Reflective Entry 2 (Week 5)

 What?

During a recent placement in a residential care setting, I was tasked with observing a resident who had recently been discharged from hospital after a urinary tract infection. Although the nurse in charge noted their vital signs were within normal range, I observed subtle signs — like slowed responses, slightly unsteady walking, and confusion about time — that suggested possible lingering effects of delirium.

I raised my concerns with the nurse, but initially, they were dismissed as “overthinking.” However, after I documented the observations and asked to review the patient’s fall risk chart, it was revealed that no update had been made post-hospitalisation. Eventually, the team reviewed the case and updated the care plan to include additional fall precautions.

So What?

This situation made me realise how essential critical thinking is in health and social care — especially when dealing with patients who appear "fine" on paper. The normal clinical indicators didn’t align with what I saw. Without questioning the surface-level data, a serious fall might have occurred.

According to Brookfield (2017), critical thinking involves “identifying and challenging assumptions, exploring alternatives, and reflecting skeptically on practice.” In this case, the assumption was that normal vitals equalled full recovery. By questioning this and drawing from previous case knowledge (where UTIs had caused falls), I avoided passive decision-making.

I also applied elements of the RED Model (Recognise assumptions, Evaluate arguments, Draw conclusions) which helped me communicate my observations in a structured way. It wasn’t just “I feel like something’s off” — I pointed to behaviour changes, confusion patterns, and comparisons to previous days.

This experience also made me reflect on power dynamics. As a student, I was initially hesitant to challenge the nurse's view. Facione (2015) highlights that critical thinking also requires “intellectual courage” — the willingness to speak up, even when it’s uncomfortable. That courage was essential here.

Now What?

This situation helped me develop a more confident, evidence-based voice. I’ve now committed to:

• Using critical reflection journals to analyse decisions I witness in practice

• Applying the 5 Whys technique to uncover root causes in clinical scenarios

• Practicing assertive communication using the SBAR method (Situation, Background, Assessment, Recommendation) when raising concerns

• Reviewing fall prevention protocols and the latest research on UTI-linked delirium in elderly patients

In future placements, I won’t wait to be asked — I’ll proactively question inconsistencies and advocate for residents’ safety. As noted in the NMC Code (2018), nurses must “preserve safety” — and critical thinking is a powerful part of that du

References

• Brookfield, S. D. (2017). Becoming a Critically Reflective Teacher (2nd ed.). Jossey-Bass.

• Driscoll, J. (2007). Practising Clinical Supervision: A Reflective Approach for Healthcare Professionals. Elsevier.

• Facione, P. A. (2015). Critical Thinking: What It Is and Why It Counts. Insight Assessment.

• Nursing and Midwifery Council (NMC). (2018). The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. Available at: https://www.nmc.org.uk/standards/code