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Running head: REFLECTION 1

Reflection 1

Marissa Brown

Trent University
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Reflection 1

Look Back and Evaluate

Performing an assessment on a patient for the first time can be stressful. On my first day

of placement in an acute care setting – an inpatient surgical floor – I was expected to perform a

head to toe assessment on a patient for my instructor. In the past, I have performed specific

assessments on patients related to their pathology, for example a postpartum assessment in my

previous placement. This was the first time that I was expected to complete a full assessment on

a patient. Going into the assessment, I had prepared by practicing in lab and on my peers. When

performing the assessment on my patient, I was very nervous. Throughout the assessment, there

were a few aspects where I made mistakes. For example, I forgot to auscultate before palpating

during the GI assessment. I remembered half way through and started to auscletate. I also feel as

if I was all over the place and seemed disorganized not only to myself but to the patient and my

instructor as well. After the assessment was completed, I felt as if I could have done it better and

have been more prepared.

Going into the assessment I was very nervous and not confident about my ability to

perform this assessment. I wanted to feel confident and organized to defy the expectation of the

patient and my instructor but when I actually started to perform the assessment, anxiety and

nervousness got the best of me and I forgot what I had previously learned. I also felt as if I was

being pressured to succeed because I did not want to seem like a student who was not sure of

what they were doing. This pressure was placed on me by myself as I did not want to embarrass

myself in front of the patient or seem incompetent to my instructor. Since the patients are used to

the confidence that the registered nurses have when they perform their assessments, I feel as if I

was expected to be nervous and make mistakes my first time. Throughout the assessment, my
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patient was very talkative and seemed relaxed. This made me feel a little more confident in my

abilities. Looking back on my experience, I realized that I was probably not the only one feeling

this way or making mistakes.

Analysis

I believe that it was the lack of confidence in myself that precipitated my mistakes and

disorganization during my first assessment. Although I had practiced the head to toe assessment

in lab and on my own time, performing the assessment on a real patient felt a lot different.

Confidence in nursing is important because we have patients in our care that rely on us for their

well-being. If a nurse appears to not have confidence, this may make the patient feel uneasy and

anxious in their care.

According to a study conducted on the level of confidence of nursing students in their

clinical placements, only 61.9% of nursing students surveyed felt confident about their ability to

practice safely and competently and only 61.3% felt confident in applying their knowledge and

skills (Panduragan, Abdullah, Hassan and Mat, 2011). The same study suggests that nurses

should be given more or extra training when needed in order to help them improve their

confidence. I believe that If I had practiced my head to toe assessments more prior to this

experience, I would have had a better outcome.

According to Jarvis’ health assessment textbook, the rationale for auscultating before

palpating is that palpation may cause bowel sounds to appear when they are not there due to

increased peristalsis (Jarvis, 2014). The reason I may have palpated first is because in the

respiratory assessment, also outlined by Jarvis, suggests palpation before auscultation (Jarvis,

2014). Understanding now the reason and rationale for the sequence of the two assessments, in

the future I should remember what to do in the right order.


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Revision and New Perspective

From this experience, I have learned that in order to feel more confident in myself in new

situations and to prevent mistakes, I should familiarize myself with the procedures and sequences

before I complete them. If I had practiced the head to toe assessments more before, I may have

felt a little more comfortable and not have made the mistakes that I did. This experience was

helpful to me to realize what I can do to help me feel less anxious in new situations, and that the

only way to learn is through making mistakes. The College Nurses of Ontario’s (CNO)

guidelines for the learner suggests that the learners can recognize their knowledge and skills in

nursing situations (CNO, 2017). In this situation I feel as if I have recognized that my knowledge

going into the assessment was lacking and for future situations I should make sure I am confident

in the theory so I can be confident in the practice. In the future, if I am expected to perform a

skill in practice for the first time outside of the lab at school, I will make sure that I know

everything there is to know about the procedure and the process in which to do it. I could do this

by reading my textbooks as well as watching the Mosby videos posted on the blackboard site. If I

have further questions after that, or still feel uncomfortable, I can ask my professors, colleagues

or even my instructors. Watching the procedure be done in the clinical setting by another nurse

or my instructor may also help me to feel confident in my abilities.

It is also important to take away from this experience the idea that no matter how much

knowledge I may have, there will still be situations where I will be nervous and there will still be

situations where I will make mistakes. I have learned that by recognizing my shortcoming, I can

reach out for assistance from my colleagues and instructors in order to help me to succeed. By

reflecting on how I feel and the mistakes that I made, can help me to learn and grow into a better

person and an ever more confident nurse.


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References

College of Nurses of Ontrio. (2017). Practice Guideline: Supporting Learners. College of Nurses

of Ontario, 44034, 1-12.

http://www.cno.org/globalassets/docs/prac/44034_supportlearners.pdf

Jarvis, C. (2014). Physical Examination & Health Assessment (2nd ed.). Elsevier Canada.

Panduragan, S. L., Abdullah, N., Hassan, H., & Mat, S. (2011). Level of Confidence among

Nursing Students in the Clinical Setting. Procedia - Social and Behavioral Sciences,18,

404-407. doi:10.1016/j.sbspro.2011.05.059