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Progress summary paper

  1. 1. Running head: PROGRESS SUMMARYProfessional Progress Summary: My Road to Nursing SuccessKristen Casey BurrittUIN 00547741ODU On CampusSubmitted in partial fulfillment of the requirements in the courseNURS 431: Transition to Nursing Practicein the School of NursingOld Dominion UniversityNORFOLK, VIRGINIASpring, 2011<br />Professional Progress Summary: My Road to Nursing SuccessIt seems like an eternity ago that I received the letter announcing that I had been one of the lucky few who had been accepted into Old Dominion University’s School of Nursing (ODU’s SON). Upon signing up for the coveted classes that so many had hoped to be a part of and reading my first round of nursing school syllabi, I noticed that they all contained the same section. This section came to be known to us as the “Great Eights” of ODU’s SON. These values were instilled in us from day one through class lectures, assignments, projects, clinical and so forth. The Great Eights of ODU’S SON include thinking critically, practicing appropriate nursing interventions, therapeutic communication skills, teaching abilities, research-based practice, leadership, professionalism and culturally-sensitive practice. While I discuss my growth throughout these three years, many clinical courses are involved. As a sophomore and first-year nursing student, I participated in a fundamentals of nursing practice clinical. Junior year involved two full semesters of clinical courses which included the first and second adult health courses, psychiatric nursing and labor and delivery/postpartum nursing. Finally, senior year included critical care, pediatric, community health and rehabilitation nursing, and role transition. As I progressed through my nursing school years, I did not necessarily feel as if I had truly progressed; however, upon looking back from where I am now I feel that I have made huge strides towards my future. This paper is intended to allow me to show how I have improved in my nursing abilities as well as how I have met the Great Eights throughout the program.Critical ThinkingSophomore YearAs a sophomore and first-year nursing student, my critical thinking abilities were relatively limited. Because our knowledge base was inadequate to allow many true nursing tasks, much of what we did in the hospital involved morning hygiene care and simple assessments. At the beginning of the clinical day, I would perform a full head-to-toe assessment which would be followed throughout the day with more focused assessments as related to the patient’s diagnosis. I would also perform certain interventions based on the patient’s medical diagnosis and the correlating nursing diagnoses and mark these off as the day went. At this beginning point in my education, I believed that critical thinking involved searching through a patient’s chart or kardex the night before clinical for data that would allow me to put together a care plan of nursing diagnoses and interventions. Another example of my critical thinking abilities as a sophomore included developing nursing diagnoses with likely etiologies and subjective and objective data to support the diagnosis. Junior YearMy critical thinking abilities took a leap forward as junior year came around. In addition to the previous interactions we had with our patients, we added in medication administration and a more active role in wound care. Many of my clinical log entries include statements involving medication information, proper formulation of and prioritizing nursing diagnoses. I also seemed to have made great strides in recognizing changes in patient conditions so that I could react appropriately. My favorite clinical was labor and delivery as I felt that the interactions with generally health patients allowed me more time to make connections about the effects of pregnancy on their lives. By having time to talk with patients, I was able to learn from one patient that she felt she and her husband had been brought closer because of her pregnancy. However, another mother claimed the opposite, that her husband had been more distant during this pregnancy than during her first. Through discussions, she came to the conclusion that it could be related to her husband’s new responsibility of caring for their first-born as she was less able to towards the end of her pregnancy. Senior YearSenior year with all of its freedoms has finally come around. The role transition class I am currently taking has allowed me to get a better feeling of “true nursing” without an instructor and seven classmates by my side. We are more capable of making our own professional judgments during this clinical. One example of this involves a patient who had an external ventricle drain that would frequently clot. We were given the option by the surgeon to pinch around his drain tubing and lower the drain as long as we felt necessary to ensure that the drain continued to function properly. We would check the drainage each hour and if it had not changed, would pinch the tubing and lower the drain to the floor until it began dripping continuously and then we would raise it back up where it could continue to drip but at a slower rate than when at the floor level. During the critical care clinical, I participated in the walking rounds with the nurses, physicians, pharmacists, nutritionists and several other departments. My patient was being tested to confirm a diagnosis of heparin-induced thrombocytopenia type two, but they had yet to stop his heparin drip. The physician in charge of rounds that day asked what this diagnosis entailed and no one else answered so I spoke up and described the lab values and signs and symptoms that should be, and were being, seen with this condition. I then asked him why it was he was still receiving heparin if these things were being exhibited and he admitted he did not realize that this patient was still on heparin and made an effort to contact the primary physician to point out this contradictory situation. Nursing PracticeSophomore YearThe first clinical rotation we experienced was during the second half of our second semester of school. Because of the early timeframe, we were not skilled enough to participate in many true nursing practices such as medication administration or many aspects of wound care. We were however able to give bed baths to our patients and change their gowns and linens. There were a few incidences where we were allowed to participate in dressing changes but as I recall, our participation was limited to observing and handling supplies for the nurse. As a sophomore, my nursing practice involved these bed baths and linen changes. Interventions that I believed I did well included reorienting confuse patients and cleaning patient rooms to ensure safety and prevent falling when the patient got out of bed. Junior YearDuring the second year of nursing school, I was finally beginning to catch my stride and understand what this whole nursing thing was about. We were finally able to give medications, preceded by the triple check of medication against medication record and the five rights of administration. Because of this new task, medication knowledge was brought to the forefront and learning the medicines was the utmost important task. Several times in my clinical logs, I identified the information about medications that I had given that day. I also began to feel more able to make the connections between medical diagnoses, nursing diagnoses. After the practice of sophomore year, I felt much more comfortable in my assessment abilities. As a psychology minor, I was able to bring in knowledge I had learned from classes outside of nursing. One of these classes was perception, during which I learned about the opposing effects of the body that allows distraction techniques to be used. There were several times where patients would complain of increased pain and an inability to sleep because they felt so anxious and irritated with all of the noise going on in the unit. For these patients, I was able to suggest music that they find relaxing to mask these annoying sounds so that they could relax, reduce pain levels and anxiety.Senior YearOne of the most memorable patients I have had as a senior is a five-month-old admitted for bilateral subdural hematomas with an investigation into what was deemed “a likely non-accidental trauma” that was most likely the cause for his brain injuries. He had received an external ventricle drain after nearly a month in the hospital because the swelling and bleeding in his brain were not decreasing. His increased intracranial pressure was being monitored via the amount of drainage present. We were also performing neurological checks every four hours and frontal-occipital circumferences daily. These interventions assured us that his brain was decreasing in size throughout his stay. Evaluation of care is easily determined in certain cases. For example, when a patient begins to have difficulty breathing, suction may be required. The outcome of suction is that immediately after, the patient should be able to breathe better and allow for better gas exchange. This occurred with several patients including one-month-old twins with bronchiolitis, and a three-year-old with a trachostomy. CommunicationSophomore YearCommunication is very important to the nursing profession. As students in lecture and lab settings, we had heard of the change of shift report but were never quite able to grasp the concept of its importance until after we began clinical. The first day of clinical when we were told we had to listen through information for all of the patients on the unit to learn about our patient. Initially, we did not understand why this report was needed when you could find all of this in the patients’ charts. However, we learned that the nurses did not read the chart unless they were looking for something in particular. Once we understood the importance of report and began our clinical days where we were constantly in contact with the patient’s nurse, we learned the importance of communication. We would listen to report and introduce ourselves to the nurse and the patient, and discuss what we were able to do in our student nurse capacity. We gave a brief report to our patient’s nurse when we left the unit. Junior YearPsychiatric nursing taught a lot about therapeutic communications so that we could appropriately interact with the patients in a non-threatening manner while still learning about them. This class enhanced my ability to properly interact with my other patients as well. I found better ways to converse with hard-of-hearing patients such as standing closer and speaking slower instead of just yelling what I had to say to them. Junior year allowed me to become more comfortable with myself as a student nurse. This, in turn, allowed me to be a better patient advocate, such as when it was time for analgesics. My documentation abilities also stepped up as I had more feedback from instructors to determine what I needed to improve on. Senior YearCommunication is one Great Eight that has become second nature to me as a senior nursing student. I am able to ask for help when I know that I need it, such as when it comes to a diagnosis or lab values that I am unsure about. My documentation has most definitely gotten better over the years and I am now documenting everything for each patient during my role transition clinical including assessments, vital signs, as needed medication usage and lab draws. I am definitely the first to admit that my documentation is not perfect, but it has definitely improved and is becoming second nature. TeachingSophomore YearThe Great Eight I had the most trouble with as a sophomore was teaching. Teaching is a difficult thing to accomplish when you feel as if you do not have the knowledge to share with your patients. With only a semester and a half of information under my belt, I did limited amounts of documented teaching. There were simple things that I discussed with each patient such as the importance of eating properly and other daily necessities. Upon reflection, it seems that my favorite teaching topic included safety teaching as this was a simple topic that could apply to everyone. I also spent one morning discussing with a patient’s family how confusion was the most frequent symptom of urinary tract infections in older adults. Junior YearAs I began to feel more comfortable in my knowledge, I realized that I was actually able to teach my patients about different things. My favorite teaching was during post-partum days in clinical when I was able to help a new mom bond with her child and interpret feedings cues. As I was able to help this woman, I felt very positive about the experience and it gave me more confidence to continue teaching. On a different day, I was able to help a mother and father find ways to incorporate their first child into their second child’s care once the family was at home together. Senior YearMy favorite teaching experience during senior year has been through the community health clinical. My group is Sentara Health Prevention and we have been working closely with Sentara and a local church. Through the initial survey, we learned that the group’s biggest concerns were their blood pressure and weight. We decided that we would help them decrease their blood pressure, a Healthy People 2010 objective, through weight loss and healthier habits. We taught things such as portion control and diet variety, and encouraged them to do things such as walk an extra 1,500 steps a day. The population we worked with at the church ranged in ages from the youth to the eldery. Another memorable teaching moment was during my role transition clinical and involved a girl who reminded me a bit of myself as she was eighteen and admitted for dental surgery. Her mother was very stressed out with trying to figure out what she could feed her daughter who was on a cool, clear liquid diet. I was able to look online to determine appropriate examples and discussed these with her as well as other alternatives such as black coffee. She was receptive to my teaching and once she knew the examples, she was able to name other options.ResearchSophomore YearIn the beginning, it was difficult to actually search to find information appropriate for each patient that showed research-based interventions because we had not yet learned how to navigate the systems. During our first clinical, this Great Eight was met by simply identifying areas that would benefit from finding research. I believed that it would benefit me to do research as to why signs and symptoms of urinary tract infections are so different in children and young adults than in older adults. At this point in my schooling, I was admittedly terrified of research because I was not quite able to determine how to go from reading the research articles to transferring the information into appropriate nursing interventions. Junior YearOnce junior year began, our research duties changed. Instead of just identifying areas that would benefit from research, we now ventured out and found the research in those areas. Culture was a big area that benefited from research. During one post-partum clinical, our group learned that Africans had what we would consider unusual post-birth restrictions. Upon researching this topic, I found a study about these beliefs, one of which was that Africans did not believe in eating or drinking anything cold for six weeks after delivery. These women cannot have anything cold because blood is considered warm and the loss of which makes the new mother cold. By drinking only warm liquids, the mother remains warm. Research for a paper I wrote for my perception class included information on the importance of differing sensations and the ability to block pain. This study found that massage can help pain by providing a bigger and more powerful sensation to overpower the painful sensations along the same nerve track. Senior YearResearch has become second nature to me at this point. I determine possible topics as I am in the hospitals and go home to find articles about these topics. The most useful article I have found this year is one about the ability of nurses to accurately weigh diapers to determine the true amout of urine present. It seems that while the general idea of weighing the diapers to determine the approximately milliliters present is useful, it may become less and less accurate as the weights increase. I have shared this with two preceptors who both asked for copies of the article so they could pass it along and maybe encourage a better way of measuring output on children. LeadershipSophomore YearOnce again, as a first-year nursing school student my ability to meet this Great Eight was definitely lacking; this was more related to being so new to the profession than it was to my being unable to lead. I believed that being a leader, showed that I was capable of taking charge of my day and my abilities. I did these things by offering to help others when they seemed behind in their day or those with an exceptionally difficult patient. Throughout this semester, I documented such things as having a completed data sheet for my patient and helping classmates as my leadership abilities. I also believed that one sign of a leader was that he or she could recognize areas of improvement and mine seemed to be my assessment abilities. Each day I documented that I had studied up on assessments so that I could better improve each week. Junior YearThe beginning of each clinical day involved meeting with my instructor to discuss the plans for my patient throughout the day. My clinical group included approximately eight of us and depending on how many patients were available on our unit, we might be paired up. By working with a peer, I was able to do things as a team to do things such as baths and linen changes, which made the situation easier and more manageable. I also became a better leader in my own learning by taking charge and initiating learning opportunities. I was able to interact more with registered nurses on the units to gain experience and knowledge. I had been introduced to a doula during one experience and spent about an hour with her throughout the day learning about her role in a healthy birth. Senior YearCommunity health has helped to improve my leadership abilities. By stepping up in an environment in which we can create our own rules so to speak, our group was able to design and coordinate all of our interventions with the encouragement of our church contacts and our faculty sponsor. The health fair we held brought in a huge number of low-income Hispanics from the surrounding neighborhoods and much of the congregation. Some of the booths included vision, hearing and blood glucose screenings, hygiene supplies and Safety Prints for kids. Unfortunately, we did not have as many participants in our “Biggest Loser” competition this year as the previous group did; however, our winner lost eight pounds by using our interventions and several others managed to lower their blood pressure. Delegation is a skill that I have learned about in the leadership class and witnessed during clinicals. Finally, as a senior nursing student working side-by-side with a preceptor, I have the ability to delegate some work such as vital signs and pain checks to the clinician working with us. ProfessionalismSophomore YearIt was difficult so early in my education to understand the true meaning of many of these Great Eights that we were being instilled within us. Professionalism was an area that I definitely had difficulty with because I did not understand it. However, I did try to meet this area in many ways.At this time I believed that professionalism involved being prepared for clinical days by completing the care plans and data sheets for each patient. On the care plan, I was able to complete the nursing process by evaluating the effectiveness of my interventions. I also believed that time management played a major role in this Great Eight. I was able to consistently manage my time in a way that provided enough time to perform my assessments, morning care and documentation each week. Junior YearAs my experiences accumulated, I was able to better understand the importance of professionalism as well as what it was. I still felt that being adequately prepared was important and addressed this in many logs. During the psychiatric clinical experience, I interacted with several patients through playing games, but I was able to keep my behavior professional. As documentation is such a huge part of nursing, I continued to document everything that was done throughout the day. This documentation included learning needs and teaching effectiveness, changes in patient status and when as needed medications are given. While interacting with the registered nurses on the unit and other nursing professionals, I learned many things. One of which was that judgments about a patient should not be passed between shifts. For example, one patient was described during report as “a complainer” because he kept paging his nurse throughout the night because his pulse oximeter kept alarming. It turned out that the machine itself was malfunctioning and would alarm because it began misreading his oxygen saturation and he just wanted to sleep. Senior YearMy professional abilities have come a long way from sophomore year. As a senior, I am having true interactions with other professionals from all different specialties during my role transition clinical. These experiences are teaching me how professionalism works in the “real world” by giving examples of how to interact with others. I am gaining the ability to take responsibility for my practice by asking for accountability. I have now taken responsibility for one round of assessments on all patients. By doing so, I must be positive that I am appropriately assessing each patient and documenting everything thoroughly. Professionalism includes being able to use legal and ethical guidelines in clinical situations. One patient in particular has a major psychosocial ordeal going on with his admission to the hospital including Child Protective Services involvement as he has experienced a “likely non-accidental trauma” which caused his bilateral subdural hematomas. Because of this likely trauma, we must record his parents’ comings and goings to show their presence in his care while in the hospital. Also, no ruling has come down from social services or Child Protective Services about visiting restrictions or who will retain custody of him upon his release from the hospital. We made sure that we did not deny his parents entry into his room or his care. CultureSophomore YearCulture has always been a difficult Great Eight to master. My generation has been taught that people are all equal despite any differences that may be apparent. I have always been taught that I should ignore the differences between myself and other people, but now I am being forced to find those differences. It was confusing to determine why I must search for differences just to show how I did not let them affect my practice. The differences I found between me and my patients for this semester were relatively simple including such things as race, age and religion. I also noticed the close ties between several patients and their families which reminded me of my own family. I also learned that culture is more than what most people believe. Culture also involves things such as family ties, beliefs, and values. Junior YearCulture became easier to determine as my learning experiences accumulated. Much of what I noticed as cultural differences included the basic religious and racial differences. However, I began to pick up on other forms of culture such as environments that people were surrounded by. During labor and delivery I was at a naval hospital and surrounded by military families who were used to this culture, whereas I have no idea as to how that culture works. Also, in the psychiatric hospital, I was exposed to several patients who were raised around people who used illegal drugs recreationally and so were taught that doing so is an acceptable way of living and I was forced to remain nonjudgmental towards these patients. Senior YearAs this program comes to an end, I realize that I have learned more about culture than I thought I had. Instead of just thinking about culture in terms of race, religion and age, I now understand other aspects of it. I understand that culture can be things such as the lifestyle a person lives and the environment they are used to such as a hospital unit or military life. During senior year, I had the pleasure of writing a couple of papers about a topic I am passionate about – sexual education in schools. Through research on the topic, I learned that studies have shown such things as an increased likelihood of certain populations to get a sexually transmitted infection or have an unplanned pregnancy. By changing policies, we would be better able to protect future generations from such risks. Today’s world is incredibly interactive and because of this, anything going on in other countries may affect how we are able to practice in ours. Such things as a natural disaster, the tsunami in Japan, can require massive amounts of foreign aid. When another country needs additional help, American often sends teams which can impact the hospital from which these members deployed in such areas as staffing, supply presence and so forth. ConclusionThis program has only been three years but my perception varies every semester or so, in that sometimes it feel as if it is flying by while at others I feel as if it must be crawling by. Going into nursing school, I felt as if I would learn everything I could possibly know about nursing. Coming out of nursing is a different scenario altogether. I have learned a lot and feel confident in my knowledge; however, I am now very aware that I have more to learn and that lifelong learning is absolutely necessary in a field such as this where things are always changing. Strengths and weaknesses are things that I have a hard time with acknowledging on my own. It is difficult to pull out things that you might be very good or bad at. I believe that at this point, I am truly strong in my assessment abilities. This will continue to develop as I move into practice and create my own unique system for such things. Medication reconstitution and administration are one of my favorite things to do as it allows me the experiences I desire. I believe that my biggest weakness is that I lack true experience. This creates other problems such as knowledge of how to deal with patient issues that are not medically related. I can give one such example from role transitions when there was a conflict between the patients’ parents about the noise levels in the shared room and rude responses which eventually led to both parents asking to be moved. Documentation is another area that I do not feel exceptionally strong in, but my preceptors assure me that my documentation is more than adequate.As I mentioned, nursing requires lifelong learning. I realize that as a student, there are certain limitations to what I can gain a grasp on. Some things, such as documentation are areas that I will be able to truly improve with constant practice. I have identified medication recall as another area for learning. I know many of the medications I have used much mostly from frequently using them and those that are used less frequently are not as easily recalled. Overall, ODU’s SON has definitely put me in a position that I feel comfortable leaving school and heading into the nursing world. I can see very well now that I have grown so much in my abilities and thought processes over these three years. At this point, I believe that I am very well-equipped to take the next step and begin an entry-level nursing career. <br />Honor Code<br />I pledge to support the Honor System of ODU. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community it is my responsibility to report all suspected violations of the Honor Code. I will report to a hearing if summoned. <br />Kristen Casey BurrittApril 15, 2011<br />NameDate<br />