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Charleen Kahapea
WSE #6
May 7, 2015

Apply the ANA Code of Ethics to care of families including client rights, dilemmas between individual
rights and the common good, identification of choices and possible consequences.
Reflect on nursing practice in managing care for groups of patients.
Seek information to develop plans of nursing care that are family-centered, age- and culturally-appropriate using evidenced-based clinical guidelines.
Apply basic leadership skills in the care of families.
Practice as a member of a multi-disciplinary health care team.
Recognize benefits and limitations of community and governmental support for family units and individual members with illness.
Deliver Family centered care.
Demonstrate therapeutic communication skills in interactions and relationships with families, individuals, and other members of the health care team with attention to the identification and correction of
non-therapeutic communication techniques.
Work with the client to implement plans of care that are based on culturally and age appropriate assessments and best evidence using information and patient care technologies that support safe, quality care

This last day of clinical was a great end to a very challenging rotation for me. I did not expect this rotation to be as challenging as it was for me. Even having a child of my own, I felt very out of my comfort
zone at times. I felt like time things were going by so fast and not enough time for me to absorb all the
new information. I have thought maybe it was because I have been working with adults for so long, I am
used to caring for that population. From this rotation I have a very different outlook on pediatric nurses.
I would definitely say it is not an easy job.
At first I was jealous the other clinical sites might get to do more than us, but I look back at the experience I had this rotation and I feel like I did grow a lot. There is still the confidence that I need to work on.
But I have to say, I was actually relaxed the night before my last clinical rotation. Since I did not stay up
late doing paper work, I was able to get a good night sleep and went in a little less anxious. I think that
one part that is hard on nursing students or new hires, is learning the unit of the routine. Even if you
know how to be a good nurse, you have to be able to adapt to the unit and the unit routines to be a great
nurse.
This last day I just felt like I did so much. I came in, looked up some information, went in to listen in on
morning report, and I was off to see the patient. The parents and the patient were really nice and easy to
talk to so that made the day go off really well. The patient was being sent off to procedures at 08 so the
nurse quickly did all his meds while I did my assessment and vitals. She felt bad knowing I was a student, but it was understandable because with procedures time is of the essence. Ive experienced on my
floor at work that sometimes surgeries can be pushed back or pick up is earlier. All the pre-op paper work
needs be done early just in case. There was this one time the patient just came up from the ER and the
nurse was trying to get the paperwork done, the surgeon came up to the floor and was trying to wheel the

patient in his bed out of the room down to surgery. I dont remember the exact details, but that was what I
saw. He didnt like having to wait for the patient to come down.
I was able to go down to watch the whole procedure. I got to see how they put him to sleep, how the
anesthesia gave the propofol. Watched how they did a bone marrow aspiration and biopsy, see a lumbar
puncture for a spinal tap, and see how PICC insertion. The nurse asked if this my first time watching this
and I said yes, so they gave me a chair in case I got lightheaded. I was good the whole time and they kept
telling me to move closer so I could see. The whole time I was there I was just still in shock that I was
able to get to see a procedure.
During the procedure I tried to listen in on what the doctor was explaining to the resident, he was soft
spoken so sometimes it was hard to hear him. But he did mention that sometimes bone marrow aspirations can be challenging when the area is fibrous and the collection becomes a very slow drain. He wanted at least 10 ml and I think it took about 20 minutes to get. The spinal tap and administration of chemo
drug intrathecal took less than 10 mins. The PICC insertion took 20 mins also. Then Xray came to confirm PICC placement. They drew blood for my patient then he was finally off to recovery.
In recovery the nurse did the frequent vitals. My patient was placed in trendelenberg for 30 mins which
the nurse said was for the chemo drugs. I tried looking up the reason but could not find other than that
position will help if someones blood pressure is low, which his was not. In recovery I got to talk to my
patient, make sure he was doing ok, told him he was in recovery, assessed if he had any pain, told him his
parents were on their way, and if he needed anything else. He had to go bathroom but the nurse asked if
he could hold on for 10 minutes then she would walk him to the bathroom. So he waited and eventually
went. I observed he was a little shaky on his feet, so good thing his dad was present to go with him to the
bathroom.
When we got back I did a set of vitals. He was hungry so I followed through. Checked with the nurse and
she said she acknowledged the regular diet order so it would be on the way. We waited and his tray did
not come up with the dietary cart. When I was in the room dietary handed me a tray and I noticed that
was not the patients name and wrong room number. Then asked dietary if he had a tray for him, but he
said none and he called and dietary said they still had my patient NPO. So I called to let my nurse know
and then she said ok she would take care of it. Because I had meds to give to the patient and he was hungry I just wanted to double check that he had a tray on the way. So I called dietary and she was not nice,
as soon as I called to say I was calling for room she snapped and told me the tray was on the way, I
said ok thank you and hung up. I thought that was uncalled for. So his tray came and I was able to give
his two meds.

Before I could give any meds I had to wait to see what meds the nurse wanted me to give. The nurse actually told me I could just give the med since the tray was on the way, but I told her we would wait since
the med administration said to give with food. Then the dose order was changed so I needed to give a
second tab.
The family was super friendly, I found out they have 3 children all born in the Philippines. The family
lives in Kauai and moved there because they have family there. They have lived in Kauai for about 6
years. The parents seemed really supportive of their son. The mom said she was receiving a lot of phone
calls from the relatives to see how things were, but she said she was not ready to talk to the family. I told
her it was okay and when she was ready. This must be a lot for them to be taking in right now. Even so
the patient was still lively. I dont exactly remember, but I think I was asking him if he was having any
pain, and he told me no, then I asked him something else and he mentioned he felt as if he was dying
when he wasnt feeling well before admission. He opened up more as the day went by. I asked him
where he went to school and asked where he would be going to high school. I also tried to see what he
was interested in going to college for. He said he didnt know what he wanted to go for. I noticed he like
airplane and drawing, but neither he was interested in pursuing.
I hope I was able to complete all the student learning outcomes this rotation. I feel like the 6 weeks went
by fast and Im still trying to absorb all that I got to do in such a short time. I know I have to work on
confidence and time management. I also feel that given more clinical time I would have been able to
show you that better. I just want to say thank you one more time, this really was a great end to the clinical
rotation. This was the best day ever for me. Thank You for this clinical experience.