BSMCON NUR 3111P

Guide for Reflection

Guide for Reflection Using Tanners (2006) Clinical Judgment Model
Refer to the Toolkit for the questions to guide your reflection

Highlight the program thread that is most applicable to this reflection:

Communication and collaboration
Caring and the Catholic Health Ministry
Servant Leadership and Global Health
Safe, Quality, Evidence-based practice
Professionalism and commitment to Lifelong Learning

Introduction

This week, my patient was an elderly gentleman who was suffering from pneumonia. He was blind as a result of

glaucoma and also suffered from pleural effusion due to his pneumonia. He suffered from excessive fluid on the lungs,

resulting in pleural effusion, and a thoracentesis was performed to alleviate the fluid excess. I was there throughout my

shift as a caring, supporting nurse who offered both emotional support and nursing care.

Background

As I spoke with my patient, I realized he was very sweet and eager to help a student nurse learn, as he has a daughter

who is a nurse. He was alert and oriented and was able to tell me if he was in pain and how best he was able to ambulate.

From our pneumonia simulation, I knew I should keep my patients head of bed elevated and to carefully monitor his

oxygen saturation, which I did. I also talked with him about the importance of ambulation to keep his strength up.

Emotionally, I was invested in this patient because he didnt have his daughter around at the time and he needed extra

attention because he was blind. I was thankful that he was ready to learn about how to get himself better. He was anxious

to get home to his wife, because he is her primary caregiver. In the meantime, he has to depend on his son and daughter to

take care of her. I was supportive as he spoke about his family.

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Noticing

Initially I noticed that my patient received his breakfast and no one had let him know that his breakfast was there.

Emotionally, it was hard for me to discover that no one had considered his disability. My patient had a good appetite, but

was unable to eat because he didnt know his food was sitting right in front of him.

As I spent more time with my patient, I learned his daughter was a nurse practitioner in Texas. I also learned he had a

daughter in the Richmond area, who is responsible for his care. He has many grandchildren and great grandchildren. I also

noticed that my patient was listed as private in the hospital directory, so having visitors was a little tricky.

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Interpreting

As my shift continued, I aided my patient with his breakfast and also in ambulating around his room. Ive

similarly encountered a pneumonia patient through classroom simulation. I used techniques learned to apply to my patient

for this shift. My patient had a thoracentesis performed, so he had a sealed bandage on his left lower lung. His cough was

productive, purulent, evidence of his pneumonia. Despite his illness, he was not in any pain, which was surprising to me.

He was very amiable and eager to help himself heal faster. He knows the best way to do this is to stay as active as possible,

without overexerting himself, staying hydrated, and taking all medications as prescribed.

Responding

After considering the situation, my goal for my patient was to have adequate fluid intake, to take all medications as

prescribed, and to ambulate comfortably. As his nurse, I encouraged him to take his medications, and to drink plenty of

fluids to help his mucous be expectorated. Also, I encouraged my patient to ambulate using his walker.

I was slightly stressed when I realized that fellow healthcare workers had not taken my patients blindness into

consideration. I reassured him that I would make sure to take care of him to the best of my abilities. I was also a little

stressed when it came to the patients visitors, as he was listed private and there was apparently a family altercation this past

weekend.

Reflection-in-Action

My patient was truly grateful that I took the time to help him with his breakfast and conversed with him. He

responded well to medications and nursing interventions that I provided.

Reflection-on-Action and Clinical Learning

Three ways in which my nursing care skills expanded during this experience were: I am now more conscious of

looking at my patient as a whole picture. Its easy to assume that a person has all of their senses and abilities, so now I

am also more careful about not assuming anything. Also I became more familiar with the Pyxis and medication

administration. Three things I may do differently are: communicate more with other healthcare personnel as to the

assumptions they were making about my patient. Also, I will be careful not to make sure to treat every patient as though

they are family. I see so many healthcare workers who treat each patient as just another task, but Ive learned that when

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you take the time to really care for the patient, it really makes a difference. This experience has reinforced my values of

non-judgmental nursing care, as well helped me display my caring values with emotional support.

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Lasater Clinical Judgment Rubric Scoring Sheet

Developed by Kathie Lasater, Ed.D.; Based on Tanners Integrative Model of Clinical Judgment (2006)

Student Name: Date/Time: Clinical Site:

Clinical Judgment Components Notes

Noticing:
Focused Observation: B D A E
Recognizing Deviations from Expected Patterns:
B D A E
Information Seeking: B D A E
Interpreting:
Prioritizing Data: B D A E

Making Sense of Data: B D A E

Responding:
Calm, Confident Manner: B D A E
Clear Communication: B D A E
Well-Planned Intervention/Flexibility: B D A E

Being Skillful: B D A E

Reflecting:
Evaluation/Self-Analysis: B D A E
Commitment to Improvement: B D A E
Summary Comments:

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