The Clinical Reflection

A clinical reflection is a descriptive "story" that nursing students write about their clinical day. As simple as this journaling exercise seems, it is a powerful tool for development of novice critical thinking skills. It facilitates active learning, as well as professional growth, in a non-threatening manner. Writing about their experiences allows students to reflect on their performance.

The Clinical Reflection

This self-assessment enables them to carefully explore their strengths and weaknesses. The narrative account requires thoughtful consideration of successful actions that could be applied to other situations.

Additionally, students can identify actions that need improvement and consider better alternatives for the future. Critically thinking on their experiences promotes the incorporation of classroom theory within the clinical environment, linking theory and practice. It also helps develop empathy by uncovering and clarifying a variety of perspectives (the patient's, the student's, and others). This personal reflective activity cultivates insight, confidence, empowerment, and healthy independence.

One of my nursing students recently wrote the following touching "story" about her clinical week:

The records accurately described my assigned patient as a "pleasant patient;" he was a wonderful patient. I always feel guilty for waking up patients with a fsbs test strip in my hand. I approach the room prepared for all reactions, but my patient responded with soaking kindness. While performing my head-to-toe assessment I explained the rationale of each test and action; my patient would always smile and respond with "do what you gotta do."

This elderly patient had his aortic valve replaced last month. As a result of the open heart surgery, the patient was placed on "sternal precautions." To prepare for my clinical experience, I read material on the precautions and understood the importance of following all the protocols.

The patient was not to reach behind him, stretch to grab something, or use his hands to assist himself out of bed. Fortunately, the patient had adls with an occupational therapist. While watching and participating in the therapy, I gained insight into the functional aspects of having sternal precautions. During this time, the occupational therapist also explained the system that is used to classify a patient's assistance level.

During occupational therapy, the patient's wife called multiple times. I noted the tone was full of distress and frustration. The wife arrived at the hospital following occupational therapy and had many questions. My patient was going to be discharged the following day and his wife was uncomfortable with the idea. I gave the couple their privacy as they discussed her concerns. Meanwhile, I got in contact with the occupational therapist and relayed the wife's questions. The therapist gave me a name and instructed me to have the wife contact the case worker.

It was clear to me that the wife was underestimating my patient's functional level. I suggested that she stay for the remainder of the therapy sessions, and encouraged her to express her concerns to the therapists. One of the wife's main concerns involved the patient getting in and out of their car, and climbing the four steps into their house. The physical therapist diminished the wife's fears by having the patient get in and out of the car without assistance, and allowing the wife to see the patient climb steps in the gym. The wife left the hospital still nervous but with more reassurance than when she entered.

I had a wonderful time getting to know my patient. I firmly believe that older generation's stories and experiences are of value to the younger generation. History gains a new perspective when told from a first person point of view versus a textbook. Also, many mistakes can be avoided by listening to the mistakes of others. I honored my time with my patient and inquired about his history. He was a young man from North Carolina who joined the army during world war II and saw the world. He crossed the Atlantic on the Queen Elizabeth, and of his two years in the service he spent a year and a half overseas. When the war ended, he was in Paris, France. He spoke fondly of his experiences in france, and said he would do it all again.

When his wife was there I inquired about their story. The wife laughed and said he had fun before they got married; he married in his late thirties.

The wife moved from Virginia with her family to inhabit the small town in North Carolina. It was there that the two met, fell in love and married. They both gave marriage advice saying "marriage is about both the good times and the bad times." while discussing their story I felt tension melt away; this was one of the "bad times." Once again this couple was being stretched and asked to care for one another on an unexpected level.

I learned a lot this week. I gained knowledge about transferring patients from the physical therapists, became comfortable with sternal precautions and tested my "peace making" skills. Most of all, i was able to invest into a patient and add to a man's life story.

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VickyRN

About VickyRN, MSN, DNP, RN

VickyRN, PhD, RN, is a certified nurse educator (NLN) and certified gerontology nurse (ANCC). Her research interests include: the special health and social needs of the vulnerable older adult population; registered nurse staffing and resident outcomes in intermediate care nursing facilities; and, innovations in avoiding institutionalization of frail elderly clients by providing long-term care services and supports in the community. She is a Professor in a large baccalaureate nursing program in North Carolina.

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Specializes in Education.

Vicky, I'm so grateful for all your posts. I've only read a fraction of them, but reading all the links you provide, and the articles in depth makes me feel like I'm in one of your classrooms. You will be an awesome PHD and maybe I'll have you one day when I finally get my MSN! (of course, I have no idea where you are located!)

But I feel we have a lot in common ("under the shadow of His wings") and I LOVE education.

I've applied for a teaching position for the fall and we'll see what happens.

In the meantime, I'm continuing to glean from your wisdom. And I'm learning a lot. You address many issues that concern me and I love reading your posts.

Thank you!

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Specializes in Gerontological, cardiac, med-surg, peds.

I'm blushing :imbar, but thank you so much, Moss1212. Glad that these entries have been helpful to you. I wish you the best in your career. Please keep us posted about the teaching position in the fall :)

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Specializes in Telemetry, Orthop/Surg, ER,StepDown.

Hi Vicki!

I have been a faithful lurker of your blog and information for a few years now, starting when i was in nursing school. You've helped keep me on an even keel a few times. Please, keep up the good work. more students than just you physically encounter are benefititing from your insight.

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