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Reflection

Tiffany Thomas reflects on her midpoint experience in an acute care practicum. She describes a challenging situation where she struggled to assess two patients' lung sounds. She asked her preceptor for help but received an unclear response. Unsure of what to do next, she waited half an hour before asking another experienced nurse. This nurse was able to clearly identify the lung sounds. Thomas researched the sounds to confirm her understanding. She reflects that developing strong assessment skills is important for patient safety. Working one-on-one with a preceptor has allowed her to focus on skills development and professional growth compared to previous clinical experiences with classmates.

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Reflection

Tiffany Thomas reflects on her midpoint experience in an acute care practicum. She describes a challenging situation where she struggled to assess two patients' lung sounds. She asked her preceptor for help but received an unclear response. Unsure of what to do next, she waited half an hour before asking another experienced nurse. This nurse was able to clearly identify the lung sounds. Thomas researched the sounds to confirm her understanding. She reflects that developing strong assessment skills is important for patient safety. Working one-on-one with a preceptor has allowed her to focus on skills development and professional growth compared to previous clinical experiences with classmates.

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© © All Rights Reserved
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Tiffany Thomas: Midpoint Reflection

Bon Secours Memorial College of Nursing


NUR 4143 - Clinical Immersion
Acute Care Practicum Reflective Journal Guidelines
Instructions:
Reflective journals will document professional growth through your acute care practicum
experiences. You will submit one acute care reflective journal by the mid-point of your acute
care practicum hours (101 hours). You must reflect on the questions below. Unsatisfactory
reflective journals must be revised and resubmitted in order to receive a PASS for the course.
Mid-point Guide for Reflection
Tanners (2006) Clinical Judgment Model

Describe the most challenging moment or event you experienced recently. What actions did you
take and what would you have liked to do differently? What specific actions are you taking to
improve the outcome in future situations or to prevent recurrence of the situation? To answer this
question, use the guide for reflection using Tanners clinical judgment model (see below).
Background

Recently I was caring for two patients with very similar conditions. Both had A-fib and both had
respiratory failure, but only one was still in need of BiPAP. My BiPAP patients sats would dip
whenever she was off oxygen, and because she had been in the hospital for such an extended stay
and refused to do physical therapy for fear of falling, she was at an high risk for pneumonia. This
was my third day being on my actual assigned unit and my first time being completely in charge
of the nursing care for my patients.
Noticing

Although it was my first time assuming the role of the nurse in its entirety, I felt comfortable
having been on this unit before in a previous clinical. I noticed that as I began doing my patients
assessments that there were just some things that I could not get a handle on. One of my patients
had what sounded like to me the most bizarre lung sounds and I just could not figure out how to
categorize them. My other patient was morbidly obese making it hard to hear her lung sounds
altogether. This situation bothered me deeply because as a senior nursing student I felt that these simple
assessment pieces should come easily to me.
Interpreting

In order to solve my problem I tried the simplest solution which was my preceptor. To my
surprise her response was that she, as well, did not know how to classify the lung sounds of the
patient we technically shared. So my first reaction after that was nothing. I couldnt really think
of what I should do next and I felt uncomfortable asking any other nurse as they may look at me

Tiffany Thomas: Midpoint Reflection


2

as super incompetent for not being able to identify the lung sounds. After about a half hour or so
I decided to just suck it up and ask another nurse on the unit. This nurse just so happen to be very
skilled at interpreting lung sounds and offered to go and auscultate the patients lung sounds with
me. The nurse confirmed for me that the patient was experiencing diminished breath sounds with
inspiratory wheezes and a prolonged expiratory phase with expiratory wheezes as well. Now
although I could have stopped and taking this nurse completely as his word, I decided to look up
and listen to audio recordings of breath sounds just to further verify what I heard. I felt that, even
though this nurse seemed to know lungs sounds well enough, that I should research and analyze
for myself. After looking up the sounds I concluded that the nurse instructed me correctly and
charted my assessment to reflect the patients lung sounds.
Responding

Prolonged hospital stays and patient immobility are said to be related to hospital acquired
pneumonia. The patient is also obese and has gas exchange issues which are also risk factors for
acquiring pneumonia. Lung sounds are an essential piece of assessment data that alerts the nurse
and other healthcare providers of patient condition. Had I auscultated crackles in the lungs it
would have alerted me the nurse to the possibly of fluid and/or pneumonia in the lungs of this
patient.
References
EHS: Nursing Diagnosis Care Plans, 4/e - Gas Exchange, Impaired - Ventilation or Perfusion
Imbalance. (n.d.). Retrieved March 12, 2015, from
http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick23.ht
ml
Breath sounds: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved March 12, 2015, from
http://www.nlm.nih.gov/medlineplus/ency/article/007535.htm
Reflection-on-Action and Clinical Learning

Initially I didnt like the idea of going to clinical without my fellow classmates; for fear that I would feel
like an outsider. All of my prior clinical experiences have been in the company of an instructor and at
least 5 or more classmates. My classmates being there has always given me comfort, however it has also
provided the opportunity to not take clinical as serious as they should be taken. Being in immersion this
semester without any teacher or fellow classmates has given me the chance to focus on the areas I needed
work in, such as sharpening my assessment skills and time management. I can truly see the need and the
difference from having this one-on-one experience and it has afforded me the opportunity to grow and
develop my skills as a nurse in a professional environment.
Based on your experience as a student nurse on a unit with a preceptor, reflect on the differences of
working one-on-one with a preceptor versus a student nurse with a group of students and an instructor.
Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing Education, 46(11), p. 513-516.

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