The Reflection

A two-year-old child was brought to the Emergency Unit with marked swelling of the right thigh.

As I passed through the department, I stopped to speak with the child’s mother. She explained that the child had received a pentavalent (Penta) immunisation a few days earlier. On their way home, she had fallen while carrying the child.

That detail immediately caught my attention.

Although the swelling had been attributed to the recent immunisation, the history of a fall raised concern for a possible fracture. I recommended an X-ray of the affected limb.

The imaging confirmed a displaced mid-shaft femoral fracture.

The child’s swelling was not a reaction to the vaccine. It was a significant orthopaedic injury requiring urgent intervention.

After discussing the findings with the Emergency Unit team, the Medical Officer, and the visiting orthopaedic surgeon, a plan was made for skin traction followed by referral for hip spica application.

However, I was concerned that transporting a two-year-old child with skin traction and an attached weight could be difficult and potentially inappropriate, particularly given the child’s delicate skin. I communicated these concerns directly with the orthopaedic surgeon and explained the clinical circumstances.

Following that discussion, approval was given to apply the hip spica locally.

The procedure was completed successfully, photographs were shared with the orthopaedic surgeon, and the application was approved.

Most importantly, the child received timely immobilisation without the additional stress, risks, and financial burden of travelling elsewhere for treatment.

This experience reinforced an important lesson.

Good clinical judgement begins with listening.

A careful history, thoughtful assessment, and the confidence to respectfully question an initial assumption can change the course of a patient’s care.

Sometimes the detail that changes everything is hidden in a single sentence.

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Key Learning Points

• A thorough patient history often provides the most important diagnostic clues.
• Avoid anchoring bias by considering alternative explanations for a patient’s presentation.
• Patient advocacy sometimes means respectfully challenging an initial clinical impression.
• Clear communication within the multidisciplinary team supports safer, more timely care.
• Professional confidence within your scope of practice can improve patient outcomes.

The best clinical decisions are built on careful assessment, sound judgement, and effective collaboration.

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Continue the Conversation

Have you ever recognised a detail in a patient’s history that completely changed the direction of care?

Share your thoughts in the comments.

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Contributor

Eva Ayorkor Blabou
Orthopaedic Nurse Specialist | Ghana

Editorial

Every patient, colleague, and shift has something to teach us.

Insights from Practice exists to capture those lessons before they are forgotten.

This reflection reminds us that good clinical judgement often begins with listening carefully, questioning assumptions, and having the confidence to advocate for the patient.

I hope it encourages you to reflect on your own practice and the lessons it continues to teach you.

Priscilla Aware-Amoateng

Editor

About Insights from Practice

Insights from Practice is a publication by A Nurse Like Me, bringing together lessons learned from nurses and healthcare professionals across different specialties and countries.

Each reflection is rooted in real practice and designed to encourage professional growth, strengthen patient safety, and improve care through shared learning.

Real experiences. Shared learning. Better care.

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Share Your Insight

Every healthcare professional has a lesson that could help someone else.

If practice has taught you something that changed how you think, communicate, lead, or care, we’d love to hear from you.

Submit your reflection:
🔗https://anurselikeme.org/%e2%ad%90-insights-from-practice-submission-page/

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Insights from Practice
A publication by A Nurse Like Me