Professional Progress Summary



Professional Progress SummaryCarl RojasOld Dominion UniversityProfessional Progress SummaryPrior to nursing school, I had acquired over eight years serving as a United States Navy Corpsman. It was through these experiences that I had developed the inspiration and desire to become a nurse. As I prepared to transition from an active duty status to a full time nursing student, I sought out to gain advice from Naval Nurse Corps Officers, who had also attended the school of nursing (SON) at Old Dominion University (ODU), as a way to better prepare for the “rigorous” curriculum I was soon to face. In addition to my hospital experience and confidence in my clinical skill application, I was somewhat arrogant as I entered into the program. However, I soon realized that nursing is more than just an application of technical skills, but requires premeditation, forethought, and a considerable amount of sociocultural consideration through evidence based research and nursing theory, prior to applying these skills into practice. These concepts were somewhat overlooked and even more difficult to apply into practice than I had originally anticipated. From the initial start of the nursing curriculum, a major emphasis had been placed on understanding the eight core competencies, established by the ODU’s SON, and applying them into practice. These core competencies consist of: (1) critical thinking; (2) nursing practice; (3) communication; (4) teaching; (5) research; (6) leadership; (7) professionalism; and (8) culture. At first, I had difficulty in fully understanding and applying these concepts. However, due to the consistency of a persistent program, I was able to not only understand them but apply them into my practice effectively, which has better prepared me as I transition from a nursing student to a novice nurse. Therefore, to demonstrate the attainment of competency behavior achieved throughout my matriculation, several course projects, assignments, and clinical experiences have been utilized throughout this professional progress summary. Critical ThinkingJunior YearDuring my junior year, critical thinking was a concept introduced through a didactic setting, which highly focused on understanding basic nursing fundamentals with a heavy reliance on textbooks, theorists, and knowledge from arts and sciences. At this phase in the curriculum, critical thinking application was limited, as the distribution of knowledge was primarily focused on gaining autonomy. However, the first semester provided me with a solid foundation of concepts and rudimentary skills, for which were important to fully understand prior to applying them into the clinical setting. As I transitioned into my second semester, I was provided with the opportunity to work in the dedicated education unit (DEU) over a six week period. It was through these clinical experiences where my critical thinking skills began to develop as I was able to take the skills learned from the classroom setting and apply them into nursing practice among real patients. The DEU provided me with a real perspective in fulfilling the role of the nurse as patient care was applied over a 12-hour shift. I was assigned to one nursing preceptor, who could monitor the development of my nursing process and intervene as necessary as I continued to progress throughout the semester. Additionally, I was assigned a clinical mentor who could evaluated my progression through the submission of clinical documentation, such as clinical logs, Docucare assessments, medication lists, and detailed nursing care plans. As a result, I soon realized that nursing care was more than just providing interventions, but required reasoning, an evaluation of their effectiveness, and potentially introducing new interventions to obtain health goals originally established for the patient. As I continued to progress, my critical thinking skills began to evolve more comprehensively. My clinical logs began to incorporate a more holistic understanding of the disease process and its relationship to the patient’s current condition. For example, during one clinical rotation, I was assigned to a 55-year-old male who had been diagnosed with pneumonia which seemed to be a reoccurring anomaly that had been documented on his electronic medical record (EMR). His past medical history included chronic obstructive pulmonary disease (COPD), asthma, smoking, and chronic heart failure, for which all contribute to the accumulation of fluid within the lung space; ultimately increasing the risk for infection. Therefore, medicinal interventions (i.e. antibiotics) focused on the primary diagnosis (i.e. pneumonia) may reduce symptomatic exacerbations of an acute illness; however, providing long term interventions that address the underlying issues will ultimately reduce further complications. In acknowledging these principles, I was able to see the importance of nursing theories, for which I began to incorporate them into my nursing care plans to help guide my practice. Senior YearDuring my senior year, I transitioned from a medical surgical DEU into an acute care cardiac surgical unit (ACCSU) for role transition. Instead of providing care to patients suffering from a variety of illness, I was now caring for patients admitted for cardiac specific reasons, for which critical thinking was applied in a more refined, in-depth, and focused way. For example, while providing care to a 74-year-old African American male who was admitted to the unit after having undergone a coronary artery bypass graft (CABG), he began to fall into symptomatic supraventricular tachycardia (SVT). After assisting the patient in performing vagal maneuvers, his symptom continued to persist, which required immediate medicinal intervention to include a diltiazem intravenous (IV) bolus infused over two minutes. Diltiazem, a calcium channel blocker, inhibits the transportation of calcium into the cell, which prevents the excitation and contraction of the cardiac muscle, and leads to a depression of the atrioventricular (AV) and sinoatrial (SA) node. Thereby decreasing the heart rate (HR) and blood pressure (BP) due to vasodilation. In knowing the pharmacological process of this medication, it was important to assess for potential contraindications prior to administering to include: (1) the presence of a second and/or third degree AV block, as this will further block electrical transmission to the AV node; and (2) a systolic BP less than 90 mm Hg, as this will result in life-threatening vasodilation. Furthermore, knowing the next step, if the primary and secondary interventions are ineffective, is important to be aware of as time becomes a factor when health status declines. In this case, synchronized cardioversion was implemented, which uses a sensor to deliver electricity that is synchronized with the peak of the QRS complex. This differs from traditional defibrillation, which is a high energy shock used when there is no coordinated intrinsic electrical activity in the heart, such as pulseless ventricular tachycardia. Therefore, continuous assessment and monitoring of the patient’s vital signs (VS) and telemetry strips were crucial when determining whether or not interventions were successful, thereby dictating the course of action. After reflecting on my progress in understanding and applying critical thinking concepts from junior to senior year, I feel that I have grown as a nursing student in multiple ways. I feel more confident when applying them into practice, especially during acute care situations where time is limited. Although I am aware that I still have much to learn, I know that I have gained a deeper understanding and appreciation of the nursing process as well as the general disease process of patients in various settings. Nursing PracticeJunior YearSimilar to the development of my critical thinking skills, the application of nursing practice was also introduced in the classroom setting and evaluated by faculty through course examinations and simulation labs. It was here where I began to understand the reasons for implementing interventions and the implications that could occur if not applied correctly. Furthermore, I was provided the opportunity to gain autonomy in the application of invasive interventions by practicing on manikins and standardized patients in a safe learning environment. Once a basic understanding and certain level of competency in nursing practice was achieved, we transitioned from the simulation setting into real world scenarios. During this time, I was able to practice the basic fundamental skills gained from the first semester and fine tune them through real patient applications in the second semester. These to include, but not limited to, the application of Foley catheters, blood draws and intravenous catheterizations, medication administration, wound care, and head-to-assessments. Senior YearDuring my senior year, I had taken my nursing practice to the next level. Now that I had established a solid foundation in understanding and applying basic interventions, I focused on more critical nursing practice skills. For example, instead of implementing technical skill interventions (i.e. blood draws), I was evaluating electrolyte balances, which was used to determine whether or not I would be giving potassium to a patient. Under the supervision of my preceptor, I was monitoring platelet counts to determine the drip rates for heparin infusions. Additionally, assessments were more refined as I transitioned into the ACCSU and was implementing focused assessments for identifying specific complications that may occur due to the surgical intervention that had occurred. For example, one patient for which care was provided to, was recovering from a CABG surgery. Thus, a neurological assessment was implemented to assess whether or not adequate cardiac output was being delivered to peripheral tissues. Furthermore, specialty specific nursing protocols were implemented such as ensuring that patients were utilizing the supportive devices for preventing compression/pressurization of the chest wall following open heart surgery, or implementing interventions to prevent blood clots such as deep venous thrombosis (DVT).The implementation of specialty specific protocols were combined with traditional nursing care practices, which ultimately enabled me to provide holistic health care to diverse populations across the lifespan. For example, when providing care in the ACCSU, successful recovery for patients after undergoing a CABG was highly dependent on the care provided throughout the perioperative stages in order to relieve symptoms, improve the quality of life, and ultimately prolong life. Therefore, it was imperative for me to be knowledgeable in delivering institutional specific protocols such as postoperative pulmonary, hemodynamic, neurologic, renal, gastrointestinal, and pain management, as well as providing generalized nursing care such as preventing infection, reducing anxiety, and providing education and resources for making necessary lifestyle adjustments. CommunicationJunior YearDuring my junior year, I realized that communication could be delivered in verbal, non-verbal, and/or written ways. Communication for this year was focused on utilizing therapeutic communication skills with patients and families, documenting nursing interventions and assessments, communicating vital information to the my nursing preceptor and instructors, and presenting competency of objectives through clinical logs by writing accurate, concise, and relevant information. In addition to my experiences gained in the clinical setting, I was required to conduct several informational presentations before my fellow nursing students, which were delivered through various methods to include pamphlet handouts, poster boards, PowerPoint, and computer-generated imagery (CGI). The combination of these methods helped me to communicate to a variety of diverse individuals (i.e. faculty, students, patients, families, interdisciplinary educators) in multiple ways, while using various forms of media for the purposes of supporting safe nursing practice. Additionally, I had establish alternative methods of communication when encountering patients who required special needs. For example, during one of my behavioral health clinical rotations at a psychiatric inpatient facility, I was caring for an 18-year-old schizophrenic patient from El Salvador who did not speak nor understand English. Although he was provided with a translator, his orientation status was altered, which made it difficult for the translator to interpret what he was saying. Therefore, communicating with this patient required the interpretation of his body language and behavioral responses to certain stimuli. For example, overtime, I noticed that he would get agitated when the television was too loud or when the room became over crowded with other patients. Therefore, I would turn it off or guide him to a quieter room in an attempt to establish an environment supportive to his recovery. Senior YearAs I continued to progress throughout the curriculum, my knowledge in disease process and pharmacology increased. Additionally, I became more familiar with the clinical environment, which increased my comfort level in communicating with various members of the interdisciplinary healthcare team (HCT) when using a variety of technology, informatics, and communication devices. For example, during my role transition clinicals, I was more descriptive in my documentation of my patients to ensure that their care was effectively communicated on their EMR and was easily interpreted by the physicians and other members of the HCT. I also gave reports to physicians directly, or by phone, as well as when turning over to the oncoming shift nurse. Perhaps more importantly in regards to my personal development, was my ability to see things from the patient’s perspective. For example, during one of my clinical rotations, I was providing care to a patient whose behavior and attitude with the nursing staff was highly negative, which was reinforced by similar behavior shared by his family members. This made it very difficult to establish a therapeutic relationship, which only worsened during an episode of prolonged SVT. Despite efforts to save the patient’s life, he remained extremely resentful for any care being provided to him. However, being aware of his collection of chronic comorbidities requiring chronic therapy (i.e. dialysis) and knowing the toll that takes on an individual’s spiritual and psychological well-being, allowed me to see past the presentation of his frustrations in order to provide quality, safe, and effective care. TeachingJunior YearDuring my junior year, teaching was primarily focused on educating patients in the hospital setting by providing basic health related information for the purposes of nursing interventions. For example, I provided education about the purposes of medications or why certain interventions were being implemented such as ambulation or blowing into an incentive spirometer. Medication education was simple and without depth. For example, when giving metoprolol, I told the patient that the medication was for hypertension. When assisting patients in ambulating or having them use the incentive spirometer, I explained that active participation would help to prevent bed sores or help to clear out the lungs. Senior YearSimilar to the development of my competency in communication, I became more confident in my teaching abilities due to my increased autonomy in disease management and further exposure in the clinical setting. Increased autonomy provided me with the confidence and comfortability in expanding in the education I was providing. For example, not only was metoprolol being described as simply an antihypertensive medication, education was now including how it reduces hypertension. Furthermore, I became aware that in order for teaching to be effective in an acute care environment, repetition must be reinforced, which often requires assessing the patient of their understanding of what has been taught prior to hospital discharge. For example, during a role transition clinical, I was about to administer Lasix for which I asked the patient to tell me what it was for. After she answered correctly, I further asked her what other medication (potassium) is typically given with Lasix and why. Despite not answering correctly, it allowed me to assess whether education was being adequately provided and/or areas where I needed to reinforce. Additionally, knowing when to deliver education became apparent. For example, when providing patient education in the ACCSU, there are over 10 pages of discharge instructions that are presented to the patient. Therefore, it was best to provide a quiet environment with limited distractions, as well as ensure family members are present and actively participating when presenting important information. ResearchJunior YearOut of all the core competencies, I would have to say that my understanding and application in nursing research has come the furthest. During my junior year, I unintentionally utilized medical research, rather than nursing research, to provide evidence for the application of nursing practice. However, I did not know how to utilize it when relating it to the application of patient care. It wasn’t until the end of the second semester that I really began to understand how to utilize nursing research. During our nursing research class (NURS 387), we were given didactic teaching that broke down the different elements of research as it applies to nursing. We were made aware of the impact that evidence based practice (EBP) has on the progression of the profession of nursing and its utilization and future research will further promote nursing as its own separate profession amongst the various healthcare fields. This class challenged us to analyze research and understand the components that make up quality research. Senior YearDuring my senior year, it became more evident that there was a better understanding of research as it pertains to nursing. I was able to better apply and integrate nursing research into written assignments, projects and presentations, as well as into my clinical practice as evidence rather than conjecture. For example, for our community health project, increasing physical activity to reduce comorbidities amongst older adults was one of the main interventions we had selected to implement. Evidence for its effectiveness has been supported by several gerontological nursing researchers and has been implemented by Health People 2020 as a result. Furthermore, I was able to differentiate between descriptive nursing literature and nursing research and incorporated both elements successfully in course assignments. For example, articles in nursing literature were utilized to establish clinical relevance for influencing readers or audience members when presenting on certain health topics, while nursing research was used to provide evidence for the inclusion of certain interventions that had been or were to be implemented in the clinical setting. Although nursing research is still an area where I feel slightly apprehensive, I am better able to rationalize my decision in selecting various research and am fully aware of the impact that research has on the nursing profession. LeadershipJunior YearAlthough leadership roles may seem limited during the nursing school, I looked for opportunities to exemplify self-direction, accountability and teamwork. During a clinical rotation in the post-partum unit, our clinical instructor designated me as the clinical group leader. To fulfill this role, I was responsible for delegating and supervising nursing care provided by other students. For example, vital sign assessments needed to be conducted for 32 patients every four hours for which I equally distributed amongst the four of us. I asked students to report any unusual blood pressures and heart rates to the patient’s nurse prior to reevaluating, for which I would be present during the reevaluation to ensure proper technique was used. Prior to ending the clinical rotation, I ensured that all VS were documented appropriately, to include the names of the nurses notified when unusual findings were assessed. Senior YearUpon entering the last year of nursing school, I was placed into several situations where I was able to take on larger leadership roles. In Community Health II (NURS 472 & 473), my group had difficulty establishing required clinical hours with the older adult aggregate we had been assigned, due to scheduling conflicts with the activities coordinator at the residential housing facility. Therefore, I reached out to several organizations within the Hampton Roads area in an attempt to provide an additional resource for my group to utilize. As a result, we were able to initiate a community partnership with Senior Services of Southeastern Virginia (SSSV) who held mutual health promotion goals for a similar population, but at a larger scale. Due to our combined efforts, we were able to distribute health education and resource information for older adults throughout the Hampton Roads area. Another leadership role I was able to assume took place while advocating for the nursing profession at the state legislation level. I attended two events in Richmond Virginia, which were hosted by the Virginia Nurses Association (VNA), to include the 2018 Legislative Summit Conference and one of three Lobby Days in preparation for the 2019 General Assembly. During Lobby Day, legislation bills HB 1640 and SB 1178 (Equitable Reimbursement for Nurse Practitioners) were presented before Senator John Cosgrove and Delegate Jay Jones. Although Virginia NPs have been authorized to apply for autonomous practice licensure, they are unable to directly charge for their services. Therefore, physician NPIs are being utilized despite being seen by NPs, which further contributes to reducing access of care for patients with limited insurance coverage. These facts, in addition to statistical supporting evidence, were used to persuade both representatives to follow up with these issues when presenting before the General Assembly. ProfessionalismJunior YearDuring my junior year, I perceived professionalism as the ability to present myself in an exemplary manner for the purposes of providing a positive reflection of my character and as a representative from the ODU SON. Therefore, I ensured that I arrived at the right place and time, in the appropriate attire, while presenting with an eagerness to learn. However, I faced some challenges upon initially first arriving to the DEU. During my first clinical rotation in Adult Health I (NURS 323) my nurse preceptor seemed somewhat reluctant to aid in the development of my nursing practice skills. After speaking with her in regards to her expectations as well as what I wanted to gain from my clinical experience, we were able to establish an effective teacher-student environment. As our relationship continued to develop, I was able to provide evidence in my ability to deliver safe and effective care to her patients. For example, I would arrive to the unit 45 minutes before shift to look up patients I was to be assigned, which better prepared me when receiving report from the off going shift nurse. In addition, I would complete my patient assessments ahead of schedule, which provided me the opportunity to present abnormal/significant findings unbeknownst to her. Due to consistently performing accurate assessments, I was able to gain her trust and respect, for which she became enthusiastic towards aiding in my development. Senior YearBy senior year, I realized that nursing professionalism was to be applied beyond the context of my own self-perception, and to include the ethical principles applicable to the standards of nursing practice. For example, during one of my clinical rotations in role transition, I was assigned to provide care to an elderly women who had submitted several complaints about the care she was being rendered. When receiving report, the off-going nurse emphasized how difficult the patient had been throughout the night shift, which was a commonly shared experience perceived by other nurses. However, I was determined to make my own assessment and establish my own therapeutic relationship with the patient, for which an increased amount of empathetic and emotional support was reinforced. Her frustrations were found to be related to her social isolation, for which active face-to-face engagement proved to be effective in managing. By charting her assessments while in the room, I was able to provide her with and additional amount of physical presence. By practicing good communication skills and providing her with respect, I was able to establish a highly therapeutic relationship with this patient, which helped me to gain perspective from the patient’s point of view rather than making irrational judgements or forming biased opinions. CultureJunior YearDuring my junior year, I was slowly becoming aware of the environmental factors that influence healthcare decisions amongst diverse individuals. Initially, I had difficulty understanding as to why a patient couldn’t adhere to a simple care plan. However, inconsistencies can be a result of an individual’s socioeconomic status or sociocultural environment. Therefore, my approach towards providing holistic and culturally sensitive care was focused on presenting myself in an unbiased and non-judgmental manner, as well as in promoting health awareness through education. For example, while in the DEU, I was assigned to provide care to a patient with a history of opioid substance abuse, who was experiencing an increased amount of pain. Care was focused on managing his pain to an effective level regardless of his negatively perceived social habits, which was reinforced by evidence of his presenting symptoms (i.e. swelling & infection to affected site). Additionally, I realized that culture extends beyond the realms of race and/or ethnicity, but may include socioeconomic status, older age, and the disabled. For example, when assessing the older adult aggregate during Community Health II (NURS 473), we found that the majority of the residents lacked access to sufficient and/or reliable transportation. When utilizing public transportation to get to the nearest clinic, the average time to travel one way was over two hours, which was also dependent on anticipating the frequency of the bus schedule. Senior YearAs I transitioned into my senior year, I had gained a better understanding of the importance of providing sensitivity to personal and cultural definitions of health. As death is inevitable, it is important to respect how others interpret life and/or their interpretation of disease/illness by acknowledging and respecting an individual’s decision based on their spiritual and/or cultural beliefs. For example, during a clinical rotation in Adult Health II (NURS 453), I was assigned to provide care to an elderly female patient whose psychological and physical health status began to decline significantly. After the HCT presented treatment options to the patient’s spouse (i.e. palliative care vs continued intervention), a decision was made to discontinue respiratory ventilation and implement comfort care. Despite any opposing thoughts I had held internally, I knew that this decision was a rational solution from a medical perspective. More importantly, it was decision that was for the patient’s family to decide upon, which was influenced by their cultural and spiritual beliefs. Encountering situations such as these, have reinforced my acknowledgement of differentiating between treating a disease versus treating a person. Nursing care involves more than just implementing interventions for improving a physical condition, but must address the spiritual needs of an individual, to include the care desired to be received by the client and their families at the end of life. ConclusionThe ODU SON curriculum has provided me with a remarkable foundation for the future implementation of my nursing practice as I transition from a student to a novice nurse. I am now a better organizer, time manager, and have established a more in-depth critical thinking ability as a result. The combination of didactic course work, simulations, and clinical rotation experiences has prepared me to think more critically, apply nursing practice more appropriately, communicate more effectively, to teach across a variety of settings, to differentiate and conduct various types of research, to lead in more effective ways, to demonstrate professionalism despite indifference, and to be culturally competent. Despite the development of these core competencies, I know that I have much to learn as learning is a lifelong process. In closing, I am appreciative of the clinical staff who have aided in my development, for my classmates who I was able to share these experiences with, and for the course instructors and faculty who have promoted necessary moments of reflection, mentoring, and most importantly, with an open ear, which is sometimes all one needs when facing adversity. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download