Nursing Reflection on Lack of Communication, Inadequate Knowledge and Stress

This report describes reflection about three different themes related to clinical nursing practice. The issues are lack of communication, inadequate knowledge and stress. The reflection is done by following Gibbs reflection model.

Running head: NURSING
Nursing Reflection
Name of the Student
Name of the University
Author Note

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Table of Contents
Introduction................................................................................................................................2
Issue 1: Lack of Communication...............................................................................................2
Description.............................................................................................................................2
Feeling....................................................................................................................................2
Evaluation..............................................................................................................................3
Analysis..................................................................................................................................3
Action plan.............................................................................................................................4
Issue 2: Inadequate Knowledge.................................................................................................5
Description.............................................................................................................................5
Feelings..................................................................................................................................5
Evaluation..............................................................................................................................6
Analysis..................................................................................................................................6
Action plan.............................................................................................................................6
Issue 3: Stress.............................................................................................................................7
Description.............................................................................................................................7
Feeling....................................................................................................................................7
Evaluation..............................................................................................................................8
Analysis..................................................................................................................................8
Action Plan.............................................................................................................................9
Conclusion..................................................................................................................................9
Reference..................................................................................................................................10

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Introduction
Reflective journals help nurses to improve their clinical practice. It is a self-analysis
process which involves in evaluation and critical thinking. This report describes reflection
about three different themes related to clinical nursing practice. The issues are lack of
communication, inadequate knowledge and stress. The reflection is done by following Gibbs
reflection model. The report is also supported by recent evident based studies reviewed from
PubMed and Google scholar.
Issue 1: Lack of Communication
Description
This portion would describe about the particular event took place at the time of my
clinical practice. I was appointed in the female psychiatric ward for three weeks. The
psychiatric ward is generally divided into two wards such as male ward and female ward.
Inside the ward, there was open space, where patients were encouraged to walk. My
supervisor instructed me to support an 80-year-old woman who is suffering from
schizophrenia. My duty was to help her in having lunch as she is suffering from to the
tremors related to the disease. The woman had difficulty in independent mobility. I quickly
had a look on her diet chart and fed her at her bed.
Feeling
This portion describes about my feeling related to the event. At the very first moment
I was little confused about the process as it was my first experience in a psychiatric ward. I
started the conversation by introducing myself, so that she felt comfortable around me. I felt

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little nervous as I was not aware of her condition. I tried to take her consent before feeding
her and realised that she may had a problem in hearing and she might be unfamiliar with my
first language. This situation made me nervous as I was not sure about how to communicate
with her. I showed my empathy to her to understand her situation. According to Sinclair et
al., 2017, empathy has its direct connection with adequate patient care. I raised my volume a
little and tried body gestures. After repeating this for couple of times, she communicated by
nodding. It helped me to start the conversation with her. Nonverbal communication such as
body gesture can help to gain the trust of a patient (Benbenishty & Hannink 2015). I hesitated
in eye contact with her at the time of feeding her. I tried my best to communicate with her
and somehow complete the whole work with her cooperation.
Evaluation
In my opinion I tried to show my empathy towards the patient as she had difficulty in
feeding by herself. I tried to provide adequate care. I tried to establish nurse-patient
relationship with her in order to fulfil the basic duties of a nurse. I got opportunity to apply
the nonverbal communication to establish the communication with her. Apart from my body
gesture I used my facial expressions. Sarabia-Cobo et al. (2016), reports that facial expression
helps to communicate with elderly patients. Body gestures and facial expressions helped her
to complete her food however I failed to explain her about the importance of the diet.
Analysis
Communication skills played an important role in providing nursing care. The
nonverbal communication helps me to provide adequate care to her. She was trying to
understand some words, but according to me language barrier was the major challenge in
establishing the communication. It was not possible for me to communicate with her in her
language. According to Dent et al. (2017), understanding of a second language can help in

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providing proper care to the patient. It would be a great opportunity for me to evaluate her
conditions if I could make a verbal communication with the patient. She gave her feedback
by showing physical gestures. According to Weiss et al. (2016) receiving feedback plays an
important in understanding the patient’s medical condition.
Action plan
My action plan to achieve the goal is as following.
Specific (S) Improvement of nonverbal
communication and communication in
a different language
Measurable
(M)
It can be measured by communicating
with people speaking with foreign
languages.
Achievable
(A)
It can be achieved by joining
communication skill classes and
involving in practical situations.
Relevant
(R)
Communication is an important factor
to establish therapeutic relationship
with the patient.
Time frame
(T)
It will require three months to achieve
the goal.

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Issue 2: Inadequate Knowledge
Description
This is the first step of Gibbs model of reflection where I will describe the situation.
In this essay, I am reflecting on administration of intramuscular (IM) injection. The event
occurred during my first clinical placement. I was instructed to administer a drug to a patient
which required IM injection. Previously, I had an experience of using IM injection under the
supervision of my mentor. At this time, two qualified nurses were supervising me. One of my
supervisors helped me by providing a detail description of the process. The process includes
surface sterilization by using alcohol. However, the patient requested to avoid the alcohol
wipe as he had an experience of stinging sensation due to this. After discussing it with my
supervisor, I continued the process without the alcohol wipe.
Feelings
The presence of the two qualified supervisors made me self-conscious. I got tensed
when one of my supervisors asked me about the surface sterilization of the skin. Trust is an
important factor in nursing which can establish an adequate therapeutic relationship between
the nurse and patient (Rortveit et al., 2015). I tried to gain the trust of the patient so that he
became comfortable. I did not want my patient to think that I have no adequate knowledge of
this field. Application of alcohol on the skin before injection is a traditional process. However

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I was confused about its use in IM injection. Apart from that, I was not sure about the clinical
skills practiced by the supervisors, as it differs from my previous experiences.
Evaluation
70% isopropyl alcohol is applied in skin before injection to prevent bacterial
infections (Rutala & Weber, 2019). However, it is also reported that alcohol can cause
different skin allergies and stinging feeling in the skin (Wong, 2019). According to a study by
Kirk (2018), using alcohol swab in case of IM administration is not always required unless the
patient is immunocompromised. This made me think about the different clinical skills which
are reported in various literatures. According to Brockbank, McGill & Beech (2017), learning
through practice can help to enhance our understanding on different skills. I used the IM
injection in the glueteus maximus. It is the most commonly used site for IM administration.
Analysis
The major reason of the drug administration via IM injections is the high absorption
rate (Jin et al., 2015). In my clinical practice it is very common to use IM injections. This
situation helps to enhance my understanding on using alcohol swipes. I understood that both
professional practice and literature supports the application of alcohol swabs. However, my
professional experience taught me that alcohol wipes should be used if the patient requires it
or requested for it. This action might lack the supported evidences but I will use the available
information to support my practice. According to Brockbank, McGill & Beech (2017)
practical experience can enhance the understanding of the work. I will look for other
literatures which challenges the general clinical practice.
Action plan
The action plan is described by smart goal analysis

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Issue 3: Stress
Description
In this reflective essay, I am describing about my experience in my second week of
clinical practice. I was instructed to take intravenous blood sample from a 50 year old women
diagnosed with high diabetes mellitus. I have collected the intravenous blood sample in from
the patients previously. However, my supervisor described me a step by step process to
collect the blood sample. I felt nervous and anxious in that environment. As a result, I failed
to find out the median cubital vein for two times and injured the skin of the patient. Finally,
with the help of my supervisor, I successfully collected the sample.
Feeling
The practical hospital setup made me anxious about the patient. As the supervisor
described the whole process in front of the patient, she felt that some inexperienced person
Specific (S) Improve the knowledge on using
alcohol swabs in clinical practice.
Measurable
(M)
It can be measured by referring
published literature and discussing
qualified nurses.
Achievable
(A)
It can be achieved by participating in
different clinical practices and
studying the available information.
Relevant
(R)
It will help to develop better clinical
practice skills.
Time frame
(T)
It will require around two weeks
achieving the goal.

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was taking her care. Her facial expression indicated lack of trust on me. As I had observed
her, I got tensed. Trust is the most important factor to establish the therapeutic relationship
between patient and health staff (Rortveit et al., 2015). As I failed to find out the median
cubital vein at the first time, my nervousness got increased which leads me to another failed
attempt to target the median cubital vein. The disturbance was clear on the face of the patient.
She got upset and impatient due to this. My supervisor helped me to target the actual vein and
I collected the blood sample.
Evaluation
Stress is a related factor with the nursing practice which can affect better nursing
outcome (Sarafis et al, 2016). This incident occurred due to stress related to the workplace. In
medical practice it is a huge responsibility to provide proper care to the patients. A minute
mistake can lead to severe results. According to Wheelock et al. (2015), error in medical
practice occurred due to stress related to the work place. My anxiety towards the patient made
me to perform the task without proper planning. As a result, I failed to collect the blood
sample. My supervisor helps me to focus on the task and described me the techniques to find
out median cubital vein. It was not a difficult task as a nurse but somehow I failed to do it at
the first time.
Analysis
In case of adult patients, median cubital vein is the most common choice to collect
intravenous blood (World Health Organization, 2019). It can be found by touching the
crevice area of elbow and located in between the median basilica vein and median cephalic
vein (World Health Organization, 2019). The situation helps me to manage my stress and
provide proper care to the patient. It is important for me to control my stress so that the
patient can trust me during the process. Apart from that, stress induces the failures in the

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practice, which are not accepted in professional nursing. Hence, I need to focus on my work
and provide adequate care to the patients.
Action Plan
The action plan is described as following.
Conclusion
To conclude, it is understood from the mentioned reflection analysis that the
mentioned issue is commonly occurred in nurses involved in clinical practice. However,
regular involvement with the work can help to avoid such issues during professional practice.
It is important to avoid these issues in professional nursing practice, as this skills are highly
required for a professional nurse to provide adequate care to the patient.
Specific (S) Involve in stress management to
provide better care.
Measurable
(M)
It can be measured by solving
difficult situation accurately.
Achievable
(A)
It can be achieved by assisting my
supervisor in practical situations and
by taking stress management classes.
Relevant
(R)
It will help to provide better care to
the patients.
Time frame
(T)
It will require around three weeks
achieving the goal.

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Reference
Benbenishty, J. S., & Hannink, J. R. (2015). Non-verbal communication to restore patient–
provider trust. Intensive care medicine, 41(7), 1359-1360.
Brockbank, A., McGill, I., & Beech, N. (2017). Reflective learning in practice. In Reflective
learning in practice (pp. 18-28). Routledge.
Dent, M., Meade, P., Schmit, N., Troyak, T., & Weber, G. (2017). Bridging Barriers:
Multilingual Flashcard Use in a Nursing Home.
Jin, J. F., Zhu, L. L., Chen, M., Xu, H. M., Wang, H. F., Feng, X. Q., ... & Zhou, Q. (2015).
The optimal choice of medication administration route regarding intravenous,
intramuscular, and subcutaneous injection. Patient preference and adherence, 9, 923.
Kirk, A. (2018). Best practice technique in intramuscular injection. Journal of Paramedic
Practice, 10(7), 304-306.
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Rørtveit, K., Hansen, B. S., Leiknes, I., Joa, I., Testad, I., & Severinsson, E. (2015). Patients'
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studies.
Rutala, W. A., & Weber, D. J. (2019). Disinfection, sterilization, and antisepsis: An
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Sarabia-Cobo, C. M., Navas, M. J., Ellgring, H., & García-Rodríguez, B. (2016). Skilful
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