Reflection On A CNursing Reflection Essay – Skills Assessmentlinical Skill During Clinical Placement Nursing Essay

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This essay will discuss Reflection on a clinical Skill during the clinical placement, using Gibbs template. The essay is divided into four main secti

According to the New Collins International Dictionary of the English language, a reflection is to reflect or to be in the state of reflection. (Collins & Brash, 1983) In this essay, I aim to give a brief description of the skills assessment that I underwent, the thoughts and feelings it provoked, the evaluation and analysis of it ,conclusion and lastly my action plan.

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2.1 Description

As part of the Fundamentals of Nursing (FON) skills assessment, I had to attend a test on week seven. Wound dressing and vital signs were the two subjects of this assessment. I had to draw lots to choose which room and subject I got and then proceed to sit outside the room to read the case scenario within the allocated five minutes. Once the case scenario of taking vital signs was clear to me, I was allowed to enter the evaluation room to perform the necessary procedure on the patient within twenty minutes. During the course of the procedure, all the vital signs such as pulse rate, respiration rate, blood pressure and temperature were recorded on a clinical chart. The entire procedure was then assessed and graded by an assessor, who was observing my nursing skills.

2.2 Thoughts and Feelings

I felt really nervous and anxious before the skills assessment as I was seated outside the assessment room. When the time came for me to read and digest the background information, I felt overwhelmed as at that point in time, remembering the information on the sheet provided was just exhausting. As I was about to enter the room and the previous student came out crying, I felt even more nervous as that gave me an intuition that the assessment might be a challenging one . Despite that, I mustered all my confidence and proceeded with the nursing procedure when my turn came. I carried out the procedure in a calm and smooth manner. After my task was complete, I felt satisfied with my performance and happy with myself for having prepared well for the assessment before-hand as it turned out to be a good experience.

2.3 Evaluation

On the whole, the skills assessment was a memorable experience for me as I felt that I had carried out the nursing procedure efficiently, keeping in mind all the protocols that had to be followed. Also, the six domains namely critical thinking, communication, technical skills, management of care, safe practice and professional and ethical practice were carried out to my ability in many instances. Then again, I could have done better in certain areas.

For instance under the critical thinking component, I could have planned my working area carefully. Instead, I was immediately involved in attending to the patient and completing the procedure within the time limit which should not have been the case. As a result I had to move around quite a bit which could have been minimized with careful area planning.

On the part of communication, I tried my level best to re-assure the patient and addressed his anxiety to a large extent. This skill I believe I portrayed well.

In terms of technical skills, I was unsure about my readings for the systolic and diastolic blood pressures and I had to repeat the procedure twice in order to double check my first reading. Even then, I experienced some level of uncertainty with the readings. Thus, I have to improve my skills in this domain to become a better healthcare professional.

To add on, I managed the patient’s care relatively well as I made it a point to ensure that he was feeling comfortable throughout the procedure. Keeping in mind the importance of understanding the emotions of the patient (Matsumoto & Hwang, 2011), I took note of the changes in his facial expressions to make sure he was receiving good care and was not in any kind of stress.

To ensure safe practice I had carried out good hand hygiene however ,I almost had forgotten to clean the ear plugs of the stethoscope, thereby downplaying on safe clinical practice on protecting myself. Furthermore, I had also plotted the readings on the wrong column which was an unacceptable mistake.

Lastly, on the part of professionalism and ethical practice, I believe I had done a commendable job. I kept the patient informed on the risks he was taking by undergoing the cataract surgery. Also, I kept the staff nurse informed of his concerns and his rash that he had developed. Apart from these, all the procedures during the assessment were within the terms of ethical practice.

2.4 Analysis

For in-depth examination, I have analyzed my skills in each of the above mentioned six domains.

Critical thinking is defined as the disciplined, intellectual process of applying skillful reasoning as a guide to belief or action (Paul, 1990). In nursing, critical thinking for clinical decision-making is the potential to think in a organized and sensible manner with the readiness to question and think carefully about the reasoning process used to ensure safe nursing practice and good care. (Heaslip, 1993) In the nursing profession, it is important to plan carefully to save valuable time while attending to the patient. During my practical assessment, I could have placed the hand sanitizer on the same table as I had placed the other medical requisites on. This would have prevented me from constantly shifting to the table close by to perform my hand rubs, saving time. As mentioned by Mr. Tan during lab sessions, area planning is very important. Nurses also need to apply their intellectual skills for sound reasoning. (Heaslip, 1993) Having noticed rashes on one of the patient’s arm, I chose to take blood pressure from the arm with no rashes as placing the non-sterile cuff on the affected hand could have worsened the rash.

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As for communication skills, I believe I played a good role as a nurse by clearly explaining the risks involved in the cataract surgery to the patient. As pointed out by Crow et. al, it is paramount for a patient to be aware of his/her medical condition and develop a better understanding of the procedures involved. (Crow, et al., 1999) To add on, I informed him of his various readings to ensure his awareness of his medical status.

In terms of technical skills, I could not distinctively identify the Korotkoff sounds hence had to repeat the blood pressure measurement. When I re-took the blood pressure however, I found it hard to release the pressure as I had turned the valve a little too much making it too tight to be released. It is mandatory for nurses to be fluent in the procedures. (Rennie, 2009) Hence, I should keep in mind not to turn the valve too much to allow easy release of the valve in future.

During the procedure, I constantly made an effort to ensure that the patient was feeling comfortable by questioning him frequently instead of just carrying out the nursing procedure silently. Reference to Bensing, reveals that it is important for nurses to communicate at an emotional level so that the patient feels cared for and also helps disclose his concerns which he might otherwise not reveal. (Bensing, 1991). Also, I addressed the presence of the rash on his left arm and questioned him on how it originated instead of only taking note of his vital signs. These actions I hope would have sent across the message to the patient that I cared for him well.

In terms of ensuring safe practice, I kept the staff nurse informed about the rash the patient had developed on his arm and what medication he had previously consumed which might have led to the allergy. However, I had not plotted the readings taken on the correct column onto the clinical chart. I was unaware of this mistake until I read the remarks on the assessment sheet. Therefore, I have to strictly avoid such a mistake in the future as it may lead to further misinterpretations.

My professionalism and ethical practice was portrayed rather well as I maintained a steady and confident poise which I trust would have also allowed the patient to place his trust in me to carry out the nursing procedure safely and effectively. Butts has given a detailed description of the ethics that needs to be followed in the nursing profession (Butts). Not only that, I ensured that the patient was aware of the side effects and risks involved in the surgery so as to maintain ethical practice.

2.5 Conclusion

All in all, this reflection has helped me better identify my mistakes in this skills assessment and how I can further improve myself in the near future. Not only that, it has also aided me in the pursuit of realizing the importance of the six different domains that we were assessed on. This assessment was also a good platform for us to reflect upon ourselves and further improve our nursing competencies bringing our skills to a whole new level. At the end of the day, such assessments are the ones that mould us into trustworthy and reliable healthcare professionals.

2.6 Action Plan

In similar situations in the future, first and foremost, I would quickly run through area planning in my mind so as to maintain minimal movement to save time when I am carrying out my nursing procedure. Then, when I am taking the patient’s blood pressure, I will remind myself not to turn the valve too hard so that it will be easier to release the pressure from the cuff when I am recording the blood pressure readings. Most importantly, I would ensure that I record my findings accurately onto the clinical chart. I hope all these precautions will help me carry out my duty as a nurse efficiently in years to come.


ons. It will first consider some definition of psychology and sociology; it will then go on to describe an incident from both psychological and sociological point of view. The third part will explain how to find solution for both incident, and then some conclusions will be drawn to show the best things should be done. Finally it is my reflection on clinical placement.

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Psychology is how patient feel, Psychology tends to emphasis the individual in contents, and it is not about how they think. Sociology is to do with relationships, which operate between people when they get together in groups. Sociology looks at how an individual operates from the contextual point of view. Class, ethnicity, religion, sex, disabilithy, age these kinds of things are sociology, and anxiety, stress, depression are psychology.

The first Gibbs is about an old lady who was waiting for her x-ray in the room. She was lying on the table, and she was crying as a child. It has been explained already her situation and the psychology point of view of this patient and how factors like being in pain and stress or anxiety might affect her. So interpersonal and good communication skill would help this patient and also would help the radiographer to be more professional and the patient may accept their advice because patient belief that the healthcares are professional and competence and they have ability to treat them. The patient was suffering from the physical and emotional stress, and it is necessary to know what the stress is and how its impact on patient. Stress is unclear response of the body to any demand further on, and can have physically or psychologically effect. Stressors are the situations that can cause stress. Physical symptom of stress can faster heart beat, increasing sweating, dry mouth, tense muscle, diarrhoea, irritability and anxiety. Anxiety is the result of being emotionally stressed. (Edward 2006)

Everybody experience stress in their life, but individuals are different and material circumstances are different. Therefore it is important to reduce stress from the patient, and it is our job as a radiographer to have a good communication with her, by using SOLER.try to sit squarely and with open position, lean forward and have nice eye contact with her and then relax (Egan, 2002).speak nice and clear, but not too slowly, and don’t inflate the movement of your leap, Use natural facial expressions and gestures and do not to turn your face away from a deaf person.55 per cent of communication is body language (Mehrabian ,1970). In this case we need to use different way of communication, because she had a little bit difficulty with hearing, so get patient attention before starting to speak. Make sure the patient can see your face and watch your lip movement and facial expressions. Speak more slowly and keep your tones of your voice low, because older people tend to have more difficulty hearing high-pinched sounds. Older patient need more time to understand and respond. Be patient and ask them to repeat instruction. Explain the procedure for her, so she would be able to understand what is going on. It is good to put your hand on her arms, so you will show your empathy and how friendly you are. It can be calm patient down. Be familiar with patients’ emotions. She had not been given enough information to know why she is there, if she had, she could not been so worried. Explain clearly so that she would be able to understand you, and give her right instruction.

According to psychologists for the patient suffering from psychological and sociological problem, there are many factors that determine our behaviour such as the genes we are born with, physiological brain, nervous system. Cognitive system, thoughts, perception. The social and cultural environments in which we develop over time. Life experiences including those from childhood and personal differences including our IQ personality and mental health. Being alone would be one of the factors that may transmit to getting old and hopelessness. As we getting old, there tends to be a decrease in mobility and social relations, with a likely for loneliness and isolation. (Oxman et al. 1992).

And now we are going to find sociological factors which might be affect her, including the psychology factors. We will consider her in terms of age, race, sex and disability. It is easy for women to be emotionally open. We can help sensible stress by change coping style and recognise it. Women are more likely than men to be diagnosed with mental illness; also they have poorer psychosocial health and use more psychotropic drugs for anxiety and depression than men. (moodle site)

Psychology is essential for health care professional because it enable the radiography to understand and care after the patient more holistically.According to this, the old lady`s brain is not functioning well because she is getting older or she has other mental problem therefore she was acting like a child scaring and fearful. So, being old, her age, sex disability causes her to be anxious. The good communicate with her and make her assure that there is nothing to worry about it, could reduce her fear and anxious.

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The second Gibbs is about young lady, who had x-ray of her abdomen, but her husband was not happy to do her x-ray alone. They were from different country and different religion and culture. Her husband must stay outside the room, preferably in a waiting area; this is because of radiation safety. Also it allows the stuff to proceed without any interruption from family members. Dealing with family was difficult. Sometimes may need a family member to stay with patient. In this case it was better for husband to stay outside, because he had a kid with him, but he insists to be with her. Before doing any radiographic procedure is necessary to informed consent from patient .In these situations should given a clear explanation to them before the procedure. It would be because of their culture or might be having another reason. Naturally people as go into the hospital, they will experience some kind of stress. Anxiety can cause some individuals to be quiet aggressive when they will be asked in emergency situation. They as you would expect experience fear and anxiety. In general Refugees’ health-related behaviour and how they communicate with health professionals will be influenced by their culture and beliefs. To be able to perform an accurate consideration and offer knowledgeable and sensitive care, the health care professional must think the patient’s religious and philosophy, as well as cultural background. Also to make them sure of what happens in x-ray room, explain the procedure to them, If we consider psychology views, both patient and her husband might be suffer from different type of depression, or stressed. In one hand, because the husband behaviour showed there is something that is afraid about it. Her husband was worried, angry and emotionally stressed, and in other hand may be they did not like doing their x-ray with male radiographer, because of their culture, and they might have personal or religious reason for not doing it alone. Generally we all have different way of engaging with different patient as a radiographer. Everybody has its value, expectation and beliefs. When individual entre a new country and new community they face many challenges in terms of adjusting to a new language, different customs and unfamiliar norms. These challenges may result in mental or general health problems. There is quite a lot of risk factor that put ethnic minority to suffer from mental illnesses. Generally in compare of general public, the health of people from ethnic minority is worse. Although there are some exeption. For the reason of many factors which affect their health. Lack of English, under or unemployment, being away from family, cultural differences and lack of social support, put people toward depression. (Journal of immigrant and minority health, New York: Feb. 2010, iss.1, pg.100)

So again you need to have good communication with them. But In this case, may be eye contact is not welcomed, because they were Muslim, and in their culture direct eye contact is supposed as being impolite or bad-mannered, particularly between the old people. In Asian and Muslim culture hand gestures and eye contact should be avoided. Occasionally between Muslims people husband may be respond the question telling their wives. In addition in their culture, silence possibly will show accepting or authorization. So it is very important to have knowledge of other culture, when dealing with patient. (Ruth Ann Ehrlich, Joan A. Daly 2009)

Therefore you need to introduce yourself to the patient. First impression you put on patient is very important , Give explanation clearly, be a good listener, be familiar with patient’s emotions, control your personal emotions by developing better cultural competency ,and have familiarity with beliefs and practices of diverse groups, But it is very important to avoid stereotyping. Also it is very important to let them understand the LMP checked. For Certain radiographic procedure it needs to check LMP (last menstrual period). It is necessary to have fully understood the procedure and its risk and benefit, so that you can explain to the patient and answer their questions. The Ionising Radiation (Medical Exposure) Regulations IE (ME) R states that, every females of childbearing ability age must have their pregnancy status recognized if the abdominal area is region of interest in radiographic examination. Where suitable, the pregnancy and breast feeding status of a female patient must be established. From knees up to below the diaphragm is abdominal region for radiographic purposes. (Ball J, Moor A, Turner s, 2008). After check the LMP and when you are sure that she is not pregnant, give the patient instruction to have her x-ray. And ask for female radiographer for her to do her x-ray. And help put her husband lead gown or ask them to stay behind the screen, so that they will be protected against radiation. Additionally, an interpreter may be required, to help them get their job done.

As a result, I should communicate more effectively and without any hesitant for both patient. Give them clear instruction and get help from radiographer staff. To know how to deal with patient in appropriate way, it is important to recognise their feeling, understand their problem and cope with different situation. Communication is very important. By using SOLER technique. Also be familiar with different culture and background, and respect everybody. . Avoid stereotyping patient. Stereotyping can direct you toward discrimination. (moodle site 2009).Also Remember to be assertive.

What I have learnt using this reflective model, is that it has helped me to recognize that my knowledge is somewhat which I have to be proactive in. By writing this essay my reflection skill and my competence has developed. Now I feel more progress in personal and professional skills. Within clinical placement I have experienced how to face with different situation and different patient. Also how communication skills is useful as a professional radiographer to deal with patient and their families. In the future communicate clearly and with greater confidence. Show empathy to patient in appropriate way. Respect all in any age, any culture and any background. Nervous, hesitant, anxious, exited, that was me on my first week of placement, but now something different and in the future more professional.


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