Student Nurse Laura

Orem – "creative effort of one human being to help another human being."

Reflection – noticing, interpreting, and responding

Posted by Laura on December 30, 2014

There are times when I have patients admitted for their surgical procedure which may be slow, quiet, or even angry. It is part of my job to do an assessment of the patient and review their background. Most of the assessment is objective, yet in the back of my mind I am thinking on how the patient is responding to my questions or actions. Such as one patient I had who was being very slow in changing into their gown, signing documents, and explaining their medical history. This behavior can be quite normal with the older generation, but a little odd with younger ones. I find when I do my vital signs and ask about their pain, I will follow up with other questions to understand their overall wellbeing. In this case I sensed a full trust wasn’t there. Using therapeutic communication, I learned the patient had a full glass of water prior to admittance, but didn’t want to share this knowing the procedure would be cancelled.

I know from my nursing background, the patient’s health and physical, or medications didn’t suggest the patients wary behavior. I was able to “reflect-in-action” to know I had to build a level of trust to get the patient to relax and divulge the information they had. This whole process did end up canceling the procedure. It also kept the patient from possibly aspirating and getting very sick. It is the patient’s feedback, after our responding, where we get our reflection-in-action.

Flo's ReflectionIn our center, we do discuss situations where we can all learn ways to help our patients be properly prepared for surgery. We share these items stating them much like the Clinical Judgment Model shown on page 208 in the Journal of Nursing Education. According to an article by Philip Kemp in work-based learning, our staff’s reflection (or reflection-on-action) helps us learn as a group to provide the best care for our patients and support our staff.

Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.

Kemp, P., Rooks, J., & Mess, L. (2009). Work-based learning with staff in an acute care environment: a project review and evaluation. Mental Health Practice, 12(10), 31-35

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