Sherry Brabon Nurs 324 Evaluation of Current Practice 1. I ensure delivery of quality care in various ways.

Chart audit, case review and cohort studies are a few ways in which I evaluate previous work. This retrospective type of quality assurance aids in preventing future errors, omissions and generally allows for more efficient care in the future. Another way in which I ensure delivery of quality care is to do my research prior to performing care or other nursing duties. For example, I will check resources, typically Michigan Department of Community Health or Centers for Disease Control websites, for vital information required to do my job safely. Furthermore, my job offers me a yearly review in which I describe my successes and list ways to improve my weaknesses. This leads me to insight of where my focus for improvement should be. Also, I am not afraid to ask my peers for feedback regarding my nursing care and skills. There a variety of ways in which I can ensure delivery of quality care. 2. There are so many ways to obtain continuing education units (CEUs). My job offers state meetings every year focused on programs in which I work. These meeting are usually all day and some are two-day conferences. This alone provides me with the required CEUs for licensure renewal. Advancements in technology have led to many CEU opportunities online. However, these online resources need to be verified as to which state the CEU is approved. I have received CEUs for webcasts and other online modules. Attending any trainings and meetings often earns CEUs also. And, last, but certainly not least, I return to school to enhance my degree and knowledge base. CEU opportunities are easily available. 3. Evaluation of my practice is somewhat answered in question number one. In addition, I often have weird feelings about things that arent right. This is probably best described as intuition, and it has proven correct every time I have used it in the past. If I experience this feeling, I stop what I am doing and re-check my actions. Typically, I have forgotten something or am doing it wrong. Also, outside of the external feedback I ask of my peers, I exercise internal reflection as well. I may review a day and determine what I could have done better or how I could have handled a situation differently. I try to remove myself from the problem under consideration and look at it from a different perspective. I also place some value on productivity standards and use that as a tool to evaluate my current practice. 4. The health department offers me little exposure to new nurses. Though, we often get RN students from the local community college. I have become much more comfortable in my practice and I enjoy having a student observe my actions. I also enjoy educating them on the resources available and how they can use them in practice. Just today a coworker claimed she was happy I was back in school. She stated that I am more efficient and that helps her do her job. This was in response to journals we must read at work called Morbidity and Mortality Weekly Report. She asked me to continue to highlight and use sticky notes to point out important information. I was pleased others were not

upset that I mark up their reading material. I try to get along with all my co-workers and collaborating bodies, to be assertive without being pushy or bossy. 5. Many programs require multiple professionals to promote quality client care. I work closely with a Registered Dietician, Social Worker and clerical support staff. We communicate face to face, via e-mail, voicemail and the occasional sticky note within the office. Furthermore, as my job requires collaboration with other outside partners, I am often speaking with many other professionals. I am on a workgroup for the state promoting development of Medicaid Health Plans for children with special needs. This workgroup consists of staff from Michigan Department of Community Health, Department of Human Services, Medicaid Health Plans and other local health department staff. I also consult with program coordinators, medical providers, epidemiologists and veterinarians. And the list of team members continues as we involve the patient, family, pharmacists, equipment specialists, various therapists, audiologist, medical specialist and schools. I use all these resources and collaborate to ensure my clients are getting their needs met in an efficient, safe and professional manner. As nurses we may feel like we do it all, though this list, and I am sure I have missed some, proves it takes a team that can communicate well with each other to provide acceptable client care. 6. After careful study of the code of ethics there are two in which I feel I can improve. The first is provision four. My experience regarding delegation has been limited. Often I feel I can do it better, quicker and more efficiently than someone else. If I can get in done in the time it takes me to tell someone else to do it, I feel I should do it myself. I realize this is a good way to promote burn out and a great way to prevent that other staff member from reaching their potential. The other provision I could improve upon would be my involvement in nursing associations. I have only just realized their importance and I am slightly appalled that more time was not taken in my ADN program to promote their roles. I am also ashamed that I have not taken the initiative to learn these facts for myself. However, I feel pretty confident in my ability to perform or meet the other provision in the code of ethics. I have always prided my work ethic, as I do not discriminate. I came from a poor background and can honestly identify with many of my clients concerns and barriers. Additionally, I understand the value of affirmation, for others and myself. I will be the first to advocate for my client or families and share with them ways in which they may understand their rights and responsibilities. In other words, I arm my clients with the tools to protect their own rights. I could continue at great length on this topic, however, I believe I may have already answered other ways in which I practice ethically in the answers supplied previously. 7. Outside of the casual search for answers to current practice as stated in previous answers, my research practices have been limited. I have completed many research papers for my degree, this typically involved reading others studies, formulating a theory and proving it, again, through others studies. I believe true research includes the whole process, stated simply; development of a theory, studies to prove or disprove and publishing the outcome. I have been instrumental in updating policies in my workplace after reading articles or publications from professional resources. All nursing practices should be based on research. The more I learn through my BSN classes, the more I want to learn. I

have been a person that tends to go wherever needed and I am considering continuing my education through PhD level. This would most certainly provide me the opportunity to conduct my own research. 8. Again, some of this answer has also been addressed in previous answers. I feel like a social worker some days due to the amount of referrals I make. Referrals such as Early on, WIC, immunization clinic, doctor, community mental health, smoking cessation, Department of Human Services, Childrens Special Health Care Services, Central health plan, family planning, childrens protective services, shelter house, 10-16, baby pantry, registered dietician and social work services; just names a few of my routine, daily referral sources. This list may be longer for more complex client needs. Most of these referrals are free to low cost. I attempt to keep fiscal fitness in mind when referring, however, my first priority is client need. Most of these agencies I refer to operate under government funding. Luckily, most of these agencies have a direct client and revenue relation; the more clients enrolled in services, the more funding is provided. 9. Before becoming involved with committees, sub groups and work groups, I was involved with organizing many office gatherings. I was the one who organized potlucks, cookouts, office parties, picnics, sledding or tubing outings. Coupled with lack of time and increasing ages of co-workers children, we are hard pressed to find time to do any of these activities. Outside of these organized events, I am always willing to help out in a busy clinic. If there is a client walk in requiring a tetanus booster, I will offer to provide the service rather than have the client return at a later date. Also, I try to promote a positive environment by suppressing negative comments or actions. It is amazing how a simple statement such as, Good morning, Kelly thanks for making coffee today does to improve morale in the office. Also, quick intervention when other staff members are entering a heated discussion prevents work place hostility. These efforts do not always come easily. I often have to mentally focus to provide a positive and professional attitude. I struggle with following groupthink; often I am the voice of reason or take the opposing view to stimulate debate. This often causes stress to others. Finally, I also struggle with communicating my needs to others. Because I do not have children, my coworkers feel I am available to provide after hour services and other specialty services in which they are exempt due to their family commitments. These two weaknesses prevent me from working in a healthy environment.