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

The most challenging event in the second half of the semester was experiencing the death of a patient I had been
taking care of. The background of the patient was she was a 37 year old nurse fighting breast cancer. She came in
with what they assumed was a reaction to some previous chemotherapy medications and were treating her for that as
well as looking for other causes.

Noticing

Taking care of this patient was an experience as I felt that she mentored me simultaneously - giving me feedback,
encouraging me with her care and allowing to do her care as a student nurse. She had a lot going on, on high flow
oxygen, IV antibiotics and IV vitamin C, steroids, and blood transfusions - all going through a port.

Interpreting

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

The patient had been deteriorating over several weeks and had decided to sign a DNR and transition to palliative
care. Care management was working on setting up things so she could go home. The hardest part for me was trying
to meet her emotional and spiritual needs as she and her family realized that this was not an acute process and that
she was terminal. It tore me up seeing her interact with her family and friends as they realized that time was running
out. I tried to do whatever I could to make them comfortable and just offer little things like privacy and bringing in
her meds when she requested.

Responding

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

In this article about Rome it talks about the importance of transitioning to palliative care as end of life draws near
and how a patient can then transition to hospice when less then six months of life is expected. This was so important
for my patient as she did not want extraordinary measures and just wanted to be at home when she died. Our goal
was to get her set up with what she needed so she could transition home, unfortunately she did not survive the night.

Rome, R. B., Luminais, H. H., Bourgeois, D. A., & Blais, C. M. (2011). The role of palliative care at the end of life.
The Ochsner journal, 11(4), 348-52.
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?

I felt so accepted by all the nurses on 3N, all of them trying to help me learn and succeed in my practicum
experience. I honestly felt like one of them by the end, they just had great teamwork and supported each other
during every shift. I really enjoyed having one on one preceptor versus a group clinical - just felt so real and
personalized to what I needed. My preceptor checked in every shift and asked what we needed to work on as a team
to make me feel more confident.

Write your final practicum goals and discuss your progress toward meeting them. Please address all 3 goals.

Call DR about patient for a new order, provide DR with SBAR - I grew very comfortable with speaking and calling
the doctor, they were very patient with me and it became easier. I also got the opportunity to speak several times to
the pharmacist and to several family members on the phone.

- Create nurse care plan for 1 patient and chart on it - so I took the feedback provided and started to chart care plans
on all patients and would just have Janie look it over to make sure I was charting correctly.

Create progress note on one patient and chart on it throughout day - I definitely wrote at least one progress note per
day, didn’t quite get to doing one on each patient, but was working towards it.

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