Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion

Acute Care Practicum Reflective Journal Guidelines
Instructions:
Reflective journals will document professional growth through your acute care practicum
experiences. You will submit one acute care reflective journal by the end of your acute care hours
(202 hours). You must reflect on the questions below. Unsatisfactory reflective journals must be
revised and resubmitted in order to receive a PASS for the course.
Final Guide for Reflection
(Example MUST be different than that provided at mid-point)
Tanners (2006) Clinical Judgment Model

Describe the most challenging moment or event you experienced recently. What actions did you
take and what would you have liked to do differently? What specific actions are you taking to
improve the outcome in future situations or to prevent recurrence of the situation? To answer this
question, use the guide for reflection using Tanners clinical judgment model (see below).
Background
Recently the most challenging moment in clinical was caring for a very unstable patient who came in from the
ambulance. The patient was actually a John Doe. No one knew who he was or what his history of illness could
have been. Most of us suspected drug overdose by his symptoms, tachycardia, rising temperature, diaphoresis,
altered level of consciousness, etc. The situation was critical, the patient had to be intubated, sedated, and paralyzed.
His temperature rose to 108! We had to think quickly and ice him, administer IV Tylenol. The physician ordered
every test! CT, XRay, standard labs, tox screen, and lumbar puncture. The problem was we had no idea of knowing
how this patient got this way because he was found unconscious with no identifying information.
Noticing
I noticed as I was gathering his clothing that he had a cell phone which I gave to the charge nurse to secure. She in
return handed it to the EMTs and had them charge it (of course it was dead). She was able to get into the phone and
find out his information! She called his most recent contacts and explained the situation he was in, got a name and a
history. She was able to find out that he had a psych history and was taking medications for his bipolar, and
depression. The physicians then felt pretty confident that this was a result of serotonin syndrome; we were able to
stabilize the patient and get additional information from his family.
Interpreting

Describe the clinical judgment or clinical reasoning that you performed. The example should include
alternatives you considered, and rationale for your decision.
The take home I got from this was how important it is to have a solid history on our patients. The
assessment piece of our job is very important to find out changes and trends, however the initial history
and gathering of information, which we do in the ED, is so important and has significant relevance to the

patient and their current state of health. I have noticed the physicians come in and take their brief history,
but its really up to the nurse to question and expand the responses of the patient. We spend more time
with the patient and we are able to create a relationship. The nurse patient relationship makes a huge
impact on what information the patient gives, and how well the patient receives treatment, and how much
compliance they will have with their future care plans and health maintenance.
Responding

What written evidence have you drawn upon for the care of your patient in this example?
Provide cites/references.
According to Chitty and Black (2011), the nurse patient relationship is built on trust. Patients do
not always understand their own health problems and symptoms and can be reluctant to discuss
them. The initial interviewing by the nurse can help the patient feel comfortable and know it is
okay to discuss even embarrassing information. In this particular case, it was the lack of
communication due to loss of consciousness that made the diagnosis and subsequent treatment
hard to determine. It was a lesson though, and showed me how important it is in less acute
situations to really dig in and get to know the patient and their history. As part of the healthcare
team it is our job as the nurse to make that connection in order to create an environment for
optimal healing and better patient outcomes.
Chitty, K. K., & Black, B. P. (2011). Professional nursing: concepts & challenges (6th ed.). Maryland
Heights, Mo.: Saunders/Elsevier.

Reflection-on-Action and Clinical Learning

Socialization is best facilitated when the new nurse feels part of a group. How has this precepted
experience and working one-on-one with a dedicated preceptor helped you to become socialized into the
nursing profession?
My preceptor has been wonderful! She is very well liked by all of the members of the MRMC ED team
including techs, transport, other RNs, and the physicians. She has made me feel welcome introducing me
to everyone. By the second week other nurses and techs were offering to have me help with their tasks
and patient care. Many of them would come down the hallway to get me to observe an unusual procedure
or code! Everyone has been fostering my learning experience. I have had a fantastic experience and just
accepted a job there as RN to start after graduation! With the one on one preceptor experience I feel like
we really get a chance to be accepted as part of the units culture. I have been well supported in this
journey that is one of the many reasons Im so excited to have my first job there.
Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing Education, 46(11), p. 513-516.