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Self-Reflection

Karyll Aira R. Biggayan

School of Health Sciences and Wellness, Humber College North

BSCN-2302-0ZW: Caring for Clients Lifespan 1

Krisann Graff

November 19, 2022

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Situation:

This happened during the ninth week of my clinical. I changed the dressing on this

female client, who has an external pelvic fixator after being hit by a car, with the help of my

clinical instructor and a colleague. I chose this situation to reflect on because it brought up

many relevant aspects that helped me become a better student nurse. In this situation, I felt

like a nurse capable of performing a dressing change on my client and a student because my

instructor was watching and guiding me step by step. My knowledge base and how my

clinical instructor engaged with and included the client in the procedure influenced my

thinking that a nurse must include the client in everything they do to them by telling them

what they're doing and why.

Elaborate:

Prior to changing the dressing, I was in the room talking with the client and preparing

the materials (the dressing tray, normal saline, betadine, gauze, and tape). The client was

chatty and in a good mood at the time because she said she felt so much better after her

shower. I opened the dressing tray to begin the procedure, trying not to break the sterile

technique. My clinical instructor showed me how to clean the pin sites with normal saline

first, and then she let me complete the rest of the first step. My instructor noticed a redness

around the right pin site while we were doing it. She then informed the client of this, stating

that it could be an indication of infection. When we cleaned that area, the client also felt pain.

Thankfully, my colleague was present to provide emotional support for my client by talking

with her and holding her hand throughout the procedure, which I found very helpful for the

client. Following that, my instructor demonstrated the next steps to me, while also explaining

what we were doing to the client. I used betadine-soaked gauze to wrap around the pin site.

The final step, which I struggled with, was wrapping the pin sites with dry dressing and
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securing them with tape. The final step, which I struggled with, was wrapping the pin sites

with dry dressing and securing them with tape. Following that, I disposed of used supplies

and equipment. I also inquired as to how my client felt following the procedure, to which she

replied, "I feel better."

The situation was beneficial to me because it revealed what I lacked and needed to

improve on—not just my ability to change my clothes, but also the things I needed to do. For

instance, I should follow what my clinical instructor did (inform the client what we were

doing and what it was for). This made me think about how I needed to work on and improve

my skills because my hands were shaky when wrapping the pin site, which just shows that

I'm not confident. The negative aspect of the situation is that I could’ve hurt my client, which

may have led her to doubt my ability to perform the procedure, and she may have lost trust in

me, which is something that I do not want to happen because trust is so important. My actions

were influenced by the 5 C's competence. While changing the dressing, I was thinking about

all of the steps I needed to take (learned from the lab and the wound care order) and

following the sterile technique and not breaking it, as well as thinking I have the knowledge

and skill and it's my second time doing this, but can I do it efficiently? I made every effort to

be as competent as possible. I followed the steps as carefully as I could; it's just that the last

part was difficult for me to finish, but I did.

Analysis:

My instructor met one important value in the sixth principle of the CNO Code of

Conduct when analyzing the situation: "Nurses clearly communicate to patients the details of

care or a service they intend to provide." (CNO, 2019) She informed the client of what we

were doing (dressing change), and our findings (redness around the pin site), and even

warned her that the normal saline solution might burn or sting around the area of the pin sites.

My classmate also demonstrates one statement from the CNO Code of Conduct's first
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principle: “nurses treat patients with care and compassion.” (CNO, 2019) She held the

client's hand and talked to her when she felt pain during the procedure. For vulnerable clients,

comforting touch, such as holding hands, is especially important. Monash University

researchers found that gestures can have an analgesic effect on stress and pain, lending

credence to the role of social connections in pain management in clinical settings (Che et al,

2018). I achieved the seventh learning outcome by demonstrating the procedure safely and

competently to the best of my ability. Using my knowledge and skill in dressing changes, I

followed the steps my instructor demonstrated as carefully as I could without endangering my

client. I didn't break the sterile technique, and I double-checked that I was doing the right

thing by asking my instructor if I was doing it correctly and efficiently. I even change gloves

when I remove the old dressing and clean and put on the new one.

Conclusion and Action Plan:

This situation influenced how I would care for future clients in such a way that it

taught me valuable lessons that I could use to provide the best care possible. If I could do

anything differently in this situation, I would have included the client more in the procedure,

as my instructor did. I could have told her what I was doing and why, which would have

made the client feel included and involved in her care. She would have learned about the state

of her pin sites and the steps we take to keep them clean and healthy. I would have also

shown compassion to my client by asking her, "Are you okay?" or telling her, "I'm going to

do it again, and it may be painful, so just let me know when you're ready," to demonstrate

that I was concerned about how she felt. As a result, by the next clinical, when I change a

dressing, I will have applied all of these lessons in order to provide effective care and achieve

better health outcomes for my client.

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References

Che X, Cash R, Fitzgerald P, Fitzgibbon BM. (2018). The Social Regulation of Pain:

Autonomic and Neurophysiological Changes Associated With Perceived Threat. J

Pain. (5):496-505. DOI: 10.1016/j.jpain.2017.12.007

College of Nurses of Ontario (2019). Code of Conduct. [Practice Standard]

http://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf

Doane. G. H., & Varcoe. C. (2020). How to Nurse: Relational Inquiry in Action

(Second, North American ed.). Wolters Kluwer.

Overall, your reflection is well done, Karyll. It is understandable that when you are learning,

you are nervous, and it makes it hard to focus on the skill and the patient at the same time.

But you recognize the importance of including the patient in care and providing health

teaching and emotional support. Keep working on building this into your practice. In time,

with more experience and more confidence, you will be able to achieve this.