Critical Reflection on Leadership Nursing: Patient Scenario Analysis

This report is a critical reflection on a student's experience as a leadership nurse managing a patient, Freda Barnett, experiencing shortness of breath and other symptoms. The student details the application of clinical skills, including the ABCDE assessment, prioritization of nursing care, and the development of a therapeutic relationship. The report highlights facilitators and barriers encountered, such as the patient's age and difficulty communicating symptoms, and the student's own anxiety and lack of experience. The analysis section discusses the importance of patient-centered care and the need for accurate documentation and problem-solving skills. The student reflects on the experience using Gibbs' reflective cycle, identifying areas for improvement and outlining an action plan that includes further training, enhanced clinical knowledge, and improved teamwork. The report emphasizes the importance of evidence-based practice, effective communication, and the development of therapeutic relationships in providing quality patient care.

Running head: CRITICAL REFLECTION
CRITICAL REFLECTION
Name of the Student:
Name of the University:
Author note:

1CRITICAL REFLECTION
Description
Reflective writing is considered as a critical learning tool that integrates practical
skills and theory in order to encourage learning (Levett, 2017). This essay will highlight my
experience as a leadship nurse for the management and treatment of the deteriorating patient,
Freda Barnett, 62-years-old women. I was appointed to conduct integrated patient care by
developing a treatment plan, gathering and assessing the result of the treatment and also
manage the patient by appropriately implementing the evidence-based clinical practice
(Pisani et al., 2018). The patient was suffering from shortness of breath associated with cough
and lethargy; hence, I was accountable for ensuring that the patient is receiving safe and
effective care within the safety protocol and standards. As the patient was old and was
experiencing extreme breathing difficulty, I had to appropriately prioritise the nursing care
that would be suitable for the patient and make sure that the documentation was accurately
noted and was conveyed to the other nurses who were assessing the patient in different shift
(Barawid et al., 2015).
Feeling
I was very stressed and nervous at the same time because I had a huge responsibility
of taking appropriate care of the patient as well develop the therapeutic relationship with the
patient so that she could easily communicate her apprehensions with me. When I was
appointed for managing the patient, I was quite anxious as I have never handled any patient
with breathing difficulty. Although I had a clear idea of the steps that I need to perform for
effective patient management. After I met the patient, I was quite relieved as the patient was
supportive, and it was easy to develop a therapeutic relationship with her. I took assistance
from the senior doctor’s regarding the management and the systematic assessment of the
patient because it was my responsibility to asses her vital signs and accordingly reported to

2CRITICAL REFLECTION
the assigned specialist who was managing the condition of Freda. Hence, the current thoughts
and feelings regarding this case management had helped me to develop more knowledge and
understanding of managing the patient with breathing difficulty and performing the ABCDE
assessment.
Evaluation
Being a leadership nurse, I had faced some facilitators as well as barriers in assessing
the patient. The major barrier that I experienced was that the patient was old and was unable
to elaborate on the essential findings that she had observed like her sputum colour, which was
significant for understanding the severity of illness. Though, the situation was resolved
afterwards because I had performed a complete ABCDE systematic assessment for the patient
in order to understand the severity or complexity of the health condition (Feneley, Clarke &
Goldsack, 2017). The assessment had helped me to understand the diagnosis method of the
patient and what improvement steps should be followed for patient recovery. I was successful
in developing a therapeutic association with the patient, which had helped me to
communicate with her and understand her daily activities of life and accordingly identify the
areas of improvement.
According to Banzett & Moosavi (2017), dyspnea or shortness of breath is considered
as the multidimensional sensation, which comprises of unpleasant and painful respiratory
sensations that reduce the patients’ quality of life. Hence, it is essential for the nurse to
develop a therapeutic association and understand the respiratory sensation and the factors
which are responsible for the condition and aim to improve the patient’s quality of life. While
assessing the patient, factors like confidence, anxiety, lack of adequate experience and
knowledge had influenced my activity of documentation and problem-solving skills and also
affected my clinical decisions. According to Baker, DeSanto & Banzett (2017), shortness of

3CRITICAL REFLECTION
breath associated with lethargy is one of the most distressing health condition that must be
accurately evaluated and documented by the appointed nurse. The researcher stated that
accurate documentation would help the nurse to understand the flow of health improvement
and also locate the area that requires effective attention for enhanced patient health outcome.
Hence, I had to work and develop my documentation and problem-solving skills for my
future clinical practice.
Analysis
Effective patient-centred care (PCC) includes improved coordination, quality of care
and safety that will aim to enhance the patients’ health outcome, particularly for the elder
people living with complex health condition. I had received the patient handover from the
emergency department nurse based on which it was identified that the patient had a low-grade
temperature, and she was administrated with Panadol medicine for the management of her
body temperature. However, according to Ouslander et al. (2018), the patient suffering from
dyspnea associated with low-grade temperature must be administrated salmeterol or beta-
agonist medicine combined with phosphodiesterase-5 inhibitors, which will aim to neutralise
the body temperature. I adopted patient-centred care (PCC) for managing the patient and
devising her care management plan like making her comfortable, changing her sleeping
positions and delivering appropriate and best health assistance to the patient (Berliner et al.,
2016). From the detailed assessment of the patient, I also examine that the patient was not
performing any exercise or activity that would improve her breathing outcome which was
further deteriorating her health condition.
According to Yohannes et al. (2017), exercise therapy was recommended for the
patient who was suffering from shortness of breath to enhance the gas exchange and also
improve the breathing pattern. Resistance exercise training is the most widely used strategy

4CRITICAL REFLECTION
for managing the patient with shortness of breath that will also aid in improving their
psychological and physical need. I also evaluated that taking assistance from the patient’s
family members would have been a mindful alternative strategy for motivating the patient
and improving her lethargy condition. I had adequately focused on delivering person-centred
care as I had developed a therapeutic association with the patient and was also taking
assistance from the specialist doctor to manage the patient and administer the required
medicines to the patient as directed by them.
Conclusion
Developing a therapeutic association with the patient was helpful for me as I was able
to easily understand the apprehensions of the patient and also manage her daily activities of
life. Nursing education should include comprehensive preparation and training that will
motivate the nurse to become more competent within their clinical setting. Odell (2015),
suggested that the nurse must adapt accurate documentation skills and also watch clinical
skills videos that will help the nurse to conduct patient-centred care (PCC) and deliver
evidence-based clinical assessment. In future I would aim to improve my problem-solving
capabilities and avoid any clinical error that could result in adverse patient health outcome.
Action plan
Gibb’s model of reflection has assisted me to extensively evaluate my knowledge and
experience and identify my improvement areas. In future, I will adapt the systematic
assessment approach based on the articles that I examined for assessing the patient health and
their dyspnoea condition and hence focus on evaluating the patient health condition regularly
and also perform the ABCDE assessment until the patient is stable. I will attend the
leadership skill training program to enhance my interpersonal knowledge and skills. I will
improve my independent clinical knowledge for managing older people and aim to devise an

5CRITICAL REFLECTION
effective care plan for the patient including physical or psychological need and would
document the changes appropriately for future assistance (Duffy, Chapman & Buttaro, 2019).
I will also motive my fellow team members to focus on developing a therapeutic relationship
with the patient and guide them to adapt the evidence-based care for improving the health
outcome of the patient. I would also seek advice and guidance form my placement supervisor
regarding the management of patient with shortness of breath and what immediate action can
I take for managing such critically ill patients (Jones, 2019).

6CRITICAL REFLECTION
References
Baker, K. M., DeSanto-Madeya, S., & Banzett, R. B. (2017). Routine dyspnea assessment
and documentation: Nurses’ experience yields wide acceptance. BMC nursing, 16(1),
3. https://doi.org/10.1186/s12912-016-0196-9
Banzett, R. B., & Moosavi, S. H. (2017). Measuring dyspnoea: new multidimensional
instruments to match our 21st century understanding. 10.1183/13993003.02473-2016
Barawid, E., Covarrubias, N., Tribuzio, B., & Liao, S. (2015). The benefits of rehabilitation
for palliative care patients. American Journal of Hospice and Palliative
Medicine®, 32(1), 34-43. https://doi.org/10.1177/1049909113514474
Berliner, D., Schneider, N., Welte, T., & Bauersachs, J. (2016). The differential diagnosis of
dyspnea. Deutsches Ärzteblatt International, 113(49), 834. 10.3238/arztebl.2016.0834
Duffy, E. G., Chapman, K., & Buttaro, T. M. (2019). Shortness of Breath With
Activity. Case Studies in Geriatric Primary Care & Multimorbidity Management-E-
Book. https://books.google.co.in/books?
hl=en&lr=&id=dNaFDwAAQBAJ&oi=fnd&pg=PA117&dq=shortness+of+breath&o
ts=-WEqahQoT5&sig=n1Q6Fi66ou9gcVZbwrjGu4Zq88I#v=onepage&q=shortness
%20of%20breath&f=false
Feneley, A., Clarke, A., & Goldsack, N. (2017). Patient with shortness of breath. BMJ, 358,
j1661. https://doi.org/10.1136/sbmj.j1661
Jones, M. (2019). Shortness of Breath. Case Studies in Geriatric Primary Care &
Multimorbidity Management-E-Book. https://books.google.co.in/books?
hl=en&lr=&id=dNaFDwAAQBAJ&oi=fnd&pg=PA403&dq=shortness+of+breath&o

7CRITICAL REFLECTION
ts=-WEqahQoT5&sig=BcocoXGQJ2aXqxItwu8FiNladn4#v=onepage&q=shortness
%20of%20breath&f=false
Levett-Jones, T. (2017). Clinical Reasoning: Learning to think like a nurse (2nd Edition ed.).
NSW: Pearson Australia
Odell, M. (2015). Detection and management of the deteriorating ward patient: an evaluation
of nursing practice. Journal of Clinical Nursing, 24(1-2), 173-182. doi:
10.1111/jocn.12655
Ouslander, J. G., Engstrom, G., Reyes, B., Tappen, R., Rojido, C., & Gray‐Miceli, D. (2018).
Management of acute changes in condition in skilled nursing facilities. Journal of the
American Geriatrics Society, 66(12), 2259-2266. https://doi.org/10.1111/jgs.15632
Pisani, L., Hill, N. S., Pacilli, A. M. G., Polastri, M., & Nava, S. (2018). Management of
dyspnea in the terminally ill. Chest, 154(4), 925-934.
https://doi.org/10.1016/j.chest.2018.04.003
Yohannes, A. M., Junkes-Cunha, M., Smith, J., & Vestbo, J. (2017). Management of dyspnea
and anxiety in chronic obstructive pulmonary disease: a critical review. Journal of the
American Medical Directors Association, 18(12), 1096-e1.
https://doi.org/10.1016/j.jamda.2017.09.007