Reflection of practicum experiences

As part of my graduation requirement I had the opportunity to complete practicum

hours for both population and community health and my final nursing capstone class. In each
class we pick an area of interest to follow a preceptor.
A summary of the practicum experience is as followed for my population and community
health class:
I spent my time with the nurse educator at Christiana Care VNA. It was interesting to see
a different view of community nursing. She was responsible for education of new staff,
developing new practice documentation, and education in the community. She was responsible
for meeting new practice requirements for Medicare documentation she was given the
assignment and had to figure out with her manager on how to meet the requirements. I didn’t
realize all that went on behind the scenes in the education department. I observed her role of
supporter to new staff. She had developed monthly calendars for each new staff member
carefully planning their education. She had weekly meeting with new staff member to review
how they are during in there orientation. I saw further in depth education on the admission of a
patient. She was responsible for education of the community she was developing a CHF
education class for the community. I saw her concern for new staff and the education that went
into that both the classroom and the home. We went on visits with staff completing medication
reconciliations, checking off skills and best practice for education of the patients. This is really
important for patients to manage their care in the home. In home care it so much more focused
on education of the patient to manage their chronic disease. Many of these patients are elderly
and lack resources needed in the home. The nurse also plays a role in monitoring and education
on wound care. It is also important to educate on signs and symptoms to report to the physician
and importance on follow-up care. It is emphasizing empowering the patient to take control of
their health.
I think some of what I learned doing my practicum experience that I can apply to my
current practice is that it is important to further recognize the role I play in education and
encouragement of those new nurses. The educator worked really hard in her part of their
orientation but then when they get to the field they still need support and encouragement and
those nursing willing the educate them, In community nursing there is a great need for nurses to
care for this population of people. I think also I can encourage my patients to take part in the
follow-up education and seminars that are offered locally at hospital or community centers to
further reinforce the education in the home.
 During my practicum experience for my nursing capstone class my experiences were
varied with time spent with a nursing instructor, a supervisor at Christiana Care and a Cardiac
Conference a summary of each day is as follows:
Date: February 8, 2019

Objective: CCPO #1 CCPO #5

PCG #2 PCG #3 PCG #3 PCG #7 PCG #9

I spent this time in the classroom at the beginning of the day the lecture was on Coronary
Atherosclerosis. I observed multiple teaching methods I was impressed how multiple techniques were
used to educate the students it wasn’t just lecture but models of diseased heart, interactive questions
for review that the class could compete in, even a small group presentation. I talked with the instructor
about it later, and she added the quick group presentation in because that was the area the students
missed on their exam, I learned how the tests are reviewed and ideas for improvements made. That the
students were expected to be accountable for their learning but were given the tools to succeed. I
observed how the instructor was able to assist the students in learning that she was available for the
student to review an exam, but it was more about getting that student to think about the answers and
even giving study tips and ways to combat her test-taking anxiety. I observed the instructor also
mentoring follow a coworker who was transiting into a full-time role giving her ideas and tips in a
positive way. As I went through my day, I learned a lot about communication and being a leader not only
to the students but coworkers.

Date: February 19, 2019

Objectives: CCPO # 1 CCPO #2 CCPO #3 CCPO #4 CCPO #5

PCG #1 PCG #2 PCG #3 PCG#4 PCG #4 PCG #6 PCG #8 PCG#9

This was a clinical day, and it was an eye-opening. I didn’t realize how much work goes into planning and
preparing for your day. The instructor had to be a leader to her students and make sure not only the
patient cares and safe but provide a good experience for her students. She provided a charge nurse role
to one of the students to get them learning about leadership. She had to make sure the students knew
all about the medications given and gave them safely while encouraging them. She was faced with many
challenges one student pushed a flush just too fast after an medications, and she had to use her
judgment on how to address this in a way that was respectful to the student but also expressed her
concerns and clear expectation. One student was not completing her task and was rude with her
response, and she had to walk away to avoid that conflict but then again address that later with the
student. She spent time explaining things took time to talk with the patients and showed the student
how to approach education with that patient. I saw how as the instructor you needed strong leadership
skill and remain focused at all times. The day wasn’t finished when the students left the floor it was
post-conference time. One student had a really difficult time supporting a patient family on the
healthcare choices regarding a patient with a poor prognosis the student was just very direct on their
objection of this care and it turned into the ethical discussion on as the nurse what is your role. Then
there was also a discussion on bullying in the workplace and how to prepare for this. These were a real-
life problem that needed to be discussed and the students needed the tools on how to address these
concerns. It was a great experience to see the dedication of the instructor of not just teaching the
students but empowering them to become better nurses and better prepared for their future careers.

Date: February 25, 2019

Objectives: PGC #1 PCG#2 PCG#3 PCG#4 PCG#7

CCPO #1 CCPO #2 CCPO#3 CCPO #4 CCPO #5

This time was spent in the classroom this was a presentation day on ethical issues in healthcare such as
the right to an abortion after rape, the right to choose euthanasia and advanced directives. It was a
really good exercise to teach issues as a nurse you will encounter in our practice. It gave the instructor a
chance to guide the student in further discuss and teach the student. The students were able to see
how as nurses they are responsible for guiding our patients without pushing our belief but educating our
patients in a framework of ethical issues in nursing. After class, the instructor's role continued opening
quizzes and counseling and student who had questions. I was impressed with the effort the instructor
gave in grading the presentation she took the time to write notes and review post giving feedback both
for improvement and encouragement for a job well done. I also took part in honor society meeting as
the instructor you hold many roles not just as a leader to your student and peers but to others in the
college to act as a club advisor and even though this may not have been a task she was interested in. As
the professional, she put in the effort and was generally interested in what was taking place in the
meeting giving ideas and suggestions. I learned so much about being a leader and the role as a nursing
instructor.

Date: March 1, 2019

Cardiology Conference

This was a bit different experience but something I enjoyed which surprised me but definitely something
I want to attend again. Not all the presenters applied to my practice but they were interesting and
things that were important to know. Throughout the day I learned about different topics. I learned
about the TVR procedure that was much less invasive way to fix valve problems. I learned about policy in
health care from Senator Koon’s how there is so much that goes into healthcare changes, but it is about
speaking up and trying to do your part to make a difference. I learned about a new idea in Cardiac care
such as is baby aspirin always appropriate. The use of blood sugar meds Jardiance and Invokane to cut
cardiovascular risks. I learned more about the use of cholesterol medications the reason behind
prescribing and that is one of the best ways to prevent the need for cardiac stenting something
important to share with patients when they wonder why they should bother with cholesterol
medication. The importance of zero harm and the consequences of not looking for new ways to
improve. There was even a presentation on how to take a correct blood pressure according to the AMA
guidelines and if the patient has a borderline BP scheduling just a check to take a proper BP. Overall it
was a good experience and a way I can see to incorporate continued learning into my practice in a
meaningful way to keep informed both for my professional growth and also to educate my patients.

Date March 3, 2019

PCG #1 PCG#2 PCG# 3 PCG#4 PCG#5 PCG#6 PCG#7 PCG#8

CCPO #1 CCPO #2 CCPO #3 CCPO #4

This day was spent at the office at Christiana Care following one of the managers. There are a lot of
responsibilities that I didn’t even realize. There was the basic housekeeping task such as reviewing
charts, making sure note are entered and completed, and reviewing discharge instruction to met oasis
guidelines. Then it was reviewing orders coming in from MD offices then making staff aware. She had to
field calls anything from a patient feeling light-headed to a cut on a finger she as the triage nurse
decided what was needed for this patient. I observed a telemonitor meeting reviewing patients
admitted to the services and ideas for improved communication between staff in the field and the
telemonitor station. Through the days she had calls from staff regarding questions and concerns it was
about remaining calm and professional then giving direction as the situation directed. It was a busy day
she also tried to work on schedules and approving requests for time off while keeping adequate staffing
levels for each day. Overall I can see the importance of being a strong leader at the same time
advocating not only for the patients but the staff you are responsible for. It also required the use of your
clinical skills and knowledge to be able to effectively triage the patients calling into the office because
you don’t want to dismiss something critical but also not waste resources if it is indeed something that
can wait.

Date: March 19, 2019

PCG #1 PCG#2 PCG# 3 PCG#4 PCG#5 PCG#6 PCG#7 PCG#8 PCG #9

CCPO #1 CCPO #2 CCPO #3 CCPO #4 CCPO #5

This day was a review of clinical and lab in the classroom. The class started with a medication quiz that
was able to be reviewed later in class. A review of clinical rules and guidelines this for me was
interesting to observe having already observed a clinical day to see what happens in the classroom
before this experience was interesting the instructor was able to give instruction and examples on how
to be professional and get the most out of your clinical experience. Then they had a lab demonstration it
was on IV administration. Before starting the instructor had IV fluids bags in a cart and split the class into
teams, and they were each given cards with different fluids, and it was a race to see who could get them
first. It was just another way to review IV fluids because picking up incorrect fluids had caused students
to fail in prior clinical check off. I learned how it is always a process on how to improve teaching skills
and look at results. The demonstration of the IV check off was next with each step performed and
discussed this allows the students to visualize the skill then practice it in the classroom with the
instructor answering questions. It was a good reminder of how learning is always a process and what
works for one student may not work for the next student. That as the instructor you want your students
to succeed and to do that you need to use different methods of teaching.

Overall my practicum experience was a really good experience it allowed me to experience new
aspects of nursing and further recognize some of the teaching we have been learning in the class such as
leadership skills, evidence based practice and even experience a good way to have continued learning
outside of the classroom by attending conferences offered so you can stay current on your nursing
knowledge.