Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion

Mid-Point Guide for Reflection

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

The most challenging moment I have experienced thus far is in caring for an infant with neonatal abstinence
syndrome. The mother of this newborn was taking methadone during her pregnancy, and therefore the newborn has
been suffering from the effects of this for about a 40 days. It is difficult not to pass judgment on the parents when
they come to visit her for only 15 minutes or so a day if they come at all. Knowing that she needs the touch and care
from her parents to help her continue to develop and progress towards leaving the hospital. It has also been difficult
knowing that she eventually will be set home with them, and trying not to judge what kind of parents they will be.

Noticing

Initially I noticed myself being guarded when her parents came to visit her having heard stories about their visits
with her in the past from other staff members. I have noticed that as have seen her parents interact with her over time
they do show love and affection towards her, but I still find myself being cautious about her future.

Interpreting

Although this situation has proven to be difficult for me to sort through. I feel that it has pushed me to continue to
take a step back, and remind myself to be non-judgmental and know that I do not know everyones life struggles. It
has forced me to become more empathic towards others even when it is difficult. I have learned that I can still prove
this infant the care she needs while trying to not pass judgment on her parents. I could have chosen to be resentful
and bitter towards her parents, but not only would that be unprofessional it would also not aid in the ultimate goal of
providing the best care for this newborn. Allowing her parents to learn how to care for her in a unbiased caring
environment is also important to providing the best future for her. Therefore, I continue to remind myself to remain
empathic as difficult as it may be.

Responding

In caring for both this infant and her mother I have drawn upon an article from the Journal of Addiction Medicine
on the care of NAS infants and their mothers. This article also sheds light on the opioid addicted mothers ability to
recognize the newborns cues. This article also states that it is the healthcare providers responsibility to help guide
the mother to tailor her care to best provide for the infants needs while allowing her to gain the confidence in
parenting.

Velez, M., & Jansson, L. (2009). The opioid dependent mother and newborn dyad: non-pharmacological care.
Journal of Addiction Medicine, 2(3), 1-16. doi:10.1097/ADM.0b013e31817e6105

Reflection-on-Action and Clinical Learning

Based on your experience as a student nurse on a unit with a preceptor, reflect on the differences of working
one-on-one with a preceptor versus a student nurse in a group of students and one instructor.

I feel that being one-on one with a preceptor versus being one of a group of students I am able to learn not only
faster, but I am given more of an opportunity to ask questions and continue to put the pieces together. I am able to
think more critically in this environment because I can think out loud with my preceptor present guiding me if
needed. I enjoy being able to continue my learning in this environment because I am immersed in the daily activities
rather than thinking about it once a week or so. I also am able to see the unit function more as a whole being more
involved on a daily basis. I also enjoy in this setting being able to ask questions as they arise rather than hoping to
remember to ask them later.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing Education, 46(11), p. 513-516.