LH+ 2008 INTERNATIONAL TRIP



University Honors Program University of Cincinnati

Experiential Learning Reflective Essay: Community Engagement

What has this experience meant to you? Within 30 days of completing a self-designed experiential learning project, write a 1,500 – 2,000 word reflective essay describing your project, what you learned, and how this experience will impact your future. The reflective essay is made up of three sections; each section should make up approximately 1/3 of your reflective essay. The following questions are prompts for your reflection. You are not required to respond to all of the questions, but you must address all bold questions. Please maintain this format when writing your reflective essay and upload your completed reflective essay to the UHP database; it will be reviewed by your honors advisor during the next review cycle.

Part 1: What?

• Provide a brief description of your experience. What did the experience entail?

This past fall semester I had the opportunity to participate in a DEU clinical. A Dedicated Education Unit (DEU) is a unique clinical teaching model and is an innovative way of providing clinical education to nursing students. This is the first year that the University of Cincinnati is using a DEU for clinical. In fact, DEU programs are still a pilot program and there are only a few DEUs in the country (University of Massachusetts in Boston, University of Buffalo School of Nursing in New York, University of Nebraska in Omaha, and now the University of Cincinnati in Cincinnati). Normally, nursing students go to a hospital as a group of approximately 8-10 students with one faculty members advising and overseeing those 8-10 students on a particular day Monday-Friday. In the DEU model, a hospital hosts a nursing school in the hopes to give nursing students the best clinical experience available by pairing up a nursing student one-on-one with a RN. There are many benefits to this for both the students, the hospital, and the RNs. Students are able to intimately work on a specific nursing unit. They have nearly constant access to their staff nurse instructor to pose questions and receive helpful feedback on their nursing knowledge and skill development. In addition, staff nurses get new perspectives on how to improve patient care while hospitals get specially-trained nursing students who have a high potential of working for them in two years. In addition to this one-on-one ratio difference, nursing students also get the opportunity to work the shift that their preceptor works. Instead of simply doing clinical on a weekday, nursing students in a DEU are able to test out their nursing skills during night shift and on the weekends.

This project entailed heading to The University of Cincinnati Medical Center (UCMC) 9 hours a week during the time that my preceptor is working (including day shift, night shift, weekdays, and weekends so that I can get a full picture of what nursing is like 24/7). This accounts for roughly 135 hours on the floor, throughout the semester (along with 4-5 hours of paperwork for each clinical day, making that an additional 75 hours for a total of 210 hours for the semester). The DEU at UCMC is on 9CCP. 9CCP is a 24-bed intensive care unit for post-operative patients. The floor is staffed by seven nurses during days and eight nurses for nights.

To me, this experience was priceless. Not only did I have an RN beside me to constantly answer my questions, but she was also always there to oversee that i was correctly documenting and doing my nursing skills correctly. For example, at the beginning of the semester she had to be there with me to simply restart and prime IVs. However, at the end I was doing heparin drips and TPN on my own.

On top of being able to be on the floor, I was also able to see a chest tube insertion and had the opportunity to see a diabetic's foot be amputated. Even though I'd be shy to admit it to anybody, I'm pretty proud of myself for obtaining a position in this prestigious clinical since only 10 of UC’s 180 junior nursing students had the opportunity to participate in.

• What was most significant about this experience?

I was paired up with Beverly Lathan, an RN who has 38 years of nursing experience. We were on 9CCP, which is the Critical Care Pavilion for post-surgical patients at the University of Cincinnati Medical Center. This event was significant to me because throughout the course of the past fifteen weeks, Beverly has not only become a great preceptor to me but also a great friend. She has come to be one of the most trustworthy people that I know. She exemplifies what it means to be a compassionate nurse and has been a great role model. Even though I probably asked her nearly a hundred questions during every shift, she never once complained or seemed to become frustrated with my questions. I feel as if through Beverly, I have learned more during this past clinical than what I have learned during my past two years of nursing school.

I would highly recommend more nursing students to become involved with the DEU program. According to our clinical instructor Robin Wagner, they will be offering another DEU program to the seniors. Although the experience of being on this floor was great, being able to be one-on-one and forming a relationship with Beverly throughout these past fifteen weeks was the real reward. I was able to confide in her and ask her all types of questions that probably seemed like common sense to her. Beverly has taught me not only how to prioritize and has helped me to grow not only as a nursing student, but into a more compassionate person as well.  Now that I have had this experience, I hope that I will be able to prioritize my shifts better, make better clinical decisions, and complete a more detailed assessment.

• How did the experience meet and/or differ from the expectations you described in your proposal?

Although this experience was different than what I imagined it to be, it has far exceeded my expectations. First of all, I expected to be able to see more MRIs, CT scans, surgeries, etc. However, when I was on the floor and had the opportunity to observe such events, I realized that what I was learning on the floor was far more important. One day I had the chance to see a MRI of a man's brain. However, since I chose to stay on the floor that morning opposed to seeing and MRI, I had the opportunity to change a PICC line. Secondly, I expected to be paired up with a different preceptor every week so that I would see clinical decisions from many points of view. However, I was with Bev (my preceptor) for every week besides one. I actually enjoyed this more since I was able to confide in her and feel comfortable asking questions that may have sounded silly and like common sense to her.

However, one thing that I did expect out of this experience was that I would learn to better prioritize. I believe that this was the biggest asset to being in this DEU clinical opposed to a regular clinical. In a regular clinical, a student nurse typically only takes care of one person and only gets to administer medications every other week. However, with the DEU clinical I was administering medications to 4-5 patients every day. Since there were four different patients that I had to give medications to at 9am, I had to prioritize which medications were most important. I also had to prioritize other skills, such as if changing a post-op dressing was more important than assessing the patient with decreasing spO2 values. I believe that this clinical has better prepared me to prioritize my patient's needs.

• How have you have made progress towards meeting at least 2 of the community engagement learning outcomes you identified in your proposal? Provide specific examples from your experience to illustrate your points.

Community engagement learning outcomes:

▪ Possesses awareness of purpose of service, including need for reciprocity, understanding of social issues, and ability to see those issues from multiple perspectives.

o Please see proposal

▪ Recognizes how public policies and practices, and power and privilege, have an influence on social issues. Explores ways to alter public policy and/or identify solutions.

o Please see proposal

▪ Relates, communicates, and works effectively with others towards sustainable social change.

o At the beginning of the semester, I had a goal of letting our clinical instructor realize how much I have learned from this special DEU clinical. However, as the semester progressed, my goals changed. Instead, I wanted UC's College of Nursing have another DEU clinical so that other nursing students would be able to experience what I had. Much to my enjoyment, both of my goals have been met. Every week, my clinical instructor came up to the floor to speak to us about how our day was going, to give us feedback on our previous week's clinical paperwork, etc. Our clinical instructor was a different person than our preceptor. Professor Wagner was my clinical instructor and is a faculty member for the College of Nursing. Beverly Lathan was my preceptor and is an RN on 9CCP at UCMC. Every week that I met with Professor Wagner, I tried to express to her how much I was learning and how much I enjoyed being one-on-one with Bev. Towards the end of the semester, I found out that my goal had been met. Professor Wagner stated that they plan on having another DEU clinical next semester for the senior nursing students. However, much to my enjoyment, this DEU would be on two units instead of one. This will allow double the amount of students to experience what us original DEU students had.

▪ Participates in community and understands own role as citizen of community.

o As a citizen, I realize that it is my duty to not only provide care within the hospital setting, but outside of the hospital setting as well. I was lucky enough to obtain a preceptor as voluntary as Bev. Not only is she a great nurse outside of the hospital, but she also is a great community nurse. She stated that she regularly does BP screenings at local fairs and festivals with a group of people. This inspired me to get involved as well. Before one of UC's football games, I joined a couple of other nursing students in obtaining blood pressures for UC students, fans, and faculty. This was a completely voluntary event that did not count for any community service hours. The event lasted roughly nearly two hours outside of Nipper Stadium. People were even asking to get their blood pressures checked after the football game started!

Part 2: So What?

• How did your experience impact your development (academic, professional, and/or personal goals)? \

This experience has greatly contributed to both my academic and professional development. Professionally, this clinical has allowed me to make many professional connections. In fact, the nursing manager of the unit even offered me a position as a nurses' aide on the floor. However, the most important professional connection that I have made is with my preceptor Bev. As previously mentioned, Bev was not just a preceptor to me. Instead, she has become one of my good friends and someone that I can confide in. She has been a great role model to me and has showed me what it means to be a compassionate nurse. This clinical has also impacted me academically as well (however not in the way that I had expected). Between having clinical one-on-one with a nurse once a week and working at two other hospitals a few other days a week, I was at a hospital 3-4 days of every week. As the semester went on, I had to study less for classes. This is because I had already seen certain meds/concepts/procedures at work or clinical while other students were reading/learning about that med/concept/procedure for the first time in class. I am confident that having this type of clinical and working at a hospital has given me an advantage compared to other nursing students.

• What academic theories, readings, courses, or concepts did you rely upon to inform to your experiential learning work? How did knowledge of this theory, reading, course, or concept contribute to your learning in this project?

I relied on previous coursework, my current textbooks, and the internet to inform me of my experimental learning work. Since I learned the most nursing information in Fundamentals I and Fundamentals II, these are the two classes that I utilized the most information from. Also, since there are many different kinds of drugs that nurses must administer, the book that I used the most was Lippincott's Drug Book. During every clinical, I carried around a piece of paper in my pocket. If I came across a drug or a procedure that I was not familiar with, I would write it down on the piece of paper. From there I would use my med book (or mainly the internet) to look up the medication or procedures. I have compiled this list into one big chart so that I can one day hopefully be familiar with all of these terms and conditions.

My previous nursing knowledge helped me with this clinical. However, since I am a hands-on person I feel as if I have learned more in this one clinical compared to the past two and a half years of nursing school. This is why I would highly recommend any other nursing student to apply to be a part of a DEU clinical.

• What new concepts, learning, skills, or abilities are you taking away from this experience?

Even though I have learned many things from this experience and have become familiar with multiple medications and procedures, I believe that the most important thing that I am taking away from this experience is the ability to prioritize. In a regular clinical, a student nurse only has to take care of one person. However, this clinical has allowed me to take care of 4-5 patients every day. At the beginning of the semester, I was very unsure about my prioritization skills. Bev had to correct me multiple times during every shift. For example, at the beginning of the semester I was about to give one patient medications before assessing a patient's JP drain that was dispensing bright red blood. Bev has been very helpful throughout this journey and has explained to me why one situation has priority over another situation. At the end of the semester, I was definitely more confident in my prioritization skills. In fact, for last 2-3 clinicals I attempted to prioritize the day on my own while looking to Bev for guidance if I was right or not. Since learning to prioritize is such a big concept to learn in regards to nursing, I believe that this has given me a huge advantage over the nursing students in regular clinicals.  

Part 3: Now What?

• How have you shared your learning with others and disseminated your work? Who was your audience and what did they learn? What did you gain from the experience of sharing your learning with others?

I have shared my learning experience with the members of the Student Nurses Association (SNA). By talking to them, I have disseminated what I have learned to a larger audience. One day, SNA went to the Great American Ballpark downtown to raise money and awareness for diabetics. Before we left UC's campus for downtown, I spoke with the SNA members about how participating in the DEU clinical was such a great experience. I encouraged the younger nursing students to apply for any DEU clinical in the future. I also explained that Professor Wagner stated that UC's College of Nursing planned to spend extra funds to have a few more DEU clinicals next year. I explained what I had learned, how my relationship with my preceptor grew, and how being one-on-one with an RN helped me to prioritize and do patient care better than a regular clinical with eight students and one preceptor.

The biggest thing that I wanted my audience to take away was that this clinical allowed me to better prioritize my time, has allowed me to take care of four-five patients daily instead on of one, and has allowed me to be one-on-one with a nurse which has allowed for me to do many more nursing skills.

At first I was very nervous to speak to this large group of nursing students. However, I have gained many things from disseminating what I have learned from this experience. Most importantly, I have learned that it is very important to disseminate your learning with others so that they can understand what you have learned. Most of the other nursing students did not even know what a DEU clinical was since this is the first year that UC has offered such a clinical. Once I explained what a DEU clinical was and why it is so much better than a regular clinical, I could see some light bulbs clicking. A few of the students even asked what I had put in my application that allowed me to earn a spot on the clinical. It made me happy to know that I was able to share such an experience with others. I sincerely hope that my encouragement has probed the other younger nursing students to apply for a DEU clinical in the years to come.  

• If you engaged in this experience again, what would you do differently? What advice you would give to peers who are preparing for similar experiences?

If I had to engage in this experience again, there is only one thing that I would do differently. Instead of observing and minimally helping the first 2-3 weeks and then diving in, I would instead just dive into fully helping. For the first 2-3 weeks, I was unsure of my nursing skills and was nervous about taking care of 4-5 patients since I was used to taking care of only one patient with my past regular clinical. However, as the weeks went on I became more confident in myself and my prioritization skills. If I had to do this experience again, I would definitely be less shy about diving into helping my preceptor care for the patients. I would also encourage myself that prioritization is not something that you can learn overnight. Instead, learning how to prioritize what needs to me done takes lots of practice.

I would give a few pieces of advice to my peers who are preparing for a similar experience. I would encourage these students to not be shy about their nursing judgment and skills as well. I would tell them that it is okay to mess up at first since your preceptor is always with you to make sure that you are doing your skills and prioritizing correctly. I would also encourage them to become familiar with medications in the beginning of the clinical. I did this and it greatly helped me. By just looking at a patient's medications, I realized that it was fairly easy to tell why a patient was in the hospital. The last piece of advice that I would give would be to stand out in your application. Most students simply emailed the clinical coordinator their resume and a paragraph of why they would be interested in participating in the DEU clinical. However, I went above and beyond since I knew that this was a clinical that I wished to belong in. I handed my application in in a new folder and personally handed that folder to the clinical coordinator. In the folder, I included my resume, a list of references that the coordinator could contact, my past nursing work experience, a few paragraphs of why I wished to be included in the DEU clinical, and a copy of my transcript. I wanted the clinical coordinator to know that this was a clinical that I really wished that I belonged in.

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