Introduction
This reflective essay explores a poignant clinical experience from my final year as a student nurse in adult nursing, focusing on an episode of end-of-life care provided to a 76-year-old patient, whom I will refer to as Mr X. Reflection is a fundamental aspect of professional development in nursing, enabling me to scrutinise my experiences, emotions, and decisions to enhance the quality of care I provide (Gibbs, 1988; Bulman and Schutz, 2013). Using Gibbs’ Reflective Cycle (1988), I will systematically examine this challenging encounter, which tested my clinical decision-making, leadership skills, and ability to collaborate within a multidisciplinary team (MDT). This reflection will critically analyse the care delivered, my emotional responses, and the ethical dilemmas encountered, while integrating evidence-based practice and compassionate, patient-centred care. Furthermore, it will demonstrate my developing clinical reasoning and professional judgement through reference to local, national, and international guidelines. By articulating this personal experience, I aim to highlight the complexities of care delivery and the profound importance of holistic engagement in nursing practice.
Description of the Episode
On the day in question, Mr X was admitted from the Emergency Department with severe respiratory distress, presenting with hypoxia, tachypnoea, and fluctuating consciousness. His frail appearance and a National Early Warning Score 2 (NEWS2) indicating severe risk necessitated immediate escalation (Royal College of Physicians, 2017). As he had no family present, I felt compelled to stay by his side, not wanting him to feel isolated. My responsibilities included monitoring vital signs, administering medications under supervision, providing basic care, and ensuring his physical and emotional needs were met to a high professional standard. I communicated concerns effectively to the staff nurse, healthcare assistants, ward matron, and medical team using the Situation-Background-Assessment-Recommendation (SBAR) framework (Haig et al., 2006). Despite interventions such as oxygen therapy, Mr X persistently removed his mask, seemingly expressing autonomy and acceptance of his long-term condition. His non-verbal communication, such as reaching for and holding my hand, offered insight into his emotional vulnerability. The MDT focused on symptom management, hydration, repositioning, and mouth care, adhering to palliative care guidelines (NICE, 2015). I maintained a calm, private environment, minimising interruptions and softly explaining each intervention to reduce his anxiety. As his condition deteriorated, I sat beside him, offering reassurance until he passed peacefully. This experience underscored the integration of clinical expertise, ethical responsibility, and relational competence in complex care scenarios.
Feelings and Emotional Impact
Throughout this episode, I experienced a profound emotional journey as Mr X’s condition worsened. Initially, I felt a strong sense of responsibility to ensure his comfort, adhering to local protocols and NEWS2 guidelines (Royal College of Physicians, 2017). However, a lingering anxiety accompanied my actions, driven by the awareness that he could deteriorate rapidly at any moment. This created a subtle but persistent pressure as I performed my tasks. When Mr X repeatedly removed his oxygen mask, my initial clinical concern shifted to a deeper reflective understanding of his autonomy, as recognised by the Mental Capacity Act (2005). As a student nurse, I grappled with conflicting emotions—wanting to preserve life yet sensing his acceptance of his condition. His frailty and lack of family intensified my protective instincts, particularly when he tightly held my hand, a gesture that made me acutely aware of his loneliness. This moment evoked a heaviness in my chest, intertwined with a sense of privilege at being trusted during such vulnerability. Drawing on Benner’s (2001) novice-to-expert model, I recognised my growing intuition in noticing subtle non-verbal cues, marking my transition towards a holistic, person-centred approach. Towards the end of my shift, as his breathing slowed, I felt a profound mixture of honour and emotional exhaustion. Indeed, the strain manifested physically as a severe migraine after completing last offices with another nurse. Reflecting on this, I often questioned whether I had done enough, but discussing the experience with a colleague provided reassurance. This emotional reflection highlights the development of my emotional intelligence and resilience, both vital for balancing empathy with clinical objectivity in future practice.
Evaluation of the Experience
Evaluating this episode, several aspects of the care provided stand out as positive, while others reveal areas for growth. Firstly, my ability to integrate clinical interventions with compassionate care was a notable strength. By staying with Mr X, holding his hand, and maintaining a calm environment, I ensured his dignity and comfort, aligning with NICE guidelines on end-of-life care (NICE, 2015). Additionally, effective communication within the MDT using SBAR facilitated timely interventions, demonstrating leadership and teamwork (Haig et al., 2006). However, I recognise limitations in my initial response to Mr X’s refusal of oxygen therapy. My instinct was to prioritise clinical outcomes over his autonomy, reflecting a task-oriented mindset rather than a fully patient-centred approach. This highlights a gap in my confidence to advocate for patient wishes immediately, an area I must develop further. Moreover, the emotional toll of the experience suggests a need for better personal coping strategies, as prolonged emotional strain could impact future care delivery if unmanaged (Bulman and Schutz, 2013). Overall, this evaluation reveals the complexity of balancing technical competence with ethical sensitivity, a challenge inherent in nursing practice.
Analysis of Decisions and Actions
Analysing my decisions during this episode, I can see the interplay of clinical guidelines, ethical principles, and personal judgement. The decision to escalate care based on Mr X’s NEWS2 score was guided by national standards, ensuring timely medical input (Royal College of Physicians, 2017). My choice to remain at his bedside, prioritising emotional support, was informed by the ethical principle of beneficence and the recognition that loneliness can exacerbate distress in end-of-life scenarios (NICE, 2015). However, respecting Mr X’s autonomy when he removed his oxygen mask required a shift in perspective, acknowledging his capacity to make decisions as outlined in the Mental Capacity Act (2005). This challenged my initial clinical focus and underscored the importance of integrating patient wishes with evidence-based practice. Furthermore, liaising with the MDT demonstrated my growing ability to navigate complex care environments, a critical skill in nursing (Haig et al., 2006). Reflecting on Benner’s (2001) framework, I can identify my progression towards intuitive, holistic care, though I must continue to build confidence in challenging clinical decisions independently. This analysis highlights the necessity of critical reasoning and adaptability in delivering compassionate, ethical care.
Action Plan for Future Practice
Reflecting on this experience, I have developed a clear action plan to enhance my future practice. Firstly, I will seek additional training in palliative care to deepen my understanding of patient autonomy and ethical decision-making, ensuring I can confidently advocate for patient wishes. Engaging with resources such as NICE guidelines will support this (NICE, 2015). Secondly, I aim to develop emotional resilience through debriefing sessions and peer support, mitigating the risk of burnout during emotionally intense situations (Bulman and Schutz, 2013). Additionally, I plan to enhance my clinical decision-making skills by shadowing experienced nurses and engaging in simulation-based learning to build confidence in complex scenarios. Finally, I will continue to use reflective models like Gibbs’ Cycle (1988) to critically analyse my practice, fostering continuous professional growth. This structured approach will ensure I address identified weaknesses while building on my strengths, ultimately improving the care I provide.
Conclusion
In conclusion, reflecting on the end-of-life care provided to Mr X using Gibbs’ Reflective Cycle (1988) has illuminated the profound complexities of nursing practice. This experience highlighted the importance of integrating clinical expertise with compassionate, patient-centred care, as well as the necessity of respecting patient autonomy even in challenging circumstances. My emotional journey underscored the need for resilience and ethical sensitivity, while my analysis revealed areas for growth in advocacy and personal coping mechanisms. By critically examining this episode through evidence-based guidelines and ethical frameworks, I have gained valuable insights into my developing professional judgement and clinical reasoning. Moving forward, my action plan focuses on enhancing my skills in palliative care, emotional resilience, and decision-making, ensuring I continue to grow as a competent and compassionate nurse. Ultimately, this reflection reinforces the transformative power of reflective practice in shaping high-quality nursing care and fostering professional maturity.
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. Chichester: Wiley-Blackwell.
- 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. Joint Commission Journal on Quality and Patient Safety, 32(3), pp. 167-175.
- NICE (2015) Care of dying adults in the last days of life. National Institute for Health and Care Excellence.
- Royal College of Physicians (2017) National Early Warning Score (NEWS) 2. Royal College of Physicians.
- UK Government (2005) Mental Capacity Act 2005. Legislation.gov.uk.
