Running head: PROFESSIONAL PROGRESS SUMMARY
Professional Progress Summary
Jasmine Wells
Old Dominion University
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PROFESSIONAL PROGRESS SUMMARY
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Professional Progress Summary
As graduation day approaches a journey started four years ago is coming to a close.
Every year in the Old Dominion University Nursing Program provided its challenges, but
overcoming these challenges was vital in shaping my nursing practice and molding me into the
person that I am today. At the end of my undergraduate clinical experience, that scared, only
allowed to take vitals and do bed baths sophomore evolved into the more confident, safely caring
for multiple patients at a time nurse that I was meant to be.
The purpose of this paper is to guide the student through a process of self-reflection and
self-evaluation in discovery of the scope of personal and professional development while
enrolled in the undergraduate nursing program. The paper will chronologically address
attainment of all eight behaviors that are specific outcomes of the nursing program included:
critical thinking, nursing practice, communication, teaching, research, leadership,
professionalism, and culture at each level of the curriculum (sophomore, junior, and senior year).
Critical Thinking
Sophomore year
Nursing and other appropriate theories and models were used to guide my professional
practice. My philosophy of nursing incorporates Hildegard Peplau’s theory of Interpersonal
Relations in nursing, Josefina Campinha-Bacote’s cultural competence model, and Florence
Nightingale’s Environment Model. As a nurse, my role is to help patients reach their goals and
get back to health/wellness through nursing interventions and therapeutic nurse-patient
relationships. Although the magnitude of this statement was not realized then, I know that all
patient encounters are cultural encounters. As nurses respect, understanding, and an effort to
work with patients and their culture make the care provided effective. The environment is known
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to aid in health restoration which is why I make sure that my patients and their families are
always in a clean, bright/colorful, friendly environment.
Creative problem solving was used when completing a complete health history of a peer.
Based on her expressed concern about stress, instead of suggesting medications for the issue,
breathing exercises were taught, a “me” time or time just for her to relax or do something
relaxing was scheduled daily, and music therapy was introduced.
Junior year
Decision making skills for clinical judgment, evaluation of nursing care outcomes
through data and inconsistencies, and revision of actions and goals based on evidence were
shown during clinical this year. While caring for a patient with an extensive cardiac history who
was on digoxin for A-fib regulation which warrants blood pressure and pulse checks before
administration. Knowing the effects of digoxin, the drug is expected to lower heart rate which
can lower blood pressure, but to a certain extent. Also the drug is not to be given if the apical
pulse is 60 or below or blood pressure ranges or low (systolic below 90) her blood pressure and
pulse was assessed and found to be low (74/41 BP and 62 apical pulse). I brought this to the
attention of my instructor and nurse in which we reassessed these findings and got similar results
(87/50 BP pulse still 62). Family member present also stated that their mother “seemed out of it”
and not herself. For all of these reasons the medication was held and the doctor was called in
regards to the status of the patient. The physician agreed with our action to hold the medication
and told us to continue to monitor the patient. Our goal changed from medication administration
to monitoring patient status.
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Senior year
Creative problem solving, evaluation of nursing care outcomes, and revision of actions
and goals based on evidence continued to improve this clinical. Care was provided to an
intubated patient. He was extremely anxious, paranoid, and fearful of being extubated due to a
previously failed attempt. When the doctor came to talk with the patient and family about
extubation the patient’s anxiety level went up (increased respirations and heart rate). Haldol and
versed were given to calm the patient so extubation could take place, which helped, but the
patient still showed signs of anxiousness. The patient had his daughter and wife at the bedside
and their presence as well as therapeutic touch (liked his hand to be held and his forehead to be
touched) seemed to help tremendously with his anxiety so I had them holding his hand and
talking with him during extubation, which was successful. Also of the ventilator the patient was
receiving supplemental oxygen, but his oxygen stats were not as high as they should be. His
oxygen mask was switched for the nasal cannula cpap fixture which fixed his low oxygen
saturation level. Because he was able to physically relax his oxygen consumption decreased
which lowered the elevated breathing rate and heart rate noted during the anxiety period.
Nursing Practice
Sophomore year
During clinical I cared for a male client with diabetes and performed my first Accucheck
of my nursing career. In applying my knowledge about diabetes, I know that it is important to
monitor the blood glucose levels of this patient. This information tells the nurse if the patient’s
blood glucose is too high or too low and based off of the reading either the administration of
insulin or the administration of blood glucose raising agents are needed to prevent potential
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complications of low/high blood glucose. The patient’s blood glucose was in a normal range so
no nursing interventions were needed at that time.
While assessing this patient it was noted that he had a Foley catheter in which the
therapeutic intervention of catheter care was performed. Peri care is done to decrease the risk for
infection. With the supervision of my instructor, cleaning of the penis from the urethra meatus
outward down the catheter with warm water and a soap/antibacterial spray, emptying the urine
collection bag noting the amount, color, and odor of the urine, and checking the red seal and leg
anchor to make sure they both were intact were done as interventions. Although his red seal was
intact, the leg anchor was starting to detach from his leg so I replaced the leg anchor making sure
the Foley tubing is secure to prevent forceful removal of the device.
Junior year
During clinical this semester I cared for two patients during the day in which traditional
nursing care practices were used to provide holistic care to diverse populations across the
lifespan and utilized outcome measures to evaluate effectiveness of care. A 78 year old African
American male in for sepsis recovering from septic shock had a heparin drip and increased
respiration rate. His aPTT revealed that his heparin was working too well so per orders the nurse
is allowed to titrate the heparin dose in which it was titrated down. It was also noted that he was
breathing rapid, shallow breaths. To make sure oxygen saturation was maintained, 3 L oxygen
via nasal cannula was provided and oxygen sats stayed within the 98-100 percent range.
The second patient cared for was a 56 year old Caucasian male with diabetes. His am
glucose check revealed an elevated blood sugar of 234 in which 4 units of insulin was
administered. At his lunch time check his blood glucose was even higher at 341 meaning that the
first intervention of insulin was ineffective and he required 8 units of insulin as coverage.
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Senior year
During role transition clinical, I cared for one of the hardest patients I have dealt with
during my undergraduate nursing clinical. At the time of care she had established anxiety
problems, but no medication to calm her anxiety were order at this time. With an awareness of
complementary modalities and their usefulness in health promotion, it took washing this patients
hair and just being in the room with her for about an hour for her to finally calm down to the
point of rest. Hair washing may not work for everyone, but it is important to incorporate those
complementary interventions because they can have an effect on health promotion.
Communication
Sophomore year
The importance of therapeutic communication was established during clinical this year. I
cared for a patient who was in for a GI bleed, but had an extensive health history that included
hepatitis C, chronic back pain, drug use, and pancreatitis. When I introduced myself and got an
angry response from the patient I thought that this was going to be a rough day. Before I left I
asked about her pain level and was there anything that I could do for her. She explained that if I
could let the nurse know that she needed some pain medication that would be great. I told my
nurse and we ended up giving her some pain medication, but not without some reluctance from
the nurse due to the patients drug seeking behavior. The patient and I ended up talking for most
of the day, in which she explained that she knows what the chart says about her past, but she is in
pain and that she appreciated that I believed her and was there to just listen to what she had to
say. Without that the therapeutic communication that went on that morning about her pain the
day could have gone downhill quickly.
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Junior year
This year I wrote the longest paper of my student nursing career which was the OB case
study in which I produced clear, accurate, and relevant writing using correct grammar, spelling,
and punctuation, as well as, accessed and utilized data and information from a wide range of
sources to enhance communication. The paper was at least 14 pages long utilizing 8-10 outside
resources. I lost no points in the APA format/grammar/spelling/punctuation section which was
an improvement because I do not claim to have the best syntax skills.
Senior year
During clinical I cared for an intubated patient who was unable to speak and express
himself verbally due to intubation. Communication methods were adapted for this patient with
special needs. By giving him a piece of paper and a pen to communicate we were able to ensure
that his needs were being met and feelings being addressed through therapeutic communication. I
was also able to see the “blue phone” or over the phone translator used when trying to
communicate with a non-English speaking, Hispanic male.
Teaching
Sophomore year
Before you can teach someone anything I learned the importance of accessing your
learner using the PEEK model for readiness to learn. In my patient teaching analysis paper I was
able to use information technologies and other appropriate methods to communicate health
promotion, risk reduction, and disease prevention across the lifespan. My 47 year old Caucasian,
female patient had an issue with chronic pain and drug addiction. Based on her assessment I felt
that she would benefit most from education on complementary alternative medicine (CAM) for
her chronic pain. Her PEEK model revealed that teaching could be done through engaging
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PowerPoint because she is a visual learner, as well as, physically doing the CAM activities
because she also learns through hands on experience.
Junior year
Assessing the learner became second nature and during clinical I partnered up with a peer
to create my personal best teaching session of my undergraduate degree. What’s all the hype
about: Lifestyle modifications for the patient with Hypertension provided relevant and sensitive
health education information and counseling to patients, and families, in a variety of situation
and settings. This presentation highlighted the importance of hypertension management through
dietary modifications and the DASH diet was introduced to help the learner adapt to a healthier
lifestyle. Our inspiration for creating this session was from all of the patients that we have
encountered in the hospital setting with hypertension related diagnosis. Specifically, this patient
was a 55 year old African American male who came in with a headache, shortness of breath, and
a blood pressure reading of 170/95 who ate whatever he want and had no restraint when it came
to using the salt shaker. Hopefully by learning about better diet choices, this patient, as well as
numerous others, can decrease hospitalizations from hypertension complications.
Senior year
The community health project at Village Pointe provides an excellent way to evaluate the
efficacy of health promotion and education modalities for use in a variety of settings with diverse
populations. The aggregate as well as our goal was to manage hypertension through healthier
eating habits and exercise. Teaching sessions on how to read nutrition labels, my plate dietary
guide, and the DASH diet were highlighted throughout the sessions. During the sessions
questions were asked about the learning objectives covered during the sessions. Due to our
aggregates learning style, repetition was found effective so teaching sessions were repeated at
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least twice to ensure learning. At the end of the semester the aggregate were tested on the
materials covered and based on the assessment tool it was found that teaching was partially
effective. Being that the aggregate are older in age cognition, memory, and interest played a role
in teaching success. Future for future reference, more repetition as well as teaching in smaller
groups were seen to have a positive effect on learning.
Research
Sophomore year
By the end of this clinical I was learning how to differentiate between nursing research
and just articles about research. It was made clear that nursing research consists of a sample size
or population, a design, measurable outcomes/data, discussion of findings, conclusion,
limitations, and implications to nursing practice.
Junior year
This year I was able to find nursing research and apply knowledge gained from the
research towards my patients, thus applying research-based knowledge from the arts, humanities,
and sciences to complement nursing practice. This week I used Patricia Benner’s Model of Skill
Acquisition in my care. Being that I had two completely new patients and no preclinical work on
them, I was coming into the care “blind”, but from past experiences I was able to handle them
(although my skill set is limited, I used the knowledge/skills that I had to provide care). My male
patient praised me on how well informed and confident I was in my care (which really made my
day). I was able to adapt to his situation because I had prior experience with stress/echo testing
(my cath lab experience) and his medications were familiar because I had given them before (he
was on Norvasc, Lopressor, Protonix, Zosyn, Aspirin, and fish oil-omega 3 fatty acid for
cholesterol). My female was being treated for diverticulitis and I drew from previous patient
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(Adult health 1 pt) theoretical knowledge. For example with diverticulosis/diverticulitis is the
damage (ulcers) to the colon are extremely bad they will remove a section of the colon and
redirect the colon outside the body (ostomy) so that affected part can heal and not be irritated by
the contents of digestion. After healing is complete and if they are able, the colon is reconnected
on the inside removing the ostomy (colostomy reversal). Without the previous experience today
could have been a real train wreck.
Senior year
From all of the knowledge gained in previous clinical experiences I am comfortably able
to share nursing research with my patients. I cared for a patient in a rehab facility who was
recovering from newly diagnosed GBS. She was wondering how long it would take for her to
recover from her illness. I told her that everyone is different so her recovery time could be long
or could be short depending on her body’s ability to regain function and shared with her research
from the article Guillain-Barre Syndrome – rehabilitation outcome, residual deficits and
requirement of lower limb orthosis for locomotion at 1 year follow-up. Although sufferers of
GBS recover significantly after rehab patients may never return to normal functioning before the
event and may have the need to use adaptive devices for the rest of their lives. Also that she is
considered lucky that she did not suffer from the respiratory complications that are associated
with GBS because that could have slowed down rehab progress majorly, if the complications did
not kill her.
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Leadership
Sophomore year
Being that the clinical experience was new, I was in charge of myself for the most part.
This included things like getting vitals and reporting off to my nurse first or being an advocate
for all of my patients.
Junior year
I was able to delegate and supervise the nursing care given by others while retaining the
accountability for the quality of care given to the patient during clinical. I peer of mine was
caring for a patient that needed an Accucheck and they did not know how to use the new
machine. Since I had previous experience with the new machine, I volunteered to show her how
to operate the machine. After we completed her patient’s Accucheck and our patients were not in
need of any care, I volunteered her to complete all of the am Accuchecks on our unit with my
supervision.
Senior year
I assumed a leadership role within one’s scope of practice as a designer, manager, and
coordinator of health care to meet the special needs of my community health aggregate on
numerous occasions. For example, I created our first teaching session on blood pressure facts for
the aggregate. The lesson included a poster that displayed how to read blood pressure
(systole/diastole), a handout with information about modifiable and non-modifiable risk factors
of hypertension, and a true false game displayed on a tri-fold poster board to assess the
knowledge gained from teaching. After quick instructions, a member of the community health
group taught the lesson, while other group members initiated the game, and questions were
answered before the end of the meeting.
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I also had the pleasure of giving report to the interdisciplinary team during my critical
care clinical rotation. I designed a care map for my patient, managing new patient orders given
by the interdisciplinary team after rounding, and coordinating services for discharge like getting
a PICC line in place so that the patient could receive antibiotics at home.
Professionalism
Sophomore year
During clinical this year professionalism consisted of showing up to clinical on time and
in a clean uniform, not sharing or talking about patient information outside of the hospital, and
sticking to the honor code and code of conduct given by ODU School of Nursing.
Junior year
I upheld all of those things mentioned in my sophomore year with the addition of
advocating for professional standards of practice using organizational and political processes. In
my OB case study I had to create an analysis of care using the Association of Women’s Health,
Obstetric and Neonatal Nurses (AWHONN) standards of practice. Although all of the standards
were done I felt that some were grazed over and not held to the highest possible standard. An
example of the team not being as thorough in assessment was during the postpartum exam. The
fundus, lochia, Homan’s signs, vitals, and general questions were checked, but the nurse didn’t
assess XY’s breath sounds. The reasoning behind this was that unless the patient expressed
shortness of breath or had complications during labor, it is not as necessary to do. Regardless of
reported feelings, all patients should have a complete respiratory assessment because although
they may not be having shortness of breath, something could have been wrong respiratory wise.
The next time we entered the room, we listened to all lung fields.
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Senior year
Professionalism was a major factor during clinical this year. During critical care clinical
in the ICU I cared for an intubated and sedated patient. Care involved maintaining the head of
bed at 30 degrees, sedation weaned daily for ventilator wean assessment, performed oral care
every 4 hours and checked his CASS tube/suctioned every 4 hours. General care was shown by
having the head of bed at least 30 degrees or higher. Institutional care would be performing oral
care every 4 hours because I have seen oral care performed in the range of every 2-6 hours in
other hospitals. Specialty-specific care would be suctioning every 4 hours because when I have
cared for patients suction was done as needed.
An understanding of the effects of legal and regulatory processes on nursing practice and
health care delivery was shown during role transition. I cared for a 34 year old African American
male who had a Thoracic Abdominal Aneurysm awaiting TEVAR procedure. Because she had
cared for him in the past, my preceptor noticed that his status of DNR had changed to full code
so we asked him was the information correct. He told us that he still wanted to be DNR and
knew nothing of the change. My preceptor allowed me the opportunity to advocate for my
patient by calling the doctor to see if he would address the issue before surgery the following
day. The doctor informed us that he did not feel comfortable changing the order and would
change it after the procedure due to possible reversal of the procedure unless the patient was
absolutely adamant about being DNR. I explained to the patient what the doctor had said in
which he was fine with the doctor’s reasoning/explanation. Although as nurses we want to do
everything in our power to save the lives of our patients, in these situations the patient has the
final say in care. If the patient was adamant about his DNR wishes to be applied during this
procedure the healthcare team would have had to respect his decision. This situation had a happy
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ending though because he made it through surgery without complication and his code status was
changed shortly after the procedure back to DNR.
During rehab clinical I demonstrated accountability for my own practice through charting
in the medilinks system and reporting off to my nurse. After charting my assessment, educational
needs of the patient, and progress of the patient, I had to sign with my signature (J. Wells, SN
ODU) along with my nurse for that day’s clinical. In report my nurse and I reviewed all that was
done for care that day and any concerns or things that were not done were addressed. If I noticed
something off about my patient during the day, that information was brought to the nurse, and to
the doctor if necessary.
Culture
Sophomore year
This year I had yet to master the concept of culture. My concept of culture was thinking
that was someone’s race, ethnicity, or religion consisted of their culture. Because of my concrete
thinking, I struggled with the clinical log section that called for culture.
Junior year
I am finally able to see culture as being this abstract image of characteristics of a
particular group of people. For example, nursing students have a culture apart from other
students studying health science. Nurses believe and provide holistic care while physical therapy
may be just worried about the functioning/physical aspects of patients care.
Senior year
During community health clinical I was able to consider the impact of research outcomes
and the effects of health and social policies on persons form diverse backgrounds. Research on
hypertension statistics show that African Americans have a high incidence of having
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hypertension than there Caucasian counterparts. Research also shows that hypertension
management is best done through medication management and diet. Being that our aggregate are
of lower economic status it is difficult for them to uphold research outcomes because of
decreased income. A lady from the aggregated shared her struggles with medication management
of hypertension. She stated that, “Medicaid only pays so much off of my prescriptions and my
doctor just changed my medication over to something more expensive. To make sure I have my
medicine I am going to have to cut back on something”. Although research suggests these
methods of lowering hypertension, financially some are not able to meet the demands of
treatment and their health suffers because of this. This is why for our project we chose to educate
our population of ways to decrease blood pressure through diet and exercise because both of
these topics are something that they can learn how to manage and gradually incorporate into their
daily lives.
Conclusion
Completing my undergraduate bachelors of science in nursing has been no easy feat.
Sophomore year I expected to be thrown out into the hospital saving lives, but that was not the
case. The reality was that after completing the fundamentals of assessment and getting my feet
wet with three weeks of basic med-surg clinical I was able to confidently complete a head to toe
physical assessment, give a nice bed bath, take vital signs with a machine, and differentiate
between normal and abnormal findings for nursing. Junior year I expected to have a little more
free range with patient care while completing OB, psych, and more med-surg clinicals, but that
was not the case. In reality, I still had to do everything with my instructor and unfortunately for
me I was unable to administer medications until the second half of my junior year due to facility
regulations. Senior year was when everything came together and expectations mirrored reality.
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With minimal assistance and supervision, I was able to administer medications, monitor patient
status, chart my assessment findings, and put into action all of the great eights that I had been
learning all throughout nursing school. At the end of my 120 hour role transition clinical, I am
confidently able take full care of 3 med-surg patients which exceeded my original goal of 2 as a
new graduate nurse.
After completing role transition, my only regret is that I was not able to start an IV.
During this time I had just mastered the art of doing blood draws and the opportunity never
really presented itself during clinical hours. I am certain that in the near future I will be able to
practice and perform this skill with ease. Skills that I acquired include blood draws (skin and line
draws), peritoneal dialysis (start to finish), wound care, trach suction/care, complete IV therapy
(includes IV push as well as infusion pump manipulation), administration of blood products,
thorough documentation, complete medication administration (from the pixis, to the computer, to
the patient, and then reassessment), and communication skills with other members of the
interdisciplinary team. Strengths include being an advocate for patients/families in my care,
critical thinking, providing safe nursing practice, and time management skills. Areas for
improvement and future learning needs as a new graduate include initiating IV access, caring for
patients with difficult personalities, and leadership skills (working up to being a charge nurse).
Graduation may be the ending of my undergraduate nursing career, but it is opening the
door to the beginning of my life as a nurse. I would be lying if I said I was not scared to be
moving on with this next chapter of my nursing journey, but I am confident with the education
and skills gained from Old Dominion University’s Nursing Program that I will be able to rise to
the challenges and surpass any obstacles that I may face as a new graduate nurse. Good bye SN
ODU, hello BSN!
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Honor Code
“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: Jasmine Wells
Date:
04/18/2014