Nursing Case Study: Reflecting on a PEP Experience and Future Practice

This report presents a critical reflection on a nursing student's experience during a two-week hospital placement (PEP), focusing on a challenging clinical scenario involving taking a patient's blood sugar level (BSL). The reflection utilizes Driscoll's model to analyze the experience, addressing the 'What,' 'So What,' and 'Now What' questions. The student describes the encounter, their feelings at the time, and the actions taken, including instances where they struggled with communication and documentation. The 'So What' section analyzes the event, highlighting areas of success and areas for improvement, such as obtaining patient consent and improving communication skills. The 'Now What' section outlines the main learning points, including the importance of patient consent, effective communication, and meticulous documentation, and identifies strategies for improvement in future clinical practice, such as carrying a notepad for documentation and practicing therapeutic communication. The report emphasizes the importance of critical thinking and continuous improvement in nursing practice. The student also highlights two key areas of improvement: therapeutic communication and documentation and provides strategies to improve these skills. This reflection aims to identify and develop strategies to improve clinical practice and ensure positive patient outcomes.

Standard 1.2 requires you to develop practice through reflection on experiences, knowledge,
actions, feelings, and beliefs to identify how these shape practice.
This assessment task requires you to critically reflect on a clinical scenario/encounter in which
you were involved in your PEP and its influence on your future practice. Driscoll's reflective
cycle should be used with a clear delineation between the three reflective steps.
1. During your PEP select a clinical scenario/case study in which you were involved, which will
become the foundation of your case study reflection.
2. Write a short (1200 word) paper in which you reflect upon your experience and its influence
on your future practice using Driscoll’s Model of Reflection as a framework. You should
identify at least two key areas within your practice in which you can improve and strategies you
can put in place to achieve positive outcomes in your next PEP.
What: In this section, give a thorough description of the clinical scenario/encounter. This should
be something that challenged you on a professional or personal level whilst undertaking your
first PEP.
So What: This is an analysis of the event. How did you feel at the time and is this different to
your feelings after the event? What did you do well and what could you have done better? What
were the effects of what you did or didn’t do?

Now What: You should identify what is the main learning you took from reflecting on your
practice? What are the implications for you in future clinical practice based on what you have
described and analyzed? What two key areas within your practice can you improve and what
help/strategies can you identify to assist you to modify your practice if a similar situation arises
in your next PEP?
Reference List:
A reference list demonstrating relevant reading must be included. Both in-text references and the
reference list must adhere to Harvard referencing guidelines
 Please note I have already created a draft reflection (Below) with the real
scenario/experience I gained during the placement. Please use that draft to understand
and reflect my experience during the Placement.***Please go through the red text in each
section:"What, so what and Now what"?
 Please carefully follow the marking rubric below.
 Please follow the attached Harvard guideline (PDF file) strictly.


Marking Rubric

DRAFT
Assessment 2: Case Study Reflection Template
Introduction:
The purpose of the case study reflection is to review my experience and skills gained during the
two weeks of hospital placement as a first-year nursing student. I have encountered positive and
negative scenario which has challenged me as a student nurse. During the placement, I learned
the most valuable lesson to think critically to identify problems or issues in nursing practice that
may be investigated through research. For improving my practice in future and developing
strategies to achieve a patient outcome, which explains about the standard of nursing and
midwifery board accreditation (NMBA). I have chosen Driscoll's model of reflection to reflect
my experience on the headings: what? so what? and now what?
What? Description of the clinical situation/encounter that was confronted on the professional
and individual level while undertaking the initial PEP
During my two-weeks placement, in the morning shift, all Registered Nurses (RN) were caught
up with attending to Activities of Daily Life (ADL), administrating medicine, taking vital signs
and blood sugar level (BSL) of their patients. I was confident in attending to a patient with ADL.
My roles were bed making and taking of vital signs (manual blood pressure, temperature, pulse,
heart rate) as I have some experience as a health services provider in an aged care facility.
Nevertheless, at the end of the first week, I had the chance to administer oral medication under
the supervision of RN (Chia-Wei 2016, p. 10). My supervising RN asked me to take the vital
signs including BSL from one patient who was 62-years-old presented to the healing facility
after falling in her garden resulting in a cracked right shoulder. My challenge was taking BSL on

a patient under the supervision of RN. It was my first patient so I was feeling little nervous and
excited about the opportunity. I went to patient's bedside and without taking consent prepared
myself for taking vital signs. I greeted the patient and manual started taking the blood pressure,
temperature, pulse, heart rate and BSL. My supervising RN reminded me to take consent before
each procedure (Islam 2016, p. 36). It was the first time in my life I was taking a BSL on a
patient in a real scenario. The NSQHSS included decision making, development of care models,
and measurement and evaluation of services. Other roles were the responsibility for safety and
quality, education and individual performance of duties. The standard 7 on blood and its products
directed me in following the implemented system of efficient, effective, safe and appropriate use.
My role was mostly in procedure matching and patient identification (Safety and Quality 2017,
p. 4). At a time, I pricked the patient’s finger but could not get out the blood and a repeat of the
procedure on another finger was still unsuccessful. After several attempts, the patient seemed
agitated and I could not reassure her. My poor communication skills necessitated the seeking of
help from my supervising RN. As I was taking the BSL, I forgot to record the patient’s vital sign.
Documentation is most important in nursing practice and for this reason, my supervising RN had
to redo the procedure again. The supervising RN questioned my placement asking me if I was
still sure I wanted to become an RN. I took this event as a learning curve. According to Nursing
standard 2, I needed to maintain a therapeutic relationship with both colleague RN and patient,
but I was unsuccessful to maintain effective communication. When messages are received, they
are interpreted to give a response between the practitioner and the patient (Ferris-Taylor, 2017).
Event analysis: The feelings at the time of practice, feelings after the event, things are done
well and those that could be done better, and the effects of what was done and what was not

done. What was done well and what could have been done better and the effects of what was
done and those of what was not done.
On the earliest time, I became nervous and was occupied by doubt, fear, and panic. This situation
filled the entirety of my first week in hospital placement. Most of the RNs and educators were
helpful and positive; however, they were too busy but did not hesitate to answer all my
questions. This way, my placement was a relief. On the first week, my roles were bed making,
showering the patient, grooming of the patient, feeding the patient, communicating with the
patient and serving the family with advisory services (Islam 2016, p. 36). All the care roles were
in line with my learning objectives (NMBA). I was glad and did every task thoroughly. On my
second week, I got opportunities to take a vital sign using Manual Blood Pressure conducting of
urinalysis, wound dressing and oral medication. Observation and inserting cannula were great
experiences and gave me the “nurse” feeling. While taking vital signs, I was tasked to take Blood
Sugar level (BSL). According to National Safety and Quality Health Standard, the clinical
workforce will record patients’ blood and its products, document the transfusion history and the
indications for use (NSAQHS and standard 7). At times, I was helpless and unable to reassure
myself on my confidence level and I even forgot to document the assessment. I should have
written it down on my notepad to enhance my memory and provide the information to the RN
(Islam 2016, p. 36).
According to Registered Nurses Standards for Practice, RN’s conduct systematic and
comprehensive assessments in analyzing information and data and communication of the
outcomes as a basis for practice. Practice and behavior are defined by the professional standards
and are the guidelines to professional boundaries, ethics codes, conduct codes and competency
standards. (Nursing Midwifery Board 2017, p. 1). My worst mistake was forgetting to get

documentation done for the clinical BSL, which means pretty much have to prove I have
actually done the intervention. The consequence of non-documentation is the creation of a barrier
to effective and safe transitions (NCBI 2017, p. 1). Anytime I noted a new abnormal condition
on assessment of the patient’s situation, I properly documented the information about the
deteriorating patient. I could have written it down on my notepad so that RN does not have to go
and reassess the BSL.
My other challenge was with communication. Where I realized that I failed to communicate with
a 62-year-old patient who was diabetic for 10 years. While taking BSL, the supervising RN
reminded me the need to get the consent of the patient because I had not done so. Informed
consent is directly related to enhanced observance to medication, prevention of errors, improved
health outcomes, improved communication and realistic expectations, and fewer claims of
malpractices (NCBI 2017, p. 1). Actually, I was nervous at the situation and forgot to get the
patient’s consent. I started pricking her finger to get a drop of blood but failed. Patient consent
is important in any nursing profession. It is required that the patients must be informed of the
purpose of the evaluation.
Communication is the process through which a meaningful exchange takes place between at
least two people to convey needs, thoughts, facts, opinions, information, and feelings through
verbal and non-verbal means and includes face to face interaction and the written words (DH,
2003).
The reflection on my practice helped me to evaluate my confidence, challenges and develop a
proactive approach in seeking for higher professional assistance to develop self-reliance in my
skills. A flaw was also present in maintaining confidence in new and challenging circumstances

and recognizing the factors that posed to influence this situation as a student (Chia-Wei 2016, p.
10).
Now What?
Main learning is taken from reflecting on the practice and the implications for the clinical
practice in the future
In my future career taking BSL, I will be careful to get consent from the patient for respect and
dignity. Reflection provided the opportunity to think and act professionally enabling the
refreshing and update in skills, knowledge, and framing and creation of solutions to complex
healthcare problems (Citeseerx 2017, p. 19). I encountered challenges while taking BSL without
patient consent and during documentation, which I must improve in next placement by being
careful. I improved my confidence while doing bedsides and ADLs in this placement. I will
review my weaknesses in communication to improve my skills by listening to professional
handovers from practicing ISBAR /ISOBAR for future placement.
I would strengthen my skills in taking care of the patient and exercise critical thinking while
attending to the patient. I have realized that I need to identify strategies to improve my practice
by thinking critically about future placement (Penny, 2006). I have learned new perspectives
from this placement for my present and future courses of action will be that I need to document
the patient's vital sign which because of its importance in assessment. In the future, I must be
carrying a notepad to keep every important note needed to be recorded.

My other key area of improvement in my future placement is therapeutic communication. I
found it frustrating that I was unable to form relationships with both the supervising RN and the
patient as required.
Research evidence indicates that willingness to listen and explain is considered by patients to be
one of the essential attributes of health professionals. It is therefore vital that health professionals
communicate effectively with the patients and peer professionals during a transition, assistance,
and advice.
Finally, the IRM specifies the six communication modes which form the basis of a therapist's
interpersonal approach, that is, collaborating, encouraging, problem-solving, advocating and
empathizing and instructing. For this reason, I have felt the importance of developing
assessments that would provide a measure for these modes (Chia-Wei 2016, p. 10).
Conclusion
In summing up, my clinical nursing experience presented the opportunity to practically work on
patients and gain experience about the work environment. Whenever I will encounter a fresh
challenge, it will be an opportunity to develop new skills that require the development of practice
through reflection on knowledge experiences, beliefs, actions and feeling to review my abilities
and confidence (Standard 1.2, NMBA). As a health service professional, I have to ensure that
each principle of legal and ethical practice is followed to the latter so that I perform my

professional duty with more effectiveness. I have to develop and improve my reporting and on
the ethical issues that may arise in my area of practice.

References
Islam, R 2016, 'My non-verbal communication skills made a big difference', Nursing Standard,
vol. 30, no. 46, pp. 36.
Penny, H 2006, 'Fundamental nursing skills', 2 ed. New Jersey: John Wiley & Sons.
Taylor, F 2016, 'Assessing therapeutic communication during rehabilitation: the clinical
assessment of modes', American Journal of Occupational Therapy, vol. 70. no. 4, pp. 10.
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6CAB2?doi=10.1.1.473.8763&rep=rep1&type=pdf>.
Ncbi, 2017. www.ncbi.nlm.nih.gov, viewed 4 October 2017,
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714367/>
Ncbi, 2017. www.ncbi.nlm.nih.gov, viewed 4 October 2017,
<https://www.ncbi.nlm.nih.gov/books/NBK133402/>
Nursing midwifery board, 2017. www.nursingmidwiferyboard.gov.au, viewed 4 October 2017,
<http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx>
Safety and quality, 2017. www.safetyandquality.gov.au, viewed 4 October 2017,
<https://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard7_Oct_2012_WEB.
pdf>