Sample: Episode of Care Reflection

Placement Overview: Multiple Learning Opportunities

Week 6 of my community district nursing placement provided significant learning across clinical skills, communication, and holistic care. Working with two practice supervisors (Jenny and Sarah), I engaged with multiple patients across home visits and clinic settings. The primary case study involves Mrs B, a 78-year-old woman living alone with type 2 diabetes and a 3-month-old left shin leg ulcer. This reflection covers four days of visits to Mrs B, parallel learning from a diabetes clinic case, and structured supervision feedback.

First Visit: Task-Focused Care (Tuesday)

Clinical Context: Mrs B presented with a 4cm x 3cm shallow leg ulcer with sloughy tissue and early granulation at edges (no infection signs). She had elevated blood pressure (142/88 mmHg—third consecutive reading) and blood glucose readings 8-14 mmol/L over the past week.

Clinical Care Delivered:Under Jenny's supervision, I performed a full wound assessment, checked ABPI (0.9—safe for compression), cleaned with normal saline, applied manuka honey dressing, and wrapped with compression bandage. Pain had improved from 6/10 to 3/10 since last week.

What I Missed: When Mrs B became tearful discussing her husband's death 4 months ago, I felt uncomfortable and moved quickly to clinical tasks.I didn't ask about her support network, consider bereavement referral, or connect her emotional state to her elevated blood sugars (she was eating more biscuits "to feel better"). In debrief, Jenny pointed out I'd completed the wound care but missed the person.

Parallel Learning: The Mr K Clinic Case (Wednesday)

In clinic with Sarah, I observed a diabetic patient (Mr K, age 72) with HbA1c 58 mmol/mol. My initial assumption was "poor compliance." But Sarah asked: "What do you actually eat? What's been happening for you?" He revealed he'd lost his job 6 months ago and stopped cooking. Sarah explained motivational interviewing: you can't fix numbers with clinical advice if the person is psychosocially not coping. This fundamentally reframed how I understood Mrs B's situation.

Second Visit: Reflection-in-Action (Thursday)

Returning to Mrs B with Jenny's coaching, I approached the bereavement conversation differently. Instead of "You should consider counselling," I asked: "Your daughter suggested counselling—what do you think?"She said she didn't "believe in talking about feelings." Rather than disagreeing, I asked: "What's helped you feel better in the past?" She mentioned gardening. I explored whether her daughter could help with that. By the end, Mrs B was more open.

Critical Difference: The clinical task (dressing change) was identical to the first visit, but the approach was completely different.Jenny's feedback: "Last time you were task-focused. This time you were curious." This taught me that nursing skill isn't just technical competence—it's relational.

Supervision and Professional Development (Friday)

Clinical Feedback from Sarah:My wound assessment is improving but I'm vague about tissue type classification and vascularity. I need to think about expected healing trajectories, not just snapshot assessments. When should this ulcer be healed? At what point do we escalate?

Legal/Ethical Feedback:I must document informed consent and capacity assessment properly. When Mrs B discussed bereavement counselling, I didn't formally document what was offered, her understanding, and her reasoned decision. This is legally and ethically important, not bureaucratic busywork.

Personal/Emotional Feedback:When asked how I'm managing emotionally with distressed patients, I was honest: "It's hard." Sarah normalized this ("Emotional labour is real") and signposted me to the university's reflective practice group. This validation was crucial—not "get over it" but "this is legitimate and you need strategies."

Key Learning: Psychosocial Dimensions of Chronic Disease

The Clinical Insight: Mrs B's leg ulcer isn't the primary problem. The primary problem is that she's isolated, grieving, has reduced her nutritional intake, and is probably experiencing depression. The ulcer is a symptom of all that. I can learn wound care from YouTube videos. I could never have learned this holistic understanding without noticing it in practice and having mentors help me see it.

The Personal Insight:My discomfort when Mrs B cried was information, not a barrier. It told me I was trying to "fix" her rather than listen to her. Once I recognized that pattern, I could change my approach. Being uncomfortable is part of professional development.

The Professional Insight:Precision in documentation matters. If I don't properly document informed consent and capacity assessment, I haven't been a safe practitioner—I've just been a task-completer.

Action Plan for Future Practice

Clinical: Read NICE NG28 (Type 2 Diabetes) and NICE CG168 (Venous Leg Ulcers) to understand expected healing trajectories and vascularity assessment. Practice ABPI measurements and wound tissue description.

Documentation:Create a template for informed consent conversations to ensure I'm thorough in recording capacity assessment and patient understanding.

Communication: Before proposing any intervention to a patient, ask one more question about their circumstances. Remember: curious > directive.

Personal Resilience: Start attending the reflective practice group on Tuesdays. Read recommended resources on grief and health. Discuss emotional labour strategies in next supervision.

NMC Proficiencies Addressed

• Platform 1 (Being accountable): Recognizing limits of my knowledge, seeking feedback immediately, reflecting on discomfort as learning data
• Platform 2 (Promoting health): Identifying bereavement and social isolation as health risks; understanding depression's link to poor diabetes control
• Platform 3 (Assessing needs): Holistic assessment integrating wound, nutrition, mental health, cardiovascular status, and social support
• Platform 4 (Providing care): Dressing technique developing; communication skills transforming from task-focused to person-centered
• Platform 5 (Teamwork): Using supervision effectively; multi-disciplinary coordination (GP, mental health, social support)

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.