NRNP 6567 Week 11 Reflection Example

Reflection: Three Moves That Now Come Without Effort, Two That Do Not, and Why Paper Speed Is Not Bedside Speed

Student Name

College of Nursing, Walden University

NRNP 6567: Critical Care Immersion: Advanced Skills and Patient Management

Instructor Name

Month Day, Year

Reflection: Three Moves That Now Come Without Effort, Two That Do Not, and Why Paper Speed Is Not Bedside Speed

Three Named Items

1. Naming the information state before defending an action. 2. Attaching a confirmation parameter, with a time window, to every plan. 3. Separating what a sequence shows from what it only suggests. In week 1 each of these took a deliberate second pass; by week 10 they appeared in my first drafts.

Paired Illustrations

Information state. My first outline for the week 4 discussion defended the intubation by noting, in effect, that his oxygenation needed prone positioning the next morning, which proved the lungs were severe. That was an argument from the future. The posted version argued from a ROX value of 3.16 at hour 6, below the threshold that predicted failure of high-flow therapy in the validation cohort (Roca et al., 2019), which was the information that existed when the decision was made. By the week 10 debrief, I wrote each finding from what the team knew at that minute without having to correct myself.

Confirmation parameters. In the week 2 pathophysiology brief, my plan-like sentences had no windows: fluid "can also add water to the lungs," with no statement of how anyone would know. In the week 6 hemodynamic analysis, every action carried its test, such as a rise of at least 10% in the velocity-time integral within 15 minutes of the bolus, matching the passive leg raise, whose predictive accuracy rests on the change in cardiac output it produces (Monnet et al., 2016). The difference is that the week 6 plan could be shown wrong.

Shows against suggests. The week 3 reconstruction ended with a section that separated them: the sequence showed a 30-minute interval between criteria and call; it only suggested that an earlier call would have helped. I wrote that section slowly and rewrote it twice. In week 5, the same distinction appeared in the first draft, including the point that rapid response systems have reduced ward arrests without a clear effect on overall mortality (Chan et al., 2010), which limits what any single episode can claim.

What Is Still Slow

Stating a threshold where the literature does not supply one. In the week 8 post, the stopping rule for prone sessions came from the trial, but the requirement for two gases an hour apart was mine, and I spent longer on that sentence than on the rest of the post, drafting and deleting it three times. I still hesitate to write a number I cannot cite, and when I do write it, I am not confident I chose well. The course asked for honesty about such numbers, and I gave it, but it has not become fast.

Writing a family's words and my own in plain language. The week 9 family note took longer than any clinical document this term. My first draft of the explanation to his wife used "bilateral infiltrates" and "oxygenation"; the plain version took four drafts. The difficulty is not vocabulary; it is that the clinical word carries a precision I am reluctant to give up, and the plain word feels less exact. I have come to think the plain word is usually more exact for the person hearing it, because it is the one she can repeat to her son, but I still reach for the clinical term first and translate it second.

Where Speed Transfers

Writing quickly about a composed case is not the same as reasoning quickly at a bedside. In a composed case, I control the order in which information arrives and I can pause the clock. In a live unit, the gas comes back while the pressure is falling and the family is at the door. What I expect to transfer is the habit, not the speed: asking what is known right now, what would prove this plan wrong and by when, and whether a record will let someone else reconstruct what I knew. What I do not expect to transfer without practice is doing those things while three other things are happening, and I will not claim otherwise.

The Forward Line

In my first ICU rotation after this course, I will write one confirmation parameter with a time window into every plan I document, and I will check at the end of each shift how many of them I actually looked at. That number, not a feeling of fluency, will tell me whether the habit has transferred. If the count is low, the habit lives only on paper, and I will know which of the three moves to practice first.

References

Chan, P. S., Jain, R., Nallmothu, B. K., Berg, R. A., & Sasson, C. (2010). Rapid response teams: A systematic review and meta-analysis. Archives of Internal Medicine, 170(1), 18-26. https://doi.org/10.1001/archinternmed.2009.424

Monnet, X., Marik, P., & Teboul, J.-L. (2016). Passive leg raising for predicting fluid responsiveness: A systematic review and meta-analysis. Intensive Care Medicine, 42(12), 1935-1947. https://doi.org/10.1007/s00134-015-4134-1

Roca, O., Caralt, B., Messika, J., Samper, M., Sztrymf, B., Hernández, G., García-de-Acilu, M., Frat, J.-P., Masclans, J. R., & Ricard, J.-D. (2019). An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. American Journal of Respiratory and Critical Care Medicine, 199(11), 1368-1376. https://doi.org/10.1164/rccm.201803-0589OC