LEARN Critical Reflection One
Student: Emma Cumming Reflection No: One Clinical Instructor: Natalie Kemp
A LEARN is a form of critical reflection where the individual uses the stages of “look back and elaborate”, “analysis of experience”, “evidence of learning”, “revision and new trial”, and “identification of further learning” to evaluate an experience that they had. Following through and reflecting on these steps allows the individual to gain insight on their experience, fully understanding their emotions and feelings, and allows them to set themselves up for future learning. When used correctly, a LEARN allows the individual to develop as a professional from their experience.
Look Back and Elaborate
Last week at clinical, I had the experience of following a very professional and competent nurse around. While we were doing our morning rounds, we went to check on one of the patients who had come back from Electroconvulsive Therapy (ECT). We knocked, and walked into the room, to find the patient sitting in her chair, visually upset, and bleeding from her arm. The nurse I was with calmly asked the patient what was wrong, and why she was bleeding from her arm. The patient, who’s first language was not English tried to explain that the people who were in charge of her ECT left the needle from her IV in her arm, and that she had to pull it out because it was hurting and it kept pulling on her sweater. When asked if there was tape securing it, the patient responded “no” and went to the washroom to show us the needle in the washroom garbage, and no tape was with it. The patient was very upset, and was in pain due to the experience.
I felt really sorry for the patient, that she had to go through that experience and that she was in pain. I felt bad for the nurse, because she felt guilty about not checking up on her patient earlier. I felt as though the nurse took good measures after she assessed the patient, by bandaging her wound and filling out a report. She also told her supervisor about the incident, which was the right thing to do.
Analysis of Experience
This experience must have been very upsetting, scary, and confusing for the patient. Being an immigrant, with English as a second language, the patient could have misunderstood the directions following her ECT to leave the needle in, or maybe, as the patient stated, the professionals performing her ECT “must have forgot” about her needle. The patient must have felt in pain and discomfort to remove the needle, and was probably confused due to her ECT, as to why the needle was left in her arm.
Throughout the experience, I was asking myself how this miscommunication could have happened between the health care professionals and the patient regarding the needle. I asked myself how the professional could have forgotten to either take out the needle, or to tape the needle, or to tell the patient not to remove the needle. Throughout the experience, I feel as though the nurse felt empathy for the patient, which was expressed in her caring tone of voice and actions taken. I think the nurse was upset at the other health care professionals who performed the ECT, and kept the IV needle in the patient’s arm. Finally, I think the nurse felt upset at herself for leaving the patient for so long after coming back from ECT (since she was very busy and the patient was never really an issue in the morning), and commented saying that she “needed to work on her practice and that this [situation] should not have happened”.
I think all of the upset and confusion was both helpful and also detrimental to the situation. It was detrimental to the situation in that the patient, who was trying to stabilize her mood, was visually upset and hurt in the situation, resulting in both the nurse and myself being upset as well. This also lead to a helpful experience of empathy, which led the nurse to take action to aid the patient, to help solve the problem.
Evidence of Learning
This experience really taught me the value of double checking everything that I will be doing as a health care professional. As the nurse I was with stated, “you always need to double check- regardless of how many times you’ve done something”. The nurse went on to say that even though she has been a nurse for 30+ years, she still double checks everything she does, and this situation was a perfect example of why professionals need to do so. This experience also taught me the value of empathy, and how nurses need to possess empathy in order to relate to patients, and to provide quality care.
Academically and professionally, I learned how to fill out an incident report, about the different situations that could happen in the hospital. I learned how to approach different situations professionally, and how to report incidents to the supervisor. I learned by watching the nurse, that even though she was upset, she did not rat out her colleagues, but rather took responsibility for the fault by stating that she “should have checked earlier” on the patient. Overall, this experience taught me the value of taking responsibility, empathy, and professionalism in the world of nursing.
Revision and New Trial
In future situations, when dealing with patients, I will definitely use the knowledge that I learned through this experience, and the values that I obtained. From this experience, I learned that in my future practice I need to check in on patients immediately following their procedures, and to double check patients before they leave procedures (for things like needles, etc.). I learned different problem-solving techniques, which I can use in future situations, to allow for the smooth de-escalation of upset patients, and for the rapid resolution of problems. I learned to use the resources around me (like the nurse used her peers, her incident forms, and her supplies in the room to solve the problem), to adequately solve problems promptly.
I learned how to adequately fill out documentation, as mentioned previously, which will help me in future situations to accurately chart and document incidents that happened, to protect the patient, myself, and my health care team. Finally, I learned to approach all situations with empathy and compassion, like the nurse did, to provide the best care that I can.
Indication of Further Learning
From this experience, I know that I need to learn, first of all, how to insert and remove needles and sharps from patients. I need to learn how to insert and IV, and how to care and remove an IV. I will learn this through my labs this summer, and with practice, hope to become fully competent and confident in my abilities to perform this skill. I also learned the need for patient education regarding sharps in the hospital and other clinical settings. This need can be satisfied by the nurse or other health care professional teaching the patients about the potential harm that sharps can cause. The patient should also be educated about what to do if they find a needle left in from an IV (just leave it and contact a nurse), and the proper disposal procedure for sharps in the hospital (not to throw it in the garbage). Mistakes do happen, and through this patient education, mistakes can be corrected promptly, to hopefully prevent situations like this from happening.
Overall, this experience was both eye-opening and thought-provoking. I am thankful that I was with such a wonderful nurse, who took the time to teach me the proper, professional way of handling the situation. I learned so many different things from this one situation, and will bring my new skills and values forward with me in my future nursing practice.
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LEARN Critical Reflection Two
Student: Emma Cumming Reflection No: Two Clinical Instructor: Natalie Kemp
Look Back
Last week at clinical I had the opportunity to work in the PICU with a variety of different nurses. I was allowed to shadow an absolutely incredible nurse around, who was extremely supportive, and was very good at what she did. We had a patient in our unit who was extremely agitated and upset. In fact, the night before, the night nurse had called in the police officers to help control the patient, as she was fearful for her and the other patient’s safety. The patient had a long history of violence and being agitated, especially in the presence of authority. However, under all of the upset, it was clear that the patient was simply scared, and worried about being in the hospital, as well as confused. The experience I am reflecting on, is how the nurse I was with dealt with this patient calmly, professionally, and treated the patient like a human being. It was an absolutely incredible situation to be a part of, and I truly felt fortunate to be in the presence of this nurse.
Analysis of Experience
This experience really made me question the different approaches that different nurses take to de-escalating agitated patients. In mental health, I have especially found that many nurses turn to medications to help to calm the patient, even before trying to talk them down, while some nurses immediately turn to security and police measures. The nurse I shadowed, however, believed in communication to try to control the agitated patient, and tried to talk-down the patient before she turned to medication to help. The nurse also excused the security guard telling him to wait down the hall out of eyesight from the patient, which helped to calm the patient down. The nurse believed in open, honest communication between the nurse and the patient, and that chatting like human beings would help the patient to de-escalate. This actually proved quite effective with the agitated patient that we were with, as he actually chatted with her for about 45 minutes while she sat outside his room, and eventually ended up sleeping for about 45 minutes (which was remarkable since he hadn’t slept in days). Although the talking technique takes longer, and is more difficult, it was remarkably useful in calming the patient, and was, in my humble opinion, a more human way to approach the situation.
In this situation, I believe that the patient, and the nurse were both anxious. The patient was indeed nervous, and scared, as he vocalized those feelings once the conversation got rolling along. I think that the nurse was nervous as well, as her colleague from the night before told her all about the violence associated with this patient, and how she had to call the police officers (and obviously stories like that never make anyone feel comfortable). However, I think it was really admirable of the nurse to push aside all of her feelings of anxiety, and to take matters into her own hands, and to approach the agitated individual in such a down-to-earth human manner. After the conversation, however, I believe that they both felt a lot more comfortable, especially the patient, as he actually learned to trust the nurse and understood that he was in a safe environment to sleep.
Evidence of Learning
This experience truly taught me the simplest of lessons: treat someone how you want to be treated. Often, myself included, in the hospital we get so busy trying to care for so many, we turn to the “easiest” solutions to problems, that maybe aren’t the best solution to the problem, but at that time are the simplest and most efficient solutions. It was very humbling to see a nurse, who was crazy busy, take time out of her day, and not just take the “easy” way out of the situation, to treat her patient how she would like to be treated in a situation. After, she actually said, “If it was me instead of (name), I would want someone to chat with me to make me feel better, sometimes we get so busy we forget to put ourselves in their (the patient’s) shoes”.
Academically and professionally, I learned numerous techniques to de-escalate anger, through watching the nurse I was with. I learned how to approach the situation open-minded, and how to introduce the topic gently. I learned how to re-direct anger, distract the patient from getting too upset, and how to talk to the patient when the patient is clearly agitated. Professionally, also, I learned how to use the resources available to make a situation more comfortable, such as bringing the patient more pillows, dimming the lights, and giving them a cool drink to try to make the patient more calm. In the future, I will bring these new techniques used into my nursing practice, guiding my practice by the golden rule, “treat others how you would want to be treated”.
Revision and New Trials
In future situations, I will definitely apply the knowledge that I learned through this experience, to provide the best possible care that I can. Through this experience, I learned that I need to approach every situation with empathy, as if I were the patient, and think about how I would want to be treated. In the future, I need to remember that time isn’t everything, and that sometimes the easiest option isn’t always the best, even though it might be the most efficient one. I learned also numerous techniques to de-escalate agitated patients, such as using a calming tone of voice, open body language, distraction and redirection, and providing a calming environment for the patient to communicate within (such as dimming lights, decreasing the room temperature, etc.)
Indication of Further Learning
From this experience, I would like to further research what words and phrases to say to help de-escalate agitated patients. Although I learned many techniques, I would like to learn some common phrases that help calm someone down, so that when I face situations like this in the future, I can approach them with confidence, and have adequate resources to provide open, therapeutic communication. I also would like to learn some relaxation techniques other than deep breathing to use with the patients when they are upset. The nurse I was with vocalized how important knowledge about relaxation techniques is, and I think it would be extremely valuable to learn different techniques that I can share with my patients in the future to help them relax. Overall, this experience was extremely insightful, and I think that I will be taking many things from this experience forward into my nursing career.
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NURS 2021H Clinical Course Evaluation Final Evaluation
Student: __Emma Cumming_
Clinical Instructor: ____Natalie Kemp___
Placement: __Lakeridge Health Center Mental Health__
Satisfactory Unsatisfactory
NURS 2021H Clinical Course Final Evaluation
Evidence/Indicators
1. Demonstrate competency in navigating the complexities of family nursing.
I believe that I am capable in navigating the complexities of family nursing to a satisfactory level at this point in my clinical rotation. I believe this is true because I have a thorough understanding of the importance of relational practice, and I bring relational practice into my nursing practice. I understand and have applied numerous theoretical lenses (HP, post-colonial) to my nursing practice, and I have a knowledge base about the importance of proper growth and development for people across all genders and ages. I advocate for my patients, and encourage them to seek professional resources to increase their health status (such as attending counselling, adhering to medication regimes, and advocating for themselves). I encourage my clients by helping them to identify their strengths, capacities, and goals, and work with them through difficult transitions that they go through in the hospital. Finally, I work hard to keep my practice free from personal biases, and to help the person I am with to my fullest capacity as a student RN.
2. Integrate knowledge from previous courses to support diverse populations.
I believe that I have integrated knowledge from previous courses to support diverse populations to the satisfactory level through this clinical placement. I have incorporated knowledge learned from previous classes, clinical placements, and journals read. I have provided care following guidelines learned in class and techniques such as therapeutic communication. I have integrated nursing theories that I learned such as theories of development and the 5Cs of Care into my practice. I have integrated previous skills learned, such as bed making, bathing, changing, feeding, and medication administration in this placement. Finally, I have integrated previous knowledge developed in placements prior to this, such as professional behavior (coming to work prepared and on time, being respectful, and conducting my care with empathy).
3. Critically appraise relational inquiry processes and skills to develop meaningful relationships with health care providers and family members.
I believe that I have fulfilled this goal by establishing therapeutic relationships with many patients, and by creating meaningful, professional relationships with numerous staff and patients. I have involved the patients in advocating for their care throughout the placement, and have made sure that my own personal beliefs and biases didn’t influence the way that I practiced nursing. I have performed culturally safe nursing care, and have accepted the numerous beliefs of my clients and their families when aiding in their recovery process. I always treat the patient first, diagnosis second, advocating for the best patient care possible. I worked hard with the different members of the health care team (doctors, nurses, social workers, family members), to attempt to make my clients’ stays as comfortable as possible, and to try and create the most holistic care that I could.
4. Collaboratively formulate a plan of care based on knowledge of family nursing related theories and scholarly literature.
I believe that I have satisfied this goal, as I worked during my last day at placement to put together a care plan for my patient. I worked with the patient and the charge nurse to come up with a plan of action, which included counselling and outpatient support. I also contacted a social worker to have a meeting with the patient, his family, and his doctor to discuss a discharge plan. I used previous knowledge learned to create the plan, including NANDA nursing diagnoses, and the RNAOs Best Practice Guidelines to guide me in my planning. I used a team approach to help develop the best care plan that I could for the patient.
5. Develop, implement and evaluate the effectiveness of health-promoting, evidence-based practice, reflecting principles of family nursing as relational practice.
I believe that I have achieved this goal this semester through the clinical placement. This is evidenced by my ability to assist and support my patients to help them make informed decisions. I also have helped my patients understand the link between health promotion and the resources available to them, and better health as an outcome of following those strategies. I helped my patients to ensure that they had an adequate understanding of the health information, and prompted them to be advocates for themselves in their care. Finally, I guided my patients towards resources so that they could help themselves to self-learn and to improve their knowledge about what resources are available to them.
6. Demonstrate increasing competence and confidence in the application of psychomotor skills in practice settings.
I believe that I have achieved this goal because I was able to implement the appropriate skills that I learned through the clinical labs into my practice in mental health. I was able to use appropriate assessment tools, such as the ABC chart, history assessment outline, and mental health status indicator, to help to consult with my patients. I also used the online charting system to communicate with the other health care professionals by documenting on time and accurately about the patient I was caring for. I collected both objective and subjective data on my patients using interviews, observation techniques, and physical assessments. These assessments were carried out safety and ethically with my patients, using appropriate infection control techniques, such as handwashing and appropriate attire(such as downing gowns and gloves when I had isolation patients). Finally, my documentation was prompt and to the point, and when I needed help, I would seek assistance, to ensure that the documentation was done correctly.
7. Demonstrate accountability and professionalism that is consistent with a nurse entering a self-regulating profession.
I believe that I demonstrated accountability and professionalism throughout this placement. This is because I was always on time and appropriately dressed. I always introduced myself by my title (“Hi, my name is Emma and I am a student nurse”), and maintained patient confidentiality. I approached every situation with a non-judgmental approach, leaving personal biases and stereotypes out of my nursing practice. I was accountable for my actions, and always tried my best to make situations comfortable for the patient. I respected all of the patients that I had, respecting their privacy and their need for companionship and guidance. I understand the value of informed consent, and always would ask permission before I did any interviews or interacted with the patients, to ensure that they felt safe and wanted to have the care I was willing to give. I kept my relationships with the patients professional, but welcoming and friendly, and always tried to make them smile.
8. Select appropriate community support services for families needing referral to enhance coping with diverse transitional experiences.
I believe that I met this goal during my last day of placement when I worked together with a health care team to make a care and discharge plan for my patient. I sought out different community supports (lawyers, Pinewood, CMH), for my patient to ensure that his transition back into the “real world” was smooth. I now understand how difficult it is for patients to receive all of the community support that they need, and I feel comfortable helping different patients navigate themselves through the different healthcare resources. I feel comfortable helping patients transition between the hospital back into the community, and really enjoy that part of the job.
Student Areas of Strength
1. Student-Patient Interactions- I always try to make patients laugh, and work hard to develop therapeutic relationships. I think I build trust well with patients.
2. Empathy- I always put myself in the other person’s shoes, and provide empathetic responses to their issues. Patients often say that they feel like I understand them.
3. Taking a Patient’s Health History- I feel confident in my interview abilities and taking an accurate, concise patient health history (as well as documenting it).
Student Areas for Future Development
1. Medication Administration- I was not able to practice this skill this rotation unfortunately, so I feel as though this is a weakness I would like to work on next clinical rotation.
2. Emotionalism- I sometimes became emotional when hearing the patient’s stories, and did not hide my facial expressions well. I need to learn to keep a straight face when patients or other health care professionals are irritated, and to not take it personally.
3. Hospital Forms- I need to do further research about the different documents and acronyms used in the hospital for numerous forms. Sometimes I felt myself wondering what form the doctor was talking about, which was not beneficial to my practice.