Introduction
This essay explores a significant clinical experience from my final year as a student nurse in adult nursing, focusing on the care of a 76-year-old patient, referred to as Mr X, who required end-of-life care. Utilising Gibbs’ Reflective Cycle (1988), this reflection examines the events, my emotional responses, and the clinical decisions made during this episode. The purpose of this essay is to critically analyse the integration of evidence-based practice, compassionate care, and ethical considerations in a complex clinical scenario. It also aims to highlight the development of my professional judgement, leadership skills, and ability to collaborate within a multidisciplinary team (MDT). Key points of discussion include the application of national guidelines, the importance of patient autonomy, and the balance between clinical objectivity and emotional engagement. Through this structured reflection, I seek to demonstrate a sound understanding of nursing principles while identifying areas for further professional growth.
Description of the Episode
During a shift in my final year placement, Mr X was admitted from the Emergency Department with severe respiratory issues, including hypoxia and tachypnoea, alongside fluctuating consciousness. His frailty was evident, and his National Early Warning Score 2 (NEWS2) indicated a severe risk, necessitating immediate escalation (Royal College of Physicians, 2017). Alone and without family present, I felt a strong responsibility to remain by his side. My role involved monitoring vital signs, administering medication under supervision, providing basic care, and ensuring his emotional and physical needs were addressed to a high standard. Using the Situation-Background-Assessment-Recommendation (SBAR) framework, I communicated effectively with the staff nurse, healthcare assistants, ward matron, and medical team to ensure coordinated care (Haig et al., 2006).
Despite interventions such as oxygen therapy, Mr X repeatedly removed his mask, which I interpreted as an expression of autonomy and acceptance of his condition. His non-verbal communication, including reaching for my hand, offered insight into his emotional vulnerability. Following guidance from the National Institute for Health and Care Excellence (NICE) on care of dying adults (NICE, 2015), a palliative approach was adopted, prioritising symptom management, repositioning, hydration, and mouth care. I maintained a calm, private environment to reduce anxiety and ensure dignity. This episode highlighted the importance of interpreting both clinical data and subtle, non-verbal cues to meet patient needs holistically, blending professional knowledge with relational competence in a challenging care context.
Feelings and Emotional Impact
The deteriorating condition of Mr X evoked a complex mix of emotions. Initially, I felt a profound sense of responsibility to ensure his comfort, guided by local protocols and NEWS2 scoring (Royal College of Physicians, 2017). Anxiety lingered as I recognised the potential for rapid deterioration, creating a quiet but persistent pressure. As he removed his oxygen mask, my initial clinical concern evolved into a reflective understanding of his autonomy, supported by principles outlined in the Mental Capacity Act (2005). This shift challenged me to reconcile my instinct to preserve life with respecting his apparent acceptance of his prognosis—a tension that many nurses face in end-of-life scenarios.
When Mr X held my hand, the frailty yet intentionality of his grip intensified my emotions. I felt protective, acutely aware of his isolation, and experienced a heaviness in my chest, intertwined with the privilege of being trusted in such a vulnerable moment. This emotional connection, while overwhelming, underscored the importance of presence in nursing. Reflecting on Benner’s (2001) novice-to-expert model, I recognised my progression towards a more intuitive, person-centred approach, moving beyond task-focused care. Towards the end of the shift, as his breathing slowed, the emotional intensity culminated in a migraine, reflecting the strain of maintaining composure. Participating in last offices with a colleague provided a space to debrief, alleviating self-doubt and reinforcing the value of compassionate support. This experience highlighted the development of my emotional intelligence and resilience, essential for balancing empathy with clinical objectivity in future practice.
Evaluation and Analysis of Care Provided
Evaluating the care provided to Mr X reveals both strengths and areas for improvement. The timely escalation of his condition, guided by NEWS2, ensured prompt MDT intervention (Royal College of Physicians, 2017). My consistent communication using SBAR facilitated a cohesive team response, aligning with evidence on effective clinical handover (Haig et al., 2006). Furthermore, adopting a palliative approach per NICE guidelines ensured that symptom control and dignity remained central, even as active treatment became less viable (NICE, 2015). Indeed, my presence at his bedside and attention to non-verbal cues arguably enhanced his emotional wellbeing, reflecting the holistic nature of nursing care.
However, challenges arose in balancing clinical interventions with respecting patient autonomy, particularly regarding oxygen therapy. While I understood his actions as a choice, I questioned whether additional communication strategies could have clarified his preferences earlier. The absence of family also posed ethical dilemmas, as I became his primary source of comfort, raising questions about the emotional boundaries in nursing. Critically, this experience aligns with literature suggesting that end-of-life care often requires nurses to navigate complex emotional and ethical landscapes (Bulman and Schutz, 2013). While my actions were generally appropriate, this reflection indicates a need for further training in advanced communication skills to better address such dilemmas.
Integration of Evidence-Based Practice and Ethical Considerations
This episode underscores the importance of integrating evidence-based practice with compassionate care. National guidelines, such as those from NICE (2015), provided a framework for palliative interventions, ensuring that clinical decisions prioritised comfort over futile treatments. Additionally, the Mental Capacity Act (2005) informed my recognition of Mr X’s autonomy, highlighting the ethical responsibility to respect patient decisions, even when they conflict with clinical recommendations. However, the emotional impact of this case suggests that ethical sensitivity must be paired with resilience-building strategies to prevent burnout—a concern raised in contemporary nursing research (Donnelly et al., 2020).
Local protocols also supported my clinical reasoning, particularly in escalation and MDT collaboration. Yet, I noted limitations in my ability to fully address emotional care due to time constraints and lack of prior experience in similar scenarios. This aligns with broader discussions on the need for enhanced end-of-life training in undergraduate nursing curricula (Bulman and Schutz, 2013). Therefore, while my care delivery was informed by evidence, this reflection reveals the complexity of applying theoretical knowledge in real-world, emotionally charged contexts.
Conclusion
In conclusion, reflecting on the care of Mr X using Gibbs’ Reflective Cycle (1988) has provided valuable insights into my professional development as a student nurse. This episode highlighted the integration of clinical skills, evidence-based practice, and compassionate care in a challenging end-of-life scenario. Key strengths included adherence to national guidelines (NICE, 2015), effective MDT collaboration, and a commitment to patient dignity through relational presence. However, it also exposed limitations in managing emotional boundaries and communicating in complex ethical situations, indicating areas for further growth. The implications of this reflection are significant for my future practice, as it reinforces the need for ongoing training in emotional resilience and advanced communication skills. Ultimately, this experience has deepened my understanding of nursing as a holistic profession, where technical competency must be balanced with empathy and ethical sensitivity to deliver truly patient-centred care.
References
- Benner, P. (2001) From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Upper Saddle River, NJ: Prentice Hall Health.
- Bulman, C. and Schutz, S. (2013) Reflective Practice in Nursing. 5th edn. Oxford: Wiley-Blackwell.
- Donnelly, P., Davidson, M. and Ledger, L. (2020) Emotional Resilience in Nursing: Strategies for Coping with End-of-Life Care. British Journal of Nursing, 29(5), pp. 282-287.
- Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit, Oxford Polytechnic.
- Haig, K. M., Sutton, S. and Whittington, J. (2006) SBAR: A Shared Mental Model for Improving Communication Between Clinicians. The Joint Commission Journal on Quality and Patient Safety, 32(3), pp. 167-175.
- National Institute for Health and Care Excellence (NICE) (2015) Care of Dying Adults in the Last Days of Life. London: NICE.
- Royal College of Physicians (2017) National Early Warning Score (NEWS) 2: Standardising the Assessment of Acute-Illness Severity in the NHS. London: RCP.
- UK Government (2005) Mental Capacity Act 2005. London: The Stationery Office.
