Sample: Episode of Care Reflection

Context and Setting

During my second-year placement on Maple Ward, an acute medical unit, I cared for Mrs Patricia Johnson (pseudonym), a 78-year-old woman admitted with community-acquired pneumonia and early signs of sepsis. This episode of care took place over a 12-hour shift and allowed me to develop my clinical assessment, communication, and person-centred care skills under the supervision of my practice assessor.

Description of Care Episode

Mrs Johnson was admitted via A&E at 07:30 with a two-day history of productive cough, confusion, and reduced oral intake. Her initial observations showed: temperature 38.9°C, heart rate 112 bpm, respiratory rate 26 breaths/min, BP 95/58 mmHg, SpO2 91% on room air, and NEWS2 score of 9, indicating high clinical risk.

Working with my practice assessor, I participated in implementing the Sepsis Six bundle within the first hour. I cannulated Mrs Johnson on my second attempt after explaining the procedure and gaining consent, administered IV fluids as prescribed, and collected blood cultures using aseptic technique. I escalated my concerns about her deteriorating oxygen saturations to the medical team, who initiated oxygen therapy via nasal cannulae.

Throughout the shift, I maintained regular observations every 30 minutes as per the escalation protocol, documented fluid balance accurately, and communicated with Mrs Johnson's daughter who was understandably anxious. I used SBAR when handing over to the night shift, ensuring continuity of care.

Analysis and Reflection (Gibbs Reflective Cycle)

Feelings

Initially, I felt anxious about caring for an acutely unwell patient with a high NEWS2 score. The urgency of implementing the Sepsis Six was challenging, and I worried about my cannulation skills. However, as the shift progressed and Mrs Johnson's condition stabilised, I felt a growing sense of confidence and professional satisfaction.

Evaluation

Positive aspects included my successful cannulation, timely escalation of concerns, and effective communication with the family. I maintained accurate documentation and worked well within the multidisciplinary team. Areas for development included my initial hesitation in the emergency situation - I needed prompting from my assessor to prioritise tasks effectively.

Analysis

This experience reinforced the importance of systematic assessment using frameworks like ABCDE (Resuscitation Council UK, 2021) and the value of early recognition and intervention in sepsis. NICE guideline NG51 emphasises that each hour of delay in antibiotic administration increases mortality risk. My understanding of the pathophysiology of sepsis - the systemic inflammatory response leading to organ dysfunction - helped me anticipate Mrs Johnson's care needs.

Conclusion

This episode demonstrated the critical importance of timely intervention in sepsis care. I learned that effective communication - with patients, families, and the healthcare team - is as vital as clinical skills. My practice assessor noted my growing confidence in clinical decision-making and my compassionate approach to family communication.

Action Plan

For future practice, I will: (1) seek more opportunities to lead in time-critical situations under supervision, (2) complete the Trust's sepsis e-learning module, and (3) practice task prioritisation using simulation scenarios. I have arranged to shadow the outreach team to better understand escalation pathways.

NMC Proficiencies Addressed

• Platform 3: Assessing needs and planning care - demonstrated through systematic assessment and care planning for Mrs Johnson
• Platform 4: Providing and evaluating care - evidenced by implementing the Sepsis Six and evaluating response to treatment
• Platform 5: Leading and managing nursing care - shown through appropriate escalation, delegation awareness, and SBAR handover
• Annexe A: Communication and relationship management - demonstrated with patient, family, and MDT interactions
• Annexe B: Nursing procedures - including cannulation, vital signs monitoring, and medication administration

References

• National Institute for Health and Care Excellence (2017) Sepsis: recognition, diagnosis and early management. NICE guideline [NG51].
• Nursing and Midwifery Council (2018) Future nurse: Standards of proficiency for registered nurses. London: NMC.
• Resuscitation Council UK (2021) The ABCDE Approach. Available at: www.resus.org.uk
• UK Sepsis Trust (2024) Clinical Tools. Available at: www.sepsistrust.org