Reflective Journaling

Name: Shadik Day NUR 4948L 6/22/16

Please submit a reflective journal describing a situation that forced you to use your clinical
decision making skills. The journaling should be done weekly, however, only a total of 5 are
due. Journals should be submitted via Canvas in the designated journaling area. Please save
as a word document and enter your journal in this format to assure that each area is
addressed.
Each journal should address the following topics:
Noticing
Subjective and objective data

A clients wife and the night shift nurse stated that the client was fixated on the
thought of leaving home. He would not respond to any distractors but was very ill
and unable to walk or stand but was making several attempts. The client also
seemed very out of breath. The wife was concerned for the clients safety and
well-being and asked for my nurse and I to assess him.

Subjective data: Patient fixated on the possibility of leaving the hospital, very
anxious

Objective data: respirations were 39 per minute; client could not finish a few
words before he seemed winded. Bilateral edematous lower extremities +3.
Client on 3L NC, alert and oriented x3. Patient made several attempts to get off
his bed.

How did you know there was a problem? Abnormal patient presentation or your gut
feeling?
o

In this situation I knew there was a problem because the patient seemed
extremely anxious and was not concerned for his safety

Interpreting
What other information do I need to make a decision?

If the patient has a past history of stroke, MI, or PE. Has the doctor been in to
see his current state this morning?

How long the patient has been hyperventilating and what interventions the family
would be willing to try

Is there anyone else I need to involve or notify?

o

I can involve the doctor in this plan to see if we can get a prescription of
Xanax/morphine and possibly try to normalize his respiratory efforts and anxiety
level.

Call respiratory stat as this is hospital protocol for patients whose respiratory rate
is about 30

Order an ultrasound of his legs to see if there are any possible clots

What could be happening and how critical is this situation?

o

Patient could be having a Pulmonary Embolism

Patient was in physical therapy for his shoulder not knowing that it was
progression of cancer until three days prior and he may be having anxiety related
to the rapid decline of his health

This is a critical situation because his respiratory efforts in conjunct with his
fixation put him at great risk to be injured

Responding

Should I do something now or wait and watch?

o

Do something rather than wait and see. My preceptor Aimee stayed in the room
with the client and I called respiratory stat, I also notified the doctor and put in the
scan for his legs. We had a conversation with his family about possibly changing
his wife to make his medical decisions moving forward, so a consult was put in
for a psychologist to evaluate the client. The patient was deemed unfit to make
decisions and we were able to receive his will and the patient was changed from
a full code to a DNR status.

The patients family was at bedside for the entire process of us stabilizing him
and it was very emotional. The wife stated, it was a very hard decision but I
know he is not comfortable.

I notified Aimee once the orders for medication was placed and she administered
that to help relieve the clients anxiety

The client was moved to a room closer to the nurses station

How will I know if I am making the best decision?

o

I know I have made the best decision if the patients objective findings appear to
be improving.

Once the family seems to be more calm and less concerned about his safety and
medical decline

What interventions can I delegate to other members of the healthcare team?

I can delegate for the charge nurse to call respiratory stat, to notify the doctor
and put in the consult for the ultrasound if unable to do it at the time

Can include evidence-based practice here to justify why you might make one decision
over another.

Reflecting
Did I make the right decision?

I think that I made the right decision because I helped the patient become
stabilized in an effective way through collaboration and care.

Patient/nurse communication is key but also listening to their spouses is just as

important. We listened to the needs of the family and was able to enforce his
wifes decisions as power of attorney and change his code status to something
they were more comfortable with.

Did I achieve the desired outcome?

o

I achieved my desired outcome because the patient was stable and less anxious
after all the tasks were implemented.

What did I do really well? What could I have done better?

o

I did well with my taking advice from Aimee and executing it in the given situation
and calling the specified personnel to make them aware of the situation

I could have helped the family cope more with the change in code status
because they were emotionally torn about the decision

Adapted from:
Tanner, C. A. (June 2006). Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing. Journal of Nursing
Education, 45(6), 204-11.
Gillespie, Mary. (2009). Helping novice nurses make effective clinical decisions: the situated clinical decision-making framework.
Nursing Education Perspectives, 30(3), 164-170.

Reflective Journaling Grading Rubric

Criteria
Did the student interpret the case situation
accurately?
Did the student present evidence of data analysis?
Did the student draw logical conclusions?
Did the student decide on an appropriate course of

S/U Notes

action?
Did student evaluate the outcome(s) of their action?
Did the student identify their strengths and areas for
improvement?