Running head: MIDPOINT CLINICAL JOURNAL 1

Midpoint Clinical Journal

Precious White

Cedar Crest College

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Journal 1

Clinical Goal #1- By the end of the practicum experience the student will perform at least 4 new

nursing skills under the supervision of the preceptor.

I have met this goal partially by completing two new skills thus far. I was able to

successfully put in a Foley catheter and change an ostomy bag. Before placing the Foley in, I had

to remind myself of the steps prior to, especially what I could and could not do once I was

sterile. The last time I walked through this skill was during my mother/baby rotation which was a

while ago, so I was both nervous and excited at the same time. Once it was time to advance the

catheter into the urethra, I had a hard time finding it. The woman was a bit older, therefore

harder to distinguish where the urethra was. But after realizing that it would not advance any

further, I took it out and tried placing the catheter a bit higher and was able to advance until urine

was visible. I don’t think I’ve been more ecstatic to see urine, in my life! It felt good for the

nurse to tell me that she was unsuccessful to place a Foley catheter on her first attempt, and that I

should be proud of myself. While doing this skill, I functioned in the role of a learner as my

nurse guided me until I completed the skill. The second skill I was able to achieve was changing

an ostomy bag. I wasn’t nervous at all before performing the task, maybe because my nurse and I

practiced beforehand. She was very creative and set up a demonstration by forming gauze pads

into a circle shape and taping it to the table; this was the stoma. Then, we practiced measuring

and cutting the sticky pad that would go onto the patient’s skin around the stoma. After that, we

then practiced applying the bag onto the sticky pad and making sure that the device was

completely secured. These steps are what I followed when in the patient’s room and doing it in

real time. In this task, I functioned as both the learner and teacher. The learner aspect because I

had to learn how to do something I’ve never done before. But, the teacher aspect because I
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educated the patient on: hot to change the bag, when was the most appropriate time to change it,

why applying the barrier cream was important, how to deal with the odors that may come with an

ostomy, and the importance of confidence in self-body image.

Clinical Goal #2- By the end of the practicum experience the student will completely care for 4

patients during the entire shift.

I have met this goal more than half way by completely taking care of three patients

during the entire shift. After getting morning report on all six of our patients for the day, I decide

which three I want to take, and my nurse then takes the other three. From there, I look up any

information on the patients given in report that I’m unsure of to obtain a better picture of the

situation. Then, I prioritize my day by deciding who I will see first by acuity, meds, procedures,

and other needs. Before starting any patient care, I get ready for huddle by marking down: the

code status of each of my patients, whether they are on telemetry with ending date, if they have

any central lines, if they have any Foley catheters, their Braden and Fall scores, whether they’re

on isolation precautions, if they’re on any high-risk medications, and if they’re due to be

discharged. I then give this information to the unit leader during huddle and am now ready to

start my day. I’ve organized, with the help of my nurse, how to go about my day. All my

assessments, morning meds, and morning procedure checklists are completed by 1030; which is

when Doctor Rounds begin. During Rounds, the progression of care while in the hospital is

discussed about each patient as well as once they’re discharged and what they’re going to need to

succeed. I’m able to: update the doctors on how my patients are doing, if they’re regaining bowel

function, if they’re tolerating meals, if they’re up and walking, if I think a rehab is appropriate

for my patients, etc. After Rounds: I chart, reassess pain, and complete any other outstanding

tasks. I give insulin before lunch and help order food trays for those that can’t. If a churn nurse is
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available, we’re able to take a lunch ourselves. After lunch is just more reassessing, meds,

charting, and procedure checklists until the shift is over. I also complete any telemetry strips for

my patients. At the end of the day, I like to evaluate the care plans utilized and reflect on what

went well and what could have gone better. With completely taking care of three patients, I feel

awesome and like I’m heading in the right direction of becoming an independent nurse. At times

I feel a bit stretched thin. At times, with one patient needing a bit more attention than the others,

I feel like I’m not giving as much therapeutic time to the others that are more stable. But when

I’m able to clarify for families what is going on with their loved one because most of my time is

spent with them, that makes me feel delighted and makes it all worth it. This is just an example

of how I structure my day and have attained the objectives leading up to the second goal

developed for the practicum experience. For this goal, I have functioned in the role of the

communicator, leader, advocate, and collaborator. As described above: I have communicated

with the family about their concerns and relayed that information back to the doctors, I have

been a leader by deciding the care my patients need and speaking about it during rounds, I have

advocated for my patients during rounds in stating my personal experience with a particular

patient and how he wasn’t being difficult but just needed a different approach to care, and I have

collaborated with the doctors and physical therapists to get a particular patient from needing a

heavy assist of two to just one person and his cane.

Clinical Goal #3- By the end of the practicum experience the student will delegate appropriate

tasks to hospital personnel, when necessary, during the entire shift.

This is a goal that I’m still working on but can remember two specific examples in which

I attained this goal. One, is delegating to a tech to make sure the blood sugar for a patient was not

taken so early in advance. I told her that I understand that she has tasks to complete as well. But,
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if a patient isn’t eating lunch until after 1pm, then having the sugar completed at 1100 was a bit

reaching. So, I kindly asked if she could obtain my patient’s blood sugar closer to his tray

arriving next time. I felt a bit weird at first, telling/asking her what I needed to be done. But then,

I didn’t feel as bad because I realized that it’s my patient that’s priority and their insulin

correction and coverage needed to be accurate. The other example was notifying and delegating

to my nurse preceptor that I had a push med in the morning, and that I would take care of

everything else but that specific med due to my restrictions as a Cedar Crest student nurse. I

told/asked her to give the med when it was due; which she understood and gave it. Delegation

makes me sometimes feel like that person is thinking that I think they’re inferior to me, but I

must realize that everyone has their own role and responsibility in taking care of the patients, and

that is what’s most important. During these examples, I functioned in the role of a leader and

advocate. I was able to be a leader and advocate by speaking up for my patient concerning his

blood sugar and making sure that he was being adequately covered by his insulin, and I was able

recognize my own limitation with giving meds and took the leadership role in assigning that task.

Personal Development Plan Goal- By the end of the practicum experience, I will make at least 3

decisions for 3 different patients based on assessments and changing health status.

I have met this goal partially in only making one decision on my own about a patient. I

had a patient who was complaining of severe right shoulder pain and nothing we gave her

relieved the pain. The patient tried morphine, tramadol, Tylenol and even an antispasmodic

agent. I acknowledged the patient’s pain but also felt like it was more a mental thing. So, I

suggested ice and the patient agreed to try it. I also realized that the patient had hand-drawn cards

all around the room from her grandson and so sparked a conversation about that. Between the

ice, laughing about what young kids do, having the tv on as a diversional tactic, and offering to
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rub BenGay on the area, the patient recovered much more quickly than with the pain meds. She

seemed happier and more willing to do things. I can’t say for sure if she was drug seeking, but

sometimes alternative pain management helps the person from within rather than pain meds. It

felt good to have the doctors come around and say that they were astonished a nursing student

could “figure out the problem” and that going home was now back on the table with the

willingness of the patient to participate in their own care plan. During this example, I functioned

in the leader, advocate, and researcher role. I was able to be a leader and an advocate by not just

treating my patient the way everyone else was (as being a drug seeker), but by focusing on what

could be done to make things better. I didn’t ask my nurse preceptor for permission in any of

these actions (other than to be with me to give the BenGay), but rather took leadership and

decided what I could do to try and help. Lastly, I was a researcher by looking up information in

the patient’s medical history and chart about pain tolerance or family support at home, and even

just researching around the room to see what the patient’s life was about.