Final Clinical Reflection: Direct Focused Care (DFC) Using Tanner’s Reflection-on-Action
Reflection-on-action is a component of critical thinking in Tanner’s Model of Clinical Judgment; it is how learning from practice is incorporated into personal experience for future patient care (Giddens, 2021, p. 375). Within two pages, write a personal reflection on your direct focused care (DFC) clinical experiences this semester, discussing:
- Professional competence: what went well; what could be improved, with explanations and a measurable plan; and at least one new technique you observed or learned.
- Challenging situations: challenges in the DFCs, their reasons and underlying causes and a plan to prevent similar situations.
- Personal and professional growth: how this semester’s patient care will influence your future practice.
This is a journal-type entry; writing mechanics, formatting, references and length are graded.
Assessment, communication, teamwork
Time management, measurable plan
Bladder scanner, teach-back
Deteriorating patient, delayed escalation
Confident, safer practice
Model response
Original example for study purposes (about 520 words). This reflection describes sample experiences. Your reflection must describe your own clinical experiences; do not copy this narrative.
Professional Competence
[Sample.] This semester’s direct focused care experiences on a medical-surgical unit helped me move from completing tasks to thinking like a nurse. What went well was my head-to-toe assessment and therapeutic communication. By midterm, I could complete a focused assessment in about 15 minutes and recognize when findings, such as new crackles in a heart failure patient, needed to be reported. Patients often told me they felt listened to, and I learned that sitting down at eye level and asking open-ended questions helped anxious patients share concerns they had not mentioned to others.
The area I most need to improve is time management, especially when caring for two patients with medications due at the same time. Twice, I gave scheduled medications close to the end of the one-hour window because I underestimated how long dressing changes would take. My plan is to (1) build a written time-based worksheet for every shift that lists medications, assessments and procedures by hour; (2) cluster care by checking which tasks can be done in the same room visit; and (3) by the end of my first four weeks in the next clinical course, administer 100% of scheduled medications within the first 30 minutes of the window, which my clinical instructor and I will track on my evaluation form.
A new technique I learned was using a portable bladder scanner to assess post-void residual volume in a postoperative patient before deciding whether intermittent catheterization was needed. I also practiced the teach-back method during discharge education, asking a patient to explain in her own words how to use her incentive spirometer, which revealed that she had misunderstood how often to use it.
Challenging Situations
My most challenging experience occurred when an older adult patient became newly confused and restless in the afternoon. I noticed the change but assumed it was “sundowning” and waited to report it until my next check-in with my nurse. When the nurse assessed him, his oxygen saturation was 88% and he was febrile, and he was later evaluated for pneumonia. The reason for the delay was my anchoring on a familiar explanation; the underlying causes were my limited experience recognizing delirium as a sign of acute illness and my hesitation to interrupt a busy nurse. Using Tanner’s model, I realized that I noticed the cue but interpreted it too narrowly (Tanner, 2006). To prevent this in future, I will treat any acute change in mental status as a priority finding, assess vital signs and oxygen saturation immediately and use SBAR to report changes right away. I also reviewed delirium screening tools so I can recognize the pattern more quickly.
Personal and Professional Growth
This semester taught me that clinical judgment depends as much on reflection as on knowledge. I now prepare more thoroughly for each shift, speak up sooner and use teach-back routinely. In my future practice, I will carry forward the lesson from my challenging experience: small changes in a patient’s condition deserve prompt attention and clear communication. I feel more confident, but also more aware of my responsibility to keep learning, which I see as the foundation for safe, compassionate nursing care.
References
Giddens, J. F. (2021). Concepts for nursing practice (3rd ed.). Elsevier.
Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204–211. https://doi.org/10.3928/01484834-20060601-04
Tip: make your improvement plan measurable (a number, a time frame and a way to track it). Graders look for this specifically.
Frequently asked questions
What are the four phases of Tanner’s model?
Noticing, interpreting, responding and reflecting, which includes reflection-in-action and reflection-on-action.
How long should the reflection be?
Two pages, as the assignment states; check your rubric for formatting such as APA and a title page.
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