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Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion


Final Guide for Reflection

(Example MUST be different than that provided at mid-point)

Tanner’s (2006) Clinical Judgment Model

Describe the most challenging moment or event you experienced recently. What actions did you
take and what would you have liked to do differently? What specific actions are you taking to
improve the outcome in future situations or to prevent recurrence of the situation? To answer this
question, use the guide for reflection using Tanner’s clinical judgment model (see below).
Background

During my clinical immersion, I encountered a patient that was very distraught with her medical care throughout the
hospital evening and night. The patient has a tragic past medical history of PTSD and depression. Upon entering the
patient room, she was tearful, sad and voiced she did not want to remain in the hospital. The patient voiced that she
did not receive appropriate care throughout the night and felt the staff members were insensitive to her needs.

Noticing

Upon entering the room, I noticed she was crying her eyes out and had a disheveled appearance. The patient was not
willing to share eye contact with the night shift nurse during report and was playing a dismissal regarding the events
that bothered her I utilized my active listening skills to allow the patient to vent her concerns and problems, so we
can determine how to solve the issues appropriately.

Interpreting

Describe the clinical judgment or clinical reasoning that you performed. The example should include alternatives
you considered, and rationale for your decision.

During this time, I found it easier to just allow the patient to talk and not to intervene to much within her
conversation. Intervention could result the patient to alter their story line and can result in trying to cocaine me into
collaborating the story. During this time, I had consulted with patient advocacy, so the appropriate staff was made
aware and was could resolve the issue. Patient advocacy are representatives that resolve patients concerns or issues
during their stay. My rationale for involving patient advocacy is to ensure liability would not become an issue later.

Responding

What written evidence have you drawn upon for the care of your patient in this example? Provide cites/references.

The article I discovered provide credible information on how to appropriate assess a patient with a past medical
history of PTSD. The article shared the notion of effective communication to patients with PTSH, its highlights the
importance of open ended questions, affirmation and reflection

http://www.nurseptsdtoolkit.org/_/workingWithPatients/3.php.

Reflection-on-Action and Clinical Learning


Socialization is best facilitated when the new nurse feels part of a group. How has this precepted experience and
working one-on-one with a dedicated preceptor helped you to become socialized into the nursing profession?

Indeed, the one on one perception period has been great in converting oneself from the student role to a new
graduate nurse. This experience allotted me to develop the routine of a nurse on the floor and perform the
responsibilities as a nurse. Socialization is great in aiding in the growth of myself in my future role as a nurse.
Having the ability to socialize with members of the interdisciplinary team’s aids in my comfort to engage in
conversations with active team members.

Write your final program outcome objectives and discuss you have met them. This section should address all 5 final
objectives.

Communication: The student will coordinate care for 4 patients and give end of shift report on full
patient load. I was able to obtain this goal with diligence and appropriate time management. To
complete a sufficient SBAR, I would ensure I had detailed information regarding the patient and
their care plan pathway.

Ministry: The student will identify and execute three appropriate techniques of healing and
incorporate techniques within individualized care plan by midpoint. During my time on PSBU I
was able to educate clients on mediation, prayer and guided imagery to promote healing.
Servant Leadership: The student will attend facility staffing meeting and learn the role of
charge nurse by end. I was able to obtain this information by shadowing my preceptor within this
role and I learned the operations of the faculty staff meeting and bed board selection.

Safety: The student will educate post-operative bariatric patients on the two-main complication
of surgery and preventive interventions. I obtained this goal by providing my patients with
educational info regarding surgical complications and nursing interventions to decrease the
occurrence of complications.

Lifelong learning: The student will attend two days of community services at endoscopy and
will identify three learned objectives by endpoint. The three objectives I learned were that
endoscopy services enable partnership among all age variations, all patients were provided with
exceptional information regarding procedure performance and identification of common illness
or ailments that require endoscopic testing.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing Education, 46(11), p. 513-516.