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Sarah Elser Ferris State University Fall 2012-NURS 324 Reflection on Thinking and Learning Throughout this semester,

I was able to assess and reflect upon my thinking and learning ability and progress on several different topics of which we studied. A nurses ability to think critically is crucial in providing the highest quality of care to patients. The more critically, deeper, and more reflective a nurse is able to think, the easier she will be able to interpret both subjective and objective assessment data and act upon this data to recognize changes in a patients conditions and implement the necessary interventions to provide the best possible outcomes for the patient. Throughout this semester, the topics that we have studied have enabled me to grow in my ability to think critically and become a more efficient and proactive nurse. I have noticed myself doing more and more reflective thinking lately; I believe this is a sign that my ability to think critically and assess my thought processes has grown. After a tough or intense situation has occurred at work where I am required to think on my feet and act quickly, I have often found myself replaying the situation in my head after it is resolved. When I do this, I am analyzing exactly what happened and why I made the decisions and acted the way that I did. For instance, I was recently caring for a fresh surgical patient who had undergone a mastectomy earlier that day; she had a large JP bulb drain that was not putting out any drainage along with a large mass in the axillary region combined with increased pain. I helped her up to the bathroom and as she was sitting on the toilet, very large amounts of blood started to pour down her side and puddle on the floor. Had this happened a few months ago, I probably would have panicked and called for help from a more experienced nurse. However, I remained very calm, spoke calmly to the patient (who was already very anxious previous to this) and began to quickly assess her, using the steps of the nursing process without even realizing that I was doing

it. I was able to figure out that her JP drain was not positioned correctly and with the movement of getting up to the bathroom, the large mass was actually drainage and it was draining out of her incisions. Taking the necessary steps to keep the patient safe and calm, I was able to get her back to bed, cleaned up, and the physician called, who came back in to reposition the JP drain. After this occurred, as I was sitting down to chart the events, I started to reflect on my thoughts and actions in the situation. By remaining calm and quickly and efficiently assessing the patient, I was able to figure out what was wrong and temporarily fix the problem until the surgeon was able to get there. By using my critical thinking skills, I provided proficient nursing care to keep my patient safe and help her achieve the best possible outcome in the given situation. I believe that another way my thought processes have matured throughout this course is evidenced by the increase my in inquisitiveness, or question-asking. I have been noticing that I am constantly asking myself why? A few months ago, I would review physicians orders and implement them without really giving it a second thought. Now, I ask myself why the physician is ordering certain things and what the reasoning is behind each order or instruction. If I do not readily know the answer to this question, I will do a little research into the patient and their diagnosis and past history to find my answers, or use a number of resources to educate myself on what I do not know. I believe that this has helped me to be a better nurse because I understand the rationale for the medications I am giving, the interventions I am implementing, and the education that I am providing by questioning myself and the reasons behind my actions. I am better able to educate my patients and prepare them for their surgeries and other procedures when I understand their plan of care thoroughly. An essential component for my personal growth in becoming a good nurse is confidence, as I talked about in depth in one of my journal entries. I have felt my confidence

grow tremendously in the past few months and I believe it is because of the increase in my ability to use the nursing process thoroughly to think critically and problem solve to promote the best outcomes in my patients. With this increase in confidence, I have found that I am more likely to make good decisions quickly and efficiently in pressure situations, such as the example I gave previously in the situation of my mastectomy patient. In one journal entry, I discussed the growth of my thought processes in legal and ethical issues; my increase in confidence has also been a factor in this area. When I am confident in my critical thinking skills and my ability to use the nursing process, I am better able to provide ethical care to my patients free of judgment or discrimination. The growth in my ability to think critically was evident through the content of the journals. After reviewing the criteria for the different levels of thinking, I believe that my level of thinking is somewhere between level III and level IV. The first one or two journal entries demonstrated thinking closer to a level III. In the entry about the nursing theorists, I think the first paragraph about the content under study that week was just mediocre thinking; there really is not much depth to the topic I was discussing. However, the second paragraph does apply the theories key concepts to my practice as a nurse on a surgical floor. In this same journal entry, I discussed my changing thoughts on nursing being a black and white science; I believe this adequately demonstrates how my thinking and thought processes have changed dramatically. I treat each patient as an individual and plan their care accordingly. According to the criteria for the level IV thinker, the work at the end of the course is, on the whole, clear, precise, and well-reasoned, though with occasional lapses into weak reasoning. The work at the end of the course shows some emerging thinking skills, but some pronounced weaknesses as well. This appropriately describes my thinking and reasoning in my work

towards the end of the course. My journal entry on the topic of legal and ethical issues discusses how I used to think just by creating a solid rapport with my patient, I would be protected from legal issues. I went further to discuss how I now think I must use critical thinking in all situations to make the best choices for my patients but having a solid rapport definitely helps in creating a good nurse-patient relationship. I believe these examples adequately demonstrate my level of thinking according to the criteria.