My Reflections

 Reflection is part of the nursing profession which encourages nurses to reflect on events and learning experiences that were most beneficial to them (Coward, 2019). Reflection is a way to think about the gaps in one’s learning and practice and explore the link between connecting theory and practice as a way of knowing and doing (Patel & Metersky, 2022). 

I begin my reflection by going back to my beginning. When I graduated high school in 1991, my career goal was to become a Registered Nurse. Unfortunately, I was not able to follow this path due to influences in my life at the time, including nurses mostly being employed in the United States. I ended up enjoying a very fulfilling career in the customer service sector for 25 years. During this time I was in a management role, which included communication, customer satisfaction and collaboration with others. When this chapter of my life closed, I knew I needed to find another career that would be satisfying. What has always attracted me to nursing is my love of people and looking after others. I want to make a difference in people’s lives, including when they are faced with some of their darkest moments. I was also encouraged by the current nursing shortage, knowing that I would have job opportunities after graduation. My passion for helping others has led to me choosing compassion as one of my core values.

Going back to school at 50 years old has not been an easy transition for me. Mature students often struggle with advances in technology which affect areas such as referencing, completing assignments and studying (Christensen & Craft, 2021). I can certainly attest to this fact, as technology and learning how assignments are now to be completed has been the biggest challenge for me. Another concern as a mature student is the anxiety that the schooling could be a one-and-only chance, with not enough time to pursue other options should the student fail (Christensen & Craft, 2021). Even though I share these concerns, I have worked hard and continue to learn how to excel in ways that are new to me, which has contributed to my core value of accountability.

I find it promising that students preparing for a second career typically are very motivated and excel in learning and clinical practice, as well as having the opportunity to demonstrate their transferable skills (Rainbow & Steege, 2019). I certainly share this same motivation when I think about my future as a nurse. Although our first semester has just skimmed the surface of the knowledge to be learned, I do have concerns that I could do something inadvertently that would harm a patient, such as a medication error. I am a very moral and honest person and am confident my value of integrity will always prevail in every action of my nursing practice. I intend to advocate for the safety of my patients, colleagues and myself, which will promote a safe environment and empower myself and others to be confident and successful (Hanson et al., 2020).

As my first semester comes to an end, I reflect on the challenges I have experienced and the goals I have set for myself. I appreciate the opportunities I have been given and look forward to being able to explore my link between connecting theory and practice as a way of knowing and doing (Patel & Metersky, 2022). 

Christensen, M., & Craft, J. (2021). “Gaining a new sense of me”: Mature students' experiences of under-graduate nursing education. Nurse Education Today, 96(Complete). https://doi.org/10.1016/j.nedt.2020.104617

Coward, M. (2019. Importance of reflection in revalidation.  Nursing Management (2014+), 26(2), 37-41. https://doi.org/10.7748/nm.2019.e1839

Hanson, J., Walsh, S., Mason, M., Wadsworth, D., Framp, A., & Watson, K. (2020). ‘Speaking up for safety’: A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis. Nurse Education Today, 84(Complete). https://doi.org/10.1016/j.nedt.2019.104252

Patel, K. M., & Metersky, K. (2022). Reflective practice in nursing: A concept analysis. International Journal of Nursing Knowledge, 33(3), 180–187. https://doi.org/10.1111/2047-3095.12350

Rainbow, J. G., & Steege, L. M. (2019). Transition to practice experiences of first‐ and second‐career nurses: A mixed‐methods study. Journal of Clinical Nursing, 28(7–8), 1193–1204. https://doi.org/10.1111/jocn.14726

My goal since I started nursing school was to obtain a consolidation and, hopefully, employment in the ER at PRHC. I have requested medical-surgical for my pre-consolidation and look forward to starting my learning on acute skills this semester. I hope to strengthen my skills and learn new ones to achieve my goal. I must be the best nurse I can be and care for people with a person-centred, culturally safe approach, making them feel the best they can while in my care.

I have been working in the Stroke and Rehabilitation unit for three weeks, and during that time, my outlook on chronic illness has been dramatically influenced. I have friends and family with chronic illnesses and have watched them navigate the waters, whether performing activities of daily living or facing uncertainty about their futures. The patients I have met have moved my heart and shaped my future practice, but the patient who affected me most was the one I cared for in my first week. Every ounce of my human compassion emerged as I felt deeply for this patient who seemed somewhat trapped in her body. I admit this experience also led me to question my mortality. 

My patient is an older female who suffered an acute ischemic stroke earlier this year, resulting in left-sided paralysis and expressive aphasia. The day before her stroke, she was an active, independent woman living alone. She has witnessed her life change completely; her body language and frequent crying indicate that it has devastated her. She has a strong support system of family and friends who sit with her every afternoon and talk to her. Observing this support system is encouraging, though it can sometimes be sad. As she struggles to communicate and subsequently cries loudly, her loved ones also begin to cry and then leave because they cannot bear to see their loved one in distress. As one of her family was leaving, they said, “I sure hope you guys can figure this out.” Some nurses I have spoken with feel there could be an element of the patient choosing not to communicate or wanting to sit in her chair.

As a future nurse, I acknowledge the various ways of knowing. I can understand this patient's many feelings: sadness, anger, frustration, and hopelessness. I would feel the same way if I were in her situation and my life changed overnight. As a future nurse, I realize she will never make a full recovery, but I also know that some interventions can improve her quality of life, even though she does not want to participate in them. I feel conflicted about the moral choices in this situation. I understand we cannot make someone do something they do not want to do, such as participating in physiotherapy and occupational therapy or spending time in her chair. However, I believe that if she engaged in some interventions, she would find hope and peace in her new reality.

I have thought about our encounter many times. I think about how I would handle this situation if it were me or my loved one. When I think of this, I become quite emotional, as the only encounter like this was when my father-in-law had a massive stroke 24 years ago and passed away after five days. I think about how painful it was to lose him, but how painful it would be to watch him suffer like my patient. I also think about how this situation has affected my future nursing practice. One of the biggest obstacles is that this patient cannot communicate. As her nurse, I felt horrible that I could not understand what she needed or wanted. Regardless of what area of nursing I will work in, I know I will encounter obstacles in communicating with patients. This is an area I have promised myself to learn about to help my future patients.

Wilson et al. (2019) found that recovery from aphasia shows the most significant gains between day two and day 15; after one month, the changes diminish, and recovery slows dramatically. This finding is essential, as our role as healthcare providers is to initiate therapies as soon as possible for optimal outcomes. A study by Preetha and Perumal (2022) confirmed this finding, emphasizing the detrimental effects aphasia has on most areas of one’s life. Moreover, as nurses, we can contribute to supporting the psychosocial interventions necessary to improve the well-being of stroke survivors, including peer support, which can increase motivation and decrease loneliness (Saunders et al., 2021). I will take these findings and incorporate them into my practice, encouraging my patients to improve their quality of life, however that may look.

Through my theory course, current placement, and life experiences, I have learned that the implications of chronic illness are often lifelong. Some people experience no or minor deficits; others experience severe ones, such as Patient A. I must consider how life-changing a chronic illness is for my patients: physically, emotionally, and financially. The effects are all-encompassing.

This event has positively changed me. I continue to empathize with my patients, but now I have a newfound respect and understanding for the journey that individuals with chronic illness must undertake, as well as the significant role healthcare providers play in that journey.

References

Preetha, U., & Perumal, R. (2022). Quality of Communication Life (QoCL) In Persons with Expressive Aphasia With and Without Communication Intervention - A Comparative Study. Neurology India, 70(3), 1125–1130. https://doi.org/10.4103/0028-3886.349635

Saunders, R., Chan, K., Graham, R. M., Adams, E., Bulsara, C. E., Seaman, K., & Cranny-Connolly, M. (2021). Nursing and Allied Health Staff Perceptions and Experiences of a Volunteer Stroke Peer Support Program: A Qualitative Study. Journal of Multidisciplinary Healthcare, 14, 3513–3522. https://doi.org/10.2147/JMDH.S341773

Wilson, S. M., Eriksson, D. K., Brandt, T. H., Schneck, S. M., Lucanie, J. M., Burchfield, A. S., Charney, S., Quillen, I. A., de Riesthal, M., Kirshner, H. S., Beeson, P. M., Ritter, L., & Kidwell, C. S. (2019). Patterns of Recovery From Aphasia in the First 2 Weeks After Stroke. Journal of Speech, Language, and Hearing Research, 62(3), 723–732.