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Running head: PROFESSIONAL PROGRESS SUMMARY
Professional Progress Summary
Kelly Wiggins
Old Dominion University
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PROFESSIONAL PROGRESS SUMMARY
Professional Progress Summary
Monitoring and measuring progress throughout the nursing program is an integral part of
learning. Reflection of each clinical experience was done through the use of clinical logs. Each
log addressed what Old Dominion University calls the Great Eights; critical thinking, nursing
practice, communication, teaching, research, leadership, professionalism, and culture based on
the clinical day. These logs will be analyzed and compared from sophomore year to senior year.
From reading my previous logs throughout the past 3 years, I realize that I have grown greatly
from sophomore to senior year. My ideas of each of the “Great Eights” have changed with an
increased understanding of each aspect.
Critical Thinking
Critical thinking is used to facilitate nursing practice through inquiry, problem solving,
and synthesis. During sophomore year, critical thinking to me was writing care plans with
nursing diagnoses and medication lists and determining what the medications were for. I thought
a good example of my critical thinking skills was feeding a patient who was unable to talk, and
making out what he wanted off of his plate even though he was nonverbal. I also included in my
critical thinking section in one log that I was able to understand a patients medications without
doing a preclinical medication sheet for him. At this point in my nursing school career, I had
neither the knowledge nor experience to really think critically. What I considered critical
thinking sophomore year is now second nature skill to me.
As my knowledge grew, so did my critical thinking skills. Junior year clinicals were
much more hands on and critical thinking based. Putting the whole clinical picture became
easier, and rather than just focusing on one system or problem at a time I was able to look at
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multiple systems at a time and determine the best course of action. Medications began to make
more sense and I began to tie different medications to their classes and effects better. I was able
to assess a postpartum woman while in one clinical. I noticed that she hadn’t urinated within 6
hours of the removal of her catheter, but the nurse thought she just didn’t want to get up to go.
Upon assessment, I discovered that she had to have an episiotomy during labor. She was in pain
when she tried to get up to go to the bathroom, and didn’t want to infect the episiotomy site. She
wasn’t taking the pain medications that were prescribed as needed though, because she wanted to
do it all without any kind of pain medication. She was drinking fluids, and her bladder scan
showed a large amount of urine, so I urged her to take a pain medication and try to void. After
teaching about episiotomy care and pain management, she went to the bathroom and did not have
to be catheterized again. If I hadn’t linked the episiotomy and pain to her impaired voiding, she
may have had to be catheterized again. As junior year continued and ended, I developed a better
knowledge base to critically think. There were still pieces missing, but they came together in
senior year.
Senior year, critical care skills and knowledge were increased even more. Because of this,
I have been able to care for more advanced patients and make faster decisions. I was able to care
for critically ill patients, as well as children, which can require more critical thinking. I cared for
a patient in an intensive care unit who had a low temperature, an increased heart rate, a low
PaCO2 level, hypotension, and a positive culture for methicillin-resistant staphylococcus aureus.
Thanks to my knowledge and critical thinking skills, I was able to piece all of these pieces
together to come to the diagnosis of septic shock. If I had this patient sophomore, or even junior
year, I would not have been able to put the pieces together and make sense of it all. I would have
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treated each component separately, and furthermore, would not have understood the treatment
being given to him.
During my role transition, I had a pediatric patient who suffered a traumatic brain injury,
and had motor deficits and comprehension deficits as a result. The doctor ordered a nasogastric
tube be placed. The primary nurse in charge of him wanted to place the tube, so I was assisting
her with it. He had a bad swallow reflex so I didn’t think the tube insertion would go very
smoothly. Thinking of past experiences when placing nasogastric tubes, I knew he was at risk for
vomiting. Because of his other conditions, I was concerned he would aspirate. While the nurse
was getting the nasogastric tube ready for insertion, I hooked up suction just in case he aspirated.
As she dropped the tube, he vomited, and I was prepared to suction him immediately. Without
the critical thinking skills gained throughout nursing school, the patient may have aspirated a
large amount of vomit and been at risk for further complications. The experiences I have gotten
to be a part of throughout my nursing school career have prepared me to think critically and
adequately care for patients holistically as I begin my nursing career.
Nursing Practice
Upon rereading my sophomore year logs on nursing practice, I realized that I have also
greatly grown in my understanding of nursing practice. Since my experience was so small, I
didn’t do much the first semester. We were not allowed to pass medications, so nursing care
consisted of assessments, bed baths, taking vital signs, and making sure safety measures were
taken into account when giving care. I frequently addressed making sure bed rails were up and
beds were in the lowest positions possible in my logs. My assessments were not very fluid
sophomore year. Nursing care sophomore year was very basic, but important care. It allowed for
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me to work out kinks in my assessment as well as get more comfortable being in the hospital
setting and interacting with patients.
With the start of junior year, we were able to administer medications via injection, orally,
or IV piggyback with supervision of our instructor. The first clinical I gave medications to an
elderly man. I had IV bags to hang, oral pills to give, and a heparin shot to give, so I got thrown
right in. I recall being very nervous when drawing up the heparin. There were many bubbles in
the syringe that I had to put most of it back in the vial and draw back a second time. My
instructor told me just to relax and concentrate, and the second time I drew it up with only a
small bubble. I identified the proper site, cleaned it, and gave the injection without accidentally
pulling out the needle. As the year went on, I got better at drawing up various medications from
vials and administering them with ease. Assessments became more meaningful and smoother. As
previously mentioned, connecting the dots became easier. I learned to cluster care better and was
able to manage time better as a result.
Senior year allowed for more opportunity to learn and develop my skills in nursing
practice. Being in the critical care setting gave me an opportunity to do things we had only
practiced in the skills lab before. I suctioned people with tracheostomy’s, did blood draws,
started IV’s, and cared for people on ventilators in the critical care setting. Suctioning for the
first time was kind of nerve-racking. I was scared I was going to hurt my patient, but throughout
the day I gained increased confidence and was able to suction other patients throughout the
semester with much more ease. In the emergency department I successfully started three IV’s on
the first stick. With the first IV I started, I let a little blood spurt out though and was careful not
to let it happen with the other two. Blood draws were easier than IV starts and I managed to do
those without much problem.
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During my role transition I was able to assess and care for multiple patients
independently and chart under my nurse. I gave medications under the supervision of my nurse
due to hospital policy, but I administered insulin, hung many IV fluids, and got very good at
managing the IV pump. I had more hands on training with the pump and by the end of the
preceptorship I was able to work them effectively and efficiently. I learned how to use a syringe
pump as well. I suctioned a patient who vomited during nasogastric tube placement.
Not only was I getting better at my skills, I was able to understand why things were being
done. I gained a lot of knowledge from sophomore year to senior year that I was able to apply in
the hospital to guide my nursing practice. I cared for patients from the ages one month old to 95
years old appropriately. The assessment for a one month old varies greatly from the assessment
of a 95 year old. Fontanels must be check, apical pulse monitored for a full minute, and reflexes
should be checked. Through the clinical experiences over the past three years, I have laid a good
foundation of which to start my nursing career on.
Communication
Communication was something I struggled greatly with in my first clinical. I was very
shy and nervous, and also didn’t have the knowledge that I have today to articulate to the patients
things they might have needed to know. I was comfortable in communication with my nurses and
care partners, but not with doctors, patients, or families. From the first week to the fourth week
of sophomore year clinical, I did develop better communication skills with my patients. In my
first log, I discussed feeling very awkward whenever I was in the room with my patient. It was
silent a lot. In my fourth log, I reflected back on realizing that good communication is a crucial
aspect of nursing care and through my explaining procedures to my patient, she opened up and
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talked more about her illness and hospitalization. She started to trust me because of good
communication. While my communication skills were not what they are now, sophomore year
helped me feel more comfortable in the clinical setting.
As my nursing school career advanced, my communication skills improved. I was getting
better at communicating with the doctors, nurses, patients, and their families. I had a patient who
had dementia and was a very high fall risk. Her husband didn’t understand why we wanted to
assist her to the bathroom or into the chair if he was in the room. He was initially very rude
towards me and the staff, saying that we were implying that he was incapable of safely
transferring her. I had to take the time to explain to him that protocol was that a staff member
assist her due to her high fall risk status. I was very nice and professional towards him and
eventually he listened to me and called for someone whenever she needed to be moved.
Junior year I also had the opportunity to have a clinical in a psychiatric hospital.
Developing therapeutic relationships with those patients was a crucial aspect to their treatment.
A lot of them wanted to talk to me like I was a friend, and I often had to redirect the discussion
to more therapeutic topics. One patient, a 23 year old male in for drug and alcohol addiction, sat
and talked to me for 2 hours about his addictions and how he started them. I got to know a lot
about him just from talking and listening to him. It was in the psychiatric hospital that I began to
understand the importance of really listening to patients.
My communication skills got put to the test in senior year. I worked primarily in the
pediatric setting senior year. While I was comfortable with talking to family members of older
patients, talking to the parents of sick children was a different ballgame. There were a lot of
parents who were open and receptive to me as a student nurse. During role transition, I had the
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opportunity to work with a lot of different families. One patient who I took care of had cystic
fibrosis and was frequently in the hospital. His grandparents were open to the staff and even gave
suggestions for working with his attention deficit hyperactive disorder. They knew I was a
student and gave me an excellent health history of the patient. I learned the value of a parent’s
advice and suggestion when working with children as a senior.
As a senior, I also had the opportunity to talk with the doctors more. I participated
actively in daily rounds of my patients with the residents. They asked me questions about the
patients’ status and included me in discussion about the next course of action. This was different
from any other clinical I had been through. I learned that communication with doctors and
having a trusting relationship with them is very important. In one instance, there was a patient
under severe respiratory distress. The residents, based off of my assessment and theirs, suggested
changing therapy or possibly moving him to the intensive care unit. The attending physician did
not seem to like the idea when my preceptor brought it up, but the residents agreed with her and
the attending physician changed his plan of care.
Teaching
Teaching was very hard to do sophomore year, because of the little knowledge I had
about disease processes and the inexperience with IV pumps and other medical equipment. In
one instance, I taught a patient very vaguely about what priming IV tubing meant and why it
needed to be done. I also did teaching to a family about contact precaution and why the gown
and gloves were necessary. I informed them to first don the gown, then the gloves, and to wash
their hands after taking them off and leaving the room.
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As my knowledge grew, teaching became easier to do. Junior year I still did a lot of basic
teaching about things like contact precautions and handwashing. I also did postpartum teaching
to a patient who was having trouble voiding about pain medication and ambulating. I taught her
what to expect in the next few days, including changes in color of lochia, a decrease in size of
the fundus, and how to alleviate any soreness from breastfeeding. My confidence in teaching
patients grew with an increase in knowledge.
My senior year allowed for a greater amount of teaching with patients and their families
in the pediatric setting. I learned a lot about diabetes in children and how to manage it and was
then able to pass that knowledge onto families. Managing diabetes in children often requires
carbohydrate counting and giving insulin based on the amount of carbohydrates eaten. I helped
the mother of a new onset diabetic 4 year old understand fractions and how to measure
carbohydrates when only portions of food were eaten. I was able to utilize a carbohydrate
counting worksheet to teach her the way to calculate insulin dosage.
Research
During sophomore year, research application was stressed less by clinical faculty,
because we hadn’t quite grasped the concept of why it was important. Instead of finding research
articles, we had to identify areas of each clinical day that would benefit from scientific research.
Without really understanding what nursing research was, I often found this section challenging. I
had no prior research experience, so identifying these areas was difficult. Often times I didn’t
feel like research in any topic would benefit the situations in encountered. I did recognize that
handwashing seemed to be an issue in the hospital, and that more research should be done in
regards to hand hygiene and its effect on patients. Looking back, there were numerous instances
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where research would have benefited situations, such as researching complimentary therapies of
pain management. Since I was so unfamiliar with nursing research, I wasn’t really able to
proficiently identify these areas.
Research was incorporated more in junior year. Not only did a situation be identified, an
article had to be found that correlated with it. Primary nursing research had to be included in
logs that correlated with patients cared for. In junior year, I learned how to find research faster
through the use of databases like CINAHL and PubMed. I found an article about adherence to
HIV treatment regimens. I also found a research article discussing the feelings of people with
new stomas to identify and learn about the psychological aspects of stomas. A lot of research
was done in my junior year that aided my education and understanding of diseases.
In my senior year, finding and applying research became easier and more enjoyable. I
began to look forward to researching. Through researching I learned alternative therapies that
nurses can do for pain management, discomfort and anxiety. Not only did I find these articles,
but I started applying appropriate research to my practice. I did research about topics that I didn’t
know much about to gain knowledge and understanding, such as decreasing ventilator associated
pneumonia. Research, both nursing and non-nursing, has given me a great deal of knowledge on
subjects that I may not have learned otherwise.
Leadership
When I first entered nursing school, leadership wasn’t necessarily one of my strongest
qualities. I often sat back and watched others lead, and followed along. This was evident in my
first semester of clinicals. While I was able to manage my time and perform my assessments
without being instructed to do so, I don’t feel like I was put in a position to demonstrate
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leadership much. Because there were limitations to what could be done, and a lack of comfort in
the hospital setting, my leadership opportunities were scarce. I did inform the nurse and the
patient about an order that the doctor put in regarding a fine needle aspiration procedure. Other
than performing basic tasks like taking vital signs and giving bed baths without needing help,
that was my only documented example of leadership.
I got a lot more comfortable in the hospital setting in my junior and senior years. I took
initiative with my patients and their treatment. Instead of waiting for the nurse to tell me what to
do, I made a plan and carried it out. There were limitations to my leadership abilities in junior
year due to needing supervision to complete many tasks. I had to have instructor supervision
when administering medications and nursing supervision when performing tasks like foley
catheter insertion or IV pump setting. I was able to assess my patient and perform
nonpharmacological interventions independently, however, and continued to do so. If I needed
assistance I would ask my fellow classmates for help and delegate tasks such as aiding in a
dressing change to them. In one instance, I had to do a large dressing change on a patient who
had an above the knee amputation and I asked my classmate to help with the changing of the
dressing. She helped support the stump and the gauze while I wrapped it. I made sure she was
properly holding the gauze and supporting the leg.
As a senior my leadership skills grew even more. I actively talked to doctors about
patients instead of my preceptor doing it. I was an active member of the interdisciplinary team
and it showed to be very effective. I independently gave report to oncoming nursing staff about
the patients I cared for. In role transition I often cared for patients independently, and only
needed the help of my preceptor when pulling medications or giving IV push medications. My
12 hour shifts were managed in a timely matter and I was on schedule with my assessments and
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medication administration. Role transition really helped my leadership skills grow, and I became
much more independent through the experience.
Professionalism
Professionalism is a key aspect to nursing. We must adhere to standards of practice, as
well as legal and ethical principles to maintain professionalism. Accountability is a crucial aspect
to professionalism. As a sophomore level nursing student, I think that having to take
accountability for my actions was a scary thing that made me more hesitant to do anything
without supervision or assistance. Legal and ethical principles were instilled in me from the
beginning of nursing school, but they still intimidated me. In sophomore year, I was required to
relate a general standard of practice to my clinical encounters. I often used assessment or
intervention as my general standard of practice. They were not very specific and often the
explanation of relatedness was vague and broad. While I acted with professionalism in every
clinical setting, I didn’t have much of a framework of ethical and legal issues.
In junior year clinicals, we were required to look up and adhere to specialty standards of
practice and institutional protocols. Standards of practice varied slightly based on the clinical
setting. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
provided standards of practice that were utilized for one of my clinical rotations. I related
standard 6, collegiality, of the AWHONN standards to care to one clinical experience. I saw
nursery nurses help out a nurse who floated up to the unit due to a shortage in staffing. She didn’t
know the flow and routine of the nursery, and the other nurses showed her the ropes. Each baby
got a “going home” bag, and one of the regular nurses prepared all of the bags for the floating
nurse.
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During my senior year, I looked up institutional protocols that related to my patients as
we as specialty standards of practice. One institutional protocol I looked up and adhered to was
in regards to nasogastric tube placement in pediatrics at the Children’s Hospital of King’s
Daughters. The policy states which size tube to be used for various age groups. My patient
required a size 6 tube, and I used the policy to figure it out. The policy outlined the proper
procedure for placing the tube, which I also followed.
As my senior year continued, I was able to take more accountability for my actions. Role
transition really allowed for me to show independence and that I could handle responsibility.
When I was assigned two patients, I made sure to stay on track with their medication and
assessment schedules without relying on my nurse to remind me or assist me. In each clinical
setting I presented myself professionally. I was always on time and correctly dressed and
groomed. I never showed disrespect towards anyone, staff or patient. My professionalism
showed throughout my nursing school career.
Culture
Culture has always been a topic that is very important to me in caring for patients. I’ve
encountered many different people with many different cultures throughout my nursing school
career. In my sophomore year, I identified the culture of one of my patients as being a lesbian.
Before her partner got to the hospital, the patient was talking a lot and was very open. Once her
partner got there and the patient realized we now knew she was a lesbian, she got quiet until we
were in the room talking for a while. She has probably had people pass judgment very quickly on
her based on her relationship preference, and she needed to feel comfortable with us and feel like
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we weren’t judging her. The nurse and I just continued to talk to her and her partner like we had
before her partner arrived.
My junior year of nursing I had a 55 year old patient who had AIDS. He was in the late
stages of liver failure as well. He was not receptive to much treatment. He refused to talk and
was very depressed. His code status was do not resuscitate (DNR). I took this into consideration
when caring for him. He didn’t want to continue his life full of health problems. He had no living
family. Knowing you have a chronic disease that will eventually cause your death can be very
hard to cope with, especially without a good support system. I had to take any judgment away
and look at his perspective of everything.
My senior year I cared for a patient who was admitted to the hospital following a
coronary artery bypass graft surgery. While in the hospital he developed respiratory failure and
ended up with a tracheostomy in a stepdown unit. He was starting trials to wean off of the
ventilator when I was assigned to him. He had no prior respiratory problems noted, so his sudden
respiratory distress came as a shock to him and his family. He coped with the tracheostomy very
well, and had a positive attitude and outlook. His daughter visited every day and his wife called
multiple times a day when she couldn’t visit.
Throughout my entire nursing school career, I have witnessed people in various stages of
life with various conditions. Patients all have differing views on their healthcare based on their
cultures. Having a support system can greatly influence decisions, as shown in the two patient
scenarios above. My patient who had AIDS didn’t want to live, because he said he had nothing
to live for. People’s culture and personal feelings greatly affect their health and healthcare
received.
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Conclusion
Through this reflection, I have gained a lot of insight about my thinking process as well
as my learning throughout the program. I realize now just how much I have grown as a student
nurse. I have gained a lot of confidence when talking to patients, families, and doctors. I have
also gained leadership skills needed to be a good nurse. I am more assertive than I was before
starting the nursing program. I have gained a respect for and understanding of culture and how it
affects healthcare in many different situations. Through this program, I have learned and
mastered many different nursing skills, such as medication administration and assessment.
Comparing my skill from sophomore year to senior year, my assessment has improved greatly. I
am able to assess thoroughly and fluidly without it taking 30 minutes, like my first head to toe
assessments. I don’t think I am adequately prepared to administer IV push medications. I
haven’t had a lot of exposure to certain areas like telemetry units or rehab units, but that will
come with time and experience.
As far as my preparedness for the beginning of a career as a registered nurse, I feel like I
am at a level that reaches the competency level required. I am good with time management. I
understand disease processes, medications functions, and interventions used in practice. I think
role transition has aided me in that the most, and I feel like my knowledge level is at a good base
level to continue as a registered nurse. My understanding of medical problems and illnesses has
grown tremendously from the start of sophomore year to now. Overall, this assignment has
shown me just how much I’ve changed and grown since starting this program. I think this
program has molded me into a proficient nurse and I hope my education continues to grow upon
starting my career.