Introduction
This reflective essay uses the Gibbs Reflective Cycle (1988) to critically examine an experience during my first clinical shift in an adult intensive care unit (ICU) as a third-year student nurse. The event I have chosen to reflect upon involves the care of a ventilated, unconscious patient and the ethical questions it raised about dignity, communication, and patient advocacy. To maintain confidentiality, in accordance with the NMC Code (2018), all identifying information has been changed.
Description
During my first week on ICU, I was assigned to shadow a senior staff nurse (I will call her Sarah) who was caring for a 58-year-old male patient (Mr K) with severe traumatic brain injury following a road traffic accident. Mr K was sedated, mechanically ventilated, and had multiple invasive monitoring lines. His Glasgow Coma Scale score was 5. His wife and adult daughter were present throughout the shift.
During a morning assessment, Sarah spoke about Mr K to a colleague as though he were not in the room, using clinical language that excluded the family. When his wife asked about his prognosis, Sarah replied “it doesn’t look good” and walked to the nurse’s station without further explanation. I felt deeply uncomfortable but was uncertain whether it was my place to intervene as a student.
Feelings
I felt conflicted — aware that Sarah was clinically competent and experienced, yet troubled by what I perceived as a lack of compassion towards the patient and his family. I felt overwhelmed by the clinical environment and uncertain of the boundary between a student’s professional responsibility and deference to qualified staff. I also felt guilty for not speaking up in the moment, which troubled me long after the shift ended.
Evaluation
On reflection, there were aspects of the care that were exemplary — Sarah’s technical proficiency was evident, and Mr K’s clinical observations were managed meticulously. However, the communication approach fell short of the person-centred, compassionate care outlined in the NHS Constitution (2021) and NMC Code (2018), which mandates that registrants treat people as individuals and uphold their dignity. Research suggests that even unconscious patients may retain auditory awareness (Lawrence, 1995; Schnakers et al., 2021), reinforcing the importance of maintaining dignity and respectful communication regardless of apparent consciousness level.
Analysis
The situation highlights the concept of the “hidden curriculum” in nursing education — the informal learning that occurs through observation of qualified staff, which may reinforce both positive and negative practices. This is supported by Spouse (2001), who identified that students frequently model the behaviour of ward mentors, even when that behaviour conflicts with theoretical learning.
The NMC Code (2018) is clear: as a student, I have a professional responsibility to raise concerns about care that may compromise patient dignity, even if this means respectfully challenging more experienced colleagues. The concept of moral distress (Jameton, 1984), experienced when one knows the right action but feels unable to perform it, accurately describes my experience in this situation.
Conclusion
This experience taught me that person-centred care is not a luxury available only in non-acute settings — it is a fundamental right for every patient, regardless of consciousness level, prognosis, or clinical complexity. I recognise that I should have found a compassionate and professional way to support the family in the moment, or escalated my concerns to the nurse in charge after the shift.
Action Plan
Following this experience, I completed the patient communication e-learning module on the NHS Learning Hub and attended a clinical communication skills workshop at university. I will practise the SBAR framework for family updates with my personal tutor. In future, if I observe care that compromises patient dignity, I will use the DESC assertiveness framework (Describe, Express, Specify, Consequences) to raise concerns professionally, as recommended by the King’s Fund (2020).
