Nursing Reflective Essay Example

Nursing Reflective Essay: Learning the Importance of Patient Communication

Reflection is a cornerstone of professional growth in nursing, providing a structured process through which practitioners can learn from their experiences, both positive and negative. It is through this critical self-examination that theoretical knowledge is integrated with clinical practice, fostering the development of competent, compassionate, and self-aware nurses. The National Health Service (NHS) in the United Kingdom promotes a culture of learning and reflection, recognising its vital role in enhancing patient safety and the quality of care delivery (NHS England, 2021). During my recent clinical placement on a busy medical ward in a district general hospital, I encountered a situation that profoundly illuminated the critical importance of effective communication and therapeutic empathy in patient care. This experience not only bolstered my confidence as a nursing student but also significantly deepened my understanding and practical application of patient-centered care, a principle that is fundamental to modern nursing.

To structure my reflection and derive maximum learning from this incident, I will utilise the Gibbs Reflective Cycle (1988). This model is particularly useful as it provides a clear and structured framework, guiding the practitioner through a description of events, an exploration of feelings, an evaluation of the experience, an analysis to make sense of the situation, a conclusion drawing on what was learned, and finally, the development of an action plan for future practice.

Description

The incident occurred during the third week of my clinical placement on a medical admissions unit. The ward was operating at full capacity, and the atmosphere was one of controlled, fast-paced activity. I was assigned to work alongside Staff Nurse Margaret, an experienced and respected mentor known for her calm demeanour and excellent patient rapport. One of the patients under our care that morning was an elderly gentleman, whom I will call Mr. Evans to protect his confidentiality in accordance with the Nursing and Midwifery Council (NMC) Code of Conduct (2018). Mr. Evans, who appeared to be in his late seventies, had been admitted the previous evening with an acute exacerbation of his chronic obstructive pulmonary disease (COPD). He was receiving oxygen therapy via nasal cannula and was on a nebuliser schedule.

When I first approached Mr. Evans’ bedside, my focus was singular: to complete the routine morning observations efficiently. I had been taught the importance of time management on a busy ward, and I was keen to demonstrate my competency in clinical skills. I gave a brief, somewhat hurried introduction – “Good morning, Mr. Evans, I’m a student nurse, and I’m just here to take your observations” – and immediately began the process of attaching the blood pressure cuff and oxygen saturation probe. Mr. Evans was quiet and offered little resistance, but I noticed he was lying very still, staring at the ceiling, and avoiding eye contact. His body language was closed off, his arms crossed loosely over his chest. I completed the tasks: his blood pressure was slightly elevated, his heart rate was within normal limits, and his oxygen saturations were acceptable at 92% on two litres of oxygen. I recorded the results on his bedside chart, made a brief note in my head to mention them to Nurse Margaret, and prepared to move on to the next patient.

Feelings

At the time, I felt a sense of quiet satisfaction at having completed the task quickly and correctly. I was focused on my role as a clinical doer. However, a subtle, nagging feeling of unease lingered at the edge of my consciousness. I had noticed his discomfort, his averted gaze, but I had rationalised it away. I told myself he was probably tired from a sleepless night on a noisy ward, or perhaps he was just a naturally reserved individual who didn’t want to chat. My own feelings of inadequacy as a student also played a part; I was hesitant to intrude or to ask questions that might be perceived as prying or that I might not know how to answer. It was easier, and felt safer, to stick to the technical script of vital signs. When I reported my findings to Nurse Margaret, I felt competent in presenting the clinical data.

Evaluation

My feeling of competence was short-lived. After listening to my report, Nurse Margaret looked at me with a gentle but probing expression and asked, “That’s the clinical picture, yes. But did you have a chance to speak with him properly? How did he seem in himself? What are his concerns about being in here?” Her questions struck me with the force of a physical blow. In that moment, I realised the profound inadequacy of my interaction. What had been good from a task-oriented perspective was a failure from a nursing perspective. The positive aspect of the morning was that I had accurately performed the clinical observations. The decidedly negative aspect, which I now saw clearly, was that I had completely neglected the person attached to the monitors. I had assessed his respiratory rate but not his emotional state; I had measured his blood pressure but not his fear. I had treated the condition, not the patient. This was a stark reminder that nursing care, as the NMC (2018) Code mandates, must prioritise people, treating them as individuals and respecting their dignity. I had fallen short of this fundamental standard.

Analysis

This realisation prompted a deeper analysis of the situation. I had approached my interaction with Mr. Evans from a purely biomedical perspective, viewing him as a set of physiological parameters to be monitored and managed. This is a common pitfall for student nurses who are still developing their clinical skills and are eager to demonstrate technical proficiency. However, this perspective is the antithesis of the holistic, person-centred care that is the hallmark of excellent nursing. Person-centred care is an approach that sees patients as equal partners in planning, developing, and assessing care to ensure it meets their needs. This means understanding the patient as a unique individual with their own values, concerns, and life story, not just a diagnosis (The Health Foundation, 2016).

The communication I had used was instrumental and one-sided. It was a transaction designed to gather clinical data, not to build a relationship. I failed to use any of the core principles of therapeutic communication. I did not use active listening; I was too focused on my next task. I did not sit down, which in itself creates a psychological barrier and signals a lack of time. I did not use open-ended questions, which encourage patients to express their feelings and concerns (e.g., “How are you feeling about being in hospital?”). Instead, I asked closed, procedural questions that required only a yes/no answer, which effectively shut down any possibility of meaningful dialogue.

Theories of communication, such as Peplau’s (1952) Theory of Interpersonal Relations, are foundational to nursing practice. Peplau describes the nurse-patient relationship as a therapeutic, interpersonal process that moves through phases: orientation, identification, exploitation, and resolution. In my interaction with Mr. Evans, I had not even successfully navigated the orientation phase, which involves the patient and nurse getting to know each other as persons and working together to identify the patient’s problem. By failing to establish this initial rapport, I had prevented any possibility of moving forward in a therapeutic way. I had also neglected the crucial aspect of empathy, which Rogers (1957) identified as a core condition for a helping relationship. Empathy is the ability to perceive the internal frame of reference of another with accuracy and with the emotional components and meanings which pertain thereto. I had not attempted to understand the situation from Mr. Evans’ point of view. I had not considered what it might feel like to be an elderly man, newly admitted to a strange and noisy environment, facing the uncertainty of a chronic illness and a future that feels precarious.

Recognising my error, I resolved to rectify the situation. Later that morning, with Nurse Margaret’s encouragement, I returned to Mr. Evans’ bedside. This time, I approached him differently. I pulled up a chair and sat down, bringing myself to his eye level. I reintroduced myself more warmly and asked a simple, open-ended question: “Mr. Evans, I’m sorry we didn’t get a chance to talk properly earlier. How are you really feeling about everything today?” Initially, his response was as brief as before. But I remained silent, offering a space for him to fill. I maintained gentle eye contact and nodded, showing I was listening. Slowly, he began to speak. He told me about his fear. He lived alone, his wife had passed away two years ago, and his daughter lived in Australia. He was terrified that this exacerbation was the beginning of the end, that he would lose his independence and become a burden. He felt profoundly isolated and powerless, trapped in a system where he felt like just another case. By simply listening without interrupting, judging, or trying to offer simplistic solutions, I was able to offer him something more valuable than any clinical task: human connection and validation. I reassured him that his feelings were completely understandable and that we, as a team, were here to support not just his breathing, but him as a person. I asked his permission to share some of his concerns with Nurse Margaret and the wider team, which he gave. This simple act of asking for permission empowered him and restored a measure of control.

Conclusion

This experience was a pivotal learning moment in my nursing education. It taught me that effective communication is not a soft skill or an optional extra; it is the very fabric of nursing care. It is the primary instrument through which we assess, plan, deliver, and evaluate care. It is the medium for building trust, allaying fear, and fostering hope. The primary learning from this incident is that clinical competence and compassionate communication are not mutually exclusive but are intrinsically linked and equally vital. A technically perfect procedure performed on a terrified and distrustful patient is, in many ways, a failed nursing intervention. I learned that the most powerful tool a nurse possesses is not a stethoscope or a syringe, but the ability to listen, to be present, and to empathise.

This situation highlighted a personal learning need: to consciously integrate communication and empathy into every patient interaction, from the most routine to the most complex. The question from my mentor served as a catalyst, forcing me to move beyond my comfort zone of task completion and embrace the more challenging, yet more rewarding, work of connecting with patients as individuals. I now understand that small, intentional actions—sitting down, making eye contact, using open-ended questions, offering silence, and actively listening for both spoken and unspoken cues—are not time-wasters but are, in fact, the most efficient and effective way to deliver holistic care. As the Nursing and Midwifery Council (2018) states in its Code, we must “treat people as individuals and uphold their dignity” and “listen to people and respond to their preferences and concerns.” This was my first real-world lesson in what that directive truly means in practice.

Action Plan

Moving forward, I am committed to embedding these lessons into my daily practice. My action plan, informed by this reflection, is as follows:

1. Intentional Patient Interaction: At the beginning of each shift, I will identify one patient with whom I will make a conscious effort to have a “communication-first” interaction, meaning I will spend at least five minutes talking with them about their life, concerns, or goals for the day, before any clinical tasks are performed. This will help me practice building rapport from the outset.
2. Skill Development in Communication: I will actively seek feedback from my mentors and practice supervisors on my communication skills, specifically asking them to observe my interactions and provide constructive criticism on my use of open-ended questions, active listening, and empathy. I will also utilise simulated practice scenarios in university to refine these skills in a safe environment.
3. Holistic Assessment: I will incorporate a brief psychosocial assessment into every set of vital signs I perform. While monitoring the physical parameters, I will also make a mental note to assess the patient’s emotional state, asking a question like, “On a scale of 1-10, how is your anxiety or worry today?” to bring this dimension of care into focus.
4. Continued Reflective Practice: I will continue to use a reflective model, such as Gibbs (1988), to analyse at least one significant patient interaction per week. This will ensure that I consistently learn from my experiences and remain vigilant against the tendency to become purely task-focused. I will document these reflections in my online portfolio as evidence of my ongoing professional development.

In conclusion, my interaction with Mr. Evans was a profound lesson in the art and science of nursing. It was a powerful reminder that behind every diagnosis, every observation chart, and every clinical task, there is a human being with a unique story, complex emotions, and a deep need for connection and understanding. While clinical proficiency is undeniably essential, it is the ability to communicate with empathy, compassion, and authenticity that truly defines the essence of nursing. This experience has reinforced my commitment to becoming a nurse who not only treats illness but also cares for people, recognising that healing is a holistic process in which communication is not just important—it is everything. As I continue my journey through nursing education and into professional practice, I will carry the memory of Mr. Evans and the invaluable lesson he taught me: to always see the person first.

References

Gibbs, G. (1988). Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit, Oxford Polytechnic.

NHS England. (2021). The NHS Patient Safety Strategy. London: NHS England.

Nursing and Midwifery Council. (2018). The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: NMC.

Peplau, H. E. (1952). Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. New York: G.P. Putnam’s Sons.

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103.

The Health Foundation. (2016). Person-centred care made simple: What everyone should know about person-centred care. London: The Health Foundation.