Reflective Journal: Nursing Experiences and Patient Interactions

This reflective journal, written by a nursing student, details three clinical scenarios encountered during their practice. The first scenario focuses on educating patients with dementia and their families, highlighting the importance of knowledge and preventive measures. The second scenario explores communication issues between nurses, patients, and the healthcare administration, particularly concerning a patient with vascular dementia. The journal emphasizes the need for improved communication training and staff ratios. The third scenario addresses ethical dilemmas related to patient autonomy and duty of care when caring for an elderly patient with dementia and a high risk of falls. The student reflects on their feelings, analyses the situations, evaluates the outcomes, and proposes action plans for each scenario, including patient education, improved communication strategies, and maintaining ethical principles in patient care. The journal concludes with references to relevant research articles.

Running head: REFLECTIVE JOURNAL
REFLECTIVE JOURNAL IN NURSING
Name of the Student
Name of the University
Author note

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Introduction
Reflection in nursing practice works as a foundation stone for development of experience
of nursing professionals (Lestander, Lehto & Engström, 2016). Through this practice, nursing
professionals are able to connect their working experiences with the theoretical knowledge of the
clinical context, and then depending on that they can modify the clinical practice and develop
fresh insights for future practice. Nursing professionals deal with multiple patients with different
ailments and hence, positive and negative effect of those experiences affect their ability to
comply with the nursing process (Snyder, 2014).
Scenario 1: Meeting educational needs of patients and their families
Description of event
While working with a patient affected with dementia, the primary thing I noticed was
their lack of knowledge regarding their ailment. They were not aware about the factors upon
which they need to focus and their family members as well, did not asked me about the
preventive measures they need to take for the benefit of the patient (Smolowitz et al., 2015).
Therefore, lack of knowledge and understanding of the need while suffering from dementia
prevailed ion patient and his family. Therefore, my objective was to make them aware of the
crucial phase of dementia and the preventive measure they should be following as Marcus (2014)
has mentioned that these information are important for health improvement of the patient.
Feeling/thought
I was very hopeful about my objectives and was confident that within a week, through
several sessions and presentations, I will be able to make the patient and his family aware of

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every minute detail of care process for dementia affected patients. Therefore, I was surrounded
with positive thoughts regarding the educational session of the patient and his family.
Analysis
While conducting the process, I came to know that dementia and other similar mental
disorders are perceived by the society as a limiting factor and hence, there is very less amount of
information is available within the society. Hence, this analysis made me more determined to
make this patient and his family aware of the dementia associated situation, so that they can
overcome the stigma such as social isolation, not trusting the healthcare professionals, doubting
their self as mentioned in the research by Turchi et al. (2014).
Evaluation
While evaluating the positives and negatives of the situation as suggested by the
researchers Turchi et al. (2014) while working with patients of dementia, I understood that,
eliminating social stigma is a long process, however I was able to make the patient understand
his condition and he was able to take proper care of all preventive measures so that improvement
in his condition could be seen.
Conclusion
Patient education and inclusion of family in the care process is a process through which
knowledge related to the disorder could be spread to the society and negative thoughts,
discrimination and stigma associated to dementia could be eliminated.

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Action plan
After successfully completing the session for the patient with dementia, I would try to
educate and spread awareness to each of my patients and their families so that through them, the
awareness could be spread to their immediate community and involving the patients and families
in the care process for patients with dementia becomes easier (Marcus, 2014).
Scenario 2: communication issues with patients and colleagues
Description
While working with a 70 year old patient suffering from vascular dementia, I perceived
the communication gap present in both, nurse and patient as well as among the administration as
I observed that patient, in his severe health condition, was unable to communicate his needs to
the nursing professionals. Further, I also observed that majority of the aged care professionals
were unable to understand the need of communication so that quality of the care process could be
sustained, as majority of the healthcare services do not provide proper aged care nursing
communication associated training to help them to improve their quality (Strang et al., 2014).
Feelings
While observing the situation within the care facility regarding the gap in
communication, I felt the importance of communication for our patients and hence, I thought of
providing a detail of this loophole to the supervisor. This was necessary for the patient as he was
suffering from vascular dementia, in which speech and memory of the patient is primarily
affected (Green et al., 2015). Hence, I felt determined that I will be sharing each of these
concerns to the higher authority so that they can implement strategies to improve the
communication situation among nursing professionals and provide necessary care to the patients.

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Analysis
While escalating this issue to my supervisor, I came to know that the communicating gap
is present within the healthcare facility because the ratio between the patient and nursing
professionals are not proper, due to which one nursing professionals have to take care of more
than 5 patients at a time. Thereby affecting the care process and communication among the
professionals (Green).
Evaluation
While evaluating the situation, the strategies taken for effective communication and the
idea of informing the higher authority of the healthcare facility regarding the process should be
mentioned. I was able to evaluate the lack of staffs, and associated mishaps occurring in the
facility and hence, as mentioned in the research of Strang et al. (2014) it was an effective step to
manage the healthcare process.
Conclusion
In conclusion, it could be said that communication and interaction among nursing
professionals and between nurse and patient is an important pillar for healthcare processes,
however due to several reasons, this communication process becomes affected. Similar aspect
was identified by me in my clinical setting and i took necessary steps to mitigate the
disadvantage.
Action plan
Besides providing training to the healthcare staff regarding the strategies for complying
with the interpersonal communication among the staff or with patients, I will advocate for

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implementation of culturally competent care, by employing translator so that instructions and
interventions could be easily transferred to the patients as Douglas et al. (2014) mentions it as an
effective step.
Scenario 3: Clinical issues and ethical dilemmas
Description of the situation
This clinical issue was faced by me while working with an elderly patient suffering from
dementia and multiple episodes of fall. The clinical issue associated to this situation was related
to his preferences and hence, it affected the clinical situation ethically (Ponte et al., 2014). The
patient suffering from multiple fractures was continuously requesting for a walk in the garden
and often used to refuse the support from the assistant while using washroom. This was a serious
concern as the patient had higher risk of fall and as his care taker, it was my responsibility to
fulfil the need of patient to comply with patients ethical rights.
Feelings
While dealing with the patient and his needs, I was very nervous about the fact that, I
wanted to comply with the ethical care process, without affecting my duty of care. However, I
was completely confident about my strategies as I had faced such situation in my early nursing
career. Therefore, I was hopeful that I will be able to provide the patient with his autonomy with
taking care of his fall related risk.
Analysis
While analyzing the situation, it was understood that due to severe health condition,
patient was suffering from depression and stress due to which, he wanted to conduct his activities

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of daily life on his own (Dwarswaard & van de Bovenkamp, 2015). To understand the mental
state of the patient I started communicating with the patient and it was found that patient was
unaware of his severe condition, and upon making him aware of his risk of fall, he agreed to
utilize the healthcare professional support for his activities of daily life. Further, I made him
aware of our duty of care and its importance in his health improvement and hence, through this
process, he agreed to utilize the wheelchair or assisted walkers for his movement within his ward
and agreed to every intervention to lower his risk of fall and improvement of his dementia
associated condition (Ponte et al., 2014).
Evaluation
The evaluation process was conducted to understand the effect of measures taken for the
compliance of ethical principles in the care process of the patient with severe dementia and high
risk of fall (Dehghani, Mosalanejad & Dehghan-Nayeri, 2015). It was seen that after educating
the patient with the risk factor associated to his situation and the strategies I am implementing to
minimize his risk of fall, he started complying with the strategy and utilizing the assistant
provided to him for his safe movement within the healthcare facility. Therefore, the strategy of
spreading awareness and complying with the duty of care for the nursing professional was an
important strategy which was successful in case of this patient (Dehghani, Mosalanejad &
Dehghan-Nayeri, 2015).
Conclusion
In the conclusion, it could be said that complying with the duty of care was an effective
step for the care process of the dementia affected patient as it included the scope of maintaining

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the ethical principles too. Therefore, it was a good decision to include this in the care process and
provide the patient with effective care process.
Action plan
To further maintain the safety of the patient above every ethical and duty of care, I would
talk to the supervisor and explain this situation to him so that he can take effective steps for the
implementation of this process. Weekly assessment of the compliance of the healthcare
professionals for safety and security will be conducted to assure this.

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References
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DOI: https://doi.org/10.1186/s12910-015-0048-2
Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M.,
Lauderdale, J., ... & Purnell, L. (2014). Guidelines for implementing culturally competent
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Marcus, C. (2014). Strategies for improving the quality of verbal patient and family education: a
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Behavioral Medicine: An Open Access Journal, 2(1), 482-495. DOI:
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