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Clinical Reflective Journal

Naomi Su

Trent School of Nursing

NURS 3021

Dawn Balsdon & Laura Gallinger

October 31, 2022

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Clinical Reflective Journal

Identification

Upon reflection, an experience that sticks out to me and I feel needs some discussion is

an incident that occurred during the first week of clinical placements. While charting in the

nurses’ station, my clinical group partner and I were asked by one of the nurses on the floor to

put a patient in bed. This patient had been up all morning, and we could tell he wanted to go back

to bed. After putting him into bed and making him comfortable, he smiled at us and thanked us

for getting him into bed. Immediately after, another nurse comes in and tells us we should not

have done that. She tells the patient “we are not doing this today, you are getting back up.” The

way she got the patient up was also unsettling as it felt forceful. The patient was clearly upset but

as students we felt there was nothing we could do.

In nursing, there is a fine line between patient autonomy and paternalism (Bladon, 2019).

As well, because we are students it may be difficult to know our place in terms of patient

advocacy. There might have been a reason the nurse wanted the patient up and out of bed.

Perhaps it would have benefitted his healing process more if he was out of bed, and this was

something we were not aware of. But from my perspective, seeing this elderly man upset broke

my heart. In that situation I felt powerless because I was afraid to stand up to the nurse.

Description

This incident upset me, and it made me question the role I play in the nursing profession.

It was frustrating having to take the patient out of bed after we tucked him in. It was

heartbreaking seeing his sad face when he was forced to sit in his wheelchair. At that moment, I

felt conflicted as a student nurse. I was afraid to question the nurse, but I also wanted to respect

patient autonomy. Throughout nursing school, we have learned about the importance of patient
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autonomy, and respecting the patient’s wishes and decisions in healthcare. Witnessing this

incident made me feel uneasy, considering what I’ve learned in school. Thinking back, I wish I

asked the nurse what the reasoning was behind having him stay up. Perhaps she had a good

reason to get him up, but that doesn’t excuse the aggressive tone she used on him.

Esthetic Way of Knowing

Esthetic knowing is the understanding of a person’s behaviour, and is achieved through

empathy and a relational approach (Rafii et al., 2021). In this situation, I don’t know the nurse’s

motivations behind her actions. But I do know that the patient wanted to lay down, the patient

was grateful my clinical partner and I helped him into bed, and was upset when he was forced to

sit up.

Personal Way of Knowing

Personal knowing involves understanding and knowing my own self, my values and

beliefs, as well as my strengths and weaknesses. I know that I respect patient autonomy and it

was upsetting seeing the patient have no choice in the situation. Especially since the patient was

an older adult, the patient should have been able to make their own choices and should be treated

with respect. But I know that as a student, I felt reluctant to speak up for the patient to a nurse

that has a lot more knowledge than I do. I know that I love caring for others and I like to make

other people feel happy. But my weaknesses lie in not having the confidence to advocate for

myself and my patients.

Ethical Way of Knowing

The ethical way of knowing involves the ethics of nursing, morality, and the wrong and

right action (Rafii et al., 2021). This situation is an ethical consideration in nursing practice.

Patient autonomy and paternalism creates an ethical dilemma. I believe that patients should have
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autonomy, and their autonomous choice should be respected. But I also understand that in

healthcare, we want to make the decision that best serves the patient’s health and safety.

Empirical Way of Knowing

The empirical way of knowing is gained through observations and is formally conveyed

through facts and theories (Rafii et al., 2021). From my observations, I could see that the patient

was upset he was forced to stay out of bed. He was visibly upset and confused. After the nurse

got him up into his wheelchair, my clinical partner and I tried to make him as comfortable as

possible. We put his bedside table right next to him, got him a hockey magazine to read, and a

drink. Even though he was upset, we tried to make sure he was comfortable.

Significance

I have seen this situation play out before. I work in a retirement home and often see

residents lose their autonomy. The nurses believe that they are making the decision that will be

of greater beneficence for the resident. For example, if a resident doesn’t want to come down for

dinner, I’ve seen some nurses force them to get out of bed and come to the dining room. This

makes me think of how the resident must feel. They are adults and it might make them feel

otherwise. It is important to advocate for our patients and respect their autonomy.

Implications

This experience made me reflect on my role as a healthcare professional and my values.

Abbate (2021) recommends a culture change movement that incorporates relational autonomy

into practice. Through this movement, a more homelike environment is created, and relationships

between family members, residents, nurses, and the community are fostered (Abbate, 2021).

With the creation of these therapeutic relationships between patients and nurses especially, will
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allow for patients to feel safe and comfortable, and be able to trust their nurse. I think that this

would aid in creating a respectful environment for both the patient and healthcare professional.

Bladon (2019) highlights the importance of reflective practice in nursing. In order to

evaluate our practice, we need to be critical and reflective. Being reflective allows us to assess

our values, beliefs, strengths and weaknesses, and how we can use past experiences to further our

knowledge base and improve our practice. Bladon (2019) describes how reflective practice

strengthened the relationship between nurses and their patients, thus enhancing their practice.
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References

Abbate, S. (2021). Reframing holistic patient care in nursing homes through the lens of relational

autonomy. Holistic Nursing Practice, 35(1), 3–9.

https://doi.org/10.1097/HNP.0000000000000419

Bladon, H. (2019). Avoiding paternalism. Issues in Mental Health Nursing, 40(7), 579–584.

https://doi.org/10.1080/01612840.2019.1570405

Rafii, F., Nasrabadi, A. N., & Tehrani, F. J. (2021). How nurses apply patterns of knowing in

clinical practice: A grounded theory study. Ethiopian journal of health sciences, 31(1),

139–146. https://doi.org/10.4314/ejhs.v31i1.16