Running head: PROFESSIONAL PROGRESS
Professional Progress Summary
Julie Teegarden
Old Dominion University
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Professional Progress Summary
The Old Dominion University School of Nursing is built on eight core competencies
reflecting the student’s work in the clinical setting. These include critical thinking, nursing
practice, communication, teaching, research, leadership, professionalism, and culture. In this
paper I will reflect on my own personal progress through the nursing program according to these
eight competencies to discover the scope of my personal and professional development.
Critical Thinking
Sophomore Year
Sophomore year, I began to implement critical thinking into my nursing practice. At this
time I had a minimal understanding of nursing, therefore, critical thinking and theory application
were limited in my practice. My focus was on activities of daily living (ADLs), vital signs,
patient safety, forming care plans, and prioritizing nursing diagnoses. During one of my clinical
rotation days, I cared for a 95-year-old female admitted with ataxia and a history of Alzheimer’s,
hypertension (HTN), stroke, and decreased hearing.
I formed my nursing care around Orem’s Theory of Self-Care Deficit because I knew that
the patient would require assistance in performing ADLs. I used assessment and professional
judgment to determine how much assistance I would need to provide, and I planned interventions
accordingly while still working to promote my patients independence. In my assessment, I found
that my patient had difficulty with bathing so I assisted her by washing her back and other areas
she could not reach.
Due to the patient’s diagnosis of ataxia and history of falls, I knew she was a high fall
risk requiring specific interventions according to hospital safety protocols. To enforce this
protocol, I retrieved a yellow wristband for her to wear so other staff could clearly see her
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limitations. I also educated my patient and her family to utilize the call bell whenever the patient
needed to get up to use the restroom. Finally, after observation of her unsteady gait, I
implemented a two-person assist status to ensure patient safety during ambulation.
Junior Year
During my junior year I greatly improved my critical thinking and formation of nursing
care plans. In the fall semester I was still working on completing head to toe assessments,
prioritizing nursing diagnoses, and listing appropriate goals and interventions for my patients. By
the spring semester I was utilizing several different nursing theories and was more confident
prioritizing patient care.
At this time I was beginning to move away from focusing on Dorothy Orem’s theory of
Self-Care Deficit to more advanced theories such as Eakes, Burke, and Hainsworth’s theory of
chronic sorrow. For example, my 55-year-old male patient with sepsis, diabetes, HTN,
paraplegia, and depression had been reluctant to participate in care and was refusing treatment
from several nurses. I utilized the theory of chronic sorrow to assess his personal feelings
regarding his condition. This theory explains that the ongoing feelings of loss from illness and
debilitation apply to patients in a chronic disease state. With this knowledge I was better able to
motivate my patient and establish a therapeutic relationship. I took the time to discover what the
patient was interested in and what he wished to gain from his care. He expressed his desire to go
home to his wife and I explained that before he could go home we had to treat his underlying
infection. I also explained the purposes of each intervention we were performing. By involving
the patient in his care, he became more motivated and willing to take charge of his health.
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Senior Year
During my preceptorship on the Advanced Heart Failure Unit, critical thinking and
problem solving were utilized on a daily basis to provide care to all patients. One patient I cared
for was a 63-year-old male patient with fungal meningitis, rectal prolapse, altered mental status,
acute renal failure, and a history of a heart transplant from 1999. Cerebral swelling associated
with meningitis caused the patient to be confused, take more time to answer questions, and have
hallucinations, photophobia, and neck pain. The patient was crying out in severe pain related to
his rectal prolapse so I assessed his vital signs, overall condition, and doctors’ orders to
determine if I could administer his Dilaudid. The patient’s vital signs were within normal ranges
so his nurse and I gave him his pain medication to provide comfort based on our professional
judgment to guide the decision-making process. I knew that the side effects of Dilaudid include
respiratory depression and hypotension so I made sure to monitor his vital signs for 15 minutes
after administering the medication. He soon became hypotensive with a blood pressure of 86/64
so I revised my actions and goals to stabilizing his blood pressure and improving his cardiac
output rather than focusing on pain control. I notified the physician who then ordered a fluid
bolus to treat his hypotension. After the bolus was given, his pressure came back up to 100/70
but I still felt that the patient required further monitoring so after consulting the transplant team
following his care that day, we transferred the patient to the intensive care unit (ICU).
Nursing Practice
Sophomore Year
Nursing practice performed sophomore year was based on physical assessment,
promoting a safe patient environment, and performing ADLs. I applied appropriate knowledge of
major health problems to guide the care I provided to my 95-year-old patient admitted with
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ataxia and a history of a falls. I knew that ataxia meant she had an altered gait placing her at high
risk for falls, therefore I promoted patient safety by keeping her bed in its lowest position with
three of the bedrails raised while leaving desired items like her call bell, water, and glasses in
close proximity to the bed.
Junior Year
Junior year I was assigned to an 86-year-old patient with a thoracic vertebral compression
fracture and chronic congestive heart failure (CHF) requiring musculoskeletal and cardiovascular
interventions. During my assessment I found she had pitting edema to the lower extremities,
became short of breath (SOB) on exertion, and had mild complaints of back pain relieved by
Tylenol. Based on my assessment findings I created a nursing care plan with decreased cardiac
output as my priority nursing diagnosis including interventions such as elevating the lower
extremities with a pillow to promote venous return, routinely performing pain assessments, and
administrating Tylenol per doctors orders.
With my current knowledge regarding her diagnosis of CHF I made sure to assess for
orthostatic hypotension that is a common risk factor associated with this condition. Prior to
ambulating the patient, I made sure to assess the patients sitting blood pressure was within a
therapeutic range prior to standing to ensure patient safety was met thus preventing falls. At one
point prior to working with physical therapy (PT), I checked her sitting blood pressure and found
it to be 90/60, which was below the therapeutic safe range for ambulation. I kept her in this
seated position allowing her body time to adjust to the position change, which prevented the
effects of orthostatic hypotension and potential injury from a fall.
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Senior Year
Senior year I mastered the ability to assess patients accurately while incorporating
complementary modalities in patient care. One patient I cared for was a 46-year-old female
admitted with SOB and pulmonary edema with a history of below the knee amputation (BKA),
heart transplant, and depression. I utilized the nursing process to assess her phantom limb pain
involved with her BKA. She said that there was a constant burning and stabbing pain that
radiated up her stump towards her hip. In addition to traditional nursing care interventions such
as facilitating coping mechanisms for depression related to her limb loss and pain, promoting
family involvement and more, we discussed different complementary modalities available to use
with her analgesic medications to relieve phantom limb pain. Based on my knowledge of
amputations and phantom limb pain, I informed my patient that stump elevation, massage,
wearing her prosthesis, heat, electrical stimulation with tens units, medications, and rest are all
complementary interventions proven to help manage phantom limb pain.
Due to her hypervolemia and edema to the lower extremities, she was not able to benefit
from the therapeutic intervention of wearing her prosthesis. Instead, she agreed to try elevating
and massaging the stump and later reported that it provided some relief but she was still in need
of pain medications. I administered the patients Roxicodone and Gabapentin per doctor’s orders
after determining what her acceptable pain level was. She reported that a pain level of three on a
scale of zero to ten was an acceptable level before requiring analgesic medications. I then formed
the expected outcome that my patient would achieve a pain level of three or less on a scale of
zero to ten one hour after administration of pain medications. I evaluated my intervention one
hour after administration of the medications and found her pain level was a zero on the pain scale
proving the effectiveness of my interventions.
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Communication
Sophomore Year
On my first clinical day I was very nervous about going into my patients room.
Communicating with my peers, instructors, and axillary staff in the hospital had been easy for
me, but I was unsure how to speak with my patients. When I received report on my 95-year-old
patient admitted with ataxia I discovered that she was diagnosed with hearing loss and required
hearing aids. She had a headset at the bedside that I had to speak into which further lead to my
anxieties. Once I entered the room, I introduced myself to the patient and her daughter and was
pleasantly surprised on how easy it was to talk with them. I was able to hold normal
conversations with the patient and her family members while performing my interventions.
By taking the time to talk to my patient using active listening, eye contact, empathy, and
silence, I was able to establish a therapeutic relationship with her. I promoted an environment
where she could feel safe and comfortable answering my questions related to her health habits,
and in return she could ask me questions about her treatment plan. The patient’s family members
had several questions regarding her expected outcomes and when she was expected to return
home. Due to my limited experience in the clinical setting, I was unsure how to answer such
concerns so I retrieved my patient’s primary nurse for the day to provide the family members
with more information.
Junior Year
Communication is an area of nursing that has always been easy for me. Junior year one
patient in particular stood out as being difficult to establish a therapeutic relationship. My 55year-old patient with sepsis, diabetes, HTN, and paraplegia was reported during shift change as
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not willing to talk or participate in care for several days. He was depressed and in a lot of pain
making him hesitant to allow a nursing student to work with him.
After hearing this report and having the patient express that he did not want to be a
student’s “guinea pig”, I felt like I was no longer welcome in the patients room. As I was about
to ask for a new patient assignment, I noticed that he was listening to the music channel and had
an iPod on his bedside table. I utilized these objects in the patient’s room to determine interests
for striking conversation. We began to talk about music and concerts I had been to over the
summer and all the artists he enjoyed listening to. He seemed to enjoy having someone actually
take the time to talk to him and his mood began to improve. He allowed me to perform a bed
bath that he had refused for the past three days and he actually requested to see the wound care
nurse that he had turned away the prior day. By taking the time to get to know my patient and
utilizing nonverbal cues and common interests, I established a therapeutic relationship making
the patient become more receptive to care.
Senior Year
During my clinical rotations I displayed innovative ways to communicate with patients
who have special needs since effective nurse-patient communication is vital to the nursing
process and quality patient care. One example of these innovative communication techniques
was utilized in my preceptorship with a patient who had severe hearing loss as a result of
complications caused by antibiotic administration. I established communication with this patient
by writing everything I was trying to say down on a dry erase board so she could then read it and
verbally respond. In a second scenario, my patient cared for during rehabilitation clinical was
experiencing global aphasia after having a left hemisphere stroke. To effectively communicate
with the patient I had to utilize several communication strategies. First, I asked simple yes or no
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questions so the patient could easily respond by shaking his head. Another strategy used was
having him point toward objects he needed so I could retrieve them for him. Finally, I utilized
picture boards with illustrations of common items the patient needed throughout the day so he
could use it as a way to communicate requests as well as help test his recognition and recall skills
of common words.
Other communication strategies I demonstrated were effective delegation of tasks and
communication with several disciplines in the hospital through a variety of media channels.
Delegation tasks included obtaining vital signs, assisting patients with hygiene needs, and
changing bed linens as needed to nurse care partners (NCPs). Multidisciplinary communication
occurred in traditional methods such as verbal handoffs with situation, background, assessment,
recommendation (SBAR), written communication, and phone calls to oncoming nurses, other
departments, and the transplant team’s daily patient rounding. New media technology was also
used to communicate through electronic pages in the electronic medical record (EMR) computer
system that allowed faster, more efficient communication with physicians and specialists.
Teaching
Sophomore Year
During my sophomore year I began to assess the teaching needs of my patients revolving
around health promotion, risk reduction, and disease prevention across the patient’s life span. For
example, during my fundamentals of nursing clinical rotation I cared for a 48 year-old female
admitted for dyspnea, chest pain, and a new diagnosis of bilateral pleural effusions and
cardiomegaly. The patient was obese and had fluid overload requiring dietary and exercise
education to improve her condition and lower her risk of heart failure. I educated her about the
importance of eating a low sodium diet and increasing the amount of time spent exercising using
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information pamphlets and showed her resources on the American Heart Association (AHA) and
ChooseMyPlate.Gov website to help her make smarter, heart healthy food choices.
Education on sodium restriction included limiting her sodium intake to less than two
grams per day by limiting foods high in sodium such as processed meats and canned vegetables
and avoiding adding extra table salt to her meals. I explained that this in turn would help limit
the fluid retention properties of sodium contributing to her fluid volume overload. I then
educated her on the importance of exercising for a minimum of 30 minutes a day. I suggested
that parking further away from the grocery store and going on daily walks with her son could
help assist her in meeting the exercise requirements. She was very receptive to this information
and began to explore alternative ways to season her foods in order to follow a low sodium diet
without sacrificing flavor.
Junior Year
Junior year I incorporated teaching with my 69-year-old female patient with colon cancer
who was postoperative day three from a bowel resection and colostomy creation. I first provided
teaching to the patient regarding how to care for the new stoma, signs and symptoms to expect,
and complications she should report to the physician. I later provided supportive counseling
techniques regarding ostomy support groups and ways to conceal the bag in order to enhance the
patients self image.
For the first education session I explained that she should assess the stoma daily to
evaluate the color of the stoma and skin around the stoma for any tissue breakdown. I told her
that the stoma would initially look beefy red in color and would progress to more of a pink color.
I then explained that if the stoma turned dusky, brown, black, or white in color that she should
contact her the physician immediately since this would be an indication of poor circulation to the
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stoma. I enforced that she should be cleaning the stoma and surrounding skin with mild soap and
water daily to limit the irritating effects stool has on the skin. She then demonstrated how to
empty and change the colostomy bag, displaying understanding of the information provided.
This in return demonstrated my ability to teach patients about health care procedures following
the medical intervention of a colostomy creation.
The next education session was initiated after having the patient comment that her
husband would never want to be intimate with her again since she had an “ugly poop bag” on her
stomach. I took the time to find current literature on ways to discretely hide the ostomy and also
talked with the wound ostomy nurse who provided me with an ostomy support group package to
help the patient cope with such a big change to her self-image. After obtaining these materials, I
went back and counseled the patient on the information I had located and spent time using
therapeutic communication techniques to calm her down. After the session, she expressed her
gratitude and reported feeling better about her new ostomy.
Senior Year
New transplant recipients require advanced information, teaching, and reinforcement on
their medication regimen and discharge instructions prior to going home. My senior year I cared
for several patients being discharged after undergoing a heart transplant. I took the time to teach
each patient about the medications they were going home on by naming each pill before I gave it
to them, allowing them time to find the pill on their medication sheet, letting them explain to me
what it was used for, how and when they were required to take the medication, and provided
additional reinforcement whenever their response was incorrect. This provided me with
information on the patients understanding of the medications so I could then determine if they
will be able to correctly take the medications once they went home.
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Another important education session I provided to each patient involved the risk
reduction strategies that would help keep the immune suppressed patient healthy and free of
infection. Such information included avoidance of large crowds and ill individuals, wearing a
mask, avoiding consuming raw meats, and ensuring they properly clean raw fruits or vegetables
before consumption. Patients were asked to recall this information to demonstrate adequacy of
the education provided.
Research
Sophomore Year
During my sophomore year I was not required to incorporate research articles into my
clinical logs. Instead, I identified different clinical situations that I believed would benefit from
nursing research. For example, after caring for a 62-year-old male patient with pulmonary
fibrosis, bilateral upper lobe pneumonia, and hypoxia I believed additional research on the
nursing management for patients with pulmonary diseases would have been beneficial to see
prior to providing patient care. It also would have been helpful to review evidence on the
importance of clustering patient care and promoting rest periods for patients in order to limit the
body’s oxygen consumption and fatigue leading to hypoxia.
In preparation for providing care for my patients, extensive care plans were created that
involved utilization of descriptive nursing literature to investigate and describe the patient’s
disease process and associated signs and symptoms. After reviewing the literature I identified
appropriate interventions and patient outcomes to help care for and evaluate patient care.
Junior Year
Junior year I began to incorporate nursing research articles and evidence based practice
into patient care. My 55-year-old male patient with sepsis and paraplegia had a central venous
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line (CVL) placed in order to administer medications and draw labs. This was the first patient I
cared for who required a CVL so in preparation I researched different management techniques to
reduce CVL blood stream infections (BSIs). One medical research article I found researched the
effects of CVL bundle kits for patients in the ICU. The study used CVL bundle kits for all
patients admitted to the ICU at their facility starting January 2008. The purpose of the article was
to determine the overall costs and infection rates for those who used a CVL bundle kit compared
to traditional techniques. The bundle kit first included removal of all lines placed in the
emergency room (ER) within 24 hours of admission to the ICU. The second part of the bundle
included nursing checklists they must sign off on indicating physicians followed all the correct
sterile procedures and precautions when placing the new CVL including use of chlorhexidine
skin prep. Results of the study found a decrease in CVL BSIs in the ICU from 9 to 2.7 per 1,000
catheters placed. With this information, research supported the procedure done for my patient by
replacing his central line and utilizing a CVL bundle kit (Kim, Holtom, & Vigen, 2011).
Senior Year
Senior year I incorporated a nursing research article regarding heart failure care
management programs and their effectiveness on improving patient outcomes after discharge
from the hospital. The article from Wakefield, Boren, Groves, and Conn (2013) performed a
review of literature from 1995 to 2008 that included 35 studies with over 8000 patients that
investigated program interventions for heart failure patients and the associated outcomes of the
patients after discharge. The most common interventions for study groups involved patient
education, symptom management and recognition by staff and patients, medication adherence
strategies, and self-monitoring techniques. Intervention groups when compared to control groups
had the following outcomes: mortality rates were lower, readmission rates were lower, heart
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failure specific quality of life was found to have higher satisfaction ratings, costs for treatment
over time were lower, and they had less clinic office visits.
These study findings were clinically significant to my patients and I utilized this
information to ensure education was a priority prior to discharge. These patients have a culture
related to chronic illness that required culturally sensitive education. Using the Chronic Sorrow
Theory previously mentioned, education was individually tailored and presented in a non-bias
and caring manor to emphasize empathy with the teaching. With the patients I cared for I
implemented education regarding what the medication was being taken for, administration
techniques, and risk reduction strategies in relation to the patients immune compromised state.
After the education was implemented I made sure that they could recall the information, and
reinforcement was provided for incorrect responses. Most patients were able to correctly recall
the information, which, in accordance to the article, will improve their overall quality of life and
health status related to their heart failure.
Leadership
Sophomore Year
As a student nurse who was brand new to the clinical setting, I was not ready to display
the level of leadership skills necessary to manage others in the clinical setting. Instead, I
demonstrated leadership skills by being self-directed while performing patient care, arrived early
to the unit, and made sure to involve myself in interdisciplinary team meetings. I also performed
patient care in a timely manner by helping my patients perform ADLs prior to breakfast. I took
initiative by obtaining my patients vital signs and reported them to both the care partner and the
nurse to be charted in the record. This clinical facilitated the importance of the nurse in
interdisciplinary teamwork by demonstrating how the nurse orchestrates the several departments
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and specialties involved with each of their patients. Without the nurse organizing and
communicating between specialties, patient care and time management would suffer.
Junior Year
During my junior year I began to notice the different leadership roles available for nurses.
On one clinical day I shadowed the charge nurse on her daily duties. She was responsible for
creating the nursing assignments during that day, overseeing new admissions and discharges,
ordering new supplies, and checking the crash cart. I was able to observe how she managed her
time and effectively delegated tasks to other staff allowing the unit to run smoothly that day.
Personal leadership skills were displayed by maintaining self-direction in completing all
of my clinical requirements. I arrived to clinical on time, completed all of my clinical paperwork,
knew all of my patient’s medications and administered them to the patient on time, and assisted
others in answering call lights when I was not busy with my own patients. In one instance while
going to observe lab draws being done with faculty by another student, I noticed they forgot to
don gloves so I casually handed them a pair to help keep my own personal accountability
regarding safe patient practices to prevent infection transmission. Finally, I demonstrated the
ability to function effectively as a member of the healthcare team and assist in coordination of
care by contacting the pharmacy to send up alteplase after the physician ordered it for my patient
with the CVL to fix the clot that had occluded it.
Senior Year
By my senior year I fully understood the importance of teamwork, communication,
fairness, flexibility, accountability, and the ability to follow legal and ethical principles while
providing patient care. During my role transition experience there were several days that
inclement weather and snow resulted in nurses and other staff members calling out of work. The
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charge nurse, unit manager, and staff nurses had to be flexible in patient assignments and were
required to take on an extra patient in order to compensate for the limited staff. The unit manager
contacted staff scheduled to work that night and the next day to make sure they either had
transportation to work or were going to spend the night in the hospital so they could arrive to
work on time. I demonstrated individual leadership skills and ability to function as a member of
the health care team by assisting a physician in placing a dialysis port in a patient with a LVAD.
I made sure that the patient had signed the informed consent, helped set up a sterile field, and
retrieved additional equipment needed by the physician to perform the procedure.
Professionalism
Sophomore Year
Professionalism was demonstrated my sophomore year by practicing professional, moral,
and ethical frameworks that incorporated the principles of beneficence, nonmaleficence, fidelity,
and justice for all of the patients regardless of cultural differences. Beneficence was practiced
with my patient who had cardiomegaly and pleural effusions whose anxiety I helped reduce by
going out of my way to have the chaplain visit her for prayer at her request. Nonmaleficence was
practiced by ensuring safety protocols were followed with my ataxic patient whom I ensured had
a yellow fall risk bracelet, non-skid footwear, three bed rails raised, sufficient lighting, and bed
lowered to its lowest position. Fidelity was practiced when answering a call light for another
patient. I observed the patient crying and in extreme distress and upon assessment their blood
pressure was very elevated and they reported being in pain at nine out of ten. This was not a
patient I was familiar with, so I made sure to locate their nurse and urgently encouraged them to
administer pain medications for them if they were ordered. The nurse reported that the patient
had only Tylenol ordered which I felt to be an inadequate form of pain control from reports from
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the patient. With my faculty, we contacted the doctor to get a new order for pain medication that
allowed the patient to experience their first pain free experience in the hospital since admission.
As a part of nursing professional ethics, I followed the American Nurses Association
(ANA) standard of assessment when advocating for patients in pain by assessing their pain level,
where it was, and any aggravating or relieving factors related to their pain. I then followed the
ANA intervention standard by checking the patient’s EMR to see if they had anything ordered
for pain. After looking at the patient’s medications I reported the pain assessment to the nurse.
Finally, after pain interventions provided by the nurse, I made sure to follow up with the standard
of evaluation by reassessing my patient’s pain in a timely manner.
Junior Year
Professionalism displayed my junior year revolved around my 52-year-old patient with
alcoholic cirrhosis. The patient had a very low blood pressure that I continued to monitor
throughout the day for her nurse. I explained that I took an electronic and a manual blood
pressure reading with both being in the low 80’s systolic. By ensuring an accurate reading using
the manual blood pressure I demonstrated accountability for one’s own professional practice.
At this time I began to utilize general, institutional, and specialty standards of practice
into my care. With each patient I cared for I followed the ANAs Standards of Practice as a means
of general nursing standards. Assessment was always first priority as stated by the ANA. Each
week we were assigned to look up institutional standards of practice for the hospital. I
investigated protocols for methicillin-resistant-staphylococcus-aureus (MRSA) personal
protective equipment (PPE) and wrote up a summary of my findings in a paper for the course.
The protocol outlined specific standards that required all personnel to don a gown and gloves to
protect themselves and other vulnerable patient populations. Finally, specialty specific protocols
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included unit nurse to patient ratios, which I learned about when following the staff nurse for the
day. Their unit protocol called for a max of six patients to one nurse which was adhered to in
order to promote patient safety.
Senior Year
Senior year professionalism was executed flawlessly with my care of patients in clinical
settings. Professional awareness regarding our limitations within our scope of practice as student
nurses have been well established and care of patients utilized all aspects of professionalism
criteria without having to actively think about it. Institutional, healthcare, and specialty-based
protocols along with school of nursing and professional nursing standards of practice were
upheld to ensure efficient, safe, and timely delivery of healthcare interventions. In lectures
throughout our courses, we learned about the legal ramifications for non-adherence to these
procedures and also were acutely aware of ramifications to our grades if nursing standards in
clinical were not practiced. For this reason I always made sure to double check hospital policies
before implementation of unfamiliar procedures to ensure the protection of my faculties nursing
license and my place as a future nurse.
Another very important aspect of professionalism for nursing is advocating for our
professional standards of practice in our organization and political settings. Nursing was not
always considered a professional practice and only recently has it gained recognition for its
contributions to medical practice. As a soon to be nurse, I know that I want to involve myself in
the interdisciplinary teams and voice my opinions using evidenced-based practice to help make
change in the healthcare setting. In our leadership and community health course, advocacy of
nursing research and opinions was delivered to political figures in our area as a way to introduce
us to political activism for our profession.
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Culture
Sophomore Year
At this time I had a very basic understanding on how culture affected patient care. I
mainly focused on the cultural impact on my patient’s diet and food preferences. For example,
my 78-year-old female patient diagnosed with precordial chest pain, abnormal weight gain, and
peripheral edema culture had a poor dietary behavioral pattern that consisted of a southern diet
that was high in sodium and fat. The patient explained that she ate fast food at least four times
per week. This along with being an African American with a sedentary lifestyle contributed to
her HTN and other clinical conditions demonstrating my knowledge of how human behavior and
conditions are affected by culture, race, and lifestyle choices.
Junior Year
Culture impacted my care during my junior year while caring for a patient admitted for
hypertensive crisis. The patient stated that he was in perfect health and that his HTN was not a
real disease. The patient’s culture related to his personal beliefs of health. The patient expressed
his belief that since the HTN was not something he could see, touch, or feel, that it was not a
health issue worth his time. He was more worried about his diabetic ulcers and personal
appearance as a definition of health. I had to respectively step back and understand the patient’s
cultural beliefs of his health in order to demonstrate sensitivity to patient’s health decisions. His
belief regarding physical ailments as an importance of health affected his reactions to his
hypertensive crisis which is why he did not want to receive medication interventions and
demanded to be released form the hospital despite efforts to educate him on the condition.
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Senior Year
During my senior year culture impacted patient care for my 59-year-old patient admitted
with heart failure, hypervolemia, anemia, and cardiomyopathy. The patient was a Jehovah’s
Witness that challenged me to integrate knowledge learned from previous lectures to help
personalize nursing interventions for the patients care while respecting her cultural boundaries. I
was aware that my patient’s religious beliefs prevented her from being a candidate for heart
transplant or surgery because she could not accept blood products. This affected her treatment
plan by limiting her heart failure treatment options strictly to management using medications.
Planning was implemented in an interdisciplinary group to help come up with a culturally
sensitive yet affective treatment plan. After this coordination effort, it was decided to discharge
the patient home on a Milrinone drip with a palliative care consult. Thankfully, the patient had a
strong support system from the church and family members that offered to assist her in her
recovery. She reported that she lived with her daughter and had several other family members
who lived nearby capable of providing assistance in her care. The patient and family members
agreed on the culturally sensitive care plan to progress to palliative care and the patient was sent
home towards the end of my shift.
Conclusion
Nursing school has been an experience I will never forget. It has definitely been a long
journey with countless late nights spent studying for exams or finalizing papers, but the
knowledge I have obtained has made it all worth it. Sophomore year I knew it was going to be a
challenging road but at the time I do not believe I was ready for how mentally, physically, and
emotionally exhausting it has been. I am thankful for all the challenges I have experienced these
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past three years in the nursing program because it has created competency in my ability to
deliver care to the acutely ill patient.
I arrived to the program with minimal understanding of the healthcare field and the only
medical experience of being a lifeguard for a community swimming pool. Now, as I am exiting
the program, I have obtained more skills than I can list. My nursing skills have changed from
providing basic care like taking vital signs, making beds, and giving baths to more hands on and
skilled interventions such as starting IV’s, reading EKG’s, administrating medications,
performing wound care, and so much more. I have progressed from being terrified to enter my
first patient’s room to providing holistic care and developing therapeutic relationships with both
patient’s and their families. After completion of the program I now know that I am ready to
transition from the student to professional nurse position.
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Reference
Kim, J. S., Holtom, P., & Vigen, C. (2011). Reduction of catheter-related blood stream infections
through the use of a central venous line bundle: epidemiologic and economic
consequences. American Journal Of Infection Control, 39(8), 640-646.
doi:10.1016/j.ajic.2010.11.005
Wakefield, B. J., Boren, S. A., Groves, P. S., & Conn, V. S. (2013). Heart failure care
management programs: a review of study interventions and meta-analysis of outcomes.
Journal Of Cardiovascular Nursing, 28(1), 8-19. doi: 10.1097/JCN.0b013e318239f9e1
PROFESSIONAL PROGRESS
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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 responsibility to turn in all suspected violators of the
Honor Code. I will report to a hearing if summoned.”
Julie Teegarden