NU577 Unit 5 seminar reflection example

Half of "Congratulations": A Reflection on Half a Word, Caught in the Moment and Examined Afterward

[Student Name]

Purdue University Global

NU577: NP II Clinical - Women's Health Focus

Unit 5 Seminar Reflection

[Instructor Name]

[Date]

The patient was a classmate playing a composite role; no real person is described.

The Exercise

Our seminar practiced delivering test results. My classmate played Ms. [A.], 22, who had come in for a missed period. Her feelings about a pregnancy had been written on a card only she and the facilitator had seen. I walked into the role-play room with the result: positive.

The First Attempt

I said, "Your test is positive. Congratu," and stopped partway through the word. I had seen her face. It was not a face that wanted congratulations.

Reflection-in-Action

Schön (1983) describes reflection-in-action as the thinking a practitioner does while still in the situation, when something unexpected prompts a change of course. That is what happened in the half-second after I stopped. I did not have time to think it through. I noticed her expression, realized I did not know what the result meant to her, and changed what I was doing.

What I did instead: I said, "Your pregnancy test is positive," and then I stopped talking. After a pause, I asked, "How are you feeling about that?" She said, "I don't know. I don't think I can do this right now." The facilitator stopped the role-play there.

The Second and Third Attempts

We restarted twice with different cards. In the second, the patient had been trying to conceive for a year and burst into tears of relief. In the third, she was frightened because her partner would be angry. Each time, I stated the result plainly, paused and asked how she felt, and each time the conversation went somewhere I could not have predicted. The same result, stated the same way, meant three different things, and only her answer told me which.

Reflection-on-Action

Reflection-on-action is the thinking done afterward, looking back at what happened (Schön, 1983). Writing this, I can see the assumption behind the half-spoken word: that a 22-year-old in a relationship would welcome a pregnancy. I did not think it consciously, but it was there, shaping what came out of my mouth. The assumption was also statistically weak. In the United States, nearly half of pregnancies are unintended, and rates are highest among young women in their early twenties (Finer & Zolna, 2016).

The federal recommendations for quality family planning services describe how to respond to a positive test: provide the result, ask how the patient feels, and offer information about all options, including prenatal care, adoption and abortion, in a neutral, nondirective way, with referral on request (Gavin et al., 2014). Nondirective means that I do not steer. "Congratulations" is directive; it tells her how to feel. "How are you feeling about that?" lets her tell me.

I also noticed a quieter assumption. When the second patient cried with relief, I felt relieved too, as if that were the right answer. It was not the right answer; it was her answer. My job was the same in all three rooms.

The Law, Without Arguing It

Since 2022, abortion law has varied widely by state, and in some states it is now banned or restricted early in pregnancy. That changes the practical details of referral, how far a patient may need to travel and how quickly she must decide, but it does not change the counseling principle. Nondirective options counseling still means giving accurate information about every option and referring as the patient requests, within whatever my state currently allows. I now keep the clinic's current referral list at hand so that I do not have to look it up while she waits.

What the Facilitator Added

After the third run, the facilitator asked what I would have done if the patient had said nothing at all after I asked how she felt. I realized I had assumed she would answer. She suggested naming a range out loud, so a patient does not have to find words for a feeling she has not sorted out: "Some people are happy, some are upset, some aren't sure yet. Any of those is okay." She also pointed out that a patient's first reaction is not always her last, and that the visit should end with a plan for the next conversation, not a decision, unless the patient is ready to make one. A follow-up call within a few days lets her think and still have someone to talk to.

A classmate added something I had not considered. In the room, I had been standing while my patient sat. When we ran the scene again, I sat down before giving the result, at her eye level, and the whole exchange felt less like an announcement. It is a small thing, but it signals that I am staying for whatever comes next.

What I Will Do

State the result plainly. Pause. Ask how she feels. Then follow her answer. I will not say congratulations until she has said something that invites it.

References

Finer, L. B., & Zolna, M. R. (2016). Declines in unintended pregnancy in the United States, 2008-2011. New England Journal of Medicine, 374(9), 843-852. https://doi.org/10.1056/NEJMsa1506575

Gavin, L., Moskosky, S., Carter, M., Curtis, K., Glass, E., Godfrey, E., Marcell, A., Mautone-Smith, N., Pazol, K., Tepper, N., & Zapata, L. (2014). Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recommendations and Reports, 63(RR-4), 1-54.

Schön, D. A. (1983). The reflective practitioner: How professionals think in action. Basic Books.