Sample: episode of care reflection

Stage 1: Description (What Happened?)

During my sixth week in the Community District Nursing Service, I engaged in multi-day clinical visits to Mrs B, a 78-year-old female patient residing alone. Mrs B has a clinical history of Type 2 Diabetes Mellitus and presents with a chronic, three-month-old, 4cm x 3cm shallow venous ulcer on her left shin. The wound bed exhibited sloughy tissue and early granulation at the margins, with no active signs of localized infection.

On my initial visit (Tuesday), supervised by Jenny Andrews, I executed a full wound assessment. Our diagnostic check included an Ankle-Brachial Pressure Index (ABPI) measurement of 0.9, which confirmed safe vascular margins for the application of compression therapy. Following aseptic protocols, I irrigated the wound with sterile normal saline, applied a bacteriostatic Manuka honey dressing, and applied a compression bandage. Mrs B's pain level had clinically improved to 3/10 (down from 6/10 the prior week).

Concurrently, Mrs B presented with elevated cardiovascular and metabolic readings, showing a blood pressure of 142/88 mmHg (the third consecutive elevated reading) and fluctuating capillary blood glucose readings ranging between 8.0 and 14.0 mmol/L over the past week. During this interaction, Mrs B became visibly tearful while discussing the bereavement of her husband four months ago.

On Wednesday, working in a parallel diabetes clinic with supervisor Sarah, I observed Mr K (72), who had an HbA1c of 58 mmol/mol. While I initially attributed his poor glycemic control to "non-compliance," Sarah's use of open-ended motivational interviewing revealed that Mr K is psychosocially struggling following job loss and had ceased cooking entirely. This experience provided immediate parallel insights into Mrs B's metabolic management.

Stage 2: Feelings (What Were You Thinking and Feeling?)

During the first visit to Mrs B, her sudden emotional distress and tearfulness made me feel highly uncomfortable. As a Year 1 student, I panicked internally, feeling unqualified to address her grief. To escape my own anxiety, I defaulted to a purely task-focused defensive posture, moving rapidly to the clinical dressing change. I focused on the ulcer to avoid the complexity of her emotional pain.

Through Sarah's subsequent clinical coaching, I realized that my discomfort was a defense mechanism. I was attempting to "fix" the patient technically to shield myself from her distress. During our Friday debrief, Sarah normalized this, validating that "emotional labour" is a core clinical reality. This allowed me to accept my vulnerability, changing my perspective so that I could view uncomfortable patient emotions as clinical signs rather than barriers.

Stage 3: Evaluation (What Was Good and Bad About the Experience?)

The Positive: On a technical level, the wound care execution was successful. The ABPI measurement of 0.9 was highly accurate, the dressing application adhered to strict aseptic technique, and pain management was successfully achieved. On my second visit (Thursday), the supervised communication strategy changed; I moved away from giving directive advice ("You should consider counselling") and instead used curious, open inquiries ("Your daughter suggested support—what do you think?"). This successfully prompted Mrs B to discuss her coping mechanisms, such as gardening.

The Negative: On the first visit, my technical success was offset by a holistic failure. By rushing to complete the dressing, I ignored Mrs B's social isolation and bereavement. I failed to assess her support network or identify the metabolic link between her grief and her poor glycemic control (using biscuits as an emotional coping mechanism).

Stage 4: Analysis (What Sense Can You Make of the Situation?)

This episode of care illustrates the complex psychosocial dimensions of managing chronic disease in community settings. Mrs B's venous leg ulcer is not an isolated physiological pathology; it is directly linked to her social isolation, bereavement, poor nutrition, and depressive symptoms.

According to holistic nursing frameworks (Johns, 2022), physiological healing trajectories cannot be separated from psychosocial health. Her elevated blood glucose values (8–14 mmol/L) were directly exacerbated by emotional distress and nutritional neglect. Attempting to manage her physical wound while ignoring her mental health is clinically ineffective.

The parallel case of Mr K taught me the theory of motivational interviewing (Schön, 1983). It is clinically counterproductive to give directive dietary advice to a patient who lacks the psychosocial resources to cook. Similarly, Mrs B didn't need a directive lecture on counselling; she needed an empathetic space to explore what had helped her manage difficult emotional transitions in the past, leading to her identifying gardening as a meaningful activity.

Stage 5: Conclusion (What Else Could You Have Done?)

I should have recognized earlier that professional nurse competency requires a balance of relational skills and technical expertise. I should have documented her bereavement and emotional distress on day one, and made a structured referral to a bereavement support network.

Furthermore, I realized that clinical documentation must go beyond ticking physical boxes. I failed to formally document Mrs B's capacity, informed consent, and her reasoned decision during our discussion about counselling. Professional documentation is a clinical and legal safety net, not administrative overhead.

Stage 6: Action Plan (If the Situation Arose Again, What Would You Do?)

Clinical Development: Read NICE Guidelines [NG28] (Type 2 Diabetes in Adults) and [CG168] (Venous Leg Ulcers) to understand healing projections and vascular tissue classifications. I will practice clinical ABPI measurements to build my confidence.

Communication Strategy: Apply motivational interviewing on every assessment. I will ask at least one open-ended question about a patient's circumstances before proposing any clinical intervention.

Documentation Standards: Create a structured documentation template for clinical consent and capacity assessments, ensuring that all informal emotional conversations and patient choices are legally and ethically recorded.

Personal Resilience: Actively attend the university's reflective practice group on Tuesdays to discuss emotional labour and learn strategies to manage clinical anxiety.

NMC (2018) Code Alignment

References

• Boyd, C. (2023). Reflective Practice for Nurses. Wiley.
• Clarke, N. (2024). The Student Nurse's Guide to Successful Reflection: Ten Essential Ingredients (2nd ed.). Open University Press.
• Gibbs, G. (1988). Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit.
• Johns, C. (2022). Becoming a Reflective Practitioner (6th ed.). Wiley.
• Mental Capacity Act 2005. UK Legislation. Available at: www.legislation.gov.uk
• National Institute for Health and Care Excellence (2015). Type 2 Diabetes in Adults: Management. NICE Guideline [NG28].
• National Institute for Health and Care Excellence (2020). Venous Leg Ulcers: Management. NICE Guideline [CG168].
• Nursing and Midwifery Council (2018). The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. London: NMC.
• Nursing and Midwifery Council (2024). Supporting Information for Reflection in Nursing and Midwifery Practice. London: NMC.
• Schön, D.A. (1983). The Reflective Practitioner: How Professionals Think in Action. New York: Basic Books.