Reflective Journal

Journal Prompt 1 (Self-Awareness Domain)

The values and beliefs that guided my interactions with the patients and other healthcare providers during the clinical included commitment to human caring, honesty, respect, social justice, and self-discipline. These values and belief systems have continuously defined my decision-making processes and interactions with others: Reflective Journal.

My values and beliefs are aligned with the nursing professional code of ethics and standards defined by the American Nursing Association (ANA). Foremost, the values of honesty and respect are in congruence with the first, second, and fourth provisions of the ANA codes of ethics. The first provision implores nurses to practice with compassion and respect for their clients. Likewise, the second provision speaks to nurses’ primary commitment to their patients, while the fourth provision requires that nurses maintain accountability, authority, and responsibility for their roles.

My values of honesty and respect have continuously driven me toward providing compassionate and respectful nursing care to my patients. Additionally, my commitment to helping patients and providing effective nursing care has enabled me to be responsible and accountable for my nursing roles and decision-making processes per the ethical codes.

My beliefs on social justice and self-discipline are aligned with the seventh and ninth provisions of the nursing ethical codes. The seventh provision points towards advancing the profession through research and innovation. Likewise, the ninth domain requires nurses to integrate the principle of social justice. Through self-discipline and belief in social justice, I have been able to provide care to all populations as well as contribute to the advancement of nursing practice through research.

My values and beliefs have also guided my interactions with the patients and other caregivers. By being respectful and honest, I have been able to foster meaningful relationships with my colleagues and patients. Additionally, my commitment to effective nursing care has driven me to push for stronger engagements with my patients to optimize their wellness.

Journal Prompt 2 (Self-Awareness Domain)

In the past week, I experienced a conflict between a patient and a family member rollout within the clinical environment. The conflict started when the patient refused to accept the prescribed therapy. A brief background check revealed the patient had moved to the US and was living with a family member already in the country. The patient’s disbelief in Westernized medicine impeded him from considering the therapy, hence the conflict.

My first interaction with the family resulted in a mixed reaction. I was first disappointed in the patient as I could not understand their reason for not considering therapy. Likewise, I felt the patient was underappreciative to his close family members and caregivers committed to his wellness. Seeing the patient’s suffering also took a toll on my physical wellness.

I not only felt sad for them but also teared up as I witnessed the patient in considerable pain. During our interactions, I felt tense and struggled to maintain coherency in my speech. The experience got me to understand my inner self and how compassionate I was with the care process for the patient.

My thoughts were the most difficult to identify during the situation. I was torn between trying to help out and letting the family respond to the issue internally. As Childers & Arnold (2021) report, families maintain autonomy over their health choices. However, caregivers are responsible for informing the families of the therapeutic possibilities to allow them to make informed consent.

Nonetheless, my feelings were driving me towards engaging the patient and the family. This resulted in me trying to mediate the ensuing conflict. However, I did not realize the patient’s disappointment and apparent discomfort in discussing the issue. It was not until the shift ended that I realized I may have overreached and perhaps wronged the patient.

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

Prioritization involves ranking clinical situations to assign the appropriate care level. During one of my clinical rounds, I experienced a situation that required me to prioritize my patient. The patient was a 65-year-old male admitted to the clinic with diabetic foot. The patient had just undergone a right foot amputation and was in recovery.

The selected therapeutic plan integrated anti-diabetic medication continuation to optimize glucose control and pain medication to manage the pain. During the routine medication administration process, I noted the patient was alone, and his eyes were teary most of the time.  Likewise, he reported complaints of hopelessness and worthlessness. On further interrogation, I noted that he had no immediate family members and was in the hospital by himself.

This experience prompted me to prioritize the patient. Foremost, I informed the healthcare team about the patient’s wellness to enable the revision of the therapeutic plan for the patients. This enabled the patients to be assigned a counselor. Likewise, I made a deliberate effort to meet the patient during my free time and engage him in his wellness.

Something difficult for me during that time was fostering a personal relationship with the patient. Initially, I thought my action would surmount a breach in my professional relationship with the patient. However, my compassion and commitment to caring would not allow me to watch and wait.  Further, several pathophysiological and ethical principles were involved in my actions.

The pathophysiological principle that was interplaying in the case was depression attributed to impaired coping. This resulted in emotional and behavioral dysfunctionality apparent in his manifestations. An ethical principle, in this case, is non-maleficence.

Non-maleficence requires that caregivers do no harm. By engaging the patient, I was able to prevent adverse events of depression, such as suicidality and health deterioration, that would otherwise be harmful to his wellness.

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

My nursing educational journey imparted me with specific lessons that are integral to my personal growth. An issue that has been particularly difficult for me during my school journey is balancing my social and school life. Foremost, the nursing educational programs are intensive. It often requires that learners maintain a commitment to the learning process and do what it takes to succeed.

Something I have sometimes struggled with is being able to put in the work required on the scholarly front while excelling in my social wellness. The challenge has always been taking more time in academic work at the expense of establishing newer relationships, trying out new things, and spending quality time with those I love.

The experiences have taught me the significance of striking a balance in life. While I recognize the importance of my academic work and its role in my ambitions, I am continuously learning to recognize the need to pursue other things outside nursing. This is also likely to be helpful to my future career as a professional nurse.

Establishing a work-life balance is integral to effective nursing practice. By learning how to navigate my academic life while pursuing things that I like outside nursing, I believe I am preparing to establish a healthy work-life coexistence in my professional life.

To further my professional development, I remain committed to lifelong learning. I intend to take every opportunity in my social, academic, and economic life as an opportunity to bolster my skills. I also plan to explore more and utilize diverse educative opportunities to enhance my personal and professional growth.

In the internet era, sources such as YouTube provide significant learning opportunities to students and professionals. By leveraging such resources, I will be better placed to bridge any apparent educational and knowledge gaps and further my professional career.

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

An ethical practice encountered during the clinical was related to refusal of treatment. The patient had strong anti-vaccination beliefs and was refusing to grant consent for his newborn son to be vaccinated. Refusal to vaccinate sometimes presents an ethical dilemma. The ethical principles evident in the clinical case scenario included beneficence and autonomy.

Beneficence requires that nurses and other healthcare professionals promote the welfare of their patients. Autonomy, on the other hand, accords patients and families the right to self-determine the available therapeutic options. This includes obtaining informed consent before initiating any therapy on the patient. The healthcare professionals managing the patients had an ethical obligation to provide care that ensures the patient’s wellness per the principle of beneficence.

The patient, on the other hand, preserved the right to accept or refuse therapy. Caregivers, however, maintained the responsibility for educating the patients on the available therapies to enhance their capacity to make the right decision. Informed consent was thus required from the parents for the newborn to be vaccinated.

This presented an ethical dilemma to the caregivers. The team was, however, able to educate the patients on the significance of vaccines in health protection. Likewise, the parents were educated on the need to consider vaccinating the baby for his wellness in childhood and later in life.

The experience widened my perspectives on ethical nursing care. Ethical practice requires that nurses base their decision-making on normative ethical codes. This means that decisions should be ethically sound (Cheraghi et al., 2023). This experience highlighted the significance of learning the nursing code of ethics and how to integrate it into practice.

For this reason, I intend to expand my understanding of the ethical provision and the standards of nursing practice defined by ANA. This will increase my capacity to provide ethical nursing care to my patients.

References

Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023). Clarification of ethical principle of the beneficence in nursing care: An integrative review. BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01246-4

Childers, J. W., & Arnold, R. (2021). “she’s not ready to give up yet!”: When a family member overrides the patient’s medical decisions. Journal of Pain and Symptom Management, 62(3), 657–661. https://doi.org/10.1016/j.jpainsymman.2021.06.002

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*Use of Artificial Intelligence (AI) to complete this assignment is strictly prohibited. Submission MUST be in a word document, in students own words, and reflect actual situation from Clinical III.*

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 student views themselves in relationship to others when engaged in therapeutic and professional communication.
4. Identify areas for student to further develop their abilities and understanding related to bedside practice.

Directions: (Professional Identity and Spirit of Inquiry)

Respond to at all five of the questions below using the same number prompts. Submission MUST be a word document. Responses to each Journal prompt should be a minimum of 300 words each, for a total of 1500 words.

Reflective Journal Prompts:

1.     Journal Prompt 1 (self-awareness domain)

Examine the values, assumptions, and beliefs that shape your behavior and how they align with The Nursing Professional Code of Ethics and Standards.  Provide specific examples.  Explore how your values, assumptions and beliefs influence your relationships with patients and families.

2.     Journal Prompt 2 (self-awareness domain)

Describe a situation you experienced in clinical this week. Describe your thoughts and feelings in this situation. Describe the way your body felt physically in this situation. What was more difficult to identify—your thoughts or feelings? How do your feelings relate to your thoughts in this situation? Were you aware of this at the time?

3.     Journal Prompt 3 (self-awareness and social awareness domains)

Prioritization is an essential skill for nursing practice. Describe in detail a situation in which you, as the student nurse, needed to prioritize for your patient. What made the decision easy or difficult? What guided your decision to prioritize in the way you chose? What pathophysiological and ethical principles were involved?

4. Journal Prompt 4 (self-awareness and self-management domains)

Personal growth often comes through personal struggle and angst. Reflect on an issue that has been particularly difficult for you during nursing school and what that experience has taught you. What are you going to do to continue your professional development in light of this learning?

5. Journal Prompt 5 (self-awareness and relationship management domains)

Discuss a legal or ethical issue you have encountered during clinical. Consider the ethical principles that were evident in the situation and how these principles were adhered to or violated (maleficence, autonomy, fidelity, justice, benevolence, etc.)? What did you learn from this experience & how will it impact your practice?

• PLEASE USE SIMPLE TERM,
• ( CLINICAL SITE: SANFORD HOSPITAL, MEDI SURG)