Running head: Practice Summary Paper 1

Practice Summary Paper

Yasmin Gonzalez

Old Dominion University

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Introduction

The purpose of this paper is to self-reflect and self-evaluate the scope of my personal and

professional development while enrolled in the RN>BSN nursing program at Old Dominion

University (ODU). My nursing journey began at Tidewater Community College (TCC) on a cold

day in January 2015. I remember being nervous about the horror stories that everyone told me

how difficult nursing school was going to be. I wish I could say nursing school was a sunny

summer day frolicking on the beach without a care in the world, but that time in nursing school

was the most challenging time in my life thus far. As I was going through my Associate Degree

in Nursing (ADN) several people were beginning the concurrent program that ODU provides

while enrolled at TCC. This program allows you to take classes towards your Bachelors in

Nursing (BSN) while completing your ADN. I decided to finish one program at a time due to the

demanding hours that nursing school can take to complete. Once completing my ADN program

in December 2016, I decided that I would take a break from school and begin my BSN in the fall

of 2017. I chose ODU’s program due to the great recommendations that my peers provided me

with. Also, the school was in the area, it was all online, and the classes that I had previously took

in my ADN transferred my credits over with ease. ODU was then the perfect option for me and

after considering the benefits I decided to attain my degree from Old Dominion. Fast forward to

this moment right now, I am about a month away from attaining my BSN degree. I couldn’t be

prouder that I once again exceeded my expectations for myself by completing another program.

This degree can bring me that much closer to my end goal on becoming a Nurse Practitioner. I

consider this program just another stepping stone to get to the end goal.

Critical Thinking
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An individual does not have innate critical thinking skills but acquires critical thinking

skills by experience and time within their career. Critical thinking demonstrates facilitating

nursing practice through inquiry, creative problem solving, clinical professional judgement, and

nursing is guided through appropriate theories and models. Application of the critical thinking

process leads to decision making resulting in life changing events. It takes ample amount of time,

constancy, practice, experience, and patience to acquire these set of skills. These set skills

demonstrate the type of nurse I hope to continue to grow into. Attainment of this skill was

evident during an event that occur on the orthopedic floor I use to work on. I had received a

patient from an outside hospital not orthopedic related but admitted due to a bowel obstruction.

Her past medical history was diagnosis of Parkinson’s disease. Upon admission she appeared

calm and cooperative. She answered all the questions appropriately when asked by me the nurse

and the doctor on-call that night. Few hours pass, I notice when administering her medication

that she is become increasingly agitated unlike before when speaking with her. Now I learned

through experience that when individuals lack oxygen to their brains that one of the symptoms is

agitation. This symptom was embedded in me through an experience during nursing school when

I didn’t understand why my patient was agitated until the discussion of the vital signs and

symptoms to my instructor. The experience in nursing school help me gain the critical thinking

skills to assist my patient with the bowel obstruction. The patient with the bowel obstruction did

have hypoxia to the brain and her vitals proved it. A rapid was then called resulting in

transferring her to the Intensive Care Unit (ICU).

Nursing Practice

Nursing practice uses practical nursing which involves using knowledge of major health

problems and therapeutic interventions to improve patient outcomes. I had an incident where I
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was caring for a patient who was quadriplegic due to a cervical injury. He was admitted for

trying to commit suicide. As I was taking his vitals his blood pressure was extremely low, but

asymptomatic. According to his wife his blood pressure runs low but not that low. I called a

rapid for him to be transferred to ICU if I can’t get his blood pressure up. The rapid was called

and ICU came down. They would not take this patient claiming that his blood pressure is always

low. I felt very uncomfortable to still care for this patient on a floor that was not proper for his

condition. I escalated this to the attending on-call to explain the situation and the condition of the

patient. The attending agreed that his condition can be better handled on an ICU floor. This

ultimate decision gave the patient the opportunity to have a better health outcome.

Communication

It is not what words that you say but it can be the tone that you used to speak to a patient.

Communication justifies verbal, non-verbal, and written communication techniques appropriate

for clients and professionals. I try to come to work every day with a positive attitude. I exhibit

this positive attitude by how I appear, dress, talk, and my body language. For instance, I had a

patient confide in me that she prefers my care more than the nurse who cared for her the night

before. She stated the reason behind her statement was that I smiled a lot more often and that my

body language was more inviting. Patients are always watching, noticing non-verbal cues just as

much as speaking with them.

Teaching

Utilization of teaching methods help maximize patient health and professional

development. Every day when I step into work there is a teaching opportunity that I can provide

to my patient. Teaching can range from educating about proper medication dosage, education on

post- operative instructions, or demonstrating which foot to lead with first when ambulating. I
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am constantly teaching information to my patients. I used to be employed on an orthopedic unit

where majority of my patients were knee and hip replacements. There biggest fear was walking

the first day after surgery. I would teach my patients’ how to utilize the walker properly as well

as, educating the patient to lead with their bad leg first. The patients appreciated the reassurance

and education regarding proper body movements with their new joint.

Research

Research incorporates primary nursing research findings as a basis for therapeutic

interventions. Evidence Base Practice (EBP) help guide nursing interventions in every aspect of

nursing. It gives us a “guideline” that we should be following to give the best patient outcomes.

Nursing 363 we did quite of research assignments, but one in particular I would like to discuss

the EBP poster presentation regarding Central Line- Associated Blood Stream Infection

(CLABSI). Research shows that maintaining sterile technique can decrease the risk from

developing an infection. I currently work on a Cardiovascular Intensive Care Unit (CVICU) and

we constantly have individuals with Central lines. I assess every four hours the integrity of the

dressing. I am assessing a dressing for occlusive, dry, intact, date, and time of the last dressing

change. If the dressing is out- dated or is compromised I change the dressing. When I change the

dressing I always maintain a sterile technique to assure the safety of the patient. EBP has shown

me that maintaining a sterile technique gives the patient the best outcome.

Leadership

Leadership demonstrates self-direction, professional accountability, and advocacy

adhering to legal and ethical nursing practice as a novice nurse. Leadership is gained through

experience and I was lucky enough to gain that experience when I worked in retail before
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nursing school. I believe this gave me the stepping stone to lead my nursing care with direction

and a purpose. As I would delegate task in my previous retail job, I began to delegate in my

nursing career. Delegating came easy to me since I had the previous years to practice. When I

stepped into my role as a nurse I would have to give direction and coordinate health care needs.

On an orthopedic floor I had to coordinate and delegate with the technician which individuals

needed to be in the chair in the morning. I would direct which patients were stable enough to be

in the chair while coordinate who would need two people to assist them in the chair. I had to lead

the way to ensure that the task at hand was done before breakfast was served to them. Delegation

is a skill that must be practiced and used in the clinical setting.

Professionalism

My nursing professionalism is maintained through adherence to standards of practices

and legal and ethical principles. There are certain protocols each floor has to adhere by. One

protocol in particular to my floor is that the Register Nurse (RN) must do a double check before

administering insulin subcutaneous. This ensures that a deadly dose of insulin is not administer

to a patient causing a harmful effect. I had a patient who was noncompliant with his diet and

would eat foods that would increase his blood glucose. His blood glucose was reading on a

glucometer in the 800’s. I followed proper protocol by notifying the physician and following

through with any other orders that the physician had put in for the patient. The orders included

administering high doses of insulin. Again, I followed proper protocol by having a RN do a

double check with me on the amount of insulin I will administer. This example is a standard of

practice to guide professional nursing care.

Culture
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Nurses must demonstrate culture awareness and sensitivity when working on a nursing

unit. Interactions with all types of culture will occur and conflicts will arise but having a non-

bias attitude will help adjust to any individual you meet. Nursing 401 cultural exploration

assignment gave me the opportunity to explore a specific culture. I decided to explore the

Muslim culture with certain criteria to search for. The criteria included: cultural beliefs related to

communication, health maintenance, health beliefs, practices specific to pregnancy, end of life,

etc. I know there are differences between cultures, but I think the most important thing to

remember is to be respectful to a belief that may be different than your own. This assignment

gave me a cultural understanding of a culture other than my own.

Appraisal and Summary

My time in ODU’s nursing program is coming to an end and I have gained so much

through this experience. This program has put me further into my career path from gaining many

professional skills. The improvements that I have made are relative to what I had hoped to gain

from this program. I saw improvements in how I communicate, my professional interactions,

leadership skills, and my nursing practice. Nursing is an evolving field with the constant flow of

new material. This is a profession that will constantly have you learning new material every day

that you go to work. Every skill from assessing, developing, planning, implementing, and

evaluating constantly build on one another. In the nursing field learning and knowledge are

endless. The ODU program has helped give me those building blocks to continue my nursing

career in the direction of greatness. This program gave me a better understanding of what it takes

to be that overall great nurse.

My personal philosophy of nursing has grown since I began in January 2016, and it

continues to build though time and experience. As I went through the program I learned about
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philosophers who have made a difference in nursing. One philosopher did stand out to me the

most, Virginia Henderson. I liked to believe I base my nursing off of Virginia Henderson. She

focused on basic human needs as the central focus of nursing practice. Expanding my knowledge

of nursing theory led me to develop strengths focusing on providing safe, effective, and quality

care. I hope to continue to grow by using her theory as my foundation of my nursing care.

That time has come, I complete my BSN in December,2018. I couldn’t be prouder

of what I have accomplished in the last two years. I continue to practice as I completed this

program, and I can see a difference in my practice. When I practice I am more confident in my

answers, communications amongst the healthcare team, teaching my patient about medications,

delegation, and many more skills that I have seen developed. I am so happy that this chapter in

my life is coming to end, but with that new chapters are waiting to be written.
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Appendix

Practice Summary Paper

Nursing 403 – Transition to Baccalaureate Nursing Practice

Purpose of Assignment

The purpose of this paper is to guide you through a process of self-reflection and self-

evaluation to discover the scope of your personal and professional development while enrolled in

the RN>BSN nursing program at Old Dominion University.

The assignment is designed to help you prepare for your Portfolio. The Practice Summary

Paper is designed to demonstrate the attainment of the 8 core competencies in general. The

Portfolio demonstrates the achievement of the Core Competencies through the attainment of

Specific elements [the bullets] within the Core Competencies

Student Approach to Assignment

This paper summarized progression in my nursing career thus far. I approached this

paper using more of my experiences in my career rather than assignments I wrote. I believe that

an individual learns more through experience, so I decided to stick to that thought process.

I used the eight core competencies guideline sheet to help guide my stories from experiences.

It was then easy for me to start writing and gather some of my experiences on paper. The paper is
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a great illustration of my personal progression as I finish my BSN program.

Reason for Inclusion of this Assignment in the Portfolio

The reason for inclusion in my portfolio is the demonstration of learning through the

eight core competencies. This is a requirement for my portfolio to demonstrate that I have met

the fulfillment of the end program outcomes.

• Critical Thinking

o Used decision making skills in making clinical or professional judgement

In the paper I talked about an individual who was becoming more agitated due to

the lack of blood being delivered to her brain. My past experiences related to agitation

and hypoxia gave me the clinical judgment to call a rapid for assistance.

• Nursing Practice

o Applies appropriate knowledge of major health problems to guide nursing practice

In my paper I discussed a situation where I had an unstable patient with a low

blood pressure. ICU didn’t think it was necessary to transfer the patient because his blood

pressure is normally low. I felt it was unsafe for the patient to stay on my floor so escalated to

the attending. The patient eventually was transferred off my floor.

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• Communication

o Uses therapeutic communication within the nurse-patient relationship

I mentioned in my paper on how non-verbal cues are just as important as verbal

words. I used the example from the time when a patient preferred my care over another nurses

care because I smiled more. Smiling made me more inviting to the patient which made them

prefer my care.

• Teaching

o Provides teaching to patients and/or professionals about health care procedures and

technologies in preparation for and following nursing or medical interventions

I used the example in my paper about how I must teach includes which leg to lead first

during their first day post-operative. I was constantly teaching proper body movements so the

patient could use their new joint properly. If I wasn’t teaching about moving your joint, I was

teaching about medications, therapy, and discharge.

• Research

o Evaluates research that focuses on the efficacy and effectiveness of nursing

interventions

Mentioned in my paper, I did a project in Nursing Research 363 regarding EBP of

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CLABSI. I gathered research to learn the effectiveness of CLABSI bundles in the hospital

setting. The nursing interventions to prevent CLABSI have proved to be effective in lowering the

incidences of infections.

• Leadership

o Assumes a leadership role within one’s scope of practice as a designer, manager, and

coordinator of health care to meet the needs of populations

As mentioned in my paper delegation is a big part of the nursing field. I would

have to delegate and coordinate who was getting ready in the morning to be in the chair. I would

delegate this task to a technician or coordinate time to assist with an individual who requires two

people to get them to the chair safely.

• Professionalism

o Differentiates between general, institutional, and specialty-specific standards of

practice to guide nursing care

As mentioned in my paper, each floor has certain protocols to follow. One policy we

followed on the orthopedic unit is that we must do dual sign-off for insulin. I follow policy to

ensure the correct dose is being administer to the patient.

• Culture
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o Articulates an understanding of how human behavior is affected by culture, race,

religion, gender, lifestyle, and age

I had an assignment in Nursing 401, as mentioned in my paper this assignment gave me

an understanding of a culture other than my own. This assignment let me explore how they view

health, how is pregnancy handled, end-of-life care etc. This help me understand what differences

that may arise from caring for someone of Muslim faith.

““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 responsibility to turn in all suspected violators of the

Honor Code. I will report to a hearing if summoned.”

Yasmin Gonzalez 11/10/18

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