This is an original excerpt written by our team to show structure, depth and referencing. It is modelled on the course named above but is not a university document. Use samples as a study guide and follow your school's academic integrity policy.
Description
Two years into my first job as an RN on a medical unit, I was caring for a 78-year-old man admitted with pneumonia. During the night he became restless and kept pulling at his oxygen tubing. I assumed he was confused and anxious in an unfamiliar place, and I reapplied his nasal cannula and dimmed the lights. An hour later a more experienced colleague walked past, looked at him and said, "He doesn't look right." His SpO₂ was 84%. We called the rapid response team, and he was moved to a higher level of care. He recovered. The patient details have been changed.
I use Gibbs' (1988) reflective cycle to structure this journal: description, feelings, evaluation, analysis, conclusion and action plan.
Feelings
At the time I felt embarrassed, and afterward I felt frightened about what could have happened. I also felt defensive, because I had been busy with an admission and had done what I thought was reasonable.
Evaluation
What went well was that the rapid response system worked once my colleague raised the alarm. What went badly was that I explained away a change in behavior instead of assessing it. I didn't check his oxygen saturation or respiratory rate when he became restless.
Analysis
Benner (1984) describes five stages of skill acquisition: novice, advanced beginner, competent, proficient and expert. Advanced beginners and competent nurses rely on rules and plans, while proficient and expert nurses perceive situations as wholes and notice when something doesn't fit. That night I was working like a competent nurse: I was organized and focused on my plan for the shift, and I fitted his restlessness into the plan ("he's confused") rather than seeing it as a new problem. My colleague, who had many more years of experience, recognized the whole picture at a glance. Restlessness is an early sign of hypoxia, which I knew as a fact but didn't apply in the moment.
Conclusion
Expertise isn't only knowing more facts. It is the ability to notice what matters in a situation, and that develops through experience and reflection on experience. I can't skip the years it takes to become an expert, but I can build habits that protect patients while I develop.
Action plan
- When a patient's behavior changes, I will check vital signs, including SpO₂, before deciding on a cause.
- I will ask experienced colleagues to "think out loud" about patients who worry them, so I can learn what they notice.
- I will review this event with my unit educator and suggest it as an anonymous case for our new-graduate orientation.
- In my BSN program, I will look for evidence on recognizing early deterioration and share it at a staff meeting.
References
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.
Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic.
