assessment is done or even every
practicum day besides the co-signing of the chart and medication administration.

Write your midpoint program outcome objectives and discuss if you have met them. This section should address all
5 midpoint objectives.

Collaborate with L&D and perform initial assessment on newborn baby by midterm, I unfortunately have only had
the chance to witness one birth and at that time I already had my patients for the night, I have expressed interest in
being included in the next delivery when it is our turn to receive a new couple.

Incorporate patient’s cultural beliefs into the plan of care by midterm, I have incorporated patient’s wishes and
cultural practices, but I have not performed a formal cultural assessment as I have not found a couple that
demonstrated a need or desire for special considerations.

Provide education on postpartum support and community resources to a postpartum patient during care by midterm,
I have included in my teaching, when prompted, information on community resources and have assisted a family
member in making an appointment at WIC to receive formula after discharge.

Educate and document on the understanding of the postpartum patient and family members on safe infant sleep
practices by midterm, I incorporate this education topic into every interaction I have with patients and always make
sure to inform patients when they receive pain medicine that it could make them sleepy, so they should really put
baby in the bassinet when they take pain medicine. I also comment on the number of blankets or stuffed animals that
are sometimes in the bassinets and remind them that nothing should be in the bassinet but baby and what the baby is
wearing/ is swaddled in.

The student will develop their own sheet for documenting their assessment in collaboration with the preceptor and
use for giving shift report by midterm. I have successfully created my own report sheet that I use while giving end of
shift report as well as doing assessments and documenting feeding and education/ teaching.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing Education, 46(11), p. 513-516.