Ashley Raybold

NUR 4948L
6/21/2016

Reflective Journaling
Please submit a reflective journal describing a situation that forced you to use your clinical
decision making skills. The journaling should be done weekly, however, only a total of 5 are
due. Journals should be submitted via Canvas in the designated journaling area. Please save
as a word document and enter your journal in this format to assure that each area is
addressed.
Each journal should address the following topics:
Noticing
Subjective and objective data

Subjective:

Patient was brought to BMC for SOB 2 days prior. Currently she was on
CVICU and ready to be discharge on the current shift.

Patient was excited that discharge was the plan for the day. Husband
was at bedside.

Objective:

Increased BP.

Patients BP was stable overnight and at the 08:00 assessment, at

09:00 the medical resident had put in orders for discharge, upon
doing the 10:00 assessment it was noted that the BP had
significantly increased.

How did you know there was a problem? Abnormal patient presentation or your gut
feeling?
o

The patient was not as relaxed as the prior assessment. By referring back to
prior vital signs, it was evident that this was the first time during this
hospitalization that the patient had an elevated BP.

Interpreting
What other information do I need to make a decision?
o

Current BP and if there are any prescribed medications that will help to lower BP.

Is there anyone else I need to involve or notify?

Primary physician, in this case it was the medical residents.

What could be happening and how critical is this situation?

o

This patient situation is not critical, however, the patient should have a stable BP
prior to discharge.

Responding
Should I do something now or wait and watch?
o

How will I know if I am making the best decision?

o

Patients BP will return to her baseline and she can be discharged.

What interventions can I delegate to other members of the healthcare team?

o

Do something now. The MAR was reviewed and there were no medications
prescribed that could assist with elevated BP, so medical residents were
contacted to obtain an order.

Nothing can be delegated.

Can include evidence-based practice here to justify why you might make one decision
over another.
o

No evidence-based practice

Reflecting
Did I make the right decision?
o

Did I achieve the desired outcome?

o

Yes, while working closely with my preceptor.

Yes, the patient returned to her baseline with no complaints and was able to be
discharged within an hour.

What did I do really well? What could I have done better?

o

I was able to make contact to the medical residents, explain the situation and
receive an order for a one-time medication. With more experience,
communication with physicians will go smoother.

Adapted from:
Tanner, C. A. (June 2006). Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing. Journal of Nursing
Education, 45(6), 204-11.
Gillespie, Mary. (2009). Helping novice nurses make effective clinical decisions: the situated clinical decision-making framework.
Nursing Education Perspectives, 30(3), 164-170.

Reflective Journaling Grading Rubric

Criteria
Did the student interpret the case situation
accurately?
Did the student present evidence of data analysis?
Did the student draw logical conclusions?
Did the student decide on an appropriate course of
action?
Did student evaluate the outcome(s) of their action?
Did the student identify their strengths and areas for
improvement?

S/U Notes