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NURS-3021: Clinical Practice Chronic Disease Reflective Journal

Maya Mitchell

Trent University

Nurse-3021: Clinical Practice Chronic Disease

Dawn Balsdon

May 27th, 2022

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A significant clinical experience that comes to mind from my NURS3021 placement is

the time where I witnessed my patient’s SpO2 level rapidly decline and enter palliative care.

The morning began like many of my other shifts. I set out to perform a head-to-toe

assessment and take my patient’s vitals. When I looked at her SpO2 level, it was in the 70’s.

Since I was previously given report about the patient’s current health status, I knew the patient’s

health was already deteriorating. Based on my empirical knowledge, I knew that that number

was an abnormal SpO2 value. My ethical knowledge, knowing what ought to be done, told me to

go and inform the nurse I was assigned to of this finding right away.

The nurse came into the room and assessed the patient. She then informed me that based

on the patient’s health status, she believed the patient would probably pass away by the end of

the day. I was shocked to hear this information as it was not something I expected to encounter

on a rehabilitation unit. I went back to the room and monitored the patient then went on to assess

my second patient.

While I took the vitals of my other patient, I listened to the sounds my first patient was

making. I noted earlier that she would groan, repeat that she was in pain, and how unwell she

felt. She quickly stopped talking and her groans turned into quiet whimpers. My aesthetic

knowledge, which focuses on understanding the person’s behavior, told me that the patient’s

level of consciousness was declining as I saw a change in the patient’s behavior.

My personal knowledge, which focuses on understanding and knowing the self, was

challenged in this situation. Thinking back on what we are taught in class or discussions had

during clinical placement surrounding death and dying, I carried a much different attitude.

Sometimes school can end up presenting sensitive topics in very objective, ‘textbook’ kinds of

ways. It was not until I was faced with a real person in front of me that I realized the weight of it
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all. Before, I would feel very detached listening to the various information or stories that would

be shared. I thought that perhaps when it came to people I did not personally know, it would not

have as much of an emotional impact on compared to dealing with a loved one of my own. This

event showed me how emotional I really am, and how deeply moments surrounding dying and

grief impact me- regardless of who it is.

The nurse ended up calling the patient’s family- her two sons and explained to them the

status of their mother’s helped and suggested they come as soon as possible. A physician was

also called to assist the patient and provide specific orders.

The main participants in this event were the patient, the nurses, the physician, the

patient’s two sons and myself. One of the hardest parts was having the two sons of the patient

come in. It was heartbreaking hear their cries and words of love towards their dying mother. I

could not help but get teary eyed, but also struggled with how much emotion was appropriate to

show in that moment. They did not know who I was or how well I could have known their

mother. In that moment, I decided not to say too much and just answer any questions I was able

to. By the time we came back from break the patient had been moved to palliative care.

After the event my clinical instructor informed me of the steps that would be taken given

the case where the patient did pass in our presence and what would need to be done. I was shown

the post-mortem kit as well as other things that would need to be put in place. For example,

knowing who calls the morgue, how to clean up the patient, how to make note of any of the

patient’s belongings and more.

It was very eye-opening getting to observe the nurses and how they acted in the situation.

I also really admired how much they supported each other in the situation as well. Chang (2018)

found that psychological support from coworkers can be very valuable to nurses when dealing
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with patient death. Moreover, that nurses can better assist patients and grieving family members

when they receive adequate social support. I feel as though I would have been very panicked and

flustered, but instead the nurses remained calm and comforted the patient as much as possible. I

also noted how my clinical instructor was able to ask the family members if there was anything

they needed. I learned how important it is to offer support in a variety of ways- emotionally,

practically and always respectfully.

This experience made a difference in practice solely by being the first of its kind for me.

Up until this point, I had yet to have a patient so close to death. While the patient did not pass in

my presence, it was still a very significant learning experience to witness such a rapid health

decline and observe the measures being put in place for a person who is about to pass away.

Again, the most challenging part of this event was my first time ever experiencing

something like. Many things crossed my mind in this scenario. Firstly, I thought of my own

mother being in the position of the patient. It made me think of having to walk into a hospital

room and seeing my mom in that state. I was overwhelmed with emotion just imagining how I

would process that situation. Secondly, I thought of how the patient was feeling- how aware she

really was of what was going on, if she could hear what her sons were saying to her, if she was

scared, if she was ready to let go. Lastly, I thought of the future situations I will most likely find

myself in. Whether I will react the same way and if I will ever become desensitized to

experiences such as that. In addition, I reflected on how the one thought that gave me some

amount of peace was that this was an older adult. Seeing as how I want to work in pediatrics, I

do not know how I will cope with a dying child.

In a different scenario the main thing I think I would have done differently would be to

offer more words of support. In the moment I did not want to say the wrong thing, but as a result
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I reflect and wonder if I could have been more helpful. I think in the future I will try to read the

room and truly think about how I can best support the individuals involved.

In conclusion, I believe this experience was important for me to have. I am thankful that

it was a calmer scenario and introduction to death and dying. I realize that it could have been a

much more hectic experience and I am fortunate that I was able to have the time to ask questions

and have them answered so thoroughly. I will be sure to use what I learned and apply it to my

future practice as a nurse.

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References

Chang, W. P. (2018). How social support affects the ability of clinical nursing personnel to cope

with death Applied Nursing Research, 44, 25-32.

Zheng, R., Bloomer, M. J., Guo, Q., & Lee, S. F. (2020). New graduate nurses' coping with death

and the relationship with death self-efficacy and death anxiety: A multicentre cross-

sectional study. Leading Global Nursing Research, 77(2), 795-804.