Running head: PRACTICE SUMMARY 1

Practice Summary Paper

Laura G. Stewart

Old Dominion University

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Practice Summary Paper

After completion of a diploma-based Registered Nursing (RN) program in 1999, I felt

very well-prepared clinically with a solid knowledge base regarding pathophysiology and disease

process. I gained leadership experience through operations and education positions, when a

Bachelor of Science in Nursing (BSN) was not required for these types of positions. As the trend

for requiring BSN prepared nurses became apparent, I pursued completion of my BSN for job

security and flexibility as I progress through my career. At the start of this endeavor, I felt a pull

toward education. I feel that strong clinical skills are paramount to early success as a nurse. As I

navigated the RN-BSN program, I discovered a particular interest in research and as I approach

completion, I do feel my goals may undergo a change.

Analysis of Outcomes

Several areas exist to support attainment of the outcome behaviors as set forth by the RN-

BSN program. These behaviors, termed “The Great Eights,” describe end-of-program outcomes

which house specific criteria to be met throughout the program.

Critical Thinking

Attainment is defined as a demonstration of critical thinking to facilitate nursing practice

through inquiry, problem solving, and synthesis. Critical thinking skills are essential to problem

solving for the best possible outcome. This was developed by applying the Christian values and

philosophies that I live by in my every-day life to my practice. Critical thinking skills were

applied in the practice setting to aid decision-making for clinical and professional judgements.

The MORAL model was utilized to drive decision-making when considering whether or not to

solicit parental involvement (professional judgement) when I felt that reported concerns over

clinical assessment changes (clinical judgement) were being overlooked. The model guided me
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through three options that included deferring to the medical team, following the chain of

command to express concerns, or enlisting parental assistance in support of family centered care.

The model drove the decision to follow the chain of command as a first step, with enlisting

parental help as a last resort. This successful decision resulted in maintaining both the integrity

of the medical team and parental trust.

Nursing Practice

Attainment is defined as the performance of therapeutic nursing and interdisciplinary

interventions to deliver nursing care in the cognitive, affective, and psychomotor domains.

Interventions that address all three of these domains will guarantee the promotion of health with

a holistic approach. A person is more than just their disease process. Care of the pediatric

population requires that I include the family in every aspect of care. Providing holistic care to

diverse populations across the lifespan was accomplished in the practice setting when caring for

a Muslim family with limited English proficiency, where explorations of culture and theory

assisted with addressing the language barrier to facilitate holistic nursing care. Holistic care

involved assessment of culturally-driven parent desires regarding care practices, emotional

support through social work consult, and evaluation of available resources. Explorations of

culture and theory also re-enforced holistic care practices that served to facilitate the use of

complementary modalities such as teaching parents and family therapeutic touch or infant

massage and including them in every-day basic care, which can be useful in promoting the health

of both patient and family regardless of age or culture.

Nursing care practices to provide holistic health care to diverse populations across the

lifespan were also explored through a group research proposal for NURS 363 (Research as a

Foundation for Practice). This involved providing therapeutic interventions to adults of all
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ethnicities post cardiac surgery to prevent intensive care unit delirium. A holistic approach

addressed the physical, functional, and neurological needs to prevent delirium. Interventions

included promoting sleep, decreasing noise levels, performing/promoting sleep hygiene,

providing ear plugs, and therapeutic pharmacology for pain management rather than sedation.

Communication

Attainment is the justification of verbal, non-verbal, and written communication

techniques appropriate for clients and professionals. Without effective communication skills,

therapeutic relationships can falter. Peplau’s Theory of Interpersonal Relations illustrates

concepts of therapeutic communication. Four phases of the theory (orientation, identification,

exploitation, and resolution) were addressed in a theory application paper for NURS 306

(Theoretical Foundations) in relation to family-centered care in the NICU. Each phase requires

therapeutic communication within the nurse-parent relationship that builds upon itself to achieve

the next level. The special needs of this population require identification, clarification, and

verification, and must be adapted based on which phase the family presents from.

Nursing informatics enhanced communication by providing several outlets for improving

skill with using technology and evaluating different communication techniques to support safe

nursing practice. Simulator explorations, an exploration of the use of Self-monitoring, Analysis,

and Reporting Technology (SMART) cards in healthcare, evaluating data breeches, and

comparing educational websites utilizing the Patient Education Materials Assessment Tool

(PEMAT) met this goal.

Teaching

Attainment involves utilizing teaching strategies to maximize client health and enhance

professional development. In practice, I am presented with patient families and professionals in

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different stages of acceptance and knowledge level. Using the nursing process to formulate a

teaching plan has helped me take a more systematic approach to assessing need and tailoring

education when providing teaching to patients and other professionals about health care

procedures and technologies in preparation for and following nursing or medical intervention.

Clinically, a situation was encountered regarding an infant’s need for a gastrostomy tube to be

placed for poor feeding. Family preparation before and teaching post-procedural care of tube

placement required individualized teaching plans based on assessment of knowledge level and

learning style of each family member. One family member had prior medical knowledge, the

other did not. Also, professionally, I precepted two nurses with different levels of experience.

Both situations required an assessment of prior knowledge and preferred learning style in order

to maximize teaching of care procedures (such as for taking a ventilated child to the operating

room) and technologies (such as our hospital-specific pumps and cardiorespiratory monitors).

Sensitive and relevant health education information and counseling to patients and

families was accomplished in clinical practice. Sensitivity is understanding that each person

brings with them a unique perspective, different levels of understanding, and varying

expectations. Sensitivity was shown during a conversation with a drug addicted mother

regarding the challenges her infant will likely experience as a result of her drug use. By

presenting the information in a factual but compassionate, non-judgmental way, sensitivity was

exemplified. With this same situation, offering social and emotional support and resources

specific to her addiction accomplishes relevant counseling and information to help her maintain

her own health. These concepts have been supported through study of teaching strategies.

Research
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Attainment involves incorporating nursing research findings as a basis for therapeutic

nursing interventions. Without evidence to support our stance on any given subject or practice,

we cannot guarantee that we are offering the best, most appropriate care to our patients and

families. Culturally sensitive practice was enhanced through application of research-based

knowledge to develop a teaching plan for a Hispanic mother faced with a newborn diagnosed

with Down’s Syndrome. Research supported that this culture is more likely to have decreased

access to support and genetic services, and that family decisions are typically deferred to

authority, which makes this group less likely to ask for help or question what they do not

understand (which is exacerbated by language barrier). Using this knowledge to assess her

available resources, her understanding of Down’s Syndrome, and ensuring she understands the

information she is given supports culturally sensitive practice through research.

Leadership

Attainment involves demonstration of self-direction, professional accountability, and

advocacy adhering to legal and ethical nursing practice as a novice nurse. Not every nurse

possesses the qualities that define a great leader, yet it is important to be able to recognize these

qualities and apply them to specific situations in your practice. In NURS 401 (Introduction to

Professional Development), an oral presentation with accompanying power point presentation

articulated the values of the profession and the role of the nurse as part of the interdisciplinary

team. The Professional Image of the Nurse was a discussion of the progression of the values of

the profession from a historical perspective, from the time of Christ through history to the

present. The teachings of Jesus encouraged holistic, compassionate care as the work of God and

not for selfish ambitions. Caregivers were members of the church and family who held these

Christian ideals. Later, as secular women entered the profession, the ideals remained, though
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credit for these ideals was not often given to these Biblical concepts. In this presentation, there

was discussion about how your view and strength of self will carry over into your practice and

professional identity and we must ask ourselves if we exemplify the long-held values of nursing.

In order to be a valuable member of the interdisciplinary team, one must always take strides to be

familiar with their patients’ conditions and treatment options so that they may contribute in a

useful way to the care plan. To be effective, we must be mindful of our approach to ensure that

interactions are respectful. We always have something to offer and do not need to be territorial

with our knowledge. As a teaching hospital, nursing staff often has more knowledge than

resident physicians. It is perfectly appropriate to share knowledge.

Delegation, supervision and accountability are key concepts in developing leadership. As

a charge nurse, I assist staff with the admission process. During an admission, I must safely and

appropriately delegate position-specific tasks to nurses, care partners, and other support staff. I

also make rounds to each nurse multiple times throughout my shift to supervise the nursing care

given by others to ensure that patient needs are being met, and to evaluate the knowledge-level

of the staff. Retaining accountability to staff and patient/family for the quality of care is

provided through follow-up of assigned task completion and through addressing staff and parent

concerns in a timely and professional manner.

Professionalism

Attainment involves demonstrating advocacy, accountability, and adherence to standards

of practice and legal and ethical principles. Utilizing these criteria in everyday practice can

make a significant difference in your ability to advocate and deliver safe care. These concepts

were explored through the analysis of a video regarding delegation and understanding was

exemplified through a discussion board narrative. This exploration re-enforced understanding of

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the legal standard differentiating between assignment and delegation, and evaluation of the

actions of those in the video exemplified understanding of the regulatory standards set forth by

the Virginia State Nursing Practice Acts and the National Guidelines of Nursing Delegation.

Demonstrating accountability for my own professional practice involves using the five rights of

delegation (right task, circumstance, person, directions/communication, and

supervision/evaluation) to determine if a task falls within the scope of practice. Understanding

of these concepts was demonstrated when delegating tasks during an admission. A particular

NCP was new and unsure, and I found assigning tasks to her inappropriate and ineffective. I

called for a more experienced NCP to assist her, which enhanced her learning while maintaining

an effective team. Often in the NICU, several tasks are being carried out simultaneously, which

requires assignment of these tasks to multiple nurses during the admission. I was accountable for

using the five rights of delegation to choose the most appropriate person for each task. Though

many tasks are standard to most admissions, I demonstrated knowledge of the limits to my own

practice by confirming these tasks with the medical practitioner first before carrying them out or

delegating them to other staff.

Aspects of this outcome were also met through application of an ethical decision-making

framework and legal guidelines to a clinical situation that incorporated moral concepts,

professional ethics, and advocacy for patient well-being and preference. A group exploration of

these concepts was applied to an ethical and professional dilemma regarding family dynamics

and genetic counseling. A discussion of the pro-perspective, con-perspective and nursing

responsibilities provided an ethical decision-making framework for this case where a patient

diagnosed with Huntington’s Disease refuses to notify potentially affected family members.

Legal guidelines were explored through the Health Insurance Portability and Accountability Act
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(HIPAA). Moral concepts discussed included the repercussions of not telling the patients’

family members about a diagnosis that could potentially impact them. Professional ethics were

explored through the duty to warn versus confidentiality and HIPAA regulations. Advocacy for

well-being and preference were explored, and a plan was formulated for providing genetic

counseling to the patient, with emphasis on the familial tendencies of the disease of the

responsibility to notify family, while respecting patient wishes to not share his diagnosis.

Culture

Attainment involves demonstrating cultural awareness and sensitivity. Having an

awareness of different cultures present in our practice is essential to providing equal levels of

care to all. Certain aspects of this outcome were met in a case study on Hispanic culture and a

diagnosis of Down’s Syndrome in NURS 455 (Genetics). Through the application of research

findings regarding Hispanic culture and their views of Down’s Syndrome, integrating knowledge

of cultural diversity into nursing interventions would lead us to assess her current knowledge of

Down’s Syndrome and its’ genetic implications, as well as advocate for providing proper

services for the future.

This emphasis on cultural exploration has helped me demonstrate sensitivity when

considering an individual’s reactions to illness experiences and end-of-life. As a Christian, I

accept that I may not understand why illness or death occurs, but I have a peace that there is a far

greater force at work. I have encountered a situation where my explorations of cultural

sensitivity helped me accept the end-of-life response of a parent that does not believe this, and

that I can still be a comfort in a neutral way.

Summary
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Having been away from a formal educational environment for nearly two decades, I had

no basis of comparison for my expectations of learning from the program. The reality for me

was simply the realization that my past motivations and desires to deliver competent care over

and above what was required of me exposed me to nearly every aspect of the program goals, to

some degree. This, greatly influenced by my Christian value system, afforded me a strong

foundation for success in this program. Rather than the acquisition of any particular skill that I

feel was acquired or not acquired, I feel that my growth and development was most influenced

by learning the importance of research and how cultural awareness can improve practice. In my

current role, I experience change in practice on a regular basis, with little support offered as to

why. My learning from the program has influenced me to be pro-active in determining the why.

The explorations of nursing theory lead me to the conclusion that, while I appreciate the

concept of formal nursing theory, the basis of most theories have a clear association with

Christianity. These are all concepts with a direct correlation to the belief system I try to live by:

caring for humankind, the giving of yourself for the benefit of another, care of the mind, body

and spirit, doing all things to the absolute best of your ability without prejudice. It has been

satisfying to have my beliefs validated in this way.

My enrollment and completion of the baccalaureate nursing program has resulted in both

subtle and significant changes in my practice. More subtly, I have found myself striving to add

cultural sensitivity during my interactions with the families of my patients. I make more of an

effort to ensure understanding of the interventions being performed and take strides to connect

them with any resources available to them. More significant is my desire to research the

foundations for practice change: more than just broad internet searches, but sound, reliable

research. This will prove fundamental to any aspirations I may have for my future practice.
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Conclusion

As the program comes to completion for me, I am confident that the end-of-program

outcomes were successfully met. Self-reflection has afforded me the ability to evaluate how my

experiences as a nurse correlate with my belief system, and how that correlates with nursing

theory. Self-evaluation has left me with a confidence that certain aspects of my learning have,

and will continue to, influence my future practice, regardless of the path I may follow in my

future endeavors. The flexibility and stability for the future that my BSN will afford me makes

the effort a worthwhile endeavor.