NU142CL Unit 4 Clinical Journal Example

Pulled Away Halfway Through an Assessment: A Clinical Journal Working Kolb's Four Stages Through a Composite Interruption, When a Call Light Took a Student From One Patient's Lungs to Another Patient's Fall Risk and Back

[Student Name]

Purdue University Global

NU142CL: Medical-Surgical Nursing I Clinical

Unit 4 Clinical Journal

[Instructor Name]

[Date]

The patients and staff are composite; the interruption is described without identifiers, and no records of time or evaluation are reproduced.

Concrete Experience

On my fourth shift I had two patients. At [0830] I was assessing Patient Y, a composite 70-year-old man with heart failure, and had listened to the front of his chest when the bed alarm for my other patient, a 78-year-old woman with a high fall risk, sounded down the hall. I told Patient Y I would be right back and went. She was sitting on the edge of the bed, trying to stand to use the bathroom. I helped her to the toilet, waited, helped her back and reset the alarm. When I returned to Patient Y, eleven minutes had passed. I picked up my clipboard, saw "lungs" half written, and was about to check the box for a complete respiratory assessment when I realized I had never listened to his back, where crackles from heart failure usually first appear at the bases (Harding et al., 2023).

Reflective Observation

Looking back, I see that I treated the interruption as a pause and expected to resume exactly where I had stopped. But my memory of what I had finished was vague, and the clipboard showed only the heading I had started. I felt a strong pull to finish the box so I could move on, because I was now behind. If I had checked it, the record would have said his lungs were assessed when the most important part was not. When I did listen to his back, I heard fine crackles at both bases that had not been documented the evening before.

The interruption was not the problem; the problem was coming back and trusting a half-finished memory instead of starting the system again. I also noticed how I handled Patient Y while I was away. I told him I would be right back, but I did not say why or how long, and when I returned he said he had wondered whether he had done something wrong. He had been lying with his gown open, waiting. A short explanation, that another patient needed help standing and I would return within a few minutes, would have respected him and cost me five seconds. My instructor pointed out that patients notice interruptions too, and that what we say as we leave shapes how they experience the wait. I had been thinking only about my task; he was thinking about being left mid-examination.

Abstract Conceptualization

Interruptions are common in nursing and are known to increase the chance of errors, especially when they break into a task that depends on memory, because the person returns and resumes at the wrong point (Potter et al., 2023). The fall-risk alarm deserved an immediate response; the safety of a patient trying to stand outweighed finishing a lung assessment. The lesson is not to avoid interruptions but to manage the return. In Kolb's model, an experience turns into learning only after it has been thought about, generalized and tried again (Kolb, 1984). The concept I took from this is simple: when an interrupted assessment resumes, it restarts the current system from the beginning, and nothing is documented until the whole system is complete.

Active Experimentation

Over my next two shifts I tested two changes. First, when I am interrupted during an assessment, I write the time and the last thing I completed in the margin, such as "anterior lungs only, 0830." Second, when I return, I restart that system rather than resuming. I also began checking the night nurse's notes before my assessment so I know what to compare against. On the second shift I was interrupted twice; both times the margin note told me exactly where to restart, and I documented both systems only after finishing them. The crackles in Patient Y's lungs had improved with diuretics by then, and because my first finding was documented correctly, the improvement was visible.

What I Still Need to Work On

I still feel rushed when I return from an interruption and want to make up time. I am going to practice telling my nurse when I fall behind, rather than speeding through the next task. My instructor suggested that the moment I most want to hurry is the moment to slow down. I plan to check in with myself at each interruption by asking one question before I go back: where exactly did I stop?

References

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Prentice Hall.

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