Reflective Journal 1: School Nurse Experience, Fracture Case

This reflective journal documents a school nurse's experience in handling a student's ankle fracture sustained during a cheerleading practice. The journal begins with an introduction to reflective writing and provides background on the nurse's role and responsibilities within an international school setting. The main body of the journal details the trigger event, which was the student's fall and subsequent ankle fracture. It includes an appraisal of the situation, drawing on medical knowledge and symptoms of ankle fractures, followed by an exploration of the nurse's actions and challenges, particularly in communication and teamwork. The journal highlights the nurse's learning from the experience, including the need to improve communication and teamwork skills, and integrates these reflections to suggest areas for professional development. The journal emphasizes the practical application of nursing knowledge and the importance of continuous learning in healthcare settings.

Reflective Journal
1

Contents
TITLE: “Reflection on own experience as a school nurse while handling a student with fracture
due to falling down”.........................................................................................................................3
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Trigger Event..........................................................................................................................4
Appraisal.................................................................................................................................5
Exploration.............................................................................................................................6
Integration...............................................................................................................................7
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................9
2

TITLE: “Reflection on own experience as a school nurse while handling a student
with fracture due to falling down”
INTRODUCTION
Reflective journal is referred as an account of work in progress of an individual, but more
significantly an opportunity to reflect on the learning experience. It is a personal record of
learning experiences of student which he or she learn while undergoing the module or during the
course of general practicum on the basis of practice area. The main purpose of writing a
reflective journal is to analyse the process of learning for self-development (Brown, & Schmidt,
(2016). This is a reflective journal based on the title “Reflection on own experience as a school
nurse while handling a student with fracture due to falling down”. In this, I provide reflection on
my own experience while handling the student who have fracture in right ankle because of
falling down during cheerleading practice in the school. It covers brief introduction about the
situation from clinical experience and the information about trigger event. Apart from this,
appraisal and exploration of the situation is done that affects my understanding and sense
making. At last, a brief conclusion is provided based on the overall learning experience get from
the situation.
MAIN BODY
I am a school nurse working in an International School where I have to perform several roles
and responsibilities. My responsibility as a school nurse is to provide health care to students with
chronic or acute health issues, developing and monitoring health plans, performing screenings as
well as writing reference for health care services (Cushion, (2018). My main goal working in an
International School is to treat illness or injuries of student and advise them, the parents or
guardians as well as the staff on issues associated with health. I have a degree in nursing along
with valid national certification based on which I got job in the International School. For
performing my job duties effectively, I need to have good communication and organisational
skills along with knowledge of basic computer as I have to perform some administrative tasks
also like updating the medical records of students.
My primary responsibility in the school is to render health care services to students when
they are in school. Apart from this, I am also responsible to educate students as well as staff
3

numbers on healthy habits like proper hygiene and nutrition and keeping track of vaccination
records of students. Moreover, I also ensure that the environment of school is safe for children
along with the school staff and make sure compliance with national as well as local laws
associated with health. All these are included in my job responsibility and I have to perform
those while working in the school. I am presenting reflection on my own experience while
working in the school (Fey, & Jenkins, (2015).
Trigger Event
This reflective report is about my experience as a school nurse working in an international
school handling a student with fracture of right ankle due to falling down during cheerleading
practice in the school. Cheerleading involves toe touch jumps, sideline cheers and kicks. It also
involves moves like hand springs, flips, partner stunts and humid pyramids. With dynamic
changes, cheerleaders run huge risk of injuries, especially those individuals who partake in
stunting. According to an institution, cheerleading is the leading female sport as well as Number
2 in catastrophic injuries in comparison to the other sports. While participated in the
cheerleading activity, a student was injured in the international school due to falling down during
practice. Because of this, the right ankle of the student was fractured and she was injured badly
(Heckemann, Schols, & Halfens, (2015). She was in too much pain and was not able to practice
cheerleading for some time due to ankle injury. The student also faced difficulty in walking or
putting weight on injured ankle or foot.
The main reason behind choosing this incidence to reflect upon is that through this, I learn
so many things. This experience improves my knowledge base and my skills which supports in
my growth and development. This also make me able to determine my strengths and weaknesses
and will make me able to take appropriate actions which will enable me to improve my weak
areas. Apart from this, the another reason for choosing to write about this particular situation is
that with the help of this clinical experience, I learn about how to handle such kind of situations
in an effective manner and provide student with appropriate guidance, support and treatment that
assist in improving their health outcomes (Husebø, O'Regan, & Nestel, (2015).
During my work tenure when I was working in the school, once an incident takes place
where one student was injured during the cheerleading practice due to falling down and the right
ankle of the student was fractured. At that time, I need to handle that situation but I was very
4

nervous as I have never deal with the situation before. That was the very first time, when I faced
such situation in school and saw the student in that much pain. But, as a nurse I have the
responsibility to handle the situation appropriately, with confidence and in organised manner.
And the same I did at that situation and provide the student with the support and the treatment
which helped in treating the injury of student (Moule, Aveyard, & Goodman, (2016). At that
time, I first assess the situation and requirement initial assessment to the student. I take the
student for the X-ray examination in order to determine the proper location as well as extent of
fracture. From the X-ray, I got to know that she had fracture in her right ankle and need proper
treatment for it. At the time of fracture, it is very important to immobilize the part of body before
patient is moved. Apart from this, in order to prevent movement of fracture fragments, I did
adequate splinting. Moreover, I covered that part with sterile dressing in order to prevent
contamination of deeper tissues.
Appraisal
As per the view point of Benjamin C. Taylor, 2020, the injury patterns associated with
ankle fracture includes isolated medium media malleolus fracture, posterior malleolus fracture,
isolated lateral malleolus fracture, open ankle fracture, bimalleolar equivalent fracture etc. And
the general treatment of ankle fractures includes short leg walking boot, open reduction internal
fixation, external fixation etc. (Ankle Fractures, 2020). According to the viewpoint of Kristen
Nunez, 2019, ankle fracture occurs when one or more bones of ankle joint break. It is made up of
tibia, fibula and talus and if these bone break, then it is very painful. At the time of handling a
student with right ankle fracture, there are some symptoms which are generally known and some
of which helped me in identifying that the student had fracture in her right ankle. Those
symptoms include severe pain, bruising, difficulty bearing weight, bones sticking out of skin,
dizziness, tenderness, swelling, difficulty in walking on moving foot, bleeding and foot appears
to be dislocated. The student was in much pain and also faced difficulty in walking which helped
me knowing that the student had fracture in her right ankle (Najjar, Lyman, & Miehl, (2015).
Apart from this, the another symptom which helped me in ensuring that was fracture was
she was not able to place weight on her ankle. There were two possibilities at that time, i.e.,
sprained ankle or broken ankle. If the ankle of student was sprained, then an individual only feel
swelling and pain. But, the broken ankle is more painful and have severe bruising (Treating and
5

Rehabbing a Broken Ankle, 2019). However, this is not the appropriate way to determine
whether the student was suffering from sprained ankle or broken ankle. There are some tests
which help in diagnosing the fracture appropriately. These includes physical examination, stress
test, MRI scan, CT scan and x-ray. When the student was injured, the first thing that I did was to
perform x-ray of her ankle joint in order to see the location, severity and type of break. It helps
me in determining the appropriate way to treat injury of the student and ensure her early
recovery.
Ankle fracture is very common injury among all age of people. the individuals who are
involved in athletic activities, basketball players etc. are at high risk open fractures due to
physical demands placed on ankles. It also occurs during slips and falls. High influence ankle
injuries are dangerous if the bone is exposed to air and pokes through the skin. An open wound
enable bacterium to contaminate the bone which is broken and highly maximizes the infection
risk (Page-Cutrara, (2015). At the time of handling the situation of injury, I reviewed the medical
history of student, specially any past injuries to ankle, lower leg or foot. After that I examined
the ankle properly along with checking for abrasions, soreness, deformity, swelling and bruising
along lower part of tibia and fibula. Then I pressed and feel the injured ankle parts to ascertain
whether there was any extreme tenderness point which can assist to determine the site of
fracture. I also compared the movements of injured ankle with an uninjured ankle. For
determining the signs of nerve and artery damage, foot movements, skin sensations and pulse
were checked by me.
Exploration
From the overall scenario and the learning from literatures, I found that I was able to
handle the situation however, due to my lack of communication skills, I faced some difficulties
in interacting with others during the situation. I felt that I can handle the situations more
appropriately if some of my skills were effective. Lack of effective communication skills leads to
create several issues for me in terms of miscommunication, misinterpretation of information etc.
as I was not able to make the people understand the situation and what I was trying to say (Pai,
(2015). Apart from this, my team working skills are also not so good due to which I faced
difficulties in working with others. However, after sometime, I was able to work with others
properly. Other than this, I have the responsibility to employ cultural competency in providing
6

effective care to culturally diverse people. For this, I needed to provide health education for
primary prevention which promote mental and physical health as well as inform the decisions
related to healthcare. In performing all the responsibilities, I must have good communication
skills in which I lack. So, by undertaking the reflection, I get to know about my strengths and
weaknesses and felt that I need to work upon my communication and teamwork skills (Presti,
(2016).
What I learnt from the literature review and what experienced in that situation was slightly
different. From reviewing the literature, I found numerous symptoms of broken ankle and I have
knowledge about only some of the symptoms through which I can be able to determine whether
situation was associated with the ankle sprain or ankle fracture. However, with the help of my
knowledge and learning as a registered nurse, I was able to handle the situation properly. Apart
from this, I was very nervous at that point of time when I saw the student in very much pain, but
the learning which I get during undertaking the nursing program helped me a lot to handle the
situation perfectly and provide appropriate treatment for the injury to student and contribute in
her early recovery (Taliaferro, & Diesel, (2016).
Integration
By performing reflection on my experience of handling a student with fracture of right
ankle because of falling down during cheerleading practice in school, I learnt so many things.
That incidence helped me in improving my learning, competencies and knowledge base which
will further help growth and development of my career as a school nurse. Apart from this, there
are several roles and responsibilities which I have performed in that situation. By performing
those, I learnt to perform those in more effective manner in future. I learned to foster the liaison
between school, health and family and prompting a close integration and relationship between
school and community. Apart from this, I learnt to work alongside with other health
professionals like educational psychologists, social workers, psychologists and community
workers. In addition to this, I known to detect growth irregularities and poor health habits about
diets, resting, leisure, hygiene, sleeping habits etc. (Thomas, & Asselin, (2018).
The overall learning experience from this event is good and with the help of it, I get the
opportunity to learn so many things. However, I feel that I require to work upon my
communication and team working skills as both these skills are very crucial for my career
7

growth and development. Communication skills will help me in interacting effectively with
others and developing good professional relationship. On the other hand, team working skills
will help me in work in collaboration with other health professionals and practitioners so that I
will be able to deliver care in more effective and appropriate way. For improving my
communication skills, I will undertake English communication classes along with taking support
of online videos and sessions on communication so as to improve my communication skills. In
addition to this, I will participate more in team working activities and groups so that my team
working skills will be enhanced and I can be able to work more cooperatively with others
(Vicary, Young, & Hicks, (2017).
CONCLUSION
As per the above mentioned report, it has been concluded that reflective journal is the
document which includes record of learning experiences that an individual learnt from the
particular situation or event. It helps in analysing the learning process for individual
development. It supports an individual to ascertain his on her strength and weaknesses and taking
appropriate actions for improving the weak areas. Apart from this, it provides an opportunity to
learn from the experiences that an individual gets in the past or from the particular situation or
event. It also assists in improving the future performance of the individual by improving the
practices. Proper exploration of situation assists in improving the understanding of a person and
make his or her able to take decisions in more effective manner.
8

REFERENCES
Books and Journals
Brown, J. M., & Schmidt, N. A. (2016). Service–learning in undergraduate nursing education:
Where is the reflection?. Journal of Professional Nursing, 32(1), 48-53.
Cushion, C. J. (2018). Reflection and reflective practice discourses in coaching: A critical
analysis. Sport, education and society, 23(1), 82-94.
Fey, M. K., & Jenkins, L. S. (2015). Debriefing practices in nursing education programs: Results
from a national study. Nursing Education Perspectives, 36(6), 361-366.
Heckemann, B., Schols, J. M., & Halfens, R. J. (2015). A reflective framework to foster
emotionally intelligent leadership in nursing. Journal of Nursing Management, 23(6),
744-753.
Husebø, S. E., O'Regan, S., & Nestel, D. (2015). Reflective practice and its role in
simulation. Clinical Simulation in Nursing, 11(8), 368-375.
Moule, P., Aveyard, H., & Goodman, M. (2016). Nursing research: An introduction. Sage.
Najjar, R. H., Lyman, B., & Miehl, N. (2015). Nursing students’ experiences with high-fidelity
simulation. International journal of nursing education scholarship, 12(1), 27-35.
Page-Cutrara, K. (2015). Prebriefing in nursing simulation: A concept analysis. Clinical
Simulation in Nursing, 11(7), 335-340.
Pai, H. C. (2015). The effect of a self-reflection and insight program on the nursing competence
of nursing students: a longitudinal study. Journal of Professional Nursing, 31(5), 424-
431.
Presti, C. R. (2016). The flipped learning approach in nursing education: A literature
review. Journal of Nursing Education, 55(5), 252-257.
Taliaferro, D., & Diesel, H. (2016). Cultural Impact With Reflective Journaling. International
Journal of Human Caring, 20(3), 155-159.
Thomas, L. J., & Asselin, M. (2018). Promoting resilience among nursing students in clinical
education. Nurse education in practice, 28, 231-234.
Vicary, S., Young, A., & Hicks, S. (2017). A reflective journal as learning process and
contribution to quality and validity in interpretative phenomenological
analysis. Qualitative Social Work, 16(4), 550-565.
Online
Ankle Fractures, 2020. [Online]. Available through:
<https://www.orthobullets.com/trauma/1047/ankle-fractures >
Treating and Rehabbing a Broken Ankle, 2019. [Online]. Available through:
<https://www.healthline.com/health/broken-ankle >
9