NM701 Office Visit Simulation Reflection:
Submit this to the Drop Box no later than 3 calendar days after your Simulated Office Visit. Before you do so, WATCH the recording of your Office Visit (located in Sim IQ) so you can reflect on your own contributions, strengths, and challenges more deeply. Please focus your answers on your own decisions, behaviors, and responses—not that of your group. Please read the rubric on the last page of this document for scoring.
Name:__
- Describe the things you felt good about in this experience. Be specific, and please focus on what you personally did well.
I felt good asking a lot of the subjective questions. I asked for clarity when the patient stated she has 2 living kids, when it was documented in her history that she had 2 pregnancys: 1 living child and 1 abortion. I was able to get a lot of information about her gyn history. I also surprised myself on how I was able to give education and clarity on vasectomy and sterilization to the patient.
- What new specific learning came about because of this experience? What new skill or insight was developed?
I have learned that as a provider we may feel that we are actively listening from beginning to end but there was some info that the patient stated that I did not hear until I rewatched the video.
- After reviewing the recording and thinking back on the visit, reflecting on your own actions or decisions, what specifically would you change or do differently?
I WOULD SPEAK SLOWER AND TAKE MY TIME. I WOULD ALLOW LILY TO SPEAK HER THOUGHTS. I WOULD UTILIZE SHARED DECISION MAKING MORE EFFECTIVELY.
- Describe and then evaluate at least one decision or intervention or plan that you personally initiated. Remember that an intervention can include the way you explain something (the words you choose to use), what you choose to teach or the order in which you decide to ask questions, what labs or diagnostics you decide to order, or which physical exam elements you decide to perform. ANY interaction with the patient involves decisions on your part — describe one, and then evaluate how well it worked.
- Describe a decision or intervention:
EXPLAINING PROCEDURE FOR VASECTOMY, STERILIZATION, AND IUD.
-
- Evaluate the decision or intervention:
LILY IS INTERESTED IN ALL 3 CONTRACEPTIONS BUT WANTS TO SPEAK WITH HER SPOUSEFIRST AND SHARE THE EDUCATION SHE RECEIVED.
- Cultural safety is a curriculum thread throughout FNU. In a paragraph or more, please describe your thoughts in response to the following questions in blue text. You’ll find helpful definitions, clarifications and tips below the questions.
Consider your own values, beliefs, and social power as a clinician. How does your own cultural background influence how you think about the clinical or other issue(s) you encountered during your Office Visit? How might it affect how you care for this client or someone facing a similar health issue? Consider how you think or feel about issues raised in the visit, and how cultural habits of thought, or biases, might impact:
- how and what you teach about the topic
- how you interact with the patient
- what you might recommend
if you were unaware of them. Are there implications for how the patient might perceive the safety of the visit?
Cultural Safety, per Frontier Nursing University,
Refers to the need for health professionals to consider the historical context, their own cultural background and the impact of power, privilege and their personal biases on healthcare systems and organizations and the relationships within them.
Curtis et al. (2019) expand on the concept:
“Cultural safety requires healthcare professionals and their associated healthcare organizations to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery. This requires individual healthcare professionals and healthcare organizations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures, and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organizations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities, and as measured through progress towards achieving health equity. Cultural safety requires healthcare professionals and their associated healthcare organizations to influence healthcare to reduce bias and achieve equity within the workforce and working environment”.
- Remember that the focus here should be on your own culture, values, attitudes, and power as a clinician, not the patient’s culture or how you “should” care for them. We are not interested in a restatement of what you’ve learned about the importance of providing culturally competent care, but in a thoughtful exploration of your own cultural (not professional) beliefs and values and how you acquired them. This will require a lot of “I” statements.
- We are not interested in a restatement of your professional values within nursing of how patients should be treated with cultural competence and respect–we assume you know that already. Rather, dig into your values and beliefs, and discover what’s there.
- Remember that this part of the Reflection should reference some aspect of the clinical situation you encountered in this simulation, as well as a thoughtful exploration of your personal cultural background. Are there aspects of the situation that triggered a response in you based on your personal culture or experiences? How could your response affect a patient?
Reference: Curtis, E., Jones, R., Tipene-Leach, D. et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health 18, 174 (2019). https://doi.org/10.1186/s12939-019-1082-3
| Criteria | Ratings | Pts | |||||
| What did you do well? Describe the things you felt good about in this experience. Be specific. |
|
1.5 pts | |||||
| What new specific learning came about because of this experience? What new skill or insight was developed? |
|
1.5 pts | |||||
| Thinking back on the visit, reflecting on your actions or decisions, what specifically would you change or do differently? |
|
1.5 pts | |||||
| Evaluate at least one decision or intervention or plan that you initiated. |
|
1.5 pts | |||||
| Consider and provide an example of how your own cultural values or personal beliefs could have influenced your care of this simulated “patient.” |
|
3 pts | |||||
| Submitted within 3 calendar days of Office Visit. |
|
1 pts | |||||
| Total Points: 10 | |||||||
NM701 Office Visit Simulation Reflection
Name: [Your Name]
1. Describe the things you felt good about in this experience. Be specific, and please focus on what you personally did well.
Reflecting on the recorded simulation, I felt good about several aspects of my performance, particularly my commitment to obtaining a thorough and accurate patient history. I am proud of how I navigated a potentially sensitive area of the patient’s medical history. For example, when the patient stated she had two living children, I noticed the discrepancy with her chart, which documented two pregnancies: one living child and one abortion. Instead of glossing over this, I respectfully asked for clarification. This allowed the patient to share her full obstetrical history in her own words, which was crucial for providing safe and informed care. This moment reinforced the importance of active listening and meticulous attention to detail, even when it might feel awkward to ask for clarification.
Furthermore, I was surprised and pleased with my ability to provide clear, patient-centered education on complex topics like vasectomy, tubal sterilization, and IUDs. When the patient expressed interest in long-term, highly effective contraceptive options, I didn’t just list them; I explained the mechanisms, procedures, and permanence of each. I felt I was able to demystify these options and empower her with the information she needed, which was reflected in her request to discuss the information with her spouse. This demonstrated my capacity for effective patient teaching, which is a core skill for a nurse-midwife.
2. What new specific learning came about because of this experience? What new skill or insight was developed?
A significant insight I gained from this experience is the critical difference between hearing a patient and actively listening to them. While I felt engaged and attentive during the visit, reviewing the recording revealed a crucial gap in my listening. The patient mentioned that her spouse was “nervous” about her considering tubal sterilization, but I did not register this point of anxiety in the moment. I was so focused on my own question sequence and gathering information that I missed an important emotional cue. This was a powerful lesson.
The new skill I developed is the practice of post-encounter self-review. Watching the recording was a humbling but invaluable form of feedback. It taught me that as a provider, my perception of an interaction can be incomplete. This experience has developed my insight into the concept of being “present” with the patient. It highlighted that true active listening means setting aside my own internal agenda—the next question on my checklist—to fully absorb the patient’s verbal and non-verbal messages. Moving forward, I will consciously practice a mental pause after the patient speaks, silently repeating their key concerns to myself to ensure I have truly understood them before responding.
3. After reviewing the recording and thinking back on the visit, reflecting on your own actions or decisions, what specifically would you change or do differently?
Reviewing the recording, the most prominent change I would make is to consciously slow down my delivery and create more space for the patient to think and speak. In my eagerness to be thorough and efficient, I noticed I sometimes spoke too quickly and transitioned from one topic to the next without allowing the patient (Lily) enough time to fully process the information or express her thoughts and feelings. This was particularly evident when she mentioned her spouse’s nervousness, and I continued on to the next question without exploring that statement.
I would specifically practice the technique of “ask, pause, and listen.” After asking a question or providing education, I would count to five in my head before speaking again. This would give Lily the necessary time to gather her thoughts, ask her own questions, and voice concerns she might have been hesitant to raise. Furthermore, I would change my approach to shared decision-making. Instead of presenting a list of contraceptive options and assessing her understanding, I would use a more collaborative framework. For example, I would start by exploring her goals and priorities, asking, “What are the most important factors for you in a contraceptive method?” This would better center the conversation around her values, making the final decision truly her own.
4. Describe and then evaluate at least one decision or intervention or plan that you personally initiated.
a. Describe a decision or intervention: The intervention I chose to evaluate is the way I explained the procedures for a vasectomy, tubal sterilization, and IUD. I made a conscious decision to provide education that was not just factual but also comparative and framed for her personal situation. I started by explaining the differences in invasiveness and permanence, compared the effectiveness rates, and explicitly acknowledged the collaborative nature of the decision by reassuring her that it was entirely appropriate to discuss these options with her spouse.
b. Evaluate the decision or intervention: This intervention was successful. By providing a balanced and clear overview, I helped demystify what can be intimidating topics. The patient’s response—that she wanted to share this education with her spouse—was a positive outcome. It confirmed that my teaching was accessible and informative enough for her to relay to another person. This is a key indicator of effective patient education: when the patient feels confident enough to discuss the information with their support system. This decision worked well because it empowered the patient, respected her autonomy by not pressuring her for an immediate decision, and facilitated a healthy dialogue within her relationship. It was a success in achieving patient-centered, shared decision-making.
5. Cultural safety is a curriculum thread throughout FNU. In a paragraph or more, please describe your thoughts in response to the following questions in blue text.
Considering my own values and beliefs, I recognize that my cultural background as a white, middle-class woman from a community that highly values independence and self-sufficiency could significantly influence my clinical interactions if I am not mindful. This cultural value of “doing it yourself” can subtly manifest in a clinical setting as an unconscious bias toward patient self-management and quick decision-making. For example, in this simulation, I felt a personal, perhaps unspoken, pressure to efficiently provide all the information and help the patient “choose” a method before she left. I had to consciously check this impulse, reminding myself that my own cultural comfort with rapid, independent decision-making is not universal. If I were unaware of this bias, I might have inadvertently steamrolled her process, making her feel rushed or inadequate for wanting to consult her spouse—a process that for her was not a sign of indecision, but of shared partnership and mutual respect.
This insight has direct implications for how I teach and interact with patients. If I was unaware of my bias, I might frame the topic of contraception solely in terms of the patient’s individual choice, ignoring the relational and cultural context that might be paramount to her. My recommendations might be clinically sound but could be culturally insensitive if they don’t account for the patient’s support system and decision-making style. For the patient, this could diminish the safety of the visit. She might perceive me as pushy, disrespectful, or out of touch with her reality, which could erode trust and prevent her from returning for future care or following through on our plan. Therefore, this experience reinforces the need for ongoing self-reflection to ensure my care is guided by the patient’s cultural values and priorities, not my own, and that I define a successful visit not by the decisions made, but by the quality of the partnership we create.
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