NU140 Unit 9 Reflection Example

The Plan I Wrote in Week Two and the One I Wrote in Week Eight: A Reflection by a Composite Former Nursing Assistant Measuring What Ten Units of Care Plans Changed in Her Bedside Reasoning

[Student Name]

Purdue University Global

NU140: Nursing Fundamentals

Unit 9 Reflection

[Instructor Name]

[Date]

The author and patients are composite; the two care plans are summarized from the course's earlier units.

Where I Started

I came into this course after six years as a nursing assistant on a medical floor. I knew how to turn patients, take vital signs, help with meals and notice when someone looked worse. When the first care plan was assigned, I thought it would be easy, because I already knew what nurses did. I was wrong about what a care plan was for.

The Plan From Week Two

My first plan was for a patient after abdominal surgery. Under nursing diagnosis I wrote "pain." Under interventions I listed what I had seen nurses do for every surgical patient: give pain medicine, reposition every two hours, encourage coughing and deep breathing, ambulate. My rationales repeated the interventions in different words. My instructor's comment was short: "These are good tasks. Which of them did this patient need, and why?" At the time I felt the comment missed the point, since all of those things are done for surgical patients.

The Plan From Week Eight

My recent plan was for a woman who could not urinate after surgery under spinal anesthesia. This time I started with the cues: no void in eight hours, a firm bladder above the pubic bone, a bladder scan of 720 mL, and her fear of pain. I named the problem as urinary retention and, for the first time, named two separate causes, the anesthetic and the pain-related tightening of her pelvic floor. Each intervention answered one of those causes: pain control before trying to void for the guarding, positioning and running water for the reflex, a catheter only if the scan stayed high. I rescanned after she voided and found a residual, so I revised the plan. Writing the related-to part of a nursing diagnosis precisely is what points the interventions at the patient's actual problem (Herdman et al., 2024).

The early plan described what nurses do; the later plan described what this patient needed, and the difference was the word "because."

What Moved

Three things changed. First, I start with cues now, not with tasks. Second, I look for the cause of a problem, because the cause is what decides the intervention. Third, I evaluate against an outcome I wrote down, which means I can find out that something did not work and change it, as I did with the residual urine. As a nursing assistant I noticed changes and reported them; I am learning to explain what they mean and decide what to do next. Our textbook describes the nursing process as a cycle in which evaluation feeds back into assessment, and the week eight plan was the first one where I experienced it that way (Potter et al., 2023).

Where My Aide Experience Helped and Hindered

My years as an aide helped more than I expected in assessment. I notice small things, a patient who stops finishing meals or who winces before standing, and those observations became cues in my plans. They hindered me in planning. As an aide, the work was a list, and finishing the list was the goal. A care plan asks me to stop and choose, and choosing feels risky when I am used to doing everything. One classmate who also worked as an aide said the hardest part for her was leaving tasks off a plan because the patient did not need them, and I recognized myself in that.

What Still Feels Mechanical

Writing outcomes still feels forced. I know they should be measurable and dated, but I sometimes choose a number because the format needs one rather than because it means something for the patient. I also find it hard to keep a plan to one or two problems when I can see five, which is a habit from aide work, where every need felt equally urgent.

What I Will Carry to Clinical

In clinical, before I do any task for a patient, I will ask myself what cue it answers and what cause it addresses. If I cannot say, I will look harder before acting. I also plan to ask my clinical instructor to review one of my outcomes each week and tell me whether it would actually show the plan worked. Benner described expertise as growing from experience reflected on, not from experience alone (Benner, 1984), and these care plans have been my first practice at reflecting on what I already knew how to do.

References

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.

Herdman, T. H., Kamitsuru, S., & Takáo Lopes, C. (Eds.). (2024). NANDA International nursing diagnoses: Definitions and classification, 2024-2026 (13th ed.). Thieme.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.