HEADER: COPA MODEL

Tammy Surrency
The COPA Assessment
August 25, 2015
Dr. L. Jurado

HEADER: COPA MODEL

Reflection 1-AICD Firing-Reflective Thinking/Learning Assignment:

This situation describes my role in resolving an issue regarding protocol for our unit. The
patient was admitted because his AICD fired three times at the prison. On this particular
admission, the device hadnt fired until day 4 of admission. The AICD fired three consecutive
times within a twenty minute period. By this time he wasnt a candidate for our unit and needed
to be transferred to a critical care setting where his AICD can monitored more closely and also
start the patient on an Amiodarone drip. If I hadnt notified the supervisor to speak to chief
resident to have the patient transferred off the unit, my belief is things may have gotten worse.
COPA Model Competency and Sub skills:
This assignment demonstrated my competency in: Assessment and Intervention with the sub
skill of safety, protection and assessment and monitoring. In dealing with particular situation I
met the competency and sub skills by monitoring the patients safety and protection due to his
age. The patient was elderly and unsteady on his feet. He couldve fallen or caused injury to
himself. In addition, the unit that I work on its difficult to monitor him closely because it is a
locked unit and the unit is not equipped to handle to cardiac urgencies.
Using Benners Stages of Competence: I identified the stage of proficiency as a proficient
nurse. Looking at the situation as a whole, I can see this patient getting worse and quickly too.
Another point is that since its a lock down unit, waiting for the officers to open doors to check
the patient. Time can definitely be lost in this scenario. In the critical care units, there is
definitely more one- on- one care and less time lost getting to the patient.
Reflection 2-Critical Thinking Assignment:

HEADER: COPA MODEL

This situation describes my role in critical thinking on a patient that had an extensive cardiac
history and ejection fraction of 10-15%. He apparently had been having some issues with his
heart earlier in the shift. He was also coughing quite frequently thru out the day. I followed
orders, gave prn meds and nothing could seem to make this cough go away. Fast forward, the
monitored alarmed asysole and the man coded and eventually expired.
COPA Model Competency and Sub skills:
This assignment demonstrated my competency in: Assessment, Intervention, and communication
skills with the subskills in safety, protection, assessment and monitoring. In every situation,
patients safety is always priority. The patient continued to have this frequent hacking cough with
minimal relief. I administered prn medications and monitored for signs of relief. In addition, we
monitored his heart through the telemetry.
Benners Stages of Competence:
Using Benners Stages of Competence: in this example, I identified the stage of
proficiency as a competent nurse. Although, Ive been practicing for a few years, Ive only had
similar situation such as this one about 2 times with each scenario slightly different. After the
code was over, I questioned myself, as if I couldve done something better.
Reflection 3: Benner 1-The Helping Role
This situation describes my role in providing comfort measures for a patient who was
admitted to the unit for an NSTEMI (Non ST segment elevation myocardial infarction). The
cardiologist recommended a cardiac cath. The family denied the recommendations due to her
age. She was later placed on a heparin drip and to bridge her on Coumadin therapy. They also

HEADER: COPA MODEL

started her on fluids and monitor her troponins. Fast forward, she developed pulmonary edema,
lung sounds were rhonchus. They gave her Lasix 20mg IVP now and ordered a foley catheter to
monitor output. My belief was she was scared from all the commotion so, she requested her
family at her bedside. The family was notified and at the bedside. In my opinion, just being
present in the room, showing empathy and holding the patients hand, made the family feel at
peace.
COPA Model Competency and Subskills:
This assignment demonstrated my competency in: Assessment and Intervention with the sub
skills of safety, protection, assessment and monitoring. As mentioned above, safety is one of our
main priorities in addition to assessments. Shes an elderly woman and shes afraid to be alone.
This could cost the patient more harm by increasing the stress on her heart which was not in
good condition.
Benners Stages of Competence:
Using Benners Stages of Competence: in this example: I rate myself in this particular
clinical scenario as competent. This was my first time in this situation regarding her cardiac
status. I understand the familys rational for refusing the cardiac catheterization. Had she gone
through with the catheterization, she may have not have pulled thru. The family decided to
comfort measures. As far as providing empathy, and showing compassion in this example I rate
myself as expert. I say this because the following morning, she express how much of a good
nurse I was and that she loves being around good people. It really made my day. My belief is that
when you go the extra mile to provide compassion, it really gives them that second wind. I seen

HEADER: COPA MODEL

the family a few days later, and they thanked me for everything and told me that she was still
hanging in there. It was the best news I heard all day.
Reflection 3: Benner 2
Teaching and Coaching
Working night shift, there are many patients that get admitted for same say surgery on our
unit. At times, they may be returning to the floor during shift change. Many of the patients
express some fear due the fact they are having a procedure done and prior to discharge. I assured
my patients the physician will be making rounds and address any concerns the patient may have.
In addition, I reviewed the post-op teachings which included splinting, cough, deep breathing,
and early ambulation decreases chances of post-operative complications. I also reviewed any
post-operative complications that may occur if these orders arent followed. I always make a
good point to revisit any teachings given because there is a chance theyre still groggy from the
anesthesia.
COPA Model Competency and Subskills:
This assignment demonstrated my competency in: communication with subskills in charting,
care plans, documentation. Teaching: with subskills individuals in health promotion and health
restoration. Nursing requires documentation, not charted not done. Care plans are initiated upon
admission then updated according to their care. Teaching is done pre-operative, intra-operative,
and post-operative.
Benners Stages of Competence:
In this the teaching/coaching domain, I demonstrated the role of the proficient nurse. As the
proficient nurse, I was able to put the patients mind at ease by providing teaching for pre-

HEADER: COPA MODEL

operative and post-operative teachings while preventing any complications. Prior to any
teachings, I assessed the readiness to learn. Without assessing the readiness to learn, the patient
wont retain any information. With my experience in bedside manner, I am able to connect with
the patient and provide a sense of calm to the patient. This promotes less complications in the
OR setting as well as post-op.
Reflection 3: Benner 3
The Diagnostic and Monitor Function
The resident following the case, we were monitoring the patients troponins. The patient was
transferred to the cardiac floor because of her elevated troponins. Once I received the patient,
there was an order to repeat the another set troponins . I had already drawn the second set and
sent it to the lab for analysis. The repeat second set of troponins were more elevated and the
patient was already on a heparin drip at 9.5 mls/hr. The last PTT was greater than 120 seconds. I
repeat level was drawn to verify the correct results. The results were the same, greater than 120
seconds. I followed the heparin protocol by turning off the heparin for an hour and decreasing the
rate of the drip by 2ccs/hr. The rate is 7.5mls/hr, next PTT in 6 hrs as the per heparin protocol
sheet.
COPA Model Competency and Subskills:
This assignment I demonstrated several of the competences in: Assessment and Intervention
with the subskills in safety and protection, Assessment and monitoring. Communication with
subskills in: care plans, charting, documentation. Critical thinking with subkills in decision
making, prioritizing, Problem solving; diagnostic reasoning. When administering drugs such as
Coumadin or heparin, it is important that you take extra precautions. In her situation, the patient

HEADER: COPA MODEL

had to be redrawn because she only one arm to draw from. She had a past medical history of a
right breast mastectomy so no blood draws or blood pressures taken in that right arm. Nursing
had to be sure the result was an accurate one.
Benners Stages of Competence:
The level of competence for monitoring and diagnostic role in this in this clinical setting is an
expert practitioner. Since my years as an LPN and an RN, Ive learned to be on top of these
medications when monitoring their therapeutic levels. Ive had many years experience with
monitoring these therapeutic levels and Ive heard many horror stories as well. In the previous
scenario, the resident repeated the PTT because he wanted to make sure the numbers were
correct. Since she had a history of a right mastectomy, our options were limited. We have only
had the one arm to draw from. I wanted to make sure those levels were correct so I turned off the
heparin prior to blood draw.

HEADER: COPA MODEL

References:
Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing
practice. Upper Saddle River, NJ: Prentice Hall.
Price, P.R. (2015). The COPA Model Competency Outcomes and Performance Assessment