Reflection

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Guide for Reflection Using Tanner’s (2006) Clinical Judgment Model

Instructions

This Guide for Reflection is intended to help you think about a given clinical situation you have encountered during the past
week and your nursing response to that situation. The situation can be a specific physiological patient problem, such as an
elevation in temperature, respiratory difficulty, or electrolyte imbalance. You may choose to describe a situation involving a
patient’s family. The situation can be a description of your role in interdisciplinary problem solving. The reflection situation may
describe an ethical issue you encountered in practice. Use the guide for reflection as a way to tell the story of the situation you
encountered.

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The guide provides you with a way of thinking about care that supports the development of your clinical judgment. Although
there are many ways of organizing your thinking about patient care and professional nursing practice, Tanner’s (2006) Clinical
Judgment Model provides the framework for the questions in this guide.

Introduction
Describe a nursing situation you encountered this week (see the instructions above).

Background
• Describe your relationship to the patient at the time you noticed the situation (e.g., previous contact with patient and/or

family, the quality of your relationship).
• Consider experiences you have had that helped you provide nursing care in the situation. Describe your formal knowledge

(e.g. physiology, psychology, communication skills), previous nursing experiences with a similar problem, and/or personal
experiences that helped guide you as you worked with the patient.

• Describe your beliefs about your role as the nurse in working on the situation.
• Describe any emotions you had about the situation.

Noticing
• What did you notice about the situation initially?
• Describe what you noticed as you spent more time with the patient and/or family.

Interpreting
• Describe what you thought about the situation (e.g. its cause, potential resolutions, patterns you noticed).
• Describe any similar situations you have encountered in practice before. Describe any similarities and differences you

observed when compared with the current situation.
• What other information (e.g. assessment data, evidence) did you decide you needed as you considered the situation? How

did you obtain this information? What help with the problem did you get from your preceptor?

Your conclusion: What did your observations and data interpretation lead you to believe? How did they support your response
to the situation? Include pertinent pathophysiology and/or psychopathology.

Responding
• After considering the situation, what was your goal for the patient, family and/or staff? What was your nursing response, or

what interventions did you do? List all actions that you took.
• Describe stresses you experienced as you responded to the patient or others involved in the situation.

Reflection-in-Action
• What happened? How did the patient, family, and/or staff respond? What did you do next?

Reflection-on-Action and Clinical Learning
• Describe three ways your nursing care skills expanded during this experience.
• Name three things you might do differently if you encounter this kind of situation again.
• What additional knowledge, information, and skills do you need when encountering this kind of similar situation in the

future?
• Describe any changes in your values or feelings as a result of this experience.

Nielsen, A. et al. (2007). Gudie for Refelction Using the Clinical Judgment Model. Journal of Nursing Education, Vol.46, No.11

NR452 Nursing Reflective Journal Assignment (Rubric)

CRITERIA

SATISFACTORY (S)

NEEDS IMPROVEMENT (NI)

UNSATISFACTORY (U)

SCORE

Identifies and Summarizes

Clearly identifies and describes the significant clinical incident/event.

Identifies and describes the significant clinical incident/event with minimal detail.

Does not identify and describe the significant clinical incident/event.

Reflective Thinking and Analysis

Evidence of strong reflective thought pertaining to personal and professional development.

Reflective statements go beyond simply answering one or two questions.

Reflection shows thoroughness and thoughtfulness.

Reflection has supporting details and examples.

The reflection explains the student’s own thinking.

Implications for future learning and/or actions are addressed.

Minimal evidence of reflective thought pertaining to personal and professional development.

Reflective statements do not go beyond simply answering one or two questions.

Reflection shows some thoughtfulness.

Reflection has some supporting details and examples.

The reflection explains the student’s own thinking.

Implications for future learning and/or actions are vaguely addressed.

Little to no evidence of reflective thought pertaining to personal and professional development.

Reflection shows little thoughtfulness.

The reflection attempts to demonstrate thinking about learning but is vague and/or unclear about the learning process.

Implications for future learning and/or actions are not addressed.

Format

Journal entry is 1-2 pages in length, excluding cover page and references.

Demonstrates a clear recognition of medical vocabulary/terminology.

Proper APA format with < 3 errors

Journal entry page length meets minimum requirement, but entry lacks sufficient detail and some required elements.

Demonstrates recognition of some medical vocabulary/terminology.

APA format reflects >3 errors

Journal entry page length does not meet requirement (less than 1 page or exceeds 2 pages).

Does not use proper medical vocabulary/terminology.

Does not comply with APA format

Total Score:

Comments:

2

CLINICAL REFLECTION

Clinical Reflection

Introduction

Mental health is a person’s well-being in which the individual knows their ability or capacity and can contribute meaningfully to discussions as well as their community. While mental illness is when an individual is not stable in reasoning, misbehaves or aggressive, would have to be on some psychiatric medication to function properly (Morgan & Townsend, 2018). As a student I had a lot of questions about this class going through my mind: “what will the experience be?” “Will I be able to cope?” “How will I be able to survive any violent reactions from any client without violating their rights?”. I cannot stand an aggressive person not to talk of taking care of them. I have always believed mental health/illness is very complex to understand.

Background

On the 11th of July, 2022 my preceptor had 3 patients which obviously had different diagnosis and intervention. Yes, at this stage of learning I should be more comfortable with caring for different patients with moderate help but coming across a mentally ill patient that is suffering from brain cancer challenged me the most. Providing care for this patient was harder because my personal safety was at stake as well, his mental illness was as result of medication misuse and other underlying condition, plans were made to have the patient transferred to a psychiatric facility. I was able to understand the definition of mental health, mental illness; Mental health is the ability to maintain homeostasis, control thoughts, environment and complete task as defined by the society/culture. While mental illness is the maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and that interfere with the individual’s social, occupational, and/ or physical functioning.

Human being can attain the state of mental wellbeing using Maslow hierarchy of needs which can occur as at any point in life without orders. There are six indicators that reflects mental health, which are positive attitude, growth and development, integration, autonomy, perception, environment, perception of reality, and environmental mastery. There is going to be a way to adapt the stress that leads to mental illness, these psychological adaptation to stress is determined by the degree to which the thoughts, feelings, behaviors interfere with an individual’s functioning. The two major primary psychological response patterns to stress are Anxiety and Grief (Morgan & Townsend, 2018).

Conclusion

At the end of the stimulation and debrief, I was able to understand properly that therapeutic communication is one major healing tool a nurse must not let go of. Also, proper use of nursing process is important in caring for patient in all situations.

Reference

Morgan, K. I., & Townsend, M. C. (2018). Davis advantage psychiatric mental health nursing. Pennsylvania: F.A. Davis Company.

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