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

A challenging moment I experienced recently while on the Oncology Unit was when I
was assigned a patient with pancreatic cancer. This patient was receiving chemotherapy prior to
this occasion and was currently hospitalized for severe pain, nausea, and vomiting.
Noticing

When I initially assessed the patient I could see that she was in a great deal of pain and
discomfort. I administered her pain and nausea medicine immediately, which proved to provide
no relief. After administering everything I could per the physicians orders I then decided that he
needed to be made aware of her condition and that her orders may need to be modified.
Interpreting

Describe the clinical judgment or clinical reasoning that you performed. The example should include
alternatives you considered, and rationale for your decision.

The clinical reasoning for notifying her physician was that the medications she was
prescribed should have been enough to control her symptoms however they were not effective at
the time. The patient was concerned about her condition because she had never experienced this
the last few times she received her chemotherapy. My hope in communicating with the physician
was that I would get new orders for something that would better control her symptoms and also
to get reassurance that her symptoms were normal and not caused by another underlying

problem. The doctor believed her symptoms were a combination of her the chemotherapy and the
cancer itself and provided new orders.
Responding

What written evidence have you drawn upon for the care of your patient in this example?
Provide cites/references.
In Patricia Benners From Novice to Expert (2001), she discusses the Diagnostic and
Monitoring Function of the expert nurse (pg. 95). Included in this discussion is the emphasis on
assessment, noting that this competency not only has a recognitional component, but also
requires expert documentation, and requires that the nurse present a convincing case to the
physician (pg. 100). In the example provided above, my assessment of my patient raised
concern about her condition because her symptoms were not responding to the treatments and
interventions I was able to provide. This led me to make the decision to call the doctor and
convince him that something else needed to be done for my patient.
Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing
practice (commemorative ed.). Upper Saddle River, NJ: Prentice-Hall.
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?

Working with my preceptor has helped me to become socialized into the nursing
profession and become a member of the interdisciplinary team. In this example, my preceptor
was able to guide me on how to get in touch with the doctor and what to communicate to him. I
felt that I was able to follow her direction and function as an active member of my patients care
team.
Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing Education, 46(11), p. 513-516.