Nursing Clinical Reflection

The idea of reflective practice first originated from Donald Schon’s practice. Basically, it is acknowledged as an essential element of a medical professional’s practices. Additionally, it provides an opportunity for healthcare professionals from numerous fields to establish and maintain best practices in their respective fields. As a result, this method is known as “clinical reflection” in the healthcare profession. 

Likewise, clinical reflection is recognized as an important skill that every medical professional should constantly put into practice due to the steadily increasing pressures for service development and career advancement. Admittedly, reflection is a significant strategy in physiotherapy to enhance clinical reasoning, collaboration, patient treatment, and clinical monitoring. Ultimately, when it is done appropriately, a nurse’s reflective practice can improve your skills as a healthcare worker. 

Explain reflective practices and reflection.

Doctors and nurses regularly face complicated clinical practice challenges, which can be controlled through reflection. Consequently, many professional associations support reflection and reflective practices to promote high-quality services. 

The subsequent definitions are given below:

“Reflection is the mechanism of reviewing a practical experience to explain, evaluate, and examine, and also inform learning about practice.” Alternatively, the reflective practice goal is to investigate numerous professional performance scenarios so that they can act as an effective environment for learning and encourage nurses to keep learning, establishing, and “discovering through their practice.” Furthermore, clinical reflection is a powerful tool that allows nurses to acquire knowledge from their experiences and observations. Although it can be utilized in daily life and the medical field. Typically, it provides an opportunity for nurses to learn from their mistakes and bad decisions as well as recognize their achievements so that the procedure can be continued.

Analytical thinking is required, so significant training is crucial before implementing this ability in a therapeutic environment and reflecting on it. However, it aids the therapist in identifying what is known already. By adding the current information obtained, it gives improved knowledge and interpretation. 

The Introspective/ reflective path

Usually, it is not common for nursing students to begin their career in reflective development journeys with the assignment of keeping a reflective journal or diary of their day spent in a healthcare environment. Besides its aim to provide inspiration and promote reflection, also this diary enables you to respond to various stimulating inquiries. These queries are listed below:

• Describe the reason you selected this approach.
• What was productive?
• What went wrong?
• Do you have any reflective evidence to support your choice?
• What could have been done to perform better?
• What are the most effective points to execute next time?

kinds of reflection

Reflection-on-action: 

• Through introspection, experience becomes knowledge. 
• After the incident, consider opinions, goals, standards, and preferences.
• Recognizing what happened, what went wrong, and how the circumstances might be changed in the future. 
• Nurses identify how their actions and observations influence patients and how you deal with them. 

Reflection-in-action 

•  Depends on an individual’s emotions, assumptions, and practical experiences.
• Conducted by expert professionals

• Immediate research means altering the circumstances while the professional discovers new ideas about it.
• Conscious dedication to the task is required.
• They assume the role of their own administrator and critically analyze their own actions.

Gibbs reflective cycle model

Basically, it offers an organized model of experience-based learning. Fortunately, with the help of this model, focusing on clinical cases and the reasons behind adverse results promotes nurses’ critical thinking skills. Its cyclical framework contains 6 stages. 

1. Description: 

• This portion of the reflection cycle provides a detailed description and background information of the situations or encounters you’re thinking of.

2. Emotions:

• This part usually focuses on feelings and ideas during and after the incident.

3. Assessment

• The analysis is based on the knowledge you gained through challenges. Evaluate both positive and negative aspects and answer the following inquiries.
• What was your reaction to the problem?
• What was your opinion then?
• How did the other person respond?
• If it was an issue-resolving condition, was the problem solved?
• Furthermore, if you have any supporting information for the problem, you can attach it here.

4. Examination:

• Here you finally have a chance to show your reflection on the experience.
• Select the main element that you consider to enhance or restrict the experience.
• Identify what went well and what didn’t work out so well.
• Relate your experience to the findings reported in the literature. 

5. Conclusion

• In this segment, identify key insights and provide an overview about the situation that is being reflected upon.
• Would you repeat the previous action?
• What would you modify?
• What measures could you take to guarantee that such problems never happen again?

6. Action plan:

• In what manner will you implement the knowledge you have learned in the future? 
• Set strategies to improve or modify your practice.

Reflection Example: A tragic, genuine story!

Night Shift Duty: Drug Round

Phase 1: Description

In a UK hospital, I am a third-year student working as head nurse during the night shift, with the cooperation of an assistant nurse who takes care of 23 patients who are seriously ill. A medical expert ordered me to inject 0.1 mg of digoxin (a heart-stimulating agent that stabilizes, slows, and accelerates the heartbeat) into a patient named Mrs. X in order to minimize respiratory problems and signs of chronic congestive cardiac failure. Usually, I calculated 4 tablets from the 0.25-milligram bottle of Digoxin, an amount of medicine I had never supplied previously. Besides, the doctor and junior nurse both approved when I gave them the prescription and medicines. In fact, all of us mutually agreed. Thus, Mrs. X was subsequently kept under hourly supervision by me. 

In the morning, around 2 a.m., I immediately recognized that I had accidentally given 10 times the suggested amount of digoxin, as per the physician’s recommendation. In fear, I called the nurse, who agreed with me.  Finally, we notified the doctor, and MRS. X family members wrote a complaint. Terrified, I received an order to go to the hospital matron in the morning. Fortunately, Mrs. X seems to recover perfectly from the digoxin during the night with no negative consequences. 

Phase 2: Characterization-Feelings 

I spend too much time at night, and I was head of the very hectic ward with only 2 night shift workers. Due to her serious sickness, she needed continuous medical attention. I hadn’t previously observed digoxin tables greater than 0.25 mg, and I had no knowledge that a pediatric blue tab containing 0.1 mg existed. I was really nervous about supplying such a heavy dose, so I showed the physician four tablets of 25 mg. After checking the tab, the doctor said, Okay. Although I was really concerned about the quantity, I waited longer than the usual 15 sec to take her pulse. Moreover, the doctor was extremely anxious; he was rushing around the hospital, and his beeper was constantly going off. He was someone I hadn’t seen before. He had just come from the child unit. 

Phase 3: Assessment

Fortunately, no one ever reassured me or put the blame for what happened to me. Luckily, the relatives of Mrs. X were understanding the circumstances, and thankfully she recovered properly. Matron was gracious and impressed that I had disclosed my mistake by saying no one would have ever realized. Similarly, I spent 2 consecutive nights and the whole day looking at Mrs. X. 

Phase 4: Evaluation

I was genuinely terrified after this situation because I had performed the correct protocols as well as verified the recommended tab with the nurse and doctor. To be honest, I had no idea that digoxin was available in blue pills or that I could pick 0.1 mg. Besides, I felt extremely hesitant to admit it. Conversely, the doctor confirmed that I had presented him with 4 white tabs. At that point he replied, “I assumed you understood what you were doing.” which isn’t particularly a reply. Despite this, I recognize how significantly patients depend on the healthcare professionals as well as their beliefs in un. In my perspective, this situation was the result of various instances related to exhaustion, misinterpretation, and workload. 

Phase 5: Conclusion

Ultimately, the fact that Mrs. X recovered from the overdose and her relatives were accepting, but in other cases if she had expired or had a serious reaction, I am not sure I could pursue my career as a nurse further. 

Phase 6: Action Plan

Now, I know to take drugs with extra care and to pay strict attention to dose recommendations. Further, if needed, double check the drugs in the reference book before providing them; I am also responsible if I supply them incorrectly. Additionally, I am always accessible to guide nurses who have come across any critical situation where they attempt a medical error and give them an opportunity to address their worries with me.