Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion

Final Guide for Reflection

(Example MUST be different than that provided at mid-point)

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).
Background

We had a patient that came into the ER complaining of an allergic reaction to a medication that she had been
prescribed in the last week or so. She had no prior medical history apart from a recent UTI, which is what the
medications were prescribed for. She ended up being intubated and was pretty unstable. She was being admitted to
the ICU. Despite her being in one of our rooms, another nurse took over because of her high level of care that was
needed. My preceptor and I went to help the nurse that took over her room. We were getting ready to take her up to
her room as her mother was leaving to go back to the patient’s house to check on the patient’s daughter. As her
mother was about to walk out the door, she asked if we would call if anything happened. I took her phone number
down because we were unsure if it was in the system and asked if this was her cell phone number. She told me that
they only have a landline. After reassuring that we would call if anything changed and telling her the room number
her daughter was going to, she left to go check on the patient’s daughter who was still at home.

Noticing

Once we got the patient upstairs and transferred to the ICU bed, the ICU nurse looked at the monitor and asked if the
patient’s rhythm was like that when we left the ER. The nurse that had been taking care of her said no, so we started
checking for a pulse. There was no pulse, so they called a Code Blue on the patient. A whole team of nurses and
doctors came in and started working the code. As they were doing compressions, someone asked if anyone had
called the patient’s mother. Since I was the one that had taken her mother’s phone number down, I got to call the
patient’s mother.

I stepped out of the room and went to the phones to call the mother. I called and someone picked up the phone and it
was not the mother. I asked whom I was speaking with and she said that she was the patient’s daughter. I asked if
her grandma was home yet and she said not yet, so I said that I would call back again in a bit because I just wanted
to check on her grandma and make sure she had made it home okay.

When I called back again a little bit later, the patient’s daughter answered again. I asked if her grandma was back
and she told me that her grandma was coming up the driveway now. I asked the patient’s daughter to just stay on the
phone with me and let me talk to her grandma when she came in. When the grandma came in, the patient’s daughter
handed the phone to her and I had to tell her that her daughter (the patient) was coding. I had to explain to her what
coding meant. About that time, one of the doctors walked out of the room and gave her a better explanation. After he
was done, he handed the phone back to me so that I could tell the patient’s mother what room number her daughter
was in.
Interpreting

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

During the first phone call, I used my judgment and reasoning to decide that I would just need to call back a little bit
later because of who answered the phone the first time. I wasn’t able to tell the patient’s daughter what was
happening, but I didn’t want her to think something was wrong either and cause her to worry. Therefore, I told her
that I was just checking to make sure her grandma made it home safely from the hospital and that I would call back
in a little bit.

I knew there was no way to tell her any of that information, but I had considered just staying on the phone with the
patient’s daughter until the patient’s mother got home, but I wasn’t really sure how far away they lived from the
hospital or if the grandma had maybe made a stop.

When the doctor handed the phone back so that I could talk to the patient’s mother, I heard the patient’s daughter
crying in the background, which means that she was on the other line while the doctor was talking to the patient’s
mother. It was difficult for me to hear the patient’s daughter and not be able to comfort her, because I knew that she
was probably very afraid and fearful about what was going on.

Responding

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

I found an article about different strategies for supporting families of patients in the ICU setting. One of the major
strategies that was discussed was communication. I felt like this article had a lot of good information about caring
for families in such a high stress time.

Adams, J. A., Anderson, R. A., Docherty, S. L., Tulsky, J. A., Steinhauser, K. E., & Bailey, D. E. (2014). Nursing
strategies to support family members of ICU patients at high risk of dying. Heart & lung : The Journal of
Critical Care, 43(5), 406-15.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150813/

Reflection-on-Action and Clinical Learning

Socialization is best facilitated when the new nurse feels part of a group. How has this precepted experience
and working one-on-one with a dedicated preceptor helped you to become socialized into the nursing
profession?

I have thoroughly enjoyed working one-on-one with a nurse preceptor on one unit because it has allowed me to learn
more about the policies of the unit and how the unit works together. It helped to socialize me into the nursing
profession because in the ER setting, I would have to interact and talk about patient care with the providers more
often than I have had to on a unit. I’ve also been able to see teamwork in action and been able to be a team member
in the ER setting.
Write your final program outcome objectives and discuss you have met them. This section should address all 5 final
objectives.

1. I would like to become more proficient in triaging patients.

a. I have been able to meet this goal. I am still not great at triaging patients, but I definitely feel
more comfortable while in the triage setting.
2. I would like to perform most of the care for multiple patients with minimal assistance.
a. My nurse preceptor has slowly stepped back so that I am doing most of the patient care on my
own. I have been able to provide care for multiple patients with her only having to step in to
administer medications with me. My preceptor is acting like a tech more so that I do more of
the patient care and assessments.
3. I would like to care for both the patient and a family member during their time in the hospital.
a. I have been able to care for patients and their family members. We are there first for the
patient, but I have been able to help family members with little things. I have also been able to
comfort family members when the patient is not doing so well.
4. I would like to continue to improve on my intramuscular injections and also work on infection
prevention while working with patients.
a. I have been able to give many intramuscular injections since midterm. A few gluteal shots and
some injections in the deltoid.
5. I would like to learn about or observe a new procedure or device.
a. I have been able to learn about a loop recorder and how it works for the heart. I have also
been able to successfully insert an NG tube.

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