Final Year Nursing Programme: Reflection on Conscious Level Assessment

This assignment presents a nursing student's reflection on their experience with conscious level assessment during a practical placement. The reflection follows the Gibbs' reflective cycle, detailing the student's experience using the Glasgow Coma Scale (GCS) on a real patient. The student describes the initial instructions, feelings of empowerment, and challenges encountered during the assessment, particularly regarding interpreting spontaneous eye movement and motor response. The evaluation highlights the significance of the GCS in avoiding ambiguities and providing precision in patient care. Analysis reveals the need for further training and practice to improve accuracy and understanding of neurological conditions. The student concludes by emphasizing the importance of accuracy and completeness in the procedure and outlines an action plan to enhance knowledge and clinical judgment through in-service training. The assignment references relevant literature supporting the use and interpretation of the GCS.

Running head: REFLECTION
Reflection
Name of the student:
Name of the University:
Author’s note

1REFLECTION
Description
As part of my practical classes in the final year of nursing programme, I visited a hospital
and got the opportunity to learn about conscious level assessment. Instead of a dummy, it was the
first that that the assessment was done in a real patient. There were two supervisors with us and
they gave us instructions regarding the significance of assessing patient’s level of consciousness
and the common scale to measures consciousness level. We were introduced to the Glasgow
Coma Scale (GCS), which is a gold standard tool for assessment (Vink et al., 2018). After giving
theoretical knowledge on consciousness assessment, our supervisor asked use to measure
consciousness level of a patient and record the results in a sheet.
Feelings
I had learnt about the importance of regular monitoring consciousness and different tools
or scale available to measure. However, this experience was very useful for me as I was
overwhelmed by instructor’s teaching style. He was giving clear instructions and also making us
note common challenges that could be encountered during consciousness assessment. The
instructor’s way of knowledge sharing was very empowering and I started my activity on a
positive note. However, I faced challenges mid way during the process which made me aware
about the limitation of the tool.
Evaluation
My theoretical knowledge and the knowledge given by instructor made me plan the
assessment process. The significance of the instruction given by my instructor was that it made
me aware about the simplicity of the Glasgow coma scale. Before the experience, I was not
aware which scale is practically useful during assessment of consciousness. However,

2REFLECTION
instructor’s advice made me aware about the advantages of the tool. The key lesson was that
GCS is effective in avoiding ambiguities during assessment and giving carers better precision
and certainty during the procedure (AbuRuz, 2016). The GCS scale mainly measures three
subscales to assess level of consciousness in patients with brain injury. The three subscales
include eye opening, best motor response and best verbal response. The lower score in the tool is
3 and the highest score is 15 which indicates that the patient is fully alert and oriented (Jain,
Teasdale & Iverson, 2019). I made three columns in my work sheet and looked for other
subcategories of eye opening such as spontaneous opening, voicing opinion, opening of eyes to
pain stimuli. During process, I failed to interpret spontaneous eye movement. I missed recording
flexion in case of motor response too. However, I realized this after the instructor assessed my
GCS score.
Analysis
On reflecting on the process, I learnt that incorrect reading during assessment occurs
because of lack of understanding about changes in neurological condition of patient and their
link with consciousness level. Since it was my first time of using the GCS tool, I realized that I
may require more training and practice experience in this area. The evidence by Kimboka (2017)
affirms too that less understanding about neurological basis and clinical application of GCS leads
to errors during recording the GCS score.
Conclusion
Based on my experience of taking part in performance of conscious level assessment, I
learnt about the importance of the accuracy and completeness of the procedure. Since I missed
one of the points form motor response, it affected the overall score.

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Action plan
Based on the mistakes that I made during the assessment, I have planned to take part in
in-service training to gain knowledge about neurological basis for consciousness assessment.
This is also important to enhance my clinical judgment and increase my capacity for assessment
for unconscious or deteriorating patients.

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References:
AbuRuz, M. E. (2016). Simplifying Glasgow Coma Scale Use for Nurses. International journal
of Nursing Didactics, 6(01), 17-22.
Jain, S., Teasdale, G. M., & Iverson, L. M. (2019). Glasgow Coma Scale. In StatPearls
[Internet]. StatPearls Publishing.
Kimboka, J. J. (2017). Nurses’ knowledge and practice in the application of the Glasgow coma
scale in the intensive care units and emergency department at Muhimbili National
Hospital and Muhimbili Orthopaedic Institute, in Dar es Salaam (Doctoral dissertation,
Muhimbili University of Health and Allied Sciences).
Vink, P., Tulek, Z., Gillis, K., Jönsson, A. C., Buhagiar, J., Waterhouse, C., & Poulsen, I. (2018).
Consciousness assessment: A questionnaire of current neuroscience nursing practice in
Europe. Journal of clinical nursing, 27(21-22), 3913-3919.