Reflective Journal Clinical II

Journal Prompt 1: Self-Awareness Domain

Starting this clinical experience at Sanford Medical Center has brought a wave of mixed emotions as I have had the opportunity to rotate across Med-Surg, the Cardiac Care Unit, the Intensive Care Unit, Same-Day Surgery, and Behavioral Health. I feel both eager and somewhat anxious as I anticipate hands-on learning across these different units, especially as each presents its unique challenges and learning opportunities. The Intensive Care Unit (ICU), in particular, makes me feel intimidated due to the critical nature of the cases. I feel an added responsibility to support the care team in delivering timely, precise care to patients in fragile states: Reflective Journal Clinical II.

Reflecting on my emotions, I realize that past clinical experiences in less acute settings shape my current perceptions. The thought of dealing with high-risk patients is daunting, as I question my preparedness and ability to respond quickly under pressure. However, my experiences in Med-Surg have equipped me with skills in patient communication and primary care procedures, giving me some confidence as I step into these higher-intensity environments. In addition, my strengths include empathy, patience, and a keen eye for detail—qualities that I believe will be particularly useful as I care for diverse patient populations with varying needs.

My primary goal for this semester is to enhance my self-awareness in high-stress situations, focusing on how I react emotionally and physically. This goal is crucial as I recognize the emotional toll that certain clinical settings, such as the ICU and Behavioral Health, can impose. Besides, according to the National Library of Medicine (2019), self-reflection in nursing can cultivate emotional resilience, enabling nurses to manage their responses better and maintain professionalism despite the challenges. Developing self-awareness will also support my personal growth as I learn to balance my natural compassion with the need for emotional regulation in patient care.

Journal Prompt 2: Self-Awareness Domain

During my first week, I encountered a high-stakes situation in the Cardiac Care Unit when a patient suddenly went into arrhythmia. As alarms went off, my initial thoughts were focused on recalling protocols and identifying the necessary steps, yet my feelings were a mixture of urgency and nervousness. Depending on the body’s actions, I could observe that my heart was racing, my hands were getting shaky, and I could feel compacting for the response. This was the first time I had been directly involved in such a critical incident, and the experience underscored the importance of both quick thinking and calm action in nursing.

Reflecting on this moment, I found it easier to identify my thoughts than my feelings, perhaps because the fast-paced nature of the environment necessitated immediate cognitive processing. My nervousness stemmed from my internal questioning of whether I could handle the responsibility and pressure of working with high-acuity patients. This connection between thoughts and feelings has reinforced my understanding of mental preparedness as essential in critical care nursing, where emotions can sometimes cloud judgment.

Moving forward, I plan to use self-monitoring strategies, such as pausing briefly to assess my emotions and calm myself, which may help me remain focused in similar high-pressure situations. Notably, Herland (2021) suggests that such reflective practices can strengthen one’s ability to remain centered, even in moments of crisis, ultimately benefiting patient care and personal growth.

In retrospect, reflecting on how I could react better to such situations in the future, I quickly came to realize that self-monitoring is a skill worth being developed in high-pressure environments. Henceforth, I will apply specific self-regulation strategies- for instance, by stopping for a short while to gauge my emotions and gather my thoughts- so that critical situations find me focused and ready. For example, two or three deep breaths before responding create those precious small moments of clarity, which allow me to approach the task in front of me with a balanced mind. This practice may allow better handling of difficult situations with more poise and, therefore, greater effectiveness.

As Herland (2021)  states, this kind of reflective practice enhances one’s ability to center oneself in times of crisis, something that will benefit so much the care of my patients and my personal growth. Developing this self-awareness not only helps in managing one’s stress but also contributes to a positive team dynamic, as composed people can have a stabilizing effect on others in the unit. This experience has motivated me to actively foster resilience and emotional stability, qualities so crucial to a successful nursing career in high-stakes environments.

Journal Prompt 3: Self-Awareness and Social Awareness Domains

During my rotation in Behavioral Health, I experienced a notable moment that forced me to confront my own biases and feelings of being judged. In one instance, I struggled to manage an aggressive patient, which my colleague seemed to observe and pass judgment via a look; therefore, I felt pretty incapable and unsure whether I could deal with such a situation. This judging look made me doubt myself, and I felt that maybe I was not meant for this aspect of nursing. These feelings then led to low confidence in my subsequent interactions with patients, leaving me feeling tentative and uneasy in the behavioral health environment.

In contrast, there was one incident on the Med-Surg unit where I subconsciously judged a patient for being admitted due to complications from substance abuse. Though my judgments of their actions were not spoken, there is a possibility that these may have impacted just how much empathy and compassion I showed them. I genuinely feel disappointed when reflecting on my reaction upon initial contact and acknowledge that personal biases can affect patient care.

Nursing is done in the frame of compassion and a non-judgmental attitude. Still, again, this is one of those moments when I was reminded about the need for self-awareness and not to let personal opinions interfere with professional obligations. Judging others internally, much as it might be, is erosive to empathy, which once more is an essential ingredient in nursing.

Recognition and the ability to work through such tendencies become significant in rapport-building and the holistic delivery of care. In the future, personal efforts will be made not to jump to conclusions but to approach each patient encounter with a fresh mind, realizing that each one has a different journey that is complicated in its unique way. This will also help me be more accepting and empathetic toward my approach, which will make for a better relationship with patients and colleagues.

Journal Prompt 4: Self-Awareness, Self and Relationship Management Domains

One of the most challenging experiences during my clinical rotation was in Same-Day Surgery, where I encountered a patient who repeatedly refused to follow post-operative instructions. My automatic response was irritation and anger at how the patient was responding and ignoring relevant information that may benefit his recovery. This sour of frustration resulted from that impression. I wished my patients to be better, but in vain, as my efforts were responded to with negligence. Physically, I noticed my shoulders tense, and I clenched my jaw in response to the situation, reflecting my internal struggle to remain calm.

At that moment, I maintained a polite yet firm tone, reiterating the instructions to emphasize their importance. However, upon reflection, I would have preferred to respond with greater empathy and patience. Instead of focusing solely on compliance, I could have asked the patient if they had any concerns or fears preventing them from following instructions. This approach could have allowed me to uncover potential barriers and address the root of their non-compliance more effectively.

One strategy I plan to use in future encounters is active listening, where I aim to engage patients by validating their concerns and demonstrating understanding. This technique can help build rapport and trust, encouraging patients to take a more active role in their care. By acknowledging their perspective, I can foster a collaborative approach to care, reducing frustration for both parties and promoting better health outcomes. Besides, active listening not only enhances patient relationships but also strengthens emotional regulation, helping one manage stressful interactions more effectively (Herland, 2021)

In addition to that, active listening during patient relationships helps improve emotional regulation. According to Herland, interaction with the patient during active listening allows for the management of stress, as this generally increases my awareness about my feelings and the needs of the patient, hence suggesting a balanced and calm approach toward stressful situations. These strategies will go a long way in ensuring that I handle future challenges in a more empathetic and effective manner.

Journal Prompt 5: Self-Awareness and Self-Management Domains

Reviewing the article “When Compassion is Lost” by Henson (2017) gave me valuable insights into the relationship between self-care and the effectiveness of care delivery. Henson (2017) discusses how compassion fatigue can develop when nurses constantly prioritize patient needs over their own, leading to a gradual erosion of empathy and emotional exhaustion. This reflection deeply resonated with me, particularly as I navigated the demanding environments of the ICU and Behavioral Health, where the emotional toll is significant and the risk of compassion fatigue is high.

From Henson’s work, I learned that by taking care of my well-being, I am better positioned to provide compassionate, high-quality care. Self-care is not only necessary for my health but is also a professional responsibility, as it impacts my capacity to maintain empathy and patience in challenging situations. For example, after intense shifts in the ICU, I often feel drained, and this affects my interactions with subsequent patients.

A specific self-care strategy I plan to implement is incorporating breathing exercises and brief moments of reflection during my breaks, allowing me to recalibrate and restore my focus. Even small acts of self-care, such as deep breathing or stretching, can reduce stress and create a calmer mindset, positively influencing patient care.

Moreover, Henson (2017) emphasizes that sustaining empathy is central to nursing, and regular self-care practices play a crucial role. By setting aside even a few minutes each day for these practices, I can better cope with the emotional demands of nursing, maintaining resilience and attentiveness throughout my shifts. This approach aligns with my goal of becoming a well-rounded nurse who values both technical skill and emotional intelligence. Additionally, prioritizing self-care allows me to model healthy practices to patients, demonstrating how small changes can contribute to a balanced and healthier lifestyle, even amidst health challenges.

Conclusion

My experiences at Sanford Medical Center hit home in nursing about the importance of self-awareness, emotional regulation, and communication. All experiences, from the intense moments in CCU to the challenging interactions with patients at Same-Day Surgery, helped me understand how a poised, empathetic, and open-minded attitude is really important in the delivery of care. This not only enhances quality patient care but also helps create a supportive atmosphere among the health team.

I come to regulate my own emotions and responses to such situations through active listening, self-monitoring, and engaging in continuous self-reflection. Consequently, this enables me to approach patient care on an even keel. In the future, I am committed to consistently implementing these in my interactions, knowing full well that emotional resilience, coupled with good interpersonal relations, will spur my development as a nurse. This experience has only strengthened my appreciation of the depth of nursing, where technology and emotional intelligence blend to create compassionate yet effective care.

References

Andrews, H., Tierney, S., & Seers, K. (2020). Needing permission: The experience of self-care and self-compassion in nursing: A constructivist grounded theory study. International Journal of Nursing Studies, 101(101), 103436. https://doi.org/10.1016/j.ijnurstu.2019.103436

Henson, J. S. (2017). When compassion is lost. Medsurg Nursing, 26(2), 139–142.

Herland, M. D. (2021). Emotional intelligence as a part of critical reflection in social work practice and research. Qualitative Social Work, 21(4), 662–678. https://doi.org/10.1177/14733250211024734

National Library of Medicine. (2019). Trauma-informed care: A sociocultural perspective. Nih.gov; Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK207195/

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Reflective Journal

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.

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.

1. Describe in detail a situation in which you felt you were being judged. Describe how you felt about this.
2. Describe in detail a situation in which you had judged someone else. Describe how you feel about this.
3. 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?
   

   Reflective Journal Clinical II

  4. Journal prompt 4 (self-awareness, self and relationship management domains)

1. Situation: Think about a situation in which you experienced frustration or anger.
2. Identify the behaviors of others in this situation that you reacted to with frustration or anger.
3. Response: How did you respond? How would you have liked to respond?
4. Analysis: Explore and discuss reasons for the differences and similarities in your actual and desired responses in this situation.
5. 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)

1. Locate on NTC library site and read: Henson, J.S. (2017). When Compassion is Lost. MedSurg Nursing, 26(2).
2. 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.