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The objective of this assignment is to explore and reflect upon a situation from a clinical
placement
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And how the incident, and the reflection has influenced personal learning and
professional practice in relation to nursing care
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Wolverson (2000, p24) includes this is an important process for all nurses
wishing to improve their practice
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In accordance with the 2002 Nursing and Midwifery Council, the clients' details and placement
setting has not been disclosed in order to maintain confidentiality
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The writer was then asked to
perform an electrocardiogram (ECG) on a sixty six year old lady in the minors department
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On completion, the ECG was checked by a doctor and instructions were given to rush the patient
to the resuscitation department of the Emergency department
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The reflective model chosen is the John's model
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The structured layout of the model is easy to follow,
and covers a broad range of reflection
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Marks (2001, p38) discusses how well reflection is accepted across nursing
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The ECG was the first to be performed alone
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Focus was only on the task in question
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The nurse said he would be back to check the results
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During teaching we had been told that we never put the ECG away in the patients notes, but we
must find a doctor to look at it immediately and it must be signed by this doctor
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The writer
did not think this was sufficient so took it and went to show it to a doctor
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As time was passing, it was taken to the Emergency Nurse
Practitioner as he was in sight
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The writer took the patient there, again working alone and attached the patient to the appropriate
machines
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As the nurse had not given any information none could be given
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Although
the doctor was told it was not possible for the writer to give medication, the situation was still left
as he had two other serious cases to attend to
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Soon after
the sister was about to leave the room so the situation was hurriedly handed over to her
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The patient was found to be suffering from unstable angina
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Pain is greater that if
the angina is stable, it is more intense and can occur spontaneously even at rest
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These figures rises
considerably after the age of sixty five
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The patient had woken with the pain and it had worsened during the morning
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The patient had signalled where the pain was but appeared very relaxed during the entire
situation
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According to
Wilkinson (1999, p37), John's model comprises of a checklist for personal reflections or to set the
agenda for supervision
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Such tools help practitioners to "make sense of the real situations by transforming nursing body of
knowledge and integrating it with their own personal knowledge and experience" Perry (1997,
p35)
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(2000, p11) states that this model involves intensive and systematic
examination and analysis of a particular experience
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This situation
certainly seemed unique
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This was attempted with little knowledge of the symptoms,
the ECG and the department
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When arriving in resuscitation and finding to be left alone once more, the calmness was
lost
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This was all new and the first emergency situation ever, not
only on this placement
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Powell (2000, p16) highlights that reflection can trigger uncomfortable thoughts
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Feelings of being left and out of depth with the situation
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On one side, it is felt that the situation was handled fairly
well, but then it is also felt that speed could have been better, although not much
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Gay and Pratt

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(1995, p351) support this, stating rewards will match efforts and time must be given for these
thoughts to develop
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Even though she did not speak any English, actions
were able to let her communicate a little
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Seeming to have full trust in the
staff, or more to the point just the student that seemed to be in charge of her
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(2000, p364) includes that up to seventy per cent of social interactions are conveyed via a nonverbal channel
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The writer did not want to be responsible for the
situation and felt of being useless as there was no information to pass on
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Feelings were analysed
further using the reflective diary
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Being, and becoming more self-aware seems to be very important
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(2000, p44)
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How did actions match
beliefs? And within emperics - what knowledge was known? A lot of nursing seems to have the
same basic skills
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We have this knowledge so the ability not to
panic and follow these skills that we know will aid any situation and will be a good start for when
the experts arrive
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Also to attach the blood pressure cuff and the
oxygen saturation probe so reading would be available
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This was all completed before
help was available
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(2000, p363) assertiveness earns respect from
others and will increase self-confidence
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(2000, p368) states that "self-awareness is
being able to analyse ones motives for behaviour"
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Arriving at the reflexivity stage of this model brings many emotions
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How would others have reacted? If I had reacted quicker would the patient have experienced less
pain? What other signs could I have observed for? I definitely would have demanded a hand
over
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(2000, p45), synthesis is defined as the process of the building up of
separate elements, especially ideas, into a connected and understandable whole
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The writer has used synthesis to gain a new
prospective form this situation and learn from it
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Also how alone and unsupported you can feel in a busy
emergency department
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The main help would have been the patients' notes
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The writer participated the information with fellow students, and discussed feelings in the hope
they would be more prepared for their first emergency
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Driscoll (2000, p24) says the practitioner must expose, confront and understand the differences
between what is practiced and what is desirable
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Nursing is an emotional roller coaster that can be hard work, requires
watchfulness, can be tiring and an emotional strain
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Taylor (2001, p11) includes that this critical thinking is the examination
of ideas, issues, conclusions, beliefs, principles and actions
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(2002, p398) says that reflection "seeks to identify the true value and meaning of
our actions in order to quantify, enhance or discard them and to enable us to replicate them
appropriately to their best effect in future interactions"
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It has been realised, from this experienced that students are often left with tasks to perform, but
are not told anything about the situation
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Then, as the student is in view the doctor will ask information from
them, as happened in the above scenario
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In the future the writer will be move forthcoming when patient information is needed, and
definitely more aware of the situation as a whole, not just the part being attempted to perform
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Driscoll
(2000, p17) states that reflective learning will help you become more self-aware in your clinical
practice
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This tool has been helpful in analysing the experience, and
drawing on different and new feelings, thus building on them for the future
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To
encourage these weak skills to strengthen, time has been spent working in the resuscitation
department to ensure correct and safe practice will be delivered in future situations
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& Berkow, R
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The Merck Manual
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Philadelphia: National Publishing
Company

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Burns, S
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(2001)
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(2nd ed)
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(2000)
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London: Harcourt
Publishers
Gay, G
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(1995)
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London: Churchill Livingstone
Ghaye, T
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& Lillyman, S
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Empowerment through reflection
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, Montague, S
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(2000)
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(2nd ed)
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, Norman, S
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(1998)
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(3rd ed)
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& Simpson, P
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Foundations of Nursing Practice
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Basingstoke:
Palgrave
Marks, C
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'Reflective practice in thermoregulatory nursing care'
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15,
(43), p38 - 41
Nicholls, C
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(2003)
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Nursing
Older People
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(1997)
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(2nd ed)
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(2002)
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Learning Disability Practice
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(2001)
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Buckingham: Open University Press
Wilkinson, J
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'Implementing reflective practice'
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13, (21), p36 - 40
Wolverson, M
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'On reflection'
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3, (2), p31-34



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