Criteria for Content

1. Think of a surprising or challenging practice situation in which you felt underprepared,

unprepared, or uncomfortable.
2. Select an important nursing issue/topic that was inherent to the identified situation.
3. Briefly explain the situation
4. Identify the nursing issue inherent in the identified situation
1. As a method of refection, use Carper's Patterns of Knowing to analyze the
situation. In your discussion, address ONE of the following Patterns of
Knowing:
1. What do you think was the underlying reason for the situation?
(Esthetics)
2. What were your thoughts and feeling in the situation? (Personal)
3. What was one personal belief that impacted your actions? (Ethics)
4. What evidence in nursing literature supports the nursing importance of
the identified issue? (Empirical)
5. What new insights did you gain through this reflective practice opportunity? How will
this apply to your practice as a nurse practitioner? Be sure to use scholarly literature to
support your position.

Dr. Williams and class,

A challenging practice situation in which I felt underprepared and uncomfortable happened when
I received a patient, into my care in the PACU, that was extremely unstable and unfit for the
elective surgery they underwent. I felt extremely uncomfortable caring for the patient because of
the high-risk and volatile health-risk they imposed on our staff. The surgery went forward under
the surgeon and anesthesiologist’s direction and approval. According to Chamberlain College of
nursing, the essence of each person for the nursing paradigm is the patient. “Nurses perform
tasks to and for the patient, as well as control the patient's environment to facilitate optimal
recovery” (Chamberlain College of Nursing, 2020).

This situation was greatly elevated to high-risk because of the patient’s poor health. A young
woman presented to the surgical center with an injured shoulder due to a car accident. While
admitting this patient, I read through her charts and health history discovering she had a
dangerous hearth condition and extremely low blood pressure history. I approached the surgeon
and anesthesiologist about my concern and they did not think it would be a problem. The visual
assessment of the patient revealed pale skin and low body weight. She did not look healthy
enough to undergo a two hour operation. I questioned the doctors again stating that she did not
look well that day. The anesthesiologist and I wheeled the stable patient still under anesthesia,
post-surgery, into the PACU while he gave me report. I again addressed my concern. The
anesthesiologist reassured me that her recovery would be fine. Within five minutes of her PACU
arrival, her airway spasmed and I could not get air into her lungs via breathing device or pump. I
yelled out for help and we rushed her back into the OR to be reintubated and be given muscle
relaxant medications. I was at the helm and needed to get air into her lungs quickly which was
soon possible without complications. Her vitals returned to normal and we returned her to the
PACU. Her recovery went well from that point on and I was very grateful.
The nursing issue in this situation was that there was not enough evidence found that would have
contraindicated the elective surgery. A proper full-assessment of this patient should have been
done by myself, prior to the surgery to relay more evidence of her poor health condition.

Ethics: My personal moral compass and high standards made me worry about my patient’s health
and safety. Even though she really needed the surgery, I wish someone had advised her to wait
until her health was better.

The insights I gained from reflecting on this situation gave me a greater look at the framework in
which I should handle difficult situations. I use reflection often as I face difficult situations every
day. By being able to reflect about stressful moments throughout the day helps me to understand
and evaluate how it could have gone better and what I could have done differently. Carper’s
Patterns of knowing “should be positioned within an outer ring of emancipatory knowing. They
view this as essential for nursing leaders to achieve the transformations that secure
improvements in care” (Terry, Can, & Curzio, 2017). Being able to apply these patterns to my
nursing practice will help push me from novice to expert nurse. Building my practice with this
framework will help me become more well-rounded, listen to my intuition, and provide the
highest quality of care.

References

Chamberlain University College of Nursing. (2020). NR501 Week 2: Metaparadigm. [Online

lesson]. https://chamberlain.instructure.com/courses/75949/pages/week-2-metaparadigm?
module_item_id=10609229.

Terry, L., Can, G., & Curzio, J. (2017). Expert Nurses’ Perceptions of the Relevance of Carper's
Patterns of Knowing to Junior Nurses. Advances in Nursing Science, 40, 85-102.
https://doi.org/10.1097/ANS.0000000000000142.