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Practice Summary Paper

Clarke Krugman

Old Dominion University

Career Pathways - Expanded Horizons

NURS403

Practice Summary Paper

This paper explores the personal and professional development I experienced while enrolled in Old Dominion University’s RN to BSN program. It is a self-reflection paper, and uses activities that were part of the curriculum to demonstrate the attainment of eight core competencies in: critical thinking, nursing practice, communication, teaching, research, leadership, professionalism, and culture.

The RN to BSN program was a natural progression for me. Based upon what I was reading in the trade publications, the associate’s degree was no longer a benchmark for the RN; major hospitals were moving toward having bachelor’s degreed RNs in their facilities. Doors to advancement would be closed to those without a desire for continuing education.

At first, my goal to obtain the bachelor’s degree was simply a means to an end: the bachelor’s degree carried with it the opportunity to work in more sophisticated environments, and posed no barriers, while the associate’s degree did. I did really well in my coursework and enjoyed it. I found that my critical thinking skills, writing skills, and research skills had grown enormously. This boosted my confidence, and I began to consider that becoming a nurse practitioner or even a doctor of nursing practice was not outside my abilities to accomplish. Thus, goals have changed; they are on an upward trajectory toward a doctorate.

What follows are brief descriptions of projects carried out while at Old Dominion University, and how they apply to the eight core behaviors/competencies.

Critical Thinking

The initial step in becoming a critical thinker was to purge myself of biases. I believe I have done this for the most part. It is not terribly difficult, but it requires perseverance and repetition to make it a habit. I take four steps in succession, in order that I entertain a situation with clarity. The first is to pause; take ten seconds to receive the information. The second step is to determine the source of the information; check it for credibility. The third is to remain open to the idea that the new information (particularly if it is in conflict with what you believe to be true) is in fact true, making the position you hold the false one. The result of this exercise is a concluding step, which is to either hold your correct position, or alter your incorrect one.

Among the examples of critical thinking skills as I was developing them was a discussion group about critique of nursing theory. The task was to apply Jacqueline Fawcett’s, Criteria for Evaluation of a Theory, to Jean Watson’s Theory of Caring. Jacqueline Fawcett is an acknowledged expert in nursing theory, and has developed systematic methodology for evaluation. The systematic approach measures elements of theory in order to judge their utility, among other things. My concluding remarks reflect my use of critical thinking using Fawcett’s criteria, and the application of my own ‘bias removal strategy’ I described before, “Upon self-reflection, this writer was at first quite skeptical of Jean Watson’s theory, thinking it to be too abstract, its constructs too vague to be implemented as a system. What has been learned after significant study of Jean Watson’s Caritas process is that its method is teachable, reproducible, and has measurable results. It warrants inclusion as an interpersonal relationship theory.” The example demonstrates applied critical thinking, which resulted in a change in position as per Jean Watson’s theory.

Another example of critical thinking was in a written exercise about a workplace experience of mine. I was a student nurse in an ICU. Using critical thinking, I was able to correctly assess a patient with a chest tube who was struggling for breath. The chest tube unit needed a closed water seal, something the ICU nurse had missed. The objective use of stepwise methods revealed to me the cause of the patient’s breathing difficulty.

Nursing Practice

There are several elements that comprise ‘nursing practice’. One of them is ‘application of appropriate knowledge of health problems in practice’. An example of this was the use of my knowledge of MRSA in order to devise a plan for infection control. Another example of using knowledge of health problems to resolve problems was my understanding of the root causes of obesity, the physiological and psychological aspects of the condition, and methods of treatment.

A second element within the nursing practice domain is ‘the performance of interventions with appropriate technique’. An example of this would be my development and execution of a teaching plan for pain management. It required correct communication and nurse educator formal teaching methodologies, as well as accepted therapeutic interventions in complementary therapy.

Communication

A couple of projects come to mind when considering the domain of communication. The first demonstrated the ability to put together a presentation that effectively addressed patient safety issues. This was an assignment using root cause analysis as a method of identifying safety risks. It utilized visual aids in a presentation to multidisciplinary staff. The presentation was warmly received.

A second assignment was the development of an advocacy letter. The advocacy letter is meant to communicate an effective argument via written word on and important topic; in my case, safe nurse-to-patient staffing ratios. It has to be well-crafted to demonstrate expertise on the subject, urgency, and motivate the reader to take action. My letter received a personal reply, indicating to me at least that my letter was read. The previous examples indicate an understanding and a readiness to use oral, visual, and written means of communication.

Teaching

Teaching is a competency that is among the ones I wanted to develop most in this coursework. The elements of teaching require an understanding of the subject matter you are communicating, the target population you are teaching, and the method of teaching to use. Several projects helped me with my teaching skills, but one from our Nurse Educator curriculum was particularly useful. I learned how to put together an effective teaching project for anxiety and pain management. It was necessary to make detailed assessment of my target audience, and the appropriate medium to approach the teaching material with. I learned the practical, necessary steps toward creating an effective teaching platform. I have used it as a model for my tutoring in cadaver lab at a local college, and in teaching youngsters as a volunteer for the Halle Heart Children’s Museum.

Research

Research is among my main interests, and I feel that I took full advantage of the Old Dominion University coursework to develop skills in this area. I had opportunity to research nursing theory, critique nursing theory using structured research methods, and develop advocacy/lobby letters on subjects I had deeply researched. Two specific research projects were group-oriented. On one group project, we took Joint Commission recommendations and researched various ways to resolve issues such as infection control and safety. Another group project required in-depth research of a community in an effort to develop a successful obesity prevention program for adolescents. These projects have given me great confidence in my ability to research and problem solve.

Leadership

Among the elements of leadership in nursing is the role ‘as a designer, manager, and coordinator of health care’. My presentation of anxiety and pain management, which I gave to a group of seniors and their families, required my leadership in guiding the group successfully through the steps of the program. This enlisted the use of public speaking as well, which I thoroughly enjoyed.

Developing the safety protocol for infection control was an exercise in leadership. The design of the program is one step. Leadership requires that one take the program, communicate it, motivate the change, and effect the change. Through this exercise, I learned first-hand the challenges of leadership in implementing change.

Another important element of leadership competency is ‘organizing, managing and evaluating the development of strategies to promote healthy communities’. My example of this competency is again with my advocacy paper. Its intent was to motivate elected officials to take action on the issue of safe nurse-to-patient ratios. This effort, combined with my work on behalf of nurses on Arizona’s ‘Lobby Day’, are apt examples of commitment to community.

Professionalism

Maintaining standards of practice and being accountable are two key features of professionalism. Maintaining standards of practice requires the use of ‘organizational and political processes’. I believe I demonstrated this competency with my work in effectively working with departments in implementing safety protocols for infection control. The project required working with department heads and applying Joint Commission recommendations. The use of political processes to maintain (improve, actually) standards of practice is exhibited in my efforts with lobbying our state representatives.

Accountability is another key element of professionalism. My personal nursing philosophy and my commentary about it speaks to accountability: “The development of a personal philosophy of nursing through research, practice, volunteerism, additional certifications, and continuing education, all demonstrate a focused effort to perform the art and science of nursing with pride and professionalism.”

Culture

Several formal projects heightened my awareness of the importance of factoring in cultural differences to nursing practice. One project which I had a great interest in was the adolescent obesity group project. It took into account ethnicity, race, and culture, because the issue was about food; food is the common denominator that defines cultures. The challenge of helping persons make healthy food choices was made more difficult in light of the southern cooking culture. Sensitivity to the collective palates of southerners had to be integrated into the planning phase.

There are reasons outside of academic curriculum that foster my interest and understanding of culture’s importance in nursing. I have a mixed-race family, with Japanese, Hispanic, and Native American relatives. I have been immersed in a multi-cultural environment, and I see the similarities as clearly as others might see the differences. It allows for an approach to others that is person-centered; culture and race are ancillary in my world view. I am fortunate to have been raised in this environment. I don’t risk the clumsy oversensitivity to other cultures that I often see; the generalizations that I have read in nursing texts tend to overstate cultural features, to the point that they are stereotypical.

Summary

My experience at Old Dominion has been overwhelmingly positive. I have gained many tools I did not have. The first that comes to mind is clarity of thinking. The exercises in critical thinking have opened up a whole different way in which I approach my work. The skills acquired in areas of research, putting together research, teaching plans, business analysis, and root-cause analysis, to name several, are invaluable to me. I understand more fully the business of healthcare. On a patient-level, I am better prepared to develop care plans. I understand the interplay among activity, food, sleep, sex, lifestyle and their role in overall health. I can address the issues facing my patients on a holistic level; no longer am I thinking task-to-task.

Nursing theory has impacted me profoundly. I did not expect it to. I was cautious about nursing theory because it didn’t seem practicable. I have seen through my experiences and study that there is a place for theory in structuring plans of care for individuals and communities. I have integrated noted theorists such as Peplau and Henderson into my practice on the more tangible aspect of patient care. I have also infused a bit of Jean Watson in the interpersonal area; I understand the bonding process of the ‘caring moment’.

My practice has changed profoundly in ways described above, and overall it has changed in that I am embarking on a doctorate of nursing practice, something I had not seriously considered prior to studying for my bachelor’s degree. In my daily work, I attempt gain the perspective of a nurse practitioner – gaining a bigger picture of what is occurring, while still tending to the minutiae. I hope to never lose the perspective of the RN when I am practicing at the more elevated levels.

Conclusion

The journey from RN to BSN is quite different from getting the associate’s degree. The RN coursework prepares one for the basics; core skills are learned. It is task-oriented. BSN coursework is of a different level. It requires higher-level thinking. One must think of the bigger picture. As such, mastery of the eight behaviors described in this paper is compulsory. The BSN-prepared nurse is expected to be a creative, critical thinker, who must be able to lead, to teach, and communicate to others at all levels. It is a position of central importance for the success of the interdisciplinary health care team. I believe I have acquired the eight behaviors, and I plan on expanding my dexterity with them as I progress through the MSN and DNP programs.

Honor Pledge

"I pledge to support the Honor System of Old Dominion University. 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 turn in all suspected violators of the Honor Code. I will report to a hearing if summoned."

Clarke Krugman

7/25/2014

Practice Summary Paper Grading Rubric

|Criteria |Comments |Points |

|Introduction | | |

|Why did you enroll in the RN>BSN program? | | |

|What did you hope to accomplish by obtaining this degree? | | |

|Did your goals change during the program? (4) | | |

|Critical Thinking | | |

|How did the activities chosen demonstrate attainment of behavior? | | |

|Provide specific examples from coursework or your nursing practice | | |

|demonstrating attainment of behavior.(9) | | |

|Nursing Practice | | |

|How did the activities chosen demonstrate attainment of behavior? | | |

|Provide specific examples from coursework or your nursing practice | | |

|demonstrating attainment of behavior.(9) | | |

|Communication | | |

|How did the activities chosen demonstrate attainment of behavior? | | |

|Provide specific examples from coursework or your nursing practice | | |

|demonstrating attainment of behavior.(9) | | |

|Teaching | | |

|How did the activities chosen demonstrate attainment of behavior? | | |

|Provide specific examples from coursework or your nursing practice | | |

|demonstrating attainment of behavior.(9) | | |

|Research | | |

|How did the activities chosen demonstrate attainment of behavior? | | |

|Provide specific examples from coursework or your nursing practice | | |

|demonstrating attainment of behavior.(9) | | |

|Leadership | | |

|How did the activities chosen demonstrate attainment of behavior | | |

|Provide specific examples from coursework or your nursing practice | | |

|demonstrating attainment of behavior.(9) | | |

|Professionalism | | |

|How did the activities chosen demonstrate attainment of behavior? | | |

|Provide specific examples from coursework or your nursing practice | | |

|demonstrating attainment of behavior.(9) | | |

|Culture | | |

|How did the activities chosen demonstrate attainment of behavior? | | |

|Provide specific examples from coursework or your nursing practice | | |

|demonstrating attainment of behavior.(9) | | |

|Summary | | |

|Discuss and reflect on your learning, skill attainment and growth as a| | |

|nurse with the coursework of the program. | | |

|How has knowledge of nursing theory influenced your overall philosophy| | |

|and practice of nursing? | | |

|How has your practice changed as a result of your enrollment in BSN | | |

|program (4) | | |

|Grammar/syntax (10) | | |

|APA formatting (10) | | |

|Total | | |

| | | |

| | | |

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