Reflective Journal

This reflective journal will discuss and give an account of the clinical exposure I have had at Stanford Hospital, including rotations through med-surg, behavioral crisis, dialysis, and surgery. Essentially, this reflection will discuss my emotional and cognitive responses toward two clinical situations that took place within these clinical settings; these relate to self-awareness, emotional competence, and professional growth. By doing so, I look for areas that need improvement regarding my bedside practice, communication, and self-care. Reflecting on these experiences will provide me with insights that will enable me to become a better future nurse and facilitate personal and professional growth.

Journal Prompt 1 (Self-Awareness Domain)

I am excited to start this clinical at Stanford Hospital, but at the same time, I am nervous and curious. I feel happy because this will enable me to practice everything I have learned in class, such as seeing patients, observing clinical procedures, and interacting with healthcare workers. At the same time, I feel rather anxious about the difficulties that I can encounter during practice, for instance, in the behavioral crisis unit or hemodialysis, where clients often have more complex health issues and need prompt decision-making and understanding. Such feelings stem from my experiences in which I saw how healthcare professionals reacted to stressful circumstances. Nonetheless, such experiences have helped me better understand the expectations that I am accustomed to concerning patient care. I do feel the pressure of those expectations as I join this rotation. I am also interested in my ability to address all the practical and psychological issues that this clinical practice will present.

As anxious as I might be, I am competent in some of the traits that come with this experience. This is particularly so since I shall be engaging in patient communication since the program entails joining a med-surg as well as the behavioral crisis unit. I also consider myself vital and hence will be able to cope with the different changes bound to happen in a hospital with the institution. An objective proposed for this semester is to enhance self-awareness with particular emphasis on the emotional aspect, as indicated by Klussman et al. (2022). This means I desire to know how my emotions affect how I handle patients and other staff members when dealing with them. Daily self-analysis of emotions will assist me in identifying causes and areas of stress and finding ways to stay calm all the time, even under pressure. In general, the enhancement of my self-awareness will help enhance the overall quality of the care I am to provide to my patients and also aid in my professional growth and development.

Journal Prompt 2 (Self-Awareness Domain)

This week, as I was in the middle of a challenging situation in the behavioral crisis unit, I started thinking about whether I could control my cognitions and emotions in the heat of a difficult situation. A resident got agitated and demonstrated violent behavior, demanding the immediate interference of the treatment team. During this situation, I thought about the safety of the patient, myself, and the staff present during the interaction. I also considered how the event could be safely and calmly de-escalated. During this time, I can honestly say that at some point, I was scared, and since I did not know how this patient would respond to the interventions being put into place, I was highly uncertain. I experienced physical tension, and my heart rate went up, making me even more aware of the seriousness of that moment. Right then, I could not distinguish between thought and feeling, as my mind was set on action.

Reflectively, my thoughts at the time were very closely connected with my feelings in that specific circumstance. The fear of further escalation of violence by the patient influenced my thoughts of what to do in such a situation. At the time, I was not as aware of how my feelings dictated my decisions. Only later, when the situation had been de-escalated, I could reflect on how all those thoughts and feelings linked up. I have learned from this incident that while I can remain on task during high-stress situations, there is room for improvement in emotional response. From now on, I want to bring mindfulness into my practice by taking even short moments during clinical shifts to check my internal state. As such, I want to be able to regulate my emotions better and be able to extend calm and reasoned care, even in trying conditions.

Journal Prompt 3 (Self-Awareness and Social Awareness Domains)

One such instance where I felt judged was when I was on rotation in the dialysis unit. I had been working with a registered nurse who seemed to question my capabilities since I was a student. She observed my every move and, from what it felt, was waiting for me to make a mistake. This made me feel intimidated and insecure, as I began to doubt myself even in the most routine things I had previously done on my own without being apprehensive at all. To feel perceived as being so judged was humiliating and, for a little while, impaired my ability to pass through this affair well and effectively. Rather than being highly bothered by the same thing, I was more into proving that I was capable, which only heightened my nervousness. I was left wondering how judgment given by others can affect self-confidence and performance, especially in clinical practice, which is already under much scrutiny.

Conversely, there was also a case wherein I was judgmental about a patient. For me, the patient was non-compliant with his therapeutic management. I thus quickly judged him as not taking his health seriously. My judgment came out of frustration because I felt the patient’s non-compliance stultified his recovery. This made me, upon reflection, realize that I had not taken the time to understand the patient’s perspective or problems that may be bothering him. Consequently, this made my attitude judgmental and negatively impinged my ability to provide empathetic care. It also left me feeling guilty afterward since I realized my misunderstanding impacted the quality of care given. Judging others, whether I am being judged or passing judgment, creates barriers to effective communication and care, as noted by Roodbeen et al. (2020). Accordingly, I will approach such situations with openness and an understanding that judgments could blur one vision of giving tender care in the future.

Journal Prompt 4 (Self-Awareness, Self and Relationship Management Domains)

One situation that bothered me was a busy shift in the med-surg unit. I had been assigned to a patient who relied on my assistance quite often because his needs were too complex to put in a mediated state. I continually felt like I could not keep up with the patient’s needs and did not receive much support from my assigned nurse. On numerous occasions, I asked for assistance, but the nurse appeared busy with other things and did not promptly respond to my requests. The lack of responsiveness frustrated me because I felt the care for the patient was consequently being compromised, and I was being left to deal with this situation alone. My immediate reaction was to internalize and thus try to manage my frustration by taking matters into my own hands, yet this only promoted overwhelming and resentful feelings. I wanted to bring this observation to the nurse’s attention but held back, afraid that my input would be considered adversarial, not in its place, considering my student status.

In retrospect, I would have liked to be more assertive in stating my concerns. The difference between what I did say and what I wanted to say lies in my being uncomfortable with, particularly with more senior colleagues; this conflict may arise. I avoid it while ensuring the patient’s health and well-being are not compromised or hurt. I have to work on becoming an assertive communicator so that when these situations arise, I can resolve them more confidently then and there. I will practice articulating my needs and concerns respectfully, clearly, and firmly. By communicating more assertively in these situations, I will limit my frustration and be able to advocate better on behalf of my patients. This will improve patient outcomes and give rise to a more collaborative and supportive working environment (Richard et al., 2023).

Journal Prompt 5 (Self-Awareness and Self-Management Domains)

After reading Henson’s article “When Compassion is Lost,” a deep understanding of how self-care and nurse effectiveness are intertwined in meaningful ways became profound. She identifies just how emotional the nursing field can be in highly tensioned settings, such as med-surg or behavioral crisis units. Nurses are continually exposed to their patients’ pains, sufferings, and emotional needs. Thus, if not put into good care, situations leading to compassion fatigue could eventually result. This hit home because there have been instances in our clinical rotations where I felt emotionally and physically drained, which somehow diminished my being fully available for my patients. The more exhausted I am, mentally and emotionally, then the less able I am to perpetuate the empathy and attentiveness that underpin high-quality care. The insight that has been reinforced is that self-care is not a personal luxury but a professional necessity. Suppose I do not self-care for my emotional well-being. In that case, I am in danger of desensitization, which would adversely affect my relations with the patient and, as a whole, impair my performance as a healthcare professional.

Notably, knowing the importance of self-care, I will implement one specific, measurable, and realistic self-care strategy in my clinical days. I will practice mindfulness exercises daily. I will do deep breathing, meditation, or take a moment to reflect for five minutes of every clinical shift. These short breaks will refresh my mind and help me deal with the stress accumulated throughout the day. I will also continue to evaluate this strategy by reflecting on my emotional and physical state at the end of each shift. I will then hauntingly ask myself if, by such mindfulness practice, I felt more centered and seemingly better able to sustain compassion for my patients. When applied continuously, this will help me avoid burnout and preserve emotional energy in a thoughtful and empathetic manner. It will not only enhance my well-being but also ensure that I continue meeting the needs of my clientele emotionally and clinically.

Conclusion

Doing this reflective journal has helped me realize the vitalness of self-awareness, emotional management, and professional communication in clinical practice. By critically reflecting on my reactions to various events, I have identified several areas for improvement, such as communicating assertively and controlling my emotions in crisis moments. I have also realized that self-care is essential for any practicing nurse to deliver compassionate and effective care consistently. I will carry these insights into the future to further strengthen my practice and ensure that my needs and those of my patients are met to provide quality care.

References

Klussman, K., Curtin, N., Langer, J., & Nichols, A. L. (2022). The importance of awareness, acceptance, and alignment with the self: A framework for understanding self-connection. Europe’s Journal of Psychology, 18(1), 120–131. https://doi.org/10.5964/ejop.3707

Richard, C., Lussier, M.-T., Millette, B., & Tanoubi, I. (2023). Healthcare providers and patients: An essay on the importance of professional assertiveness in healthcare today. Medical Education Online, 28(1). https://doi.org/10.1080/10872981.2023.2200586

Roodbeen, R., Vreke, A., Boland, G., Rademakers, J., Muijsenbergh, M. van den , Noordman, J., & van Dulmen, S. (2020). Communication and shared decision-making with patients with limited health literacy; Helpful strategies, barriers and suggestions for improvement reported by hospital-based palliative care providers. PLOS ONE, 15(6). https://doi.org/10.1371/journal.pone.0234926

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Clinical site: 

• (Stanford Hospital ( med surg, behavior crisis, dialysis, surgery. These are all the units students have shadowed.)

Objectives:

1. Reflect on thoughts, ideas, experiences, and insights related to the course.
2. Examine personal skills, frames of reference, and assumptions about the provision of care.
3. Gain insight on how students views themselves in relationship to others when engaged in therapeutic and professional communication.
4. Identify areas for students to further develop their abilities and understanding related to bedside practice.

Directions: (Professional Identity and Spirit of Inquiry)
Respond to all 5 of the questions below using the same number points. You will be submitting this assignment as a word document. Grading is based on word count & thoroughness of reflection, consider utilizing about 300 words for each prompt to reach 1500 word goal.

Reflective Journal

Emotional Competence Reflective Prompts:

1. Journal prompt 1 (self-awareness domain)
   • What are your feelings as you begin this clinical experience? Make sure you identify feelings, not thoughts. Complete the following statement: “l feel…” What past experiences, perceptions, and thoughts might be contributing to the above feelings? What personal qualities, strengths, and talents do you bring to this clinical experience? Identify one goal for the semester related to your personal self-awareness and growth.
2. Journal prompt 2 (self-awareness domain)
   • Describe a situation you experienced in clinical this week: Describe your thoughts in this situation. Describe your feelings in this situation. Describe the way your body felt physically in this situation. What was more difficult to identify—your thoughts or feelings? Explain why you think this may be. How do your feelings relate to your thoughts in this situation? Were you aware of this at the time? Reread and reflect on your entry. Identify one specific strategy you will use to focus your attention on your internal states during your next clinical day.
3. Journal prompt 3 (self-awareness and social awareness domains)
   • Judgment is making opinions as to the value of someone or something, considered to be lacking in tolerance and objectivity.
     • a) Describe in detail a situation in which you felt you were being judged. Describe how you felt about this.
     • b) Describe in detail a situation in which you had judged someone else. Describe how you feel about this.
     • c) How did judging another impact your sense of self in a positive way? In a negative way? How might judging another have impacted that person’s sense of self in a positive way? In a negative way? Describe how being judged affected your subsequent behavior?
4. Journal prompt 4 (self-awareness, self and relationship management domains)
   • a) Situation: Think about a situation in which you experienced frustration or anger.
   • b) Identify the behaviors of others in this situation that you reacted to with frustration or anger.
   • c) Response: How did you respond? How would you have liked to respond?
   • d) Analysis: Explore and discuss reasons for the differences and similarities in your actual and desired responses in this situation.
   • e) Future Implications: Discuss one strategy for coping with the emotion you experienced in a future situation.
5. Journal prompt 5 (self-awareness and self-management domains)
   • a) Locate on NTC library site and read: Henson, J.S. (2017). When Compassion is Lost. MedSurg Nursing, 26(2).
   • b) Describe one new insight you have into the relationship between your self-care and your effectiveness as a nurse. Identify one specific, measurable, and realistic strategy related to your self-care that you could implement during the clinical day.