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New Learning And Clinical Reasoning Cycle

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Discuss about the New Learning And Clinical Reasoning Cycle.


While reflecting on the process and new learning from the clinical reasoning cycle by Levett-Jones et al. (2010), there were many emotional and intellectual responses throughout. The case scenario made me realize that I need to consider my learning needs on the needle phobia and develop my communication skills so that patients overcome their phobia. The incident took place when I was placed in the mental health ward and was asked to take blood from a patient named John who is anxious in nature. As I approached for the bedside consent and prepared myself for the procedure, he declared that he was needle phobic. I said him that I am experienced at taking blood and might explain the whole procedure, however, he was not convinced and at the last minute, he ripped his arm away as the needle touched his skin.

The positive approach during the whole incident was that I stayed calm and composed. John apologized, insisted me to try again. I was in peace and tried a new technique by making him listened to music. However, the technique did not work and as there was urgency for the test, I contacted the doctor and assured John that if he needs anything, the doctor would be around. Finally, keeping the urgency in mind, I informed in-charge nurse that I was unable to get the sample by trying reasonable techniques. After the incident, I realized that I failed to make connection with John as I lacked communication skills and unable to obtain the blood sample. It did not work well as I lacked techniques that helped to overcome needle phobia and so need to look for best practices and techniques. I was feeling distressed and disappointed. I also need to enhance my professional communication skills so that I act in a better way and do differently when I encounter such situation in the future.

In mental health, effective communication is an essential skill as identified by Nursing and Midwifery Board of Australia (NMBA) required by mental health nurses. It is important that the nurses should build rapport and develop therapeutic relationships, as it is not instinct for everyone. It is important to exercise and encourage reflection that help to develop communication skills while practicing reflection-in action (Ellis 2016). If I were able to establish rapport with John through interpersonal communication skills, he would have agreed for the blood test. While gaining insight from the incident, I realized that I should have communicated with my colleagues regarding the techniques and that might have helped me in obtaining the blood sample. Interpersonal communication is required that help to improve patient satisfaction levels and their adherence to the diagnosis and treatment. After the incident, I communicated with my peers as it can help me promote learning. When I consulted with my peers regarding the incident, I realized that I have to acquire new skills as well as construct understanding on how to talk and collaborate in learning bets practices on needle phobia.


If I would have consulted my peers, I would have been able to solve and handle the situation in a better way by building on their knowledge, asking questions and get suggesting ideas that would have helped me in convincing John for obtaining the blood sample. The social interactions with the colleagues have a positive motivation effect where I gained an insight that I have to enhance my communication skills with the patients so that they overcome their fear and anxiety. After this, I looked for the best practice techniques in the literature and the communication skills that can help patients to overcome needle phobia in the future.

The most effective technique for overcoming needle phobia is systematic desensitization and behavioural exposure. According to Iglesias and Iglesias (2013) for the treatment of phobias and anxiety, systemic desensitization is used where the phobic individuals are exposed to situations and through repetition and practice, the anxiety provoking power is gradually lost. For the behavioural exposure method, Cognitive Behavioural Therapy (CBT) can be used for injection phobia treatment.  The management of negative thoughts that lead to anxious situations can be dealt using this intervention (Hofmann et al. 2012). As John mentioned that, the site of blood and withdrawing technique makes him anxious and sick, the anxiety management strategy would have been useful instead of convincing him verbally. The breathing exercises like relaxation technique would have helped him alleviating the anxiety symptoms (Leichsenring et al. 2013). With this technique, the patient overcome fear and phobia by getting engaged in relaxation exercise and gradually getting exposed to anxiety-producing stimulus (needle).

Creation of trusting dialogue through effective communication with the patient helps to reduce anxiety. It enhances patient’s self-efficacy and ability to overcome fear and be soothing in the present moment. An important step is to ask the patients about their concerns and feelings regarding needle phobia. Empathetic communication is important to be sensitive and understand the feelings of the patients (Tregoning, 2015). Interpersonal communication skills are important in mental health for developing the capacity to transform and enrichment of patient experiences. Good communication skills help to overcome resistance by providing an appropriate environment and establishing a therapeutic relationship with the patient. According to Peplau’s interpersonal theory, empowerment is important for the individuals that provide confidence and strength to overcome their fears (Deane and Fain 2016). At times, anxiety impairs the communication process and therefore, as a nurse, one should attempt to alleviate the anxiety symptoms that help in overcoming the barrier to effective communication.  

In the case scenario, I should have not given any false assurance to the patient saying that I am experienced in drawing blood and the patient is safe. This acted as a conversation stopper that led to the anxiety and unwillingness of John in sharing his concerns, thoughts and fears to me. I need to develop my active listening skills to understand the underlying feelings and fear of the patient regarding the needle phobia (Cunico et al. 2012). It also helps to gain trust and interpersonal communication can be established. Therefore, while reflecting on the incident, I ensure to consider these learning needs while helping needle phobic patients in the near future.



Cunico, L., Sartori, R., Marognolli, O. and Meneghini, A.M., 2012. Developing empathy in nursing students: a cohort longitudinal study. Journal of clinical nursing, 21(13-14), pp.2016-2025.

Deane, W.H. and Fain, J.A., 2016. Incorporating Peplau’s Theory of Interpersonal Relations to Promote Holistic Communication Between Older Adults and Nursing Students. Journal of Holistic Nursing, 34(1), pp.35-41.

Ellis, P., 2016. Evidence-based practice in nursing. Learning Matters.

Hofmann, S.G., Asnaani, A., Vonk, I.J., Sawyer, A.T. and Fang, A., 2012. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), pp.427-440.

Iglesias, A. and Iglesias, A., 2013. I-95 Phobia treated with hypnotic systematic desensitization: A case report. American Journal of Clinical Hypnosis, 56(2), pp.143-151.

Leichsenring, F., Salzer, S., Beutel, M.E., Herpertz, S., Hiller, W., Hoyer, J., Huesing, J., Joraschky, P., Nolting, B., Poehlmann, K. and Ritter, V., 2013. Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: a multicenter randomized controlled trial. American Journal of Psychiatry, 170(7), pp.759-767.

Levett-Jones, T., Sundin, D., Bagnall, M., Hague, K., Schumann, W., Taylor, C. and Wink, J., 2010. Learning to think like a nurse. HNE Handover: For Nurses and Midwives, 3(1).

Tregoning, C., 2015. Communication skills and enhancing clinical practice through reflective learning: a case study. British Journal of Healthcare Assistants, 9(2).


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