Running head: FINAL REFLECTION PAPER

Final Reflection Paper

Tracy Terrones
University of Arizona

Final Reflection Paper

Overview
As I reflect back over my past two years at the University of Arizona to advance my
degree in the ADN-MSN program, I realize just how much I have learned and how very proud I
am of this accomplishment. I originally started the program to add credentials to my experience
but along the way I developed a passion for nursing leadership. As resource of my cardiac
catheterization lab (CCL) and overseeing approximately 30 registered nurses (RN) and radiology
technologists (RT), this program has enlightened and enhanced my leadership style, a leadership
style I was unaware I had prior to many different assignments and projects in this program. Each
course opened my nursing eyes, starting with the Foundation Leadership course, Evidence

Based, Population Health, Informatics, Health Promotion, and lastly the delightful Holistic
Healing. Population Health informed me about Healthy People 2020 and their goals to achieve
health equity, eliminate disparities, and to improve the wellbeing of all Americans (Stanhope &
Lancaster, 2014). This was new to me and I really enjoyed learning the terms, definitions, and
important aspects brought by the course Population Health. I have learned the necessity for the
collaboration of the healthcare professionals to strengthen their skills and encourage public
policy to better serve their patients. Nursing leaders must continue to work for changes in the
healthcare system that will benefit patient care in the United States (Tillett, 2011). As providers
we must understand the different situations are patients are involved in and inform them of the
opportunities the government has to offer. We have the great ability to influence our publics
healthcare by enlightening and presenting them access to appropriate, efficient, and effective
quality care (Maryland & Gonzalez, 2012). One other key reference that sparked my thinking
was the video, Caritas Nursing: Taking Time Making Time that Jean Watson presented the
attending caring nurse model (Watson, 2014). I truly believe if the caregiver is well taken care of
they will be more apt to provide optimal care (Quinn, 2014). A highlight for myself as a nursing
leader is the positive energy you can bring to your staff and patients to create and implement an
ideal healing environment. Following this course I began and continue to use touch therapy as I
keep one hand on my patient as I prepared them for their cardiac catheterizations, a technique
that makes use of human energy for healing (Jackson & Latini, 2013).
Program Outcomes
Leading my CCL team to focus on the patient and patient-centered care begins with an
essential requirement that I implement (Dewar & Cook, 2014). As the nurse brings the patient to
the cath lab suite and the double doors open, the staff is aware to stop all non-patient related

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conversation and redirect focus to the patient. The staff is to greet the patient, introduce
themselves, explain their role in the patients care, and explain the procedure. I create this patient
care environment and I see others continue with this methodology. This program has improved
my nursing skills, helped me grow from being a compassionate nurse to an educated leader,
which improves patient outcomes.
Collaborating the CCL staff and the surgical staff for the start up of our Transcatheter
Aortic Valve Replacement (TAVR) program was at first very challenging. I had two teams with
very different knowledge bases and strong personalities as to whose approach to patient care was
superior. Using the evidenced based theory model as a guiding force and presenting to the
healthcare providers that this new collaboration of teams will utilize and combine the finest
concepts of care from both departments for paramount patient outcomes. Over 100 TAVRs later
this past year, we have blended both units for a very successful program with amazing patient
success stories. I acknowledge that my learnings from the University of Arizona had a part in
the delivery of evidence-based quality care in my Hybrid suite TAVR program.
I enjoyed the integrative nursing course profoundly and it brought together my mind,
body, and spirit. During this holistic course I was caring for my 26-year-old son in Germany,
during and following his knee surgery in the United States Air Force. For his recovery I used
integrative nursing/mother therapies to improve his healing process and decrease his pain level.
Prior to this exposure to integrative therapies, I have to admit, I had my doubts how this
enhanced patient care. To assist in my sons recovery, I would light a scented candle that I had
purchased at the Base Exchange, put on his PlayStation 4 game, and give him a relaxing pedicure
in preparation for his rehabilitation exercises. His surgeon stated at 2 weeks recovery he was at a
6-week recuperation level! I have learned through application of these healings in patient care,

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there is an improvement in pain management and at now in the CCL we provide music therapy,
warm blankets, dim lighting, touch therapy, and true compassion for all patients and families.
I have incorporated innovative healthcare technology to deliver safe and effective patient
centered care in our CCL by orienting both the RNs and RTs to the electronic health records
(EHR) we utilize for the patient procedures. I implemented the procedure to look up the patient
in our hospital EHR prior to going to get the patient to better understand who the patient is and
why they are coming to the CCL. We are to review the history and physical, labs, medications
etc. and as we enter them on our x-ray system, we are to pull up any prior CCL exams they have
had in our facility. All of this information shared with the team safeguards sounder and improved
quality of care for each patient. The nursing leadership program reinforced the importance of the
value of the EHR and healthier outcomes for our cardiac patients.
In order to have a successful ST elevation myocardial infarction (STEMI) to
percutaneous coronary intervention (PCI) program, it takes coordination of care amongst many
healthcare providers to meet the necessary 90 minute door to balloon time. This 90 minute
national standard for STEMI programs involves the pre hospital department, emergency
department, interventional cardiologist, CCL call team, transportation personnel, the house
supervisor, and the intensive care unit. To save the patients heart muscle, every healthcare
continuum needs to do their part in order to quickly reestablish coronary artery blood flow to
give the patient the best quality of life and outcome possible. Communicating and working
together as one team for our community, even though we are separate units and personnel in the
organization, is what makes our program so successful. Care coordination taught in this program
has made it evident that it improves patient outcomes and is also extremely valuable for cost
reductions (Dearholt & Dang, 2012).

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As an organizational leader in the CCL, in order to design, coordinate, and evaluate

patient care systems, I have improved my leadership with the understanding of complex adaptive
systems. Realizing we are all individuals connected and interacting to make up a larger system,
different from the traditional rigid, linear, or top-down system, I encourage and empower my
staff to bring to the CCL their ideas for improvements for our patients, families, and the
community (Crowell, 2016). I understand through this program that healthcare leadership is a
process and we need to move our organization in more innovative and effective ways. As the
CCL resource and as problems arise in the ever changing healthcare world, I will be open, offer
alternatives, collaborate, be adaptable, be engaged/connected, value individuals, listen, and work
with others to achieve enhanced healthcare provider and patient satisfaction (Crowell, 2016). A
recent example would be our EHR is being updated for the 3rd time in 2 years and adding
additional charting for reimbursement, quality, safety, etc. As the CCL staff groaned and
complained with the news of the changes, I listened, thought about complex adaptive systems,
smiled, and let them know I was with them all the way, and we could do this together.
Conclusion
Dear Professors at the University of Arizona ADN-MSN program, all of you have
brought forth numerous ideas and scholarly guidance for myself, this nurse who had been out of
college since 1985. In the beginning I had concerns about completing this program but I should
graduate with a 3.9 and an intact mind, body, and spirit. I wanted the educational credentials to
put along side my 30 years of critical care nursing. The achievement of my personal goals truly
amazes me and I wish to thank you all. I have become a role model for furthering ones
education, not only for my fellow RNs/RTs at work but also for my family. Strengths I

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developed throughout this program include the ability to research articles, interpret the data, and
apply to my practice. My mind was opened up to holistic nursing and I will forever be grateful
developing that skill for my own life and as a future leader in healthcare. Learning to write and
read at the graduate level through scholarly papers and discussions has improved my clinical
discussions at the CCL. With this degree I have a vision of advancing to the CCL nurse
educator/resource position, bringing the most recent evidenced based knowledge to our facility,
and being a strong leader for improved healthcare in the CCL. I am applying for a Doctor of
Nursing Practice (DNP) program this fall and would like to express that it is partly because of
the inspiration exhibited by the nurse leaders that I have encountered in this program.

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7
References

Crowell, D. M. (2016). Complexity leadership: Nursings role in health-care delivery (2nd ed.).
Retrieved from https://play.google.com/books/reader?
printsec=frontcover&output=reader&id=1IezCgAAQBAJ&pg=GBS.PA157
Dearholt, S. L., & Dang, D. (2012). John Hopkins Nursing Evidence-Based Practice: Model and
Guidelines (2nd ed.). Indianapolis: Sigma Theta Tau International.
Dewar, B., & Cook, F. (2014). Developing compassion through a relationship centered
appreciative leadership program. Nurse Education Today, 34, 1258-1264.
http://dx.doi.org/10.1016/j.nedt.2013.12.012
Jackson, C., & Latini, C. (2013). Touch and hand-mediated therapies. In B. Montgomery Dossey,
L. Keegan, C. C. Barrere, & M. Blaszko Helming (Eds.), Holistic Nursing A Handbook
for Practice (6th ed., pp. 417-437). Burlington, MA: Jones & Bartlett Learning.
Maryland, M. A., & Gonzalez, R. (2012, January 31). Patient Advocacy in the Community and
Legislative Arena. The Online Journal of Issues in Nursing, 17.
http://dx.doi.org/10.3912/OJIN:Vol17No01Man02
Quinn, J. F. (2014). The integrated nurse: wholeness, self-discovery, and self-care. In M. J.
Kreitzer, & M. Koithan (Eds.), Integrative Nursing (pp. 17-32). New York, NY: Oxford
University Press.
Stanhope, M., & Lancaster, J. (2014). Public Health Nursing Population-Centered Health Care
in the Community (8th ed.). Maryland Heights, Missouri: Elsevier Mosby.
Tillett, J. (2011, April/June). Practicing to the Full Extent of Our Ability. Journal of Perinatal &
Neonatal Nursing, 25, 94-98. http://dx.doi.org/10.1097/JPN.0b013e318217ed3c

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Watson, J. (2014). Caritas Nursing: Taking Time/ Making Time [Video file]. Retrieved from
https://www.youtube.com/watch?v=5j707OGRBbg&nohtml5=False