Concept: Clinical Judgement Student Reflective Journal for ALTERNATIVE CLINICAL ASSIGNMENT
This guide for writing a Reflective Journal is to help you think about the alternative clinical assignments and your response to that situation.
Use the guide for reflection as a way to tell the story of the situation. The guide provides you with a way of thinking about patient care that supports the development of your clinical judgment based on Tanner’s Model. Instructions: Think about the clinical assignment that you were given this week and answer the questions.
| Phases | Questions | Situation
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| Background | · Describe how the alternative clinical experience assisted you in understanding the role of the nurse (e.g. link to previous clinical contact). · Describe your formal knowledge (e.g. physiology, psychology, and communication skills), previous experiences that helped guide your work in this situation. (Patient-Centered Care, Teamwork and Collaboration) | The experience provided significant insight on the fact that nursing care does not only involve the conventional nursing practices that involve individual nurses but needs collaboration between different care professionals who are expected to provide evidenced-based care that is patient-centered and involving past clinical reviews.
Through what I studied in class and my experience while volunteering and working in various care institutions, particularly in the critical care unit i worked with several professionals and patients with organ failure. This allowed be to develop significant knowledge in physiology which guided my work in the situation. |
| Noticing | · What did you notice initially? · As you worked through the alternative experience (case study or discussion) how did what you notice change? (Patient-Centered Care) | I initially noticed that the patient did not regularly take water and was overweight and feeling pain. As I worked through the alternative experience I noticed that patient began taking more water and monitoring his diet. As he did this, the pain she was experiencing gradually reduced. |
| Interpreting | · Describe what you thought about the situation (e.g. cause, patterns).
· Describe any similar situations you have encountered before in practice including similarities/differences compared to this situation.
· What other information (e.g. assessment data) did you decide you needed? How did you obtain this information? (Patient-Centered Care, Informatics and Technology, Safety and Quality Improvement) | I thought the situation was complicated by the fact that a patient-centered approach for treating the patient at the start.
I have also experienced a situation where a patient was experiencing cardiac problems and unable to explain himself properly. However, through observation and following the steps in the Taner’s model a clinical team was constituted and the problem was appropriately diagnosed through discussion and reflection. The similarities between these situations are that a collaborative approach was used and the Taner’s model applied with technology being used for diagnosis where a heart scan was done. The only difference was the treatment approach as is involved the treating of a cardiac condition rather than a condition of the urinary system.
I needed information on the urine on concentration and a urine concentration test was utilized. |
| Conclusion | · What did your observations and data lead you to believe? Include pertinent pathophysiology and /or psychopathology.
| The data revealed that the patient was developing kidney stones. Given the fact that he was not properly hydrating and he was obese. These led to poor water intake and the kidneys lacked sufficient fluids hence the stones. |
| Responding | · After considering the situation, what was the goal for your patient/family/staff? What was your nursing response and/or interventions? List all the actions you took. (Patient-Centered Care, Professionalism, Safety and Quality) | The goal was to increase water intake and manage the patient’s weight and pain. The nurse ensured team ensured that the patient took water regularly and adhered to the medication provided to eliminate the stones. The actions involved included: · Taking patients history. · Urine concentration testing and observation · Putting the patient on I.V fluids, · Setting a schedule for taking water. · Establishing a healthy diet. · Pain management with medication. · Medication to dissolve the stones. · Setting up a collaborative nursing team. · Making follow-up.
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| Reflection | · What worked and what did you find challenging with the alternative clinical assignment and why?
· Describe 3 ways your nursing care and/or skills can be expanded during this experience.
· Describe any changes in your values of feelings as a result of this experience. (Safety and Quality Improvement, Professionalism) | The establishment of a collaborative team ensured that each step of care was efficiently taken. The most challenging aspect to understand the patient as she was inaudible due to the pain.
The nursing skills can be expanded where better nurse communication should be taught, by improving the collaboration among nurses, and the use of patient centered approaches that will ensure quality care provision.
The key value that has changed is the need to focus on the patient and what they are experiencing rather than what I know. This will ensure that I conduct my work professionally and provide quality care.
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Nielsen, A.et al. (2007). Guide for Reflecting Using the Clinical Judgement Model. Journal of Nursing Education, Vol. 46. No. 11