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Professional Progress Summary
Corinne Mayer
043827089
ODU Main Campus
Submitted in partial fulfillment of the requirements in the course
NURS 431: Transition to Professional Nursing Practice
Old Dominion University
NORFOLK, VIRGINIA
Spring 2012
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Professional Progress Summary
Throughout this nursing school journey, I have grown not only professionally, but
personally as well. The purpose of this assignment is to review my progress as a student from
the beginning of Old Dominion University’s School of Nursing (ODU SON) accelerated
program, to the end, and how eight core competencies were attained. The core competencies
include critical thinking, nursing practice, communication, teaching, leadership, research,
professionalism, and culture. Within this paper, the development of each of these competencies
will be addressed through sophomore, junior, and senior year at ODU.
Sophomore
Critical Thinking
The first two semesters, critical thinking skills were limited and focused more on putting
pieces together through classroom assignments and exams. Our clinical experience was only a
short five week session, one day a week, for only a couple hours. The five week session
concentrated on assessment skills and incorporating the basics of critical thinking. I was able to
begin to put pieces together at week three, when I was caring for diabetic patient, who had within
the last year had a below the knee amputation. At this point, my knowledge was limited;
however, through critical thinking, I was able to recognize the effects that the unmanaged
diabetes had on his body. Through this, I was able to provide a holistic approach to my
assessment, concentrating on being as thorough as possible, in order to maintain the holistic and
thorough care.
Nursing Practice
This first clinical rotation concentrated on fundamentals of nursing, including head to toe
assessments, daily hygiene care, and safety. This clinical experience allowed me to complete
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thorough and systematic assessments due to being able to spend time with only one patient.
Daily hygiene was also a skill that was important to gain, and there were plenty of opportunities
to do this. One area that I ran into that seemed to cause me some issues was the fatigue of the
patients. As a sophomore, I was very slow with all of my skills, and often stopped to consult my
templates to ensure that I was assessing all the areas required. Often patients would become
frustrated with this, and I learned quickly to the skill of clustering care to conserve energy and
prevent fatigue. During this clinical, I also encountered several safety issues which I was able to
address. One particular patient had a habit of getting out of bed to move around. My assessment
finding showed that she had an unsteady gait, which required a cane; however she was very
determined to be as independent as possible throughout her hospital stay. Additionally, she was
very forgetful and tended to leave items within the walkway, such as, used towels and her tray
table. I was able to provide safety by ensuring a clear walkway and educate her on the
importance of keeping this area free from clutter to prevent further injury.
Communication
I had a rough start with communication during this first clinical rotation, which impacted
my communication skills throughout nursing school. This became my principal weakness to
overcome over the semesters. We were on an oncology floor at Chesapeake Regional Medical
Center, where many of the patients were suffering from terminal illness. I tended to always be
assigned to the patients who were very close to death, and sometimes receiving news of poor
prognosis and outcomes. One particular patient who had been battling lung cancer for ten years
had been informed that there was nothing that they could do for him any longer. This devastated
the patient, and I was able to see these effects on the patient and family early on. He requested
that he not be assigned any students, as he just wanted to be alone. Even though this situation
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made my confidence level decrease, it also made me realize the importance of therapeutic
communication with the patient.
Teaching
This clinical included a patient teaching assignment in which we were to choose a patient
that had been in our care, assess their learning needs, and create a patient teaching analysis. The
patient chosen for this assignment was a 75 year old Caucasian female who was diagnosed with
stage four chronic obstructive pulmonary disease (COPD) whose quality of life was impaired
due to shortness of breath and constant exacerbations. Physical assessment, informal
conversation, and a structured interview were conducted to gather the information needed for the
teaching assignment. Through discussion of her lifestyle and dietary choices, it was evident that
her diet was inadequate to maintain the level of function of her heart and lungs. The patient’s
readiness for learning was then assessed discussing her physical, emotional, experiential, and
knowledge readiness. Even though this teaching was not implemented, researching these areas
allowed me the experience of developing a teaching plan and strategy for patient education.
Research
Research has been an integral part of the nursing program and the importance of research
has been evident since the beginning of nursing school. Even though we were learning the
importance of research to clinical practice, our research was not utilized as much as it was later
in future clinical experiences. The focus during this time was gaining knowledge of the different
types of research and deciphering the data. This included gaining knowledge about the
differences between studies such as qualitative and quantitative; literature reviews and nursing
research; and the differences between nursing research and other multidisciplinary research.
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This knowledge was the foundation for the rest of the clinical experiences and allowed me to to
apply evidence based practice in future clinical settings.
In this clinical rotation, we did not search for relevant research; rather we identified areas
in the clinical setting which could benefit from research. For example, one of the areas that I
identified was the benefit of nursing research on end of life decision communication, support
from caregivers, along with the delivery of care and how it affects the patients.
Leadership
During this clinical, my focus was on how to guide my own practice, learning my current
role as a nursing student, and my future role as a registered nurse. My goals included thoroughly
conducting physical assessments and proper documentation. Toward the end of the rotation, I
took the initiative to search for learning opportunities by asking the primary nurse if she needed
help or had any other learning experiences that I may be able to be part of. I also used the
opportunity to help other students when needed, which allowed me to gain more experience with
skills and learn about their patient’s diagnosis. I began to be able to think about health
promotion activities for communities which could benefit some of the patients with long
standing comorbidities. Even though I was not able to act on these thoughts, it allowed me to
begin to develop my philosophy of my own nursing practice.
Professionalism
Clinical logs showed accountability by documentation of my clinical experience.
Preparing for each clinical by completing necessary pre-clinical paperwork, timeliness with a
professional appearance, and presenting my completed assessment documentation also showed
my professionalism and accountability this semester.
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Culture
During this clinical rotation, I had a difficult time differentiating culture and its impact on
healthcare and the patient. One aspect of culture that I did gain this particular semester was that
of discovering my own cultural values as a person and how my views would affect my own
future nursing practice. This became evident when one of the last patients that I was able to
provide care was a young 60 year old female smoker who was diagnosed with lung cancer and
had decided to not undergo treatment. Not only did she not want treatment, she continued to
smoke. Additionally, she had two daughters and several grandchildren. Even though I could not
understand why this patient had chosen this path, I was able to put my own values aside to
provide culturally diverse patient care. I was able to do this by putting my own values and
culture aside and concentrating on the patient as a whole, rather than the choices she had made.
Junior Year
Critical Thinking
It was during my junior year where I felt that my critical thinking skills were beginning to
emerge. During the Adult Health clinical at Maryview, the patient that I had been assigned to
had a history of schizophrenia and bipolar disorder. She was taking numerous antidepressants
and antipsychotic medications for her various disorders. While completing preclinical
paperwork the evening prior to clinical, I noticed that one of her medications dosing, Zoloft, was
above the safe dosage. According to my nursing drug handbook, the safe dose for Zoloft was
between 50 milligrams and 200 milligrams; this patient’s prescribed dose was 300 milligrams.
This concerned me, as I was slated to administer medications the next day with my instructor.
When it was my turn to pull medications with the instructor, I voiced my concerns regarding the
dosage. We looked through her medical chart and found that this medication and dose was one
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that she stated she received at home. After consulting with the pharmacist, who confirmed this
dose was above the maximum safe dose, we decided to hold the medication until the physician
was able to consult with the patient. Through the acquisition of data and questioning of
inconsistencies, I was able to prevent possible complications. The primary nurse did seem
annoyed by this action; however, both I and my instructor felt as though this was the right thing
to do.
Nursing Practice
I felt as though the difference in my nursing practice between sophomore and junior year
grew by leaps and bounds. During the Adult Health II clinical at Norfolk General Hospital, I had
been assigned to a patient who had within the last 24 hours had a hepectomy. This patient was a
very pleasant and educated man in his mid-50’s who barely complained of any pain and did not
request pain medications except for ibuprofen. After spending the morning with him, the only
pain that he began to complain about was in his upper back near his shoulder. I was able to offer
him complementary interventions by massaging that area several times. The patient was
extremely grateful, thanking me several times and stating, “You have no idea how much that
helped the pain”. Since this experience, I have increased the use of massage therapy in patients
who have expressed muscle pain.
Communication
During junior year, communication was still my weakest area of clinical practice;
however, I continued to mature. I feel as though in junior year, I was able to gain the most
confidence in communication than in any other clinical setting. During Adult Health II clinical
at Maryview, a 68 year old male had been admitted for a syncope episode. He also had a number
of cardiac conditions in which they were worried were related. When I first spoke with the
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patient, he was grumpy and didn’t want to be bothered. This patient was ambulatory and was
alert and oriented to person, place, time, and self; however, he insisted on urinating in a brief
because he stated that the nurses told him he should not get out of bed. When I discussed the use
of the urinal, he snapped at me and told me that he would “urinate all over myself”. After
spending the morning with him, I learned that he was a Norfolk State graduate, and an avid
college football fan. During this time frame, Norfolk State University and Old Dominion
University had just played each other for the first time ever. This prompted discussion between
the patient and I about not only football, but other issues as well. By the end of the day, I was
able to for a therapeutic relationship enough to get him up and to the bathroom several times in
addition to using his urinal when there was nobody there to help him to the bathroom. I felt as
though I used therapeutic relationship with this patient to improve his care and his wellbeing.
The following week, the patient was still admitted to the same room; however I was not taking
care of him and neither were any of the other students. Out of curiosity, I asked the primary
nurse if he was still getting up to the bathroom with assistance and using the restroom. She
stated he had been doing great. This example of therapeutic relationship made me feel as though
I made a large impact on this man’s hospitalization.
Teaching
During junior year, I began to become more comfortable with implementing teaching
strategies as a student. I realized how eager most patients are to learn, and that given the
opportunity to answer questions, they usually took it. I found this the most during the obstetrics
rotation while working with new mothers. One mother in particular was having a difficult time
with breastfeeding her baby, as he would not latch on to the breast. The lactation consultant was
requested; however, she had a number of other patients to visit before she got to this patient.
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Using the extensive information gained from class, along with my own experiences, I was able to
give her suggestions on different holding methods to enhance the baby’s position for
breastfeeding. With persistence, we were able to get the baby to latch on to the breast, but only
for a short period of time. The lactation consultant did come into the room shortly after this and
spent about 30 minutes with the patient. When evaluating the efficacy of both my teaching and
that of the lactation consultant, the patient stated that both the information I was able to give
along with that of the lactation consultant made her much more comfortable, and that she
planned on breastfeeding as long as possible.
Research
During junior year, applying research was a required requisite for every clinical. During
Adult Health I clinical, our clinical faculty designated a day to discuss research articles with our
classmates. The research I chose discussed the length of time it took to inject heparin and its
effects on pain and bruising. The article stated that patients who had heparin injected over the
course of 30 seconds reported less pain, and less bruising. Not only did I discuss this with my
colleagues, this is a practice that I implement when administering heparin as well.
During Adult Health I clinical, we were required to write cultural reflection paper which
integrated research to support our discussion regarding the patient. The patient I chose was an
overweight African American, Jehovah’s Witness female. In this paper I utilized three cultural
research articles which discussed religious needs of hospitalized patients, implications of treating
a Jehovah’s Witness patient, and the effects that culture has on food, weight, and diabetes in the
United States. Not only did these research articles allow me to provide culturally sensitive
practice with this patient, it gave me an insight to the lives of other patients, allowing me to
provide nonjudgmental care.
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Leadership
During all clinical settings during the junior year, I strived to find learning opportunities
for myself from other students and the nursing staff. This was evident during both Adult Health
I and the obstetrics clinical. In part because both of these were completed at Norfolk General, a
teaching hospital with plenty of learning opportunities and a staff that is eager to teach. It is also
here where I had my first experiences observing the role of the nurse as a member of the
interdisciplinary health care team. There were several occasions in both clinical settings where
physicians and physical therapists would seek out information and opinions regarding patient
care from the nurses. For example, a patient who was recovering from a hypertensive crisis was
receiving 5 liters of oxygen via nasal cannula. The physician and residents who were rounding
consulted with the nurse for the patient’s readiness to begin weaning the patient off the oxygen.
This was refreshing to see, as many times I feel as though there is not enough of the
interdisciplinary discussion regarding patient treatments.
This is also the semester that I took on the role of the Student Nurses’ Association
Secretary. This position assumes a leadership role and gave me the opportunity to participate in
organizing the participation of students in community events. For example, I organized a team
to walk in the “Race for a Cure” campaign, where we raised over $500 for breast cancer
research. This also allowed teaching opportunities as we were all wearing student nurse shirts.
Professionalism
During junior year, I became more aware of general and institutional protocols. For
example, this is the semester we began to administer medications. Using the six rights of
medication administration guided my nursing practice when administering medications. This
was particularly evident when administering medications at Maryview because they did not have
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a computer system as a backup to catch any possible administration errors. Cross checking that
you have the right medications, patient, route, time, dosage, and documentation, took on a whole
new meaning. While I was only giving medications to one patient at a time, I could see where
there could be medication administration mistakes if one was not careful to follow these standard
guidelines.
Culture
There was a large variety of cultural areas that I encountered throughout this year. One
in particular that will stand out was a patient that I had cared for who was awaiting surgery and
was a Jehovah’s Witness. This patient was adamant that she would not receive any blood
product should it be needed during her surgery, even as her hematocrit and hemoglobin were
borderline becoming low even prior to surgery. This patient was fully aware of the implications
that came with the fact of not receiving blood products. It was stated in her chart several times
that she wanted to make sure that everybody understood that she did not want to receive any
blood product. During a conversation with me before her surgery, she expressed that she
understood that because of her beliefs she may not make it through the surgery. I respected her
decision and listened to what she had to say about her beliefs and values. Since this patient was
admitted long term to this unit, there were several other students who also took care of the
patient. Due to this, I was able to find out that the patient had made it through surgery and was
discharged shortly after that. Additionally, I was able to write a cultural reflection paper about
this patient. In this paper I used research supporting the discussion regarding her health and
blood transfusion status. In one of the research articles used, discussed the implications of
treating a Jehovah’s Witness. This also discussed using tools that could be used as policies in the
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hospital, such as a “no blood” card or wrist band. Using tools such as these would increase the
likelihood that the patient’s wishes are carried out.
Senior
Critical Thinking
During critical care and role transition, I was able to work alongside one individual nurse
as more of a peer. In this setting, my clinical judgments became more apparent and I started to
become more independent. For example, while spending two days in the emergency department
I was able to use critical thinking while assessing a patient who had come in via rescue due to
altered mental status. Her 6 year old son had called 911 because she had fallen on the floor and
vomited. The patient stated that she could not remember anything since she woke up. During
the assessment, the patient had mentioned that she had bit her tongue, but didn’t know when or
how. I realized that her symptoms were suggestive of a seizure and discussed this with the
primary nurse and she agreed. Shortly after, the physician came to see the patient while we were
completing her assessment. The primary nurse discussed this with the physician, and at this time
ordered keppra and referred the patient for further testing.
Also, during role transition, one of the patients was a morbidly obese man who was
waiting for a possible Transcatheter Aortic Valve Replacement (TAVR) or a stent placement.
His medications included coreg and metoprolol do decrease his heart rate. Both of these
medications are to be held should the systolic blood pressure be below 90 and diastolic below 50.
Additionally, the heart rate should not be below 60 beats per minute. Prior to administering
morning medications, a blood pressure and heart rate was obtained. At this time it was noted
that his blood pressure was low at 89/55. For this reason, both medications were held and
administered at a later time.
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Nursing Practice
During senior year, all the pieces began to fit together. During role transition, I was able
to implement traditional nursing care to a diverse population. Even though I was on a cardiac
stepdown unit, the population varied from the young age of 28 to 96. On a cardiac unit, I was
able to monitor the heart by looking and reading telemetry strips. Monitoring for changes in
status and lab work is essential on this floor. Bumex and Lasix drips are common on this floor
for diuresis purposes. It was imperative to monitor potassium, magnesium, and calcium levels.
Additionally, there are many different cardiac medications and combinations of these
medications. It was important to be able to recognize these side effects and act appropriately.
Communication
Of the eight curricular objectives outlined in this course, I think that communication is
where I have had the most difficulty, and grown the most. I no longer feel threatened by
communicating with other staff members due to my lack of knowledge. As an almost graduate, I
can accept the fact that I have a lot of knowledge and skills to learn while still being able to
maintain and feel comfortable with the basics of care. I have also grown when it comes to
communicating with patients.
During my senior year, I was able to adapt my communication methods with several
patients. One example of this occurred during rehabilitation clinical with the patient that I
followed for six days. This patient had suffered a right cerebrovascular accident (CVA) and as a
result had some cognitive impairment. When communicating with this patient, I was sure to
speak clearly and use words that the patient would understand. In addition, both she and her
husband were very hard of hearing. I was able to overcome this by speaking close enough for
them to be able to see my lips and spoke clearly rather than louder.
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Throughout role transition, I was able to complete the discharge teaching for a number of
patients. While applying the discharge teaching, I also sometimes included information
regarding their condition, new medications, and smoking cessation information. These handouts
were found through Sentara’s Wavenet database and Lexicomp.
Teaching
There were several areas where I was able to provide teaching to my peers as well as to
other professionals. During Critical Care clinical, three other students and I put together a
presentation about noninvasive cardiac output monitoring (NICOM). This presentation included
information on what NICOM is, clinical applications, why it is essential in the critical care
setting, advantages, how it works, the procedure of how its use, and compared it to the pulse
induced contour cardiac output (PiCCO). Additionally, nursing research was included that
supported the use of NICOM.
During role transition, there was an abundance of teaching opportunities. One area of
teaching that was new to me was being able to perform discharge teaching. I was able to do this
on a number of patients. This included healthy living tips, the importance of attending follow up
appointments and when they were scheduled, medications in which should no longer be taken,
and new medications. There were almost always questions from the patients and their families,
most often regarding their new medications, what they were used for, and what their side effects
were. To evaluate this discharge teaching, I asked them to look over the papers and discuss any
changes from their normal routine.
Research
Senior year, I began to incorporate research into my every day nursing practice. For
example, during rehabilitation clinical, I read an article that discussed the rehabilitation process
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after a stroke and the different emotional barriers that limit recovery. One of those barriers was
the nurses. The patients thought that nurses were one of their largest barriers to a successful
recovery because they often would not allow them to try certain tasks while telling them that
they were being unsafe. This was evident in rehabilitation clinical with my patient who suffered
a right CVA, and as a result severe left hemiparesis. In the beginning of the clinical, she would
try to feed herself; however she would push her food off her plate. Rather than me allowing her
to try to pick it up herself, I would help her. After reading this research, I incorporated it in the
patient’s care, allowing her to be as independent and functional as possible. Even though I do
not aspire to become a rehabilitative nurse this research can also be used in the acute care setting
by encouraging patients to perform their activities of daily living on their own or with assistance,
rather than completing these tasks for them.
Leadership
Delegating tasks as a student is difficult because you are not an established or
experienced nurse. During role transition, I was able to delegate certain task to the care partner.
For example, towards the end of my time on the cardiac unit, I had assumed full care for four
patients. While administering morning medications, every patient had eight o’clock medications.
I found that some tasks were difficult to complete at the same time. While passing medications
one morning, one of the patients had urinated in the bed. In order for the patient to not have to
sit in her wet bed, I was able to delegate this to the care partner. I did not feel uncomfortable
doing this, especially because I knew that it was a task within her scope of practice in addition to
delegation being in my scope of practice.
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Professionalism
During role transition, I had many opportunities to differentiate between standard,
institutional, and specialty specific standards of practice. For example, all patients were assessed
and cared for according to nursing standards of practice and ethics, as indicated in my logs.
When having to contact a physician, I utilized SBAR, an institutional protocol at the Heart
Hospital. In this stepdown unit, there are many protocols that are specific to cardiac medicine.
For example, there is a magnesium protocol for patients whose magnesium level drops below
1.8. Additionally, magnesium serum needs to be drawn STAT if the level is less than or equal to
1.5 mg/dL or if the patient is symptomatic. Magnesium replacement can be given orally or
intravenously (IV); however, not both. It is available in tablet form, and 1 gram in D5W 100 mL
intravenous piggyback (IVPB) or 2 grams normal saline 50 mL IVPB. Doses vary between
levels; 1.8 mg/dL=1 gram; 1.6 mg/dL= 2 grams; 1.4 mg/dL=3 grams; 1.2 mg/dL=4 grams.
Additionally, I was able to advocate for a patient during the rehabilitation clinical. The
patient, who had suffered a right CVA, still had a percutaneous endoscopic gastrostomy (PEG)
tube in place four months later. The patient’s appetite was great, and she was eating almost 100
percent of all meals. She was due to be discharged in three days, when I began wondering about
the PEG tube and whether or not it was going to be removed. After speaking with our clinical
instructor, we decided that it was within my scope as a student to advocate for this patient and
discuss the removal of the PEG tube with the physician. I was able to speak with him about this
situation, and an order was placed to remove the PEG tube prior to discharge.
Culture
Between critical care, pediatrics, and role transition rotations, I was able to see more
cultural aspects of patients than I ever could have imagined during sophomore year. I also
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learned the importance of knowing your own beliefs and values in order to be able to provide
thorough, nonjudgmental nursing care. One situation where this was important was with a
pediatric patient and her young mother. Even though the mother seemed to love the infant, she
was not an active participant in her care. She would not get off the cot to help nursing staff or
comfort the baby during procedures or feedings. In addition, she was always sleeping, watching
television, playing games, or on the telephone; not paying any attention to the patient. Even
when the mother was present, the patient spent the majority of the time in the crib. She also
informed me that she would not be coming back on Thursday because it was her birthday. When
she said this, it was very matter of fact, as though it was no big deal that she was leaving the
patient alone overnight. I think that when young people have children, it greatly affects their
social life and feels as though time to go out is owed to them.
Summary
Overall, the nursing school experience has really changed my life in the most amazing
ways. My expectation was to go through two years of school and come out with nursing skills. I
have found it to be much more; I have come out of nursing school a new and better person, with
more compassion for the sick than I had before, and most importantly, I have realized what kind
of nurse that I want to be and the level of care that I want to provide. Writing this paper has
really made me realize the changes that I have gone through over the years. Additionally, this
nursing program has taught me that as a nurse, I should never stop learning and striving to be
better. Not only have I met the eight core competencies, I have also been able to identify my
own beliefs and learn the basic skills to provide patient care with compassion and maintaining
patient dignity.
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“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 hearing if summoned.”
Signature:
Corinne Mayer
Date: 07/25/12