Reflective Journal

*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?
   

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Reflective Journal

Journal Prompt 1 (Self-Awareness Domain)

My values, assumptions, and beliefs are centered on empathy, respect for human dignity, and the delivery of equitable care. These principles adhere to the Nursing Professional Code of Ethics, which entails compassion, integrity, and accountability, as pointed out by the American Nurses Association (2024). For example, honesty and equity when addressing or attending to any patient, irrespective of their origin, are very important to me. One of the worst and most substantial experiences that enriched this belief was during one of my clinical rotations when I was assigned to look after a patient who was homeless. As much as I thought they might harbor some mistrust from healthcare professionals, I took my time and was open with them. This not only helped to establish rapport but also facilitated the patients’ autonomy to engage in their own health decisions.

It is also true that the above-mentioned values and beliefs affect my relationship with the patients’ families. I believe that family is part of the care process, and I try to explain everything to them as well as offer emotional support. For instance, while dealing with a family that has just been diagnosed with a terminal illness, I saw to it that the family was included in the care planning and confirming care plan while engaging them with kindness via professional communication. This applied the principle of beneficence, as I tried to address the family’s emotional concern while remaining loyal to the patient’s preferences for treatment. Thus, such types of interactions support my idea that trust and constructive communication are important factors shaping the client-clinician relationship.

Furthermore, I would like to stress some of my assumptions can sometimes turn into sources of oppression. For instance, I have considered that patients comprehend certain medical information, which, in fact, creates confusion. Recognizing this, I now make the language easier and put questions in my conversations so that I can be sure the words I am using are clearly understood. To achieve that, I will examine and respond to the following assumptions: As a practicing nurse, the success of the nursing interventions depends on how well I understand the patient’s needs while adhering to the Nursing Professional Code of Ethics. This framework serves as a continual guide in my commitment to excellence in nursing practice.

Reflective Journal

Journal Prompt 2 (Self-Awareness Domain)

This week, being in the clinical setting, performing my dialysis and oncology rotations, I met a patient with unbearable pain who needed to be given medicine. However, the administration of the medication was not done as planned because only the doctor could alter the dosage. The patient kept on going around calling many different departments of the hospital, asking to be helped, but the response given was that nothing could be done until the arrival of the doctor. It was painful to see the patient in discomfort as she complained of being irritable during the whole period of dialysis.

At that point, I only focused on the systems issues that contributed to the delayed treatment of the patient. Sometimes, I felt frustrated, and at the same time, I cared for her and wished I could do more for her, but I was restricted since I was only a student nurse. In physical terms, I felt my shoulders tense up, and my heart started to pound, which responded to my inner conflict, a state of confusion in this case. It was easier for me to uncover my thoughts because I was in the process of working through the issue and trying to figure out the steps taken. However, identifying my emotions of feeling sad and frustrated called for a little more introspection. Later on, these emotions were somewhat concealed, but the tight interconnection between the thoughts regarding the predicament and the wish to speak for her was evident.

During that time, I had an understanding of how my emotions and cognition intertwined. The fact that I could not get an opportunity to explore how I could help this patient because of the delay made me work harder to look for the means and ways of helping the patient within my capacity. Looking back, I noticed to what extent my feelings interfered with my consideration of the patient and the importance of proper advocacy. This has made me more determined to learn more about how hospitals work and strategies for handling patients experiencing severe pain. This also brought back memories of the focal areas of nursing, such as empathy and advocacy for patient-centered care.

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

Pavedahl et al. (2022) noted that prioritization is a crucial competency in nursing practice, and this assignment has shown how critical prioritization is in practice during a recent clinical assignment. On one particular occasion, on my shift, two of the patients needed attention in an emergency. One of the patients had fluctuations in his vital signs, such as a drop in oxygen status and tachycardia, which signify a critical condition. The other patient felt a lot of pain and had asked for medication that would be given to them in order to minimize the pain that they felt. In this case, one had to discern which of the patients needed attention most while at the same time trying to satisfy the needs of the other patient. This scenario required the use of one’s reason, sound moral judgment and communication skills.

I, therefore, deemed it appropriate to attend to the patient with unstable vital than the other one since the patient’s life was in more critical danger. This decision was based on the pathophysiological knowledge that if respiratory distress and cardiac condition are not addressed, they can have detrimental consequences and may result in death. According to Varkey (2021), ethical principles like non-maleficence, which means acting in a manner that does not harm the patient and beneficence, the action that will benefit the patient, I decided to first attend to the life-threatening condition. However, this decision was not easy because I also had a second patient to consider, and her pain needs were another aspect of being a compassionate, caring provider. To counter this, I was quick to report to my preceptor, and he attended to the pain medication issue while I set the first patient stable.

Notably, this propelled my understanding of the value of teamwork and communication in nursing to further heights. This was done by assigning tasks that would enable both patients to access care as soon as possible without neglecting the quality of the care that will be given to them. It also outlined the importance of coping with stress and patients’ focus on clinical expertise rather than emotions. Thinking over this case, I grew conscious of the necessity of preparation and flexibility in order to succeed in a difficult situation. In order to enhance my understanding further, I propose to dedicate my free time to case studies on prioritization and to seek advice from other nurses. This will aid me in gaining confidence and delivering safe, ethical, and patient-centered care.

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

One of the biggest challenges I faced while attending nursing school was how to balance my time between clinical rotations, coursework, and personal responsibilities. At times, it felt like everything was too much to handle, and I felt like I was failing at managing it all. This phase of struggle really tested my resilience and taught me valuable lessons about self-awareness and self-management. Initially, I tried to handle everything by myself, which only added to my stress. It soon became apparent that if I was to be successful in both my academic and clinical roles, a change in approach was needed.

In turn, I did some reflection to realize that one needed to have realistic goals as well as put in place some measures in terms of reasonable time organization. I started dividing big tasks into manageable steps and prepared detailed schedules on priority. I reached out for guidance from professors, peers, and my family members; they were the motivating factors. And this experience showed me that this weakness promotes growth and learning. Moreover, I learned about self-care, to which I had paid little attention. Setting time for mindfulness, regular physical activity, and relaxation improved my focus and overall condition.

From this experience, I will build on this and continue my professional development. I will also attend workshops in time management and stress reduction to enhance my organizational skills further. Reflection will be a continuous part of my practice, allowing me to highlight my further improvements and progress, as noted by Shin et al. (2022). I also try to remain proactive in seeking mentorship from seasoned nurses who have a lot to contribute in terms of insight and guidance. With this growth mindset, coupled with embracing challenges as opportunities for improvement, I am well-placed to handle the pressures that come with nursing and offering quality care to my patients. This experience has reinforced my commitment to lifelong learning and professional growth.

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

In the clinical setting, there was a legal and ethical dilemma concerning the autonomy of a patient and the directives of the family members. The patient – in our example, an older adult with a terminal illness – frequently does not want intensive, life-sustaining therapy. However, the family of the patient insisted on getting treatments that the patient did not wish, so conflict arose and made the treatment of the patient tricky. Watching this was difficult because it is not easy to determine what is ethical and what is not under some circumstances and how most people fail to speak up for others.

Besides, this particular case was based on the principle of autonomy since the patient had a right to make decisions regarding their care in accordance with their values and preferences. Although it was against the family’s wish, the idea of patient self-authorization demanded that the patient’s wish as recorded be respected. The concepts of fidelity and beneficence were also present since the healthcare team attempted to maintain the patient’s stated preferences besides satisfying the family’s wishes with regard to the patient (Varkey, 2021). Even when dealing with emotions, the ethical best practice was followed because the team arranged for a family meeting to enable the relatives to be fully expressive. Using this approach, the family was more able to appreciate the position of the patient and, consequently, respected the decision of the patient.

From this, I learned that while adhering to ethical standards, there is a need to handle delicate issues ethically yet professionally. I realized that advocating for patients includes not only the recognition of patient’s rights but also helping families during some critical moments. In the future, I would, therefore, like to further my knowledge regarding ethical frameworks and be mentored. Through this experience, I felt the importance of assuring patients’ self-governance and dignity, along with building strong and trustful relationships with families. In my future practice, I intend to ensure that I embrace open communication and ethical decisions, which would help ensure that patient-centered care is embraced.

References

American Nurses Association. (2024). Ethics and human rights. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/

Pavedahl, V., Muntlin, Å., Summer Meranius, M., Thiele Schwarz, U., & Holmström, I. K. (2022). Prioritizing and meeting life‐threateningly ill patients’ fundamental care needs in the emergency room—An interview study with registered nurses. Journal of Advanced Nursing, 78(7). https://doi.org/10.1111/jan.15172

Shin, S., Hong, E., Do, J., Lee, M. S., Jung, Y., & Lee, I. (2022). Development of critical reflection competency scale for clinical nurses. International Journal of Environmental Research and Public Health, 19(6), 3483. https://doi.org/10.3390/ijerph19063483

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119