NU480CL Unit 6 Reflective Practice Entry Example

"Does This Mean She's Dying?": A Reflective Practice Entry on a Composite Daughter's Question About a Positive Goals Screen for Her 88-Year-Old Mother After Hip Repair, Why Reassurance Came First and the Sentence Prepared for Next Time

[Student Name]

Purdue University Global

NU480CL: Four Spheres BSN Capstone Practicum

Unit 6 Reflective Practice Entry

[Instructor Name]

[Date]

The moment is composite and written to demonstrate the form of an entry, not a shift anyone lived; the header lines for date and practicum hours are left for the writer to complete from their own log.

Header

Date on site: [date]. Practicum hours this entry covers: [__]. Cumulative hours: [__]. Preceptor present: [yes/no].

What Happened

[Mrs. A.], 88, was admitted to the rehabilitation hall after surgery for a hip fracture. On admission she was frail, had heart failure with [two] hospitalizations in the past six months and needed help with all transfers. The admitting nurse completed the goals screen: positive on two items. The next morning, her daughter stopped me in the hallway. She had seen the social worker's note asking to schedule a goals conversation. "Does this mean she's dying?" she asked. "Nobody told us she was dying."

What I Said

I said, "No, no, it's just a routine thing we do for everyone." She looked relieved and went back to her mother's room.

Why Reassurance Came First

I reassured her because her fear was obvious and because I wanted to protect the project from sounding frightening. Both reasons were about comfort, hers and mine. But what I said was not quite true. The screen is not done "for everyone" in the sense of everyone being positive; it was positive for her mother because her mother has serious illness. My reassurance closed the conversation at the moment she was ready to have it.

I protected her from a question she had already asked, and in doing so I made the real conversation harder for whoever came next.

What I Should Have Done

It would have been better to name her fear, been honest about the purpose and offered the conversation, without discussing prognosis, which is not a student's role. Clinicians who handle serious illness conversations well often begin by asking what the person understands and what worries them, and they avoid both false reassurance and unrequested predictions (Bernacki & Block, 2014).

The Project, Examined

The daughter's question exposed a gap in the project, not only in me. The social worker's note had been visible to the family through the patient portal before anyone had spoken with them. Nobody had planned how families would first hear about the screen. The staff handout, still in draft, told nurses what to say to patients but not what to say to a family member who discovered the screen on their own. I raised this with my preceptor, and we agreed on two changes: the note would be worded as a routine invitation to discuss goals of care, and nurses would have a prepared reply.

What Families Need

The daughter's reaction is likely to be common.

Hearing the word "palliative" or "goals of care" without explanation can sound like a prognosis. Older adults sent for rehabilitation near the end of life often reach that point without anyone having discussed their goals (Flint et al., 2019), so families may meet the subject for the first time on a screen or in a note. The screen's value depends on the first few sentences people hear about it.

A Sentence Prepared in Advance

"That's a good question to ask. The screen means your mother has some health conditions where it helps to talk early about what matters most to her and to you. It isn't a prediction. The social worker and her doctor would like to sit down with you this week, and they can answer questions about what to expect."

What Happened Next

That afternoon I found the daughter in the lounge and told her I had answered too quickly in the morning. I explained, in the prepared words, what the screen meant and what it did not. She said she had been worried all day and would rather know. The social worker met with her and her mother two days later; her mother chose to continue therapy with a plan to revisit goals if she was readmitted.

What My Preceptor Said

She said the reassurance was a natural reflex and that the useful part was noticing it. She also said the portal problem would have surprised her too, and that it was better found in week four than in the final report.

What I Learned

Comfort is not the same as care. A reassurance that ends a conversation can protect the speaker more than the listener. Projects that touch serious illness need their words planned as carefully as their measures.

Connection to Program Outcomes

This entry shows growth in communication and person-centered care, as described in the national essentials (American Association of Colleges of Nursing, 2021): recognizing a misstep, correcting the process and preparing language for the next family.

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education.

Bernacki, R. E., & Block, S. D. (2014). Communication about serious illness care goals: A review and synthesis of best practices. JAMA Internal Medicine, 174(12), 1994-2003. https://doi.org/10.1001/jamainternmed.2014.5271

Flint, L. A., David, D. J., & Smith, A. K. (2019). Rehabbed to death. New England Journal of Medicine, 380(5), 408-409. https://doi.org/10.1056/NEJMp1809354