University Nursing: Reflective Essay on Clinical Practice Experience

This nursing reflective essay critically examines a clinical incident involving a patient with delirium and communication challenges, using Gibbs' reflective cycle as a framework. The essay describes the situation, the author's feelings, and provides an evaluation and analysis of the incident, highlighting the importance of effective communication, psychosocial interventions, and patient-centered care. The author reflects on their actions, decisions, and the impact of the experience on their professional development, including the application of evidence-based practices and the development of a care plan in collaboration with a mentor. The analysis includes the importance of recognizing the patient's needs, and the application of communication skills in the clinical setting, and concludes with an action plan for future similar incidents.

Running head: NURSING REFLECTIVE ESSAY
NURSING REFLECTIVE ESSAY
Name of the Student:
Name of the University:
Author’s Note:

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Table of Contents
Introduction................................................................................................................................2
Description.................................................................................................................................2
Feelings......................................................................................................................................4
Evaluation..................................................................................................................................5
Analysis......................................................................................................................................6
Conclusion..................................................................................................................................9
Action Plan...............................................................................................................................10
References................................................................................................................................11

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Introduction
Reflection is an examination of their own experience using thoughts and cognitive
actions that involve contemplating and critical thinking for understanding the scenario and
making operational decisions in the future to address similar situations in life. According to
Rasheed, Younas and Sundus (2019), self-awareness is stated to be an evaluation process
conducted by an individual for consciously evaluating own behaviour, attitude and actions
that can be considered as strengths or limitations. As per the Royal College of Nursing, the
nurses are required to redirect their personal development on an on-going basis through
reflection. This paper intends to critically think about a particular incident that I encountered
and analyse based on the learning and professional development that has been achieved
through the course of training. The aspect of clinical decision-making and evidence-based
enhanced communication techniques and psychosocial interventions will be focused on
systematically for completing the essay. For a comprehensive approach to examining the
scenario, the use of Gibb's reflective cycle will be used as a guide that offers a
straightforward framework to explain my perception in a lucid manner. According to
Sekarwinahyu et al. (2019), Gibbs reflective cycle provide a structure of elucidating learning
from experience by examining them and using cyclic nature allowing to reciprocate them in
six different stages, description, feelings, evaluation, analysis, conclusion and finally
development of an action plan for dealing akin scenarios in the forthcoming incidents.
Description
During my clinical placement period, I had encounter both positive and negative
communication incidents that affected by practice. During a handover session, Joseph who
was suffering from delirium, poor vision and hearing ability and memory loss. At night when
the handover process will be taking, he approached the nurse for some reasons. He was found

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to be agitated and anxious because of some aspects that he wanted to talk about. The nurses
in the office was not ready to hear him out as a result, they raised their voice and asked him
to return to his ward. They shouted at him and later laughed at the situation in front of him.
They even mimicked him because he was not collaborative while they attended him in the
past. I was present there however, was unable to protest against my seniors because of their
position. I decided to help him and went to him and offer to assist in making his bed. He was
defensive and did not wanted my help initially. He misbehaved and was irritated because of
my presence. I still supported him and did my best to resolve his queries and issue. He felted
at ease and shared his concern and the reason of misbehaving. He stated that no one took him
seriously as a result, he was not comfortable in anyone’s presence.
With knowledge of the Nursing and Midwifery Council, policies and regulation of the
mental healthcare setting, I decided to have a session with Joseph prior to planning his
medication or course of action (Nmc.org.uk 2020). When I was about to enter his room, I saw
he was anxious and was looking about as if someone was there. When I intervened in the
situation, he behaved normally as if there was no one. A colleague asked him whether he was
talking to someone, he became agitated and rudely said, ‘Do you see someone, if you can’t
then there is no one.’ I understood that he was conscious of this matter and decided to use
communicational strategies to mitigate the issues. With dignity and respect, I tried to develop
a strong therapeutic relationship with him and asked other members not to involve in this
case (Robertson 2019). This reassured Joseph that I was giving him space and time. His
mental state was superficially calm and, thus, voluntarily reciprocated to my queries. He
slowly opened up and categorically described this problem without any hesitation. I felt that
he was not able to express his feeling to anyone because he feared being judged. After the
session, he stated that he was feeling better prior to the session. From time-to-time, I used
interventional therapy based on his unpredictable attitude toward nursing practitioners and

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other service users. This allowed in providing him information about the dosage and its
impact on him. I was able to offer him a relaxed environment that helped him to open up.
I discussed all the details of the interventional session with my mentor and with his
support a care plan was developed. After the meeting, I evaluated the criticalness of the
situation and decided upon the treatment process. The use of communication, along with a
collaborative approach from family, friends and healthcare professionals, was used to treat
him. According to Jackson (2018), delirium does not have any permanent cure; however, it
can be managed to a controllable state and after three months, he was discharged from the
hospital.
Feelings
From this particular section of Gibb’s reflective cycle, a systematic review of my
feelings, actions and both positive and negative aspects of the situation were assessed
(Hilliard, James and Batt 2017). After the session was over, I reported the entire proceeding
to my mentor. He critically assessed all the diagnostic criteria and shed light upon the areas
that I need to focus on. This was an opportunity for me to learn as well as apply my studies of
the three years course work of nursing in the clinical practice. When he called me and said
that there is a case that I was going to led, I felt extremely obliged and decided to meticulous
work on the case before even attending the patient. With mixed feelings of nervousness and
apprehension, I decided to use my understanding in the case. As per the study of Boekaerts
(2016), feelings and emotions are vital parts of a learning process and understanding them
will be useful in catering to the needs and demands of the patient. I understood that he was
irritated because people did not valued him and thus, I utilised my communication skills and
knowledge from clinical practice to address the issues. After a thorough examination of the
case, I sensed that underlying psychological stress exists that was intense in nature because

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he was unable to communicate effectively. As a part of good practice and evidence-based, I
decided to involve his family members in the treatment. The approach was effective as
slowly; signs of improvement were observed (Brockbank, McGill and Beech 2017). One of
the major factor that was ignored by the other nurses were his poor eyesight and hearing
ability. This was the reason because of which, he was unable to hear the instructions and
conduct them in a proper manner.
The incident gave me a sense of sheer joy and achievement that boosted my
confidence level and feedback from my mentor encouraged me in professional development.
From this experience, I learned a great deal of things from the basic handling of people with a
mental health condition, to use effective communication strategy in practical situations. I
independently took decisions, escalated the given scenario of agitated behaviour,
communication and leadership. The ability to make decisions autonomously was one of the
objectives that I had while I was in the first year as a nursing student (Nibbelink and Brewer
2018). At this stage, I am more confident and slowly moving toward understanding the
advanced stage of clinical practice that the registered nurses use. This training is one of the
most critical experiences of my life because it helped in attaining competency and
proficiencies in nursing practice. As a nurse the development of competencies and skill of
reflective practice can be considered as vital.
Evaluation
According to Edwards (2017), reflective practices allow the nurses to make sense of a
situation and, thus, improve the care. It is considered as one of the critical skills for nurses
and regular engagement of reflection support the practitioners to manage the professional and
personal influence of addressing the needs of the patients as well as focusing on the
fundamental health and well-being of those patients. In this particular incident, it can be

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stated that the improper attitude and behaviour of people toward Joseph was the prime reason
that leads to ineffective communication. He was unable to share his feelings and emotion
during the onset of the disorder that slowly developed into an acute mental illness.
Analysis
In this section, the entire incident, feeling, emotions, action undertaking, strengths,
limitation and legal issues associated with it was analysed. According to Ludwin and Meeks
(2018), psychosocial intervention is therapies used to support people to restore the balance in
a healthy manner when he or she gets disconnected from society.
During his admission to the hospital, the staff did not readily understand him as a
result of which demonstration of violent behaviour was found. As stated by Wang et al.
(2018), the importance of effective communication cannot be denied because it plays an
influential role in the healthcare experience of patients and it helps the nurses to work in the
setting effectively. The transfer of information among the healthcare professionals and
patients need to be efficient, precise and include either written or verbal communication that
is invaluable in nature (Nilsson, Törner and Pousette 2018). As found in Joseph’s case, the
initial issue was the identification of the exact problem that was only possible with an
accurate transfer of information and thoughts from the perspective of patients. The
collaborative team efforts were found to be an effective aspect of offering care and support to
a mentally ill patient. By developing a professional relationship with Joseph, I was able to
extract a large amount of information that helped my mentor and me to evaluate the situation
and diagnosed the disease. It was found that Joseph was diagnosed with psychosis, where an
individual experiences sensations that do not exist in reality. Clark et al. (2017) opined that
the most common symptoms of the disease are hallucination and delusional episodes that led
to hearing voices and feeling the presence of an unknown entity. Joseph was sure of the fact

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that no one believes him as a result; he responded with violent and aggressive behaviour. As
we entered his room, I wanted to have a confrontational session with him to gain information;
however, when he behaved rudely with one of the team members, I thought my approach
would further worsen the scenario (Johns 2017). I was unable to assess the signs and
symptoms reported by the night staff and, thus, thought of addressing the situation with a
wrong approach. On examination, I understood that I did not have any clear discernment in
handling such a situation thus, it affected my decision-making ability. From my professional
clinical development, the risk assessment was not upgraded in order to address such a
situation and therefore, I had to report to my mentor for assistance. I felt gratified that I was
supported by him because, without his guidance, I would not be able to treat the patient with
success. Moreover, the use of evidence-based intervention needs to be performed in such
cases as the patient wants someone to comprehend their situation rather than being judged.
As per the National Institute for Health and Care Excellence (NICE) guidelines and Nursing
and Midwifery Council Code, the importance of debriefing laid emphasis on the theoretical
concepts. However, I was unable to abide by the codes of conduct and ethical aspects, as no
documentation or post-incident template was being filled. From the opinion of Dreifuerst
(2017), the significance of the post-incident report is stated that address the harm, risks and
emotional impacts of the particular incident and provide a prospect for the nurses to assess
history to act on a case. The application of communicational intervention is found to be
common in case of social disorder, prevention of relapse episodes and cessation from
substance abuse. From the case, it is evident that the use of this intervention was useful in
Joseph’s case as it targeted behavioural, biological, emotional, interpersonal, cognitive, social
and environmental factors to focus on improving the health and well-being (Webster, Ekers
and Chew-Graham 2016). As a nurse, I was not responsible for treating him however, my
role was to address his emotional challenges that he was facing in the hospital and mitigating

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them. From the analysis of the case given, it can be stated that the belligerent and antagonistic
behaviour of Joseph was due to his underlying condition. From the evaluation of my clinical
experience and skills used in upon treating Joseph, I came to various known intricacies of
nursing practice and professional development. I was able to acknowledge the use of routine
nursing interventional strategies that is prevalent in a specific case. From the understanding, I
can state that there is no particular pathway that needs to be followed during treatment; this is
because of the diverse need of the patient that does not allow the same treatment to be
followed. In this case, the use of evidence-based practice was appropriate in the case of
Joseph as it helped in gaining information and making a decision based on his situation. In
addition to this, the practical interpretation of various cases requires theoretical knowledge on
pharmacology as stated by the physician in-charge, nursing practices, effective
communication skills, ethical and legal standards and hands-on training (Suveg et al. 2018).
The individual needs to have awareness, education and zeal to act according to the
environment during the training. This intends to offer involvement in engaging with patients
and making appropriate clinical decisions that would affect the outcome of patients. The aim
of the interventional strategy used on Joseph was to improve the behavioural aspect, improve
emotional response and engage him with society.
From the analysis of the observation at the time of administering, the case allowed in
gaining knowledge of delirium commonly faced by the people. As per the current researches
conducted in this particular aspect, it can be stated that multi-dimensional approach was
required in treating the patient that include medications and communication that helped in
addressing a different areas of the broad syndrome of the disease (Taipale et al. 2018). The
most predominant goal of my treatment was envisioned to effectively address the issue by the
management of the symptoms to the lowest dose. One of the most detrimental impacts that a
patient exhibits are aggressive behaviour that may be harmful to other service users or

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practitioners that may complicate the situation to a severe extent. In order to control it, the
use of physical restraint can be used, which has ethical implications. As per the NMC
guidelines, it is specified that the nurses need to identify and minimise the risk, conduct in a
professional manner with knowledge and competencies for offering care to patients. The
Code of Professional Standards of practice is another important aspect that asks the nurse to
conduct inline and with the best possible evidence (Kielo et al. 2019). The guidance used in
Joseph’s case for administering medication, therapy and other aspects should be safe and
accountable in nature. With the knowledge of my shortcoming, I will be able to be more
focused in addressing the issue in such a manner that I do not repeat the same mistake
repeatedly and contemplating each of issue demonstrated by the patient without ignoring any
secondary one, which can be later found to be the most significant. Therefore, it was one of
those experiences turning a novice into a professional nurse. I need to accumulate knowledge
and understanding of developing in both professional and personal areas. I personally took
time from my placement to help him gaining more information about the signs and symptoms
of the disorder and helping him to become comfortable to the unfamiliar environment that
was difficult for him to adjust. The uncertainty of the diagnosis and management is noted to
be the major factor in loss of personal space that affected his independence and privacy to a
large extent. Since Joseph was uncertain, she was unable to comprehend the purpose of
admission to the care setting and thus, made him behave the way he was in due course of
time.
Conclusion
From the practical experience in the placement course, I gain gained understanding
and knowledge of a varied and diverse field in nursing practices. It made me become more
conscious, sensible and acquainted with the care process in order to caters to the complex
need and adapt in the challenging situation demonstrated by the service users. From the

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reflective piece of information that involves Joseph’s incident, I can state that it was an
insightful experience that allowed in understanding my weaknesses and strengths that may
affect my practice in later life. The findings stated that the reason of Joseph being upset and
the reluctance of the nurses to help him was same and thus, communicational issues was
occurring that affected the quality of care. He was unable to emote his feelings and emotions
to any of the healthcare professionals, thus apprehending the value and behaviour of the
client was done. One of the most predominant learning in critical reflection was the
systematic process that helped in examining various components and issues that may have
prompted the incident. It helped in diving deep into the issue and extracting various aspects
that may not allow in understanding the root-cause. The key element of the intervention was
the development of a therapeutic relationship with Joseph that facilitated an effective flow of
information enabling in assessing the condition from a holistic perspective. I learned that
being calm and positive help in reducing the anxiety level of service users. I will apply this to
future incidents.
Action Plan
From evaluating the entire incident, I need to focus on improving the limitations by
developing an action plan. The most important hindrance was communication skills that
required to be improved. Therefore, I need to conduct a study pertinent to my area of work, as
I understood that effective communication could be a tool that can win half of the battle. In
addition, communication with my mentor and colleague is also important, as an integrated
and collaborative approach of care is always preferred in mental health care. Moreover, I
need to focus on quality improvement using the PDCA (plan–do–check–act) cycle that will
be continuously assessed from time-to-time to improve my competencies, skill and
knowledge to assimilate information and help me in decision-making and use of the
evidence-based practice in my work.

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