Running head: CLINICAL REFLECTION
Clinical Reflection: A2 Stroke and Rehab @ PRHC
Student: Chloe Clark
Date of Submission: July 7th, 2015
Clinical Instructor: Sharon Marsh
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Running head: CLINICAL REFLECTION
Describe an experience or event in your clinical placement that has been significant for you (what
happened; how were you involved; what did you see/hear/feel?)
At the beginning of my placement on A2- Stroke and Rehab at PRHC, my preceptor spread the word to
all the nurses that I was here to learn and asked if I could step in if something interesting was going on
with their patients. In the first half of placement, I was given the opportunity to insert a nasogastric
tube on another nurse’s patient. I jumped at the opportunity to practice this skill because I did not think
the chance would come up frequently during my pre-consolidation. I checked on all of my own
patients and then went with my preceptor to collect the supplies I would need for the NG tube insertion.
After I got my supplies ready, my preceptor gave me a tip to help the insertion feel more comfortable
for the patient. She suggested that I put the end of the NG tube into a cup of ice while I set up
everything else for the insertion. She said that having the end of the tube cold made it easier on the
patient and it would be a little more rigid which would help me insert it. I am very appreciative for
receiving these types of tips from my preceptor and the other nurses on the unit because sometimes it is
the small things you do that can help a patient feel more comfortable in difficult situations. As I set
myself up for the NG tube insertion, I realized that there were 3 other nurses in the room ready to help.
I was unsure why we had so many people in the room until we explained to the patient what procedure
we needed to do. The patient became very combative and was clearly distressed by the events that
would occur. This made me feel uncomfortable and unsure of how I should go about the task. The
other nurses did not seem phased by the patient’s actions and this really struck me because I was
surprised how desensitized nurses can become after working for so long. I attempted to calm the patient
down by explaining what I was going to do and told her what I needed her to do in order for the tube to
go in smoothly. I kept a friendly face and smiled even though I was uncomfortable. The patient was
very uncomfortable and did not want to listen so the nurses told me to just go for it. They held her
down and I attempted to insert the NG tube. I felt stressed and did not feel as though I was the suitable
choice for this task. I made 2 attempts to insert the tube before I asked my preceptor to take over. She
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Running head: CLINICAL REFLECTION
could see that I was having trouble and I was very appreciative that she was there to help me finish the
task. When Sharon inserted the tube I took note of how she angled the tube and when she asked the
patient to swallow so that the next time I went to attempt this skill I would have a better understanding
of the procedure.
I felt that I did not have a good enough rapport with the patient to complete this task. Something like
this needed a nurse who was skilled in the procedure and could get it done efficiently. The patient was
confused, distressed, and combative and I think by me attempting the procedure I caused her more
distress than necessary.
Based on what you described above, what were your strengths in the situation and what are your
areas for improvement?
I feel as though my strengths in this situation revolved around empathy for the patient. I tried to be very
supportive of the patient and explain everything that was going to happen to the best of my ability. I
felt as though I made a good effort in trying to comfort the patient. I tried to understand how she was
feeling; 4 nurses surrounding her about to complete something that would be perceived as painful and
uncomfortable, not having a say in whether or not she would have the tube inserted, and not having a
familiar face in the room with her. I think that my understanding of how she felt allowed me to pass the
reins over to Sharon and have her finish the job so that I did not have to put the patient through any
more distress. My strength is knowing what I can accomplish and what I am comfortable doing, but it
is also knowing what my limitations are as a student right now.
An area of improvement for me is being able to accomplish unpleasant tasks in times of distress or
discomfort. There will be many instances where I am putting a patient through an uncomfortable
procedure in order to benefit the patient in the long run. The NG tube insertion was a great example of
this. I think that if I was more comfortable with the task then I would have had an easier time getting
through this and it would have been easier on the patient. I think that it was good that I tried to insert
the NG tube because it was an enlightening experience and I was able to learn from it. The more I
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Running head: CLINICAL REFLECTION
practice my clinical skills, the more comfortable I will be when situations are uncomfortable for the
patient and myself.
What evidence have you found in the literature? Students must identity a minimum of four (4)
relevant research articles from a scholarly nursing journal. Article published preferably within the past 5
years.
As a student nurse, it is my responsibility to have the competence to practice ethical care. Ulrich et al.
(2010) studied the different ethical and non-ethical issues that create stress for nurses in their practice.
Their research showed that younger, less experienced nurses encountered more ethical dilemmas and
experienced more stress related to these issues. As a student nurse, I feel as though there are numerous
ethical issues that I encounter that cause me stress because I have not experienced these events before
and I have not had the time to establish proper coping methods for these events as they unfold. As I
continue my practice, I hope to develop personal interventions to help address ethical issues in order to
provide evidence-based ethical care.
As I continue my practice and experience new situations, I am increasing my ability to critically think
about my actions. Lisko and O’Dell (2010) express that having varying clinical experiences
throughout your undergraduate degree helps aid in your ability to critically think. Having the
experience of my first attempt at an NG tube insertion during my undergrad has allowed me to have my
preceptor and the other nurses there to guide me through what I did. They were there to help evaluate
my decisions and point out areas of improvement for me. Collectively this experience has aided in my
development of strong critical thinking. Having the opportunity to experience a number of different
clinical settings has increased my ability to think critically. Fero et. al. (2010) also recognized that
critical thinking skills were better developed when hands-on high-fidelity human simulations were
conducted compared to vignettes. At Trent, we have had the ability to practice both of these learning
situations better preparing us for careers after graduation.
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Running head: CLINICAL REFLECTION
The day after I made my first attempt at inserting an NG tube I actually had the opportunity to try
inserting one on my own patient. She had gotten her tube tangled in her arms as she slept and it had
been pulled out more than half way. I had a good rapport with this patient and she trusted me enough to
let me do the procedure. I was able to take in the experience from the day before and go about my task
in a much more calm and effective way. I felt more comfortable inserting the NG tube into my patient
because of the therapeutic relationship we had built. I took into account the advice Sharon had given
me the day before and felt confident now with my ability to complete the task. I was able to insert the
NG tube with little-to-no difficulty and the patient tolerated the experience very well. Dinç and
Gastmans (2013) explored the importance of trust development between nurse and patient. There had
not been a developed sense of trust between myself and the first patient I attempted an NG tube
insertion on. As a student, I think it is more challenging to develop this sense of trust because in my
experience, peoples initial reaction to students is that we are learning and not completely competent in
our ability to perform skilled tasks. This poses a difficulty as it makes it more challenging to practice
new skills in a clinical setting. Thankfully, my preceptor and other nurses are there to help patients
develop a sense of trust with me as they express their trust in my ability to perform tasks.
What input have you received from your clients, your peers and your instructor about your
practice that relates to this event?
I have had many patients show their appreciation for the care I provide them. They have mentioned that
it is the small things, like coming in to see if they are comfortable or if they would like anything, which
helps them feel more comfortable during their stay at the hospital. They have mentioned that they enjoy
seeing someone who is always smiling. I think that this is something that people tend to over-look
when they are going about their nursing practice. I have always considered my facial expressions to be
a helpful tool in providing comfort to patients. During this event, although I was smiling and trying to
provide the patient with comfort, I did not have a rapport with her and I was unable to comfort her with
my reassurance. Although I did not receive feedback from the family, it was clear that they were upset
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that their family member needed a feeding tube. I feel as though I should have attempted to provide
some comfort or better explanation for them but at the same time I do not think I was the most suitable
for this.
My preceptor said that I handled the situation as best as I could. She gave me tips about how to insert
the NG tube more comfortably. Sharon was very supportive of my efforts and this was very important
to me because it allowed me to focus on what I needed to do next time instead of wondering what my
preceptor thought of my initial attempt. Reassurance is extremely important when practicing new skills.
Based on your own reflection and the input you received, what learning need(s) can you define
that, when met, will result in your improved performance? How will you update your learning
plan?
As identified early, a clear learning need for me is the ability to practice skilled tasks. With more
practice I will increase my own comfort with the task therefore allowing myself to provide more
comfort to the patient. Once I have had more experience with the many nursing skills available for me
on the Stroke and Rehab floor, I will improve my performance. My preceptor has provided me with a
number of new experiences involving tasks such as IV insertion, NG tube insertion, in/out catheters, IV
line priming, etc. I feel more confident with each attempt I make and I am able to find my own way of
going about tasks with the best practice standards in mind. I will update my learning plan with a list of
tasks and experiences that I wish to work on and have an area that I can incorporate notes related to tips
and techniques that seem helpful when completing these tasks. This will help me keep track of the
skills I have practiced and feel confident doing.
What competency (ies) relate to these learning needs?
Competencies for nursing are comprised of knowledge-based practice, ethical practice, service to
public, self-regulation, and professional responsibility and accountability. My learning needs are
geared towards knowledge-based practices as I continue to build my knowledge of the skills needed to
provide care. I am practicing self-regulation by keeping inventory of skills I have practiced and feel
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confident with. I self-regulate by knowing when I should and should not complete a task
independently. This relates back to ethical practice as well because I am ensuring my patients are safe
and that I have someone supervising me when I am learning new skills. My learning needs show my
respect for professional responsibility and accountability by expressing my understanding of
competence within my scope of practice.
REFLECTIVE PRACTICE TOOL (Adapted from the College of Nurses of Ontario)
http://www.cno.org/Global/docs/qa/qa2013/QA%20Practice%20Reflection%20worksheet.pdf
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References
Dinç, L., & Gastmans, C. (2013). Trust in nurse-patient relationships: a literature review. Nursing ethics.
Retrieved from
http://journals2.scholarsportal.info.cat1.lib.trentu.ca:8080/pdf/09697330/v20i0005/501_tinralr.xm
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Fero, L. J., O’Donnell, J. M., Zullo, T. G., Dabbs, A. D., Kitutu, J., Samosky, J. T., & Hoffman, L. A.
(2010). Critical thinking skills in nursing students: comparison of simulation‐based performance
with metrics. Journal of Advanced Nursing, 66(10), 2182-2193.
Lisko, S. A., and O'Dell, V. (2010). Integration of theory and practice: Experiential learning theory and
nursing education. Nursing Education Perspectives, 31(2), 106-108.
Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010). Everyday
ethics: ethical issues and stress in nursing practice. Journal of advanced nursing, 66(11), 25102519.