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 post-operative hysterectomy patient on the floor who was pro-active about moving and using her
incentive spirometer which made us excited and proud. She was getting up with the PCT for her second walk of the
day and I felt comfortable allowing her to walk alone with the PCT since my preceptor and I had gotten her up and
taken her for a walk around the unit earlier to assess her strength, pain, and so on. I had barely left the room and the
PCT comes out asking for help with urgency. My preceptor, myself and all of the nurses on the floor (because we
were at shift change) came in to see what the problem was. The PCT thought the patient was having a seizure due to
the symptoms (eyes rolled back into her head, eyelids fluttered, was unresponsive), somebody went to call a rapid I
recorded the time and checked her blood sugar while we were waiting on the rapid response team. Shortly the
patient was responsive and was able to answer orientation questions appropriately. Everyone came to the consensus
that she had a vagal response and passed out versus having a seizure especially since there was no history of seizures
and she was a relatively new post-operative patient.

Noticing

Everyone jumped in to help, one nurse hooked up the suction, while another had oxygen ready, and another called
the rapid while I made note of timing and checked the blood sugar. It was chaotic, but relatively organized chaos. I
felt kind of out of the loop, but it was a great experience, especially since I felt mild panic, and now I feel more
prepared for an event like that to happen in the future.

Interpreting

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

I was trying to recall the simulation we had with a patient who had a seizure. Recalling the steps was difficult for
me on the spot because I haven’t reviewed that in a while/haven’t had real life experience which makes a difference
in my learning. I noticed the room was warm and she was diaphoretic so a vagal response was my next guess as to
what happened.

Responding

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

Decreasing environmental stimuli can reduce the risk of someone experiencing a vasovagal syncopy episode. In this
case it would turn the heat down to a more comfortable level. Other ways to prevent this from happening is getting
up slowly, not straining during a bowel movement, and avoiding standing for long periods of time (Mayo Clinic,
2017) .

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 felt welcomed to ask questions, but sometimes I felt in the way. I got along with the staff, but had troubles feeling
included at some points. With time and once the staff gets to know me as a nurse on the unit versus a nursing
student I’m hoping they will view me differently and try to make me feel more included. I enjoy my unit, the
patients are exciting to me, so I’m feeling hopeful that I will like the floor, just need to put myself out there more to
be included.

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

Assist with discharge teaching for all of our patients

 I was able to provide discharge teaching on a variety of patients from the hysterectomy to thyroid to
antepartum patients. I gained confidence after each teaching and was able to answer questions without
doubting my answers as much.

Complete progress notes and document the care plans

 I helped write progress notes which helped the physicians and nurse practitioners get a better picture of
what the day looked like for us as well as continue to update the care plans and education so that the
patients are well prepared for discharge.

Provide information on health disparities in women

 I collaborated with my preceptor as well as other nurses to figure out how we can make our cancer patients
in particular more comfortable, and It was difficult. Palliative was a major help and we were able to
educate and provide resources for our patients.

Follow up on Quality Improvement projects for the unit

 There isn’t data yet since the unit is still new, but they are trying to increase the rate of TDaP vaccines
given to our antepartum patients

Teach breast feeding techniques and apply fetal monitors on antepartum patients

 There was some breastfeeding teachings, but I was able to successfully place external fetal/contraction
monitors on multiple patients
 References
Mayo Clinic. (August, 4 2017). Vasovagal Syncope. Retrieved from Mayo Clinic:

https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/symptoms-

causes/syc-20350527

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