Nursing Reflection and Professional Practice: A Detailed Analysis

This essay presents a reflective analysis of a nursing student's experience communicating with a medical officer (MO) during a clinical placement in an oncology department. The student recounts a specific incident where they struggled to communicate patient observations, particularly concerning a patient undergoing chemotherapy, and reflects on the feelings of nervousness, regret, and the positive impact of empathy from the MO. The essay evaluates the experience, identifying the negative impact of self-criticism and the positive aspects of empathy and understanding. The analysis emphasizes the importance of clear communication, the use of handover tools like ISBAR, and the development of interpersonal skills for effective professional relationships. The student outlines strategies for future practice, including using the ISBAR tool and practicing empathy, to improve communication with healthcare professionals and enhance patient care. The essay highlights the importance of these skills for nurses transitioning into professional practice and adhering to nursing standards.

Running head: NURSING REFLECTION AND PROFESSIONAL PRACTICE
NURSING REFLECTION AND PROFESSIONAL PRATICE
Name of the Student:
Name of the University:
Author note:

Introduction
In addition to engagement in patient centered therapeutic relationships with patients and
families, nurses are also required to engage in professional conversations and communication
practices with various inter-disciplinary healthcare professionals. Medical officers of any
organization comprise of a hospital’s supervising doctors and thus need comprehensive patient
details from nurses to ensure deliverance of robust patient treatments (Chua et al., 2020). The
following paper will be based on a reflection of scope of personal as well as professional
improvement with regards to opening conversations with medical officers during discussion of
abnormal patient parameters. This reflective paper will also briefly expound upon the key
outcomes acquired from this self-evaluation practice and the strategies which will be considered
with regards to future professional practice.
Personal and Professional Self-Reflection
Description: One of my first experiences with engaging in a conversation with a medical
officer was during my previous clinical placement as a graduate nurse where I was assigned to
the oncology department. Under the supervision of my supervisor – a Registered Nurse – I was
assigned to a 40 year old woman with breast cancer who was undergoing chemotherapy. In
addition to being entrusted with responsibilities of preparing and managing the daily handover,
assessments, hygiene and self-care requirements of the patient, I was also required to
communicate daily screening results and prevalence of any progression or deterioration to my
supervisor, who in turn, would evaluate my performance. However, it was observed that the
patient was heavily experiencing cachexia in response to the treatment and was found to
demonstrate a number of abnormal clinical observations like excessive loss, bleeding and
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thickening of breast tissue. There thus, arose a need to transfer her to another healthcare
organization specializing on cancer treatment. To my surprise, my supervisor requested me to
communicate these findings to one of the medical officers (MO) of the organization – a reputed
oncologist, regarding these clinical observations and the need for her transfer. I was extremely
nervous and during the conversation I completely fumbled and seemed to lose track of my
words. The MO was however kind enough to understand that I was new and persuaded me to
calm down and take my time. While I managed to recover my composure and communicate all
the necessary details, I did encounter a range of thoughts and feelings during this situation.
Feelings: One of the most prominent feelings which I encountered was nervous. I was
indeed extremely nervous regarding how to present the clinical observation. However, after
closely being mindful and reflective of my own personal thoughts, I came to the conclusion that
my main cause of fear was a personal expectation that I must present myself to the MO with
professionalism and credibility. The inability to the same and instead fumble initially also
contributed my feelings of regret, guilt and shame after the incidence. Indeed, it has been
evidenced by Khamisa, Peltzer, Ilic and Oldenburg (2017), that personal expectations of learning
and feeling of duty towards one’s responsibility can often aggravate into unrealistic goals and
thus result in fear and guilt. This experience thus demonstrated that the need to attend to nursing
professional standards of maintaining professional and therapeutic communications with
healthcare professionals beyond my scope of practice were important to me and was an aspect I
wanted to improve upon during my transition to professional practice.
Another key thought and feeling which I encountered was the realization that empathy
and reassurance from the MO assisted me to complete my clinical observation handover
effectively. Indeed, it has been evidenced by Choi, Lee and Kim (2019), that interpersonal
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communication skills like empathy largely assists in generating meaningful and comprehensive
professional relationships across patients as well as across healthcare professionals. Thus, this
experience facilitated my understanding that maintaining sound interpersonal and empathetic
conversations are important of maintaining therapeutic relationships with patients as well as
healthcare professionals. This understanding has further prompted me to adopt these principles
while communicating with my peers and the multidisciplinary team members of relevant
healthcare organizations after transitioning.
Evaluation
The above reflecting insights prompted me to evaluate the positive and negative aspects
of this experience. One of the negative or bad experiences which I encountered were my
nervousness and as a result my inability to communicate the patients’ clinical observations to the
MO. A key reason for this my overly critical perception of myself and my personal expectation
of strictly adhering to a sound, comprehensive and robust professional discussion with the MO. It
has been evidenced that self-criticism or unrealistic personal expectations can often result in
nervousness and hindrance to communication or performance (Magtibay, Chesak, Coughlin &
Sood, 2017). In criticism however, it has been also been evidenced that positive self-perceptions
and criticism in the form of mindfulness and reflection can pave the way for self-improvement
(Kelly & Adams, 2018). However, placing unrealistic expectations on oneself can largely
contribute to issues like nervousness, stress and compassion fatigue in healthcare professionals
which in turn, can increase risk of medical errors (Büssing, Falkenberg, Schoppe, Recchia &
Poier, 2017). Indeed, my nervousness and inability to communicate almost resulted in a loss of
valuable patient information being communicated to the MO. Thus, upon evaluation of this
experience, I learned that avoidance of unrealistic expectations and comprehensive handovers are
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essential to deliver a complete, professional and efficient communication to an MO regarding a
patient’s clinical observations and thus avoid errors in the process.
A key positive experience which I encountered was the display of empathy and
understanding by the MO during my inability to communicate effectively. This is because, it is
only after the MO had empathized with my situation that I was able to communicate effectively
the abnormal clinical observations of the patient I was assigned to. It has been evidenced that
implementation of interpersonal communication skills like empathy assist healthcare
professionals such as nurses in terms of reduced feelings of fatigue, stress and anxiety (Duarte,
Pinto-Gouveia & Cruz, 2016). This in turn, can pave the way for nurses to deliver efficient
clinical interventions and in turn, reduce medical errors and contribute to overall professional
development during transition to nursing practice (Vioulac, Aubree, Massy & Untas, 2016). This
in turn will assist me to adhere to standards 1.1 and 1.2 of the Nursing and Midwifery Board of
Australia (NMBA, 2016), which informs nurses on the need deliver optimum evidence based
practice. Thus, upon evaluation of this experience, I learned that engagement in positive
communication skills of empathy can assist me in maintaining positive interpersonal
relationships with not just the future patients but also the healthcare professionals I will be
engaging in as I transition to professional practice. This, in turn will also assist me to adhere to
NMBA (2016) standards 2.2 and 2.3 which informs nurses to deliver respectful conversations for
the purpose of maintaining therapeutic professional relationships with healthcare professionals.
Analysis
Thus, based on the reflective findings above, the need for me to be less self-critical
towards myself is an important aspect which I could make sense of. It has thus been evidenced
that assertively communicating one’s needs and doubts to supervisors can provide better clarity
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on the areas of nursing improvement future nurses can work upon rather than being self-critical
(Gao, Newcombe, Tilse, Wilson & Tuckett, 2017). Thus, I realized that instead of being overly
critical of myself, had I communicated my doubts to the MO or even my supervisor first, then I
would have been to deliver a better handover to the MO.
Additionally, another aspect which I could sense of in this situation is the importance of
being compassionate and empathetic towards the needs of others and how the same can greatly
improve the practice and confidence of transitioning nursing. Indeed, it has been evidenced that
newly enrolled nurses transitioning to professional practice encounter feelings of stress and role
ambiguity which in turn greatly impacts their performance (Jeong, 2017). Thus, inclusion of
such positive interpersonal skills by senior nursing and clinical personnel can greatly assist
newly enrolled nurses in confidently delivering clinical interventions without errors during future
practice.
In addition to the above, another key sense which I could decipher regarding this
situation is my absence of engaging in any form of comprehensive handover tool while
communicating the abnormal clinical observations to the MO. The usage of an effective clinical
handover tool has been evidenced to be beneficial in directing nurses in delivering patient
assessment results in a professional, comprehensive and empathetic manner (Pang, 2017). Thus,
a key activity which I could have done better is to communicate to the MO using a
comprehensive and evidence based handover tool like the ISBAR or Introduction, Situation,
Background, Assessment and Recommendation tool developed by the Clinical Excellence
Commission (CEC, 2020) of the New South Wales Government of Australia. The ISBAR
handover tool has been evidenced to be a useful, convenient and beneficial way in which nurses
can communicate patient details by maintaining sound positive and therapeutic relationships
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(Foronda, Walsh, Budhathoki & Bauman, 2019). It is thus imperative that I also include the same
in my future practice as I transition into professional environments in the future.
Strategies for Practice
If met in the future with such a similar situation, one of the major strategies which I will
include as a part of my action plan is the inclusion of a nursing handover such as that of ISBAR
when communicating to medical officers any abnormal patient observations. Thus, as per the
sane, during future communication with a medical officer, I will firstly introduce myself, the
patient’s situation and background, the key assessment results and lastly recommend intervention
strategies. Not only will this assist me in delivering patient centered information but also in
maintaining professional therapeutic relationships with the multidisciplinary team like the MO
(CEC, 2020; Foronda, Walsh, Budhathoki & Bauman, 2019).
Additionally, if I am ever met with future situation of communicating with an MO or my
peers or even newly enrolled nurses as a future registered nurse, I will ensure to empathize and
be emotional intelligent towards their side of the situation or expectation as well. This will assist
me in developing positive relationships and being respectful towards other professionals. This in
turn will assist in delivering collaborating and comprehensive care by both the nurse as well as
the multidisciplinary team. Additionally, this will also assist in fulfilling comprehensive patient
needs and encouraging positive patient feedback and recovery (Jeong, 2017).
Conclusion
This paper thus provided a succinct yet detailed discussion of the key experiences and
learning which I encountered during my reflection of an experience of communicating a patient’s
clinical observations to a medical officer. One of key learnings which I encountered due to this
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experience was the importance of following a comprehensive clinical handover tool like the
ISBAR tool in delivering comprehensive patient details to medical officers. Additionally, this
reflection also taught the importance of engaging in empathetic interpersonal communication for
maintaining positive interpersonal relationships. To conclude, this reflective exercise proved to
be useful in identifying my strengths, limitations and scope of improvement in communicating
with medical officers after transition to professional practice.
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References
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from http://cec.health.nsw.gov.au/improve-quality/clinical-handover.
Choi, J. H., Lee, S. O., & Kim, S. S. (2019). The Effects of Empathy and Perceived Preceptor's
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