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Critical Reflective Practice #5
Carley Mayer
Bachelor of Science Nursing, Loyalist College
NURS 3009, Clinical Practicum: Mental, Chronic or Rehab Health Challenges
Professor: Roger Renaud
November 10, 2023
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Critical Reflective Practice #5
Description of the Experience
On Wednesday, at my clinical placement, I completed patient research, completed a
round, received report and introduced myself to my patient. I later returned to my patient and
began a conversation with them. Through this conversation, they advised the reason for their
admission. They shared their struggles and feelings surrounding their home life, family, spouse
and children. They were very open about their life, struggles and plans. They also shared feeling
as though their goals had been derailed. Throughout this conversation, I stood between the
patient and the door as previously advised to ensure safety. During the conversation, my clinical
partner and I spoke to the patient about breathing, journaling, and the power of small goals. After
the conversation, we thanked my patient and left the room. I later briefly spoke with my clinical
instructor about my feelings of standing and engaging in the conversation.
Reflection
My body language of standing near the door when my patient was sitting comfortably
and sharing openly did not fit the situation. They had no history of aggression or anything that
may have impeded my safety. I understand that having an escape route planned and at the front
of my mind is essential for my safety, but in this instance, I felt as though it took away from the
therapeutic value of the conversation because it placed me in a positioning that was not
conducive to a therapeutic conversation. When the conversation was completed, I spoke with my
professor about this. Through discussion, it was determined that it might be possible to sit down
if it adds therapeutic value, so long as you are closest to the door and have a safe path.
Could I Have Dealt With it Better?
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I could have dealt with the situation better by asking my patient if I could sit to talk with
them. I had assessed the situation and determined that the chair was closest to the door, I had a
safety partner and felt comfortable. Sitting may have helped build a better relationship with my
patient as I would have been on their level, and my body language may have been better
received. Another option may have been to excuse myself from the conversation earlier to
discuss with my clinical instructor and return later to complete the conversation; however, this
may have impeded the information my patient was willing to share as it would have interrupted
the conversation.
Learning
This experience was valuable because it allowed me to question something we have been
taught in a classroom setting. According to Lessard‐Deschênes and Goulet's (2021) research,
nurses believe the therapeutic relationship is the most critical thing in mental health nursing. In
addition, nurses who were interviewed discussed the importance of authenticity and the
sometimes unfortunate legal responsibilities that can affect their clinical judgements and impact
their therapeutic relationships (Lessard‐Deschênes & Goulet, 2021). This research is larger than
sitting or standing in a room; however, it is an important highlight that there are barriers in place
for perceived safety that can inhibit a nurse's ability to use their judgement in situations, even as
simple as sitting or standing when speaking. Fleishman et al. (2019) discuss trauma-informed
care within healthcare and how non-threatening body positioning is essential to avoid triggering
past experiences that could leave the patient feeling powerless or trapped. A recommendation
they share is to attempt to have the nurse’s body sitting at the same level or below of the patient;
an additional suggestion included raising the hospital bed to bring the patient up higher
(Fleishman et al., 2019). This consideration would also have to consider the risk to the patient to
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ensure they would not fall from the bed. However, it could perhaps be helpful with a bedridden
patient. This experience reminds me that I need to apply my learning and question when I feel
my patient could benefit from a different method and advocate for them where possible. Overall,
this experience allowed me to feel more confident in speaking with my patient, gathering
information, and asking questions. I can apply this experience in my coming weeks of clinical by
building therapeutic relationships and navigating these new conversations.
Ways of Knowing
Ethical
My ethical ways of knowing have changed as I encountered a situation where I was
required to decide based on what I was taught. I did ultimately follow the direction I had
received; however, because of this experience, I will be assessing situations like this on a go-
forward and making more of an effort to be cognizant of my body language. My way of knowing
has changed because I recognize that even something as simple as sitting or standing in a room
can become an area for decisions and ethics.
Personal
The personal way of knowing involves knowing about yourself. I did not feel it was right
when I decided to continue to stand and speak with my patient. Through discussion and
reflection, I have determined that listening to myself was right. I will consider situations such as
this sooner through reflection in the future to have a greater therapeutic outcome.
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References
Fleishman, J., Kamsky, H., & Sundborg, S. (2019, May 31). Trauma-Informed nursing practice.
The Online Journal of Issues in Nursing.
https://ojin.nursingworld.org/table-of-contents/volume-24-2019/number-2-may-2019/
trauma-informed-nursing-practice/
Lessard‐Deschênes, C., & Goulet, M. (2021). The therapeutic relationship in the context of
involuntary treatment orders: The perspective of nurses and patients. Journal of
Psychiatric and Mental Health Nursing, 29(2). https://doi.org/10.1111/jpm.12800
