MedSurg Learning Plans Angel St Denis.docx



APPENDIX TWO: MEDSURG LEARNING PLANS AND TYPES OF EVIDENCE ANGEL ST.DENIS Different types of evidence are required for assessing the accomplishment of different objectives. The examples below may provide guidance in thinking of ways you might go about getting evidence that is appropriate for your objectives.ObjectiveTypes of evidenceKnowledgeReports of knowledge acquired, as in essays, examinations and audiovisual presentations.UnderstandingExamples of utilization of knowledge in solving problems, as in critical incident cases, simulation games, proposals of action projects, research projects with conclusions and recommendations.SkillsPerformance exercises with ratings by observers.AttitudesAttitudinal rating scales, performance in role playing, critical incident cases, simulation games, sensitivity groups, etc., with feedback from observers.MEDSURG LEARNING PLAN for ANGEL ST.DENIS- Kamloops cohort 0513 RDPNLearning ObjectivesResources and StrategiesTypes of Evidence of achievementCriteria to validate objectives achieved1. Clinical competency4.04 Utilizes appropriate resources/references for teaching. This correlates to CRNBC Standard of Practice 2.My goal is to be able to use the right resources and reference teaching material that would be applicable to use for teaching one patient about one condition that they have.I expect to achieve this goal by July 30th, 2014.2. Clinical competency 4.02 Prepares, implements and evaluates teaching plan. This correlates with CRPNBC Standard of Practice 2.My goal is to prepare, implement and evaluate a teaching plan for one patient for one condition that they have.I plan to achieve this goal by July 30th, 2014. 3. Clinical competency3.49 Follows established procedures for safe medication administration. This competency correlates to CRPNBC Standard of Practice 2.My goal is to administer medications using established and safe nursing procedures to five patients by July 15th, 2014. 4. Clinical competency 5.04 Identifies own learning needs in relation to client care. This correlates to CRPNBC Standards of Practice 3.This is a whole new area of nursing for me and I have a lot to learn. My goal is to be aware and identify what I am having challenges with in relation to caring for my patients during June 6th to July 15th, 2014. 5. Clinical competency 7.04 verbalizes observations to appropriate persons and Clinical competency 7.07 Uses appropriate communication channels within the agency. This correlates to CRPNBC Standard of Practice 4.My goal is to take information that I have observed from doing a 12 hour head to toe assessment with my client and share that information with the nurse on my team and/or the acting physician for that patient. I will know I have achieved this goal when I have shared this information with the appropriate person and they validate that this information is appropriate and necessary. I plan to achieve this goal by July 15th, 2014.6. Clinical competency 6.09 Utilizes appropriate problem solving techniques during interactions. This also correlates to CRPNBC Standards of Practice 1. I plan to achieve this goal by July 30th, 2014.7. Clinical competency 1.05 Makes pertinent observations. This correlates to CRPNBC Standard of Practice 1.I will achieve this goal by July 30th, 2014.8. Clinical competency 3.03 Provides a safe environment. This correlates to CRPNBC Standard of Practice 2.I will attain this goal by July 28th, 2014.I will know that I have obtained this goal when I observe that my patient’s environment and my nursing environment is kept as safe as possible.9. Clinical competency 3.29 Carries out isolation techniques. This correlates with CRPNBC Standard of Practice 2.I will attain this goal by having a patient that I will care for that is in isolation. I will perform isolation techniques every time I enter, exit and care for that patient. I will achieve this goal by July 7th, 2014. 10. Clinical competency 3.29 Performs sterile dressing techniques and clinical competency 3.30 Applies wet and dry dressing techniques. This correlates with CRPNBC Standard of Practice 2. I will attain this goal by performing sterile dressing technique on a patient that has a wound that needs to be cleaned, and dressed. I will accomplish this goal by June 23rd, 2014. Lewis, S., Heitkemper, M., Dirksen, S. R., O' Brien, P. G., Barry, M., Goldsworthy, S., & Goodridge,?D. (Eds.),?Medical-surgical nursing in Canada?(2nd ed.). Toronto, ON: Mosby Elsevier.Review teaching plans in textbook. Springhouse. (2012). Patient teaching made incredibly easy. Ambler, PA: Lippincott Williams & WilkinRead and review teaching plans from the above textbook.Observe other nurses and students teaching their patients. Lewis, S., Heitkemper, M., Dirksen, S. R., O' Brien, P. G., Barry, M., Goldsworthy, S., & Goodridge,?D. (Eds.),?Medical-surgical nursing in Canada?(2nd ed.). Toronto, ON: Mosby Elsevier.Review teaching plans in textbook. Springhouse. (2012). Patient teaching made incredibly easy. Ambler, PA: Lippincott Williams & WilkinRead and review teaching plans from the above textbook.Observe other nurses and students teaching their patients. Lilley, L., Harrington, S. and Snyder, J. (2005). Nursing practice in Canada and drug therapy. pp 12-15.Pharmacology and the nursing process (4th Ed). St Louis: Mosby.Go over the five, seven and ten rights of medication administration in the above text book.Ensure I know about the drug before administering it by researching it in my Davis Drug Guide. Observing other nurses administering medications to their patients. Stuart, G. (2009).?Chapter 2: Theraputic Nurse-Patient Relationship. Principles and Practice of Psychiatric Nursing?(9th?ed.).pp. 14, 15, 16, 17. Mosby Elsevier, St. Louis, MissouriRead and review the above pages in textbook covering nurse patient relationship, self-awareness, personal qualities of a nurse and exploration of feelings. Observe how other classmates and nurses on my team identify the areas they need to work on with regard to patient care. Keep open communication with my instructor and receive feedback with regard to how I can improve. My instructor will also provide feedback for me to reflect upon in my journal.Be alert, use critical thinking skills and personal awareness when caring for each patient. Use my reflective journal to reflect upon how I cared for my patient that shift and to also bring awareness on the areas I need to work on. Observe other nurses on my team sharing information that they have observed from a patient and verbalizes to other nurses or to a physician. Listen to how the team nurses share their observations with the ward team during shift change and in report. Observe my classmates in how they share their observations with their nurse. Read Chellel, A., & Fraser, J. (November, 2012). Nursing observations on ward: Patients at risk of critical illness. Nursing . Retrieved from how other nurses use critical thinking skills and solve problems during interactions.I will observe how nurses on 7North make pertinent observations with their patients. Observe how other nurses on 7North create a safe environment.Read resources on how to create a safe environment for your patient. Read in my Medsurg Textbook how to create a safe environment for my patients. Watch you tube videos on how to create a safe nursing environment for patients.Attend workshop on isolation technique procedures on 7North.Read Perry, A. & Potter, P. (2010). Caring for patients under isolation precautions. Clinical nursing and skills techniques. (pp.179, 180, 181, 182, 183, 184). Mosby Elsevier, St. Louis, MissouriWatch John Hopkins University School of Nursing youtube video on isolation nursing techniques: Evolve video on medical asepsis and isolation procedures. will observe other nurses performing sterile dressing technique on their patients and applying either a wet or dry dressing with the proper techniques. I will observe classmates performing sterile dressing and doing wet and dry dressing changes on their patients.I will read the following:Perry, A. & Potter, P. (2010).Preparing a sterile field. Clinical nursing and skills techniques. (pp.192, 193, 194, 195, & 196). Mosby Elsevier, St. Louis, MissouriAnd also read over:Perry, A. & Potter, P. (2010). Applying a dressing (dry and moist to dry). Clinical nursing and skills techniques. (pp.1005-1018). Mosby Elsevier, St. Louis, MissouriI will watch Evolve video on Wound care and irrigation: reviewed the teaching plans in my textbooks.I also observed other nurses teaching their patients about different topics during clinical.I accessed and read the reference teaching material on MIBIs from 7North.I accessed and read the material on discharge teaching from 7 North.I used the reference and teaching manual for diabetic teaching that was in the nursing station on 7North.I accomplished this goal by July 8th, 2014.I achieved this goal on July 7th and on July 8th, 2014.I had the opportunity to do discharge teaching as well as diabetic and lifestyle teaching to my patient that was diabetic and also had a heart condition. I went through the patient teachings that I had resourced together with her. I also evaluated that my teaching was a success by asking her pertinent questions to see if she understood what I had taught her. She was very encouraged and motivated to move forward with a new healthy lifestyle. I also gave her brochures on the teaching materials. I also taught one of my patient’s about the MIBI test that she was going to do, and helped calm her fears by going through the resources together. This was accomplished on July 8th, 2014. I would always go into the hospital on the night before shift and research my patient’s MAR and chart. Then I would go home and research the medications they were on.June 16th, 17th, 23rd, 24th and 30th, 2014 I administered oral medications, and SC injection medications of different types on different patients. I followed safe medication procedures using the Right drug, Right Dose, Right time, Right route, Right patient, Right reason and Right documentation and 3 checks on all of these patients and medications. I also ensured that my instructor was present with me during the entire process for each patient to confirm that I had done all of my checks, and administered the medications safely. I did have to trouble shoot and use critical thinking on one patient that was tiny and had no abdominal fat for her SC injection. Instead I gave it to her in the arm and pulled extra skin from the back of her arm to ensure the injection went into her properly. On June 17th, 2014, my patient needed a subcutaneous injection of Heparin. I knew that I did not feel confident enough to just go ahead and do the injection, as I had never done one before. I shared with my team nurse my learning concern and asked her if I could observe her doing a subcutaneous injection on her patient first. She agreed to let me observe her and I did so within that hour. I then shared with my instructor that I had observed my team nurse and asked if she could support me in doing this injection on my patient. My instructor readily agreed to support me and I was able to carry out the administration of Heparin via a subcutaneous injection in my patient’s abdomen. My patient told me that I did a great job! On June 17th, 2014 I did a full head to toe assessment on my patient that has pneumonia and pericarditis. I spend a lot of time with her asking questions, and performing nursing skills such as auscultation of her lungs, vitals, BM sounds and palpitation, and more. I was able to share with her physician how her morning had been and share specific issues such as the fact that she was having sharp abdominal pain, rated at 8 on a scale of 1-10 when she would urinate. The physician asked me to do a urine collection for C & S and told me he was going to do a CT scan of her chest. In report that afternoon with the ward team of nurses and other health care professionals I was able to give report on my patient and share what I had observed as well as what the physician had shared with me. During the week of July 21st and 22nd, 2014. I was able to be part of the team which included myself, the physician, the psychiatrist, the social worker, the life skills worker and the community mental health nurse for my patient as they were trouble shooting whether my patient was able to be discharged to live independently alone or whether he would have to go into assisted living. I was able to share and report my observations and findings from my two days of doing his care that it was not in his best interest to live independently because of the notable cognitive decline that I observed. The team really appreciated my input and used it in the decision making process. I loved being apart of the team! I achieved this goal on July 22, 2014.I accomplished this goal successfully on 14th, 2014 when I observed my patient to have pallor, was drowsy, confused and weak. I took his BGM and it was 2.7mmol/L. I immediately go him some apple juice and peaches. I then and told the kitchen that I needed his breakfast asap and gave it to him right away. I had also informed the RN immediately of his condition. I took his BGM again every 15 minutes for the next hour. I observed significant improvement after he ate his breakfast and his BGM went up to 6.0mmol/L. I also told my instructor. I also noted from his MAR and from the situation that he should not have his Insulin. I charted the hypoglycemic event in his chart and on the cardex at the end of shift. I accomplished this goal on July 22nd, 2014. During every patient interaction during clinical I would ensure that my patient had the bed rail up if required. I would make sure that they had their walker close in reach if necessary. I would ensure they were wearing non-slip socks. I would make sure that there was nothing that wasn’t safe around their area. I would also adjust their bed and their positioning to ensure that they were safely positioned and that there would be no opportunity for them to fall out of bed. I also used gloves when necessary and made sure that the patient’s area was clean.I accomplished this goal by July 28th, 2014 with all of my patients in clinical.On June 16th and 17th I cared for two patients in the same room that were in isolation. I used the proper gown, gloves and procedures that were needed every time I entered that room. I used the vital machines that were already in that room and used disposable BP cuffs for each patient. I wrote my observations and findings on a paper that I placed near the door so that I could look at it and record the info from outside of the room in the patient’s chart. I used CAVI wipes on everything that I used during the patient care (such as the vital machines). I made sure to change my gown and gloves between each patient and every time I went in and out of the room. I attended an isolation workshop on 7 North on June 16th, 2014.On June 17th, 2014 I had the opportunity to perform sterile dressing technique while changing the dressing for 2 wounds on my patient that was in isolation. The first wound was a pressure ulcer on his coccyx and needed a wet dressing. The second wound was on the bottom of his right foot and needed a dry dressing. I also irrigated, cleaned, measured, the wound and took note of the skin integrity as well as the color and smell of the discharge and wound. There was purulent discharge on the coccyx wound. This was a great challenge and opportunity for me because not only was I able to perform sterile technique, wound care and dressing changes with him, but he also had two BMs during the process and I had to start up a new sterile field after each BM, so it was a great experience. I would give myself a 4/5 for this learning competency. I made it a goal of mine to find and read teaching material on different subjects such as discharge teaching, MIBIs, and diabetic/lifestyle materials. I successfully accomplished this goal and plan to continue utilizing appropriate resources and references for teaching throughout my career in nursing.I would give myself a 5/5 on this competency. I prepared the material in advance both times. I also implemented and evaluated the teaching plans by asking the patient’s questions to check their understanding. Patient Teaching is a very important part of nursing interventions and I plan to continue to teach patients throughout the rest of my nursing career. I would give myself a 4/5 on this learning competency as it is one that I will continue for the rest of my career. I feel confident to always start with my 5 rights and 3 checks. Further to that, if I ever had a question about a drug I would look it up in my drug book, if I still needed help I would seek help from another nurse. If I had a discrepancy with a medication I would ask the physician and or pharmacy. I would give myself a 5 out of 5 for this learning goal. It is in my character to acknowledge I need help when I need it. I believe this situation was a prime example of this because I acknowledged immediately when I knew I needed to improve my learning before performing the injection on my patient, and I sought out help and received help from both my team nurse and my instructor. I am still a nursing student and have many areas that I still need help in. I am not afraid to identify this and get the help I need to ensure I am giving quality care to my patients. On a scale of 1-5 I would give myself a 5. I was able to give a clear, concise and to the point report of what I had observed in my patient with the physician and then later in report I was able to share both my information and the information from the physician with regard to my patient with the other health care team members in a confident and professional manor. I would give myself a 4/5 on this competency as it is one that I will continue working on and this was my first opportunity to be a part of the problem solving process.I would give myself a 5/5 for this, as it was a stressful situation. I acted immediately to the pertinent observations without any delay. I put my game face on even though it was stressful, and was able to complete everything I needed to do to get his BGM stabilized. Pertinent observations are something that I will continue to engage in with my patients on a daily basis in nursing.I would give myself a 5/5 as I believe that I did accomplish this with every patient that I had during medsurg clinical rotation. It was something that was always on the forefront of my mind during nurse/patient interaction and care. Creating a safe environment will be something that I will always be aware of during my nursing practice. On a scale of 1 to 5, I would give myself a 4. I did use all of the proper isolation techniques but I am not an expert. I know that this is something that is very important to learn and I will continue to practice proper isolation technique. I would give myself a 4 out of 5 on this competency. I believe the degree of difficulty was heightened because not only was the patient in isolation and I had to adhere to isolation protocol but also I had to do two sterile fields because of his bowel movements during the wound care of his pressure ulcer on his coccyx. I know that as I practice wound care on patients I will become more confident in this area. ................
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