NUR 206 – CLINICAL SKILLS APPLICATION

REFLECTIVE JOURNAL ASSIGNMENT NUMBER 2

Summer 2010

The goal of the reflective journal writing assignment is to provide an opportunity for student nurses to practice the
skill of reflection in their nursing practice, in order to become more proficient in thinking like a nurse. Reflection is
a skill that involves taking the time to pay attention to the moment “on purpose” in order to notice all the significant
data in a patient care situation, thinking about the situation after it occurs in order to increase understanding of the
total situation, as well as increasing self-awareness of the nurse’s response to the situation. Reflection can be a
building block that leads to evidence based patient centered nursing care and maturing clinical judgment.

Directions:

For each course objective, answer all of the questions related to the objective. Journal entries must address
all course objectives.

Course Objective 1: Minimize risk of harm to patients and providers by implementing individual safety
measures and participating in safety promotion at the facility level consistent with the PN
and ADN dimensions of practice.

A. What new skills did you perform during the last two (2) clinical days? Review each skill using the
agency’s policy manual and related texts/ resources to make sure you are performing the skills
correctly and competently. What variations did you find in the policy manual and what you were
doing? Were the differences you found acceptable variations or are there changes you need to correct
in your practice? Explain your answer.

The new skill performed involved discontinuing an IV catheter site and applying dressing for

catheter site care. All IV sites must have dressings. Both gauze and transparent dressings are

acceptable for peripheral intravenous lines. A variation that I learned from my nurse is, when

removing transparent tape, to pull the corner so the tape stretches, making it easier to release it

from the skin. This variation is acceptable; if anything, it reduces the amount of discomfort

caused by irritation of the skin that patients normally feel when transparent dressing and tape are

removed from IV sites.

B. Give an example of using technology to promote patient safety. How did this contribute to
patient safety?

A great example of technology used to promote patient safety is the Hover Jack. It is a

floor-to-bed lifter that can be used to raise patients who are injured or have fallen. The

technology behind it consists of four connected inflatable mattresses stacked on top of each

other. They inflate from the floor upward to the height of a bed. Patients can be transferred

bedside by using the Hover Jack equipment. Using proper body mechanics and taking the time

Dec-21 40854806.docx
to use the appropriate equipment in the transfer and repositioning of patients reduces the risk of

injury for both nurses and patients. Patient transfer is an important component of medical care.

The Hover Jack contributes to patient safety by helping to transfer patients who have fallen,

particularly in instances in which moving them could cause further injury.

C. Describe a policy that is practiced in the facility where you are assigned (a policy that applies to the
entire facility) which promotes safety for all patients and staff in the facility. What is the rationale for
the policy?

Minimizing self-administration of medications is a policy practiced in the facility. The

policy promotes safety for all patients and staff in the facility. The rationale for the policy is

That self-administration of medication should be minimal because it decreases accountability,

creates a potential for overuse, and increases the hospital’s liability.

Course Objective 2: Demonstrate a working knowledge of the nursing process when providing caring,
compassionate, coordinated patient-centered nursing care and promoting health in a diverse population consistent
with the PN and ADN dimensions of practice.

A. How many patients did you care for each time you worked during the last two (2) clinical
days? Describe their level of care.

On June 7th, I cared for five patients; they were in rooms 401, 402, 403, 404, and 406 on the
med-surgical floor. On June 9th, I cared for four patients on the Spine and Neurology floor; the
rooms 507, 514, 516, and 518.

Date of care: June 7, 2010

Patient #1: Room 401
Patient initials: M.R.

- Patient is an 89-year-old African-American male who came in complaining of a cough which

produced greenish phlegm and a fever of 102, accompanied by shaking chills 6/6/10.
- Patient admitted to hospital for progressive dyspnea and was a febrile.
-
Doctor suspects possible pneumonia.
- A chest x-ray revealed inflammation of the lungs and confirmed mild pneumonia.
- Patient is undergoing intravenous antibiotic therapy.
- He is at risk for falls.
- Independent in terms of his hygiene, feeding, showering, and elimination, but requires one-
person assistance with ambulating.

Date of care: June 7, 2010

Patient #2: Room 402
Patient initials: T.D.

- An 85-year-old Caucasian female brought by EMS to the emergency room for weakness.
- Patient complains of ataxia and tremors.
Dec-21 40854806.docx
- EMS personnel reported possible elder abuse and neglect to South Carolina Adult Protective
Services due to dirty and unfit living conditions.
- Has allergies to eggs and flu vaccine.
- Past medical history includes pyelonephritic UTI, hypertension, and hyperglycemia.
- She needs complete care in terms of her hygiene. Diet is consistent carbohydrate/GI soft/ low
residue; requires only set-up for meals and has a Foley catheter.
- Patient is considered a fall risk.
- Vitals and glucose monitored every 4 hours.

Date of care: June 7, 2010

Patient #3: Room 403
Patient initials: G.F.

- Patient is a 76-year-old African-American male admitted due to weakness caused by a second

round of chemotherapy.
- Past medical history includes prostate cancer, prostatectomy, congestive heart failure, and
hypertension.
- Doctor suspects cancer may have spread to lungs.
- A bone marrow biopsy was ordered, but patient refused to sign until he talked with his primary
doctor.
- He needs one-person assistance to get up and out of bed for ambulating, showering, and
eliminating.
- Vitals checked every four hours.
- Patient is on fall precautions.

Date of care: June 7, 2010

Patient #4: Room 404
Patient initials: I.W.

- Patient is an 84-year-old Caucasian female admitted due to severe vomiting and UTI.
- She was a transfer from Ashley River Oaks assisted living facility.
- Medical history includes Alzheimer’s and UTIs.
- Patient is a DNR and bloodless procedure patient.
- Requires complete care and fall precautions are in effect for her.

Date of care: June 7, 2010

Patient #5: Room 406
Patient initials: J.W.

- Patient is a 46-year-old African-American female presented to ER in full respiratory cardiac

arrest 4/16/10.
- Suffered brain damage resulting from cardiac arrest, then transferred to ICU.
- Medical history of sarcoidosis and syncope.
- Patient is on full code status.
- Requires complete care and is on fall precautions.

Date of care: June 9, 2010

Patient #1: Room 507
Dec-21 40854806.docx
Patient initials: W. M.

- Patient is a 52-year-old African-American with degenerative disc disease and lumbar stenosis.
- Posterior lumbar interbody fusion completed on 6/7/10.
- He has allergies to Ibuprofen.
- Patient is diabetic with a consistent carbohydrate diet.
- Independent for his hygiene, meals, and showering, but requires two-person assistance with
ambulating to bedside commode.

Date of care: June 9, 2010

Patient #2: Room 514
Patient initials: N.P.

- Patient is a 78-year-old Caucasian male, presented to emergency room complaining of right

sided weakness when it was admitted due to a stroke 6/8/10.
- He has allergies to adhesive tape.
- Patient history of hyperlipidemia, osteoarthritis, benign prostatic hypertrophy, diverticulitis,
and nephrolithiasis.
- Past surgeries include laminectomy in 2009, bilateral total knee arthroplasty in 2004, and
cholecystectomy in 1979.
- Patient has an altered mental status; he is on fall risk precautions.
- His diet is low fat and low cholesterol.
- Required partial assistance for set-up with hygiene, meals, showering, and requires two-person
assistance with ambulating to bedside commode.

Date of care: June 9, 2010

Patient #3: Room 516
Patient initials: J.P.

- Patient is a 44 year-old Hispanic male, recovering from surgery from lumbar spinal stenosis
(L-5 region) completed on 6/7/10.
- The patient has allergies to Latex.
- He is on a regular diet.
- Patient is independent in terms of hygiene, meals, and showering, but requires one-person
assistance to get up and ambulate.
- He will be discharged today.

Date of care: June 9, 2010

Patient #3: Room 518
Patient initials: B.R.

- Patient is a 66-year-old African-American female admitted for surgery due to cervical spinal
stenosis
- Surgical procedure for her anterior cervical discectomy and fusion was completed on 6/8/10.
- Patient has allergies to penicillin, aspirin, sulfa, and codeine.
- Patient is on fall precautions.
- She is on a regular diet.

Dec-21 40854806.docx
- Requires partial assistance for set-up with hygiene and meals and requires one-person
assistance with ambulating to the bathroom.
- She will be discharged today.

B.Select a brief patient care interaction (approximately 5 minutes) with a patient you have not seen before.
Immediately after leaving the patient’s room, make a list of everything you remember about the patient and
the room environment. Include observations of the patient, equipment (IV tubing, IV pumps, catheter bags,
etc), family members present and the condition of the room. After you have made the list, go back into the
patient’s room with paper and pencil and make another list of the same type of observations. When you have
time to compare the lists and reflect on your observations, answer the following questions:

1. What was the greatest difference in your 2 lists?

2. What was the most significant observation that you made on your second list that you omitted
from the first list? Why do you think this was a significant omission?
3. Are your two (2) lists more similar in this journal than in your previous journal? If not, what will
you do to improve your observational skills?

1) The greatest difference between my two lists is that my first list was much shorter. I found it

difficult to recall much because there were so many things in her room. The second list was

much longer; it included items that I had not noticed the first time.

2) A significant observation made on the second list that was omitted on the first list is that the

information board in the patient room had not been updated. It did not have the correct date or

the name of the nurse on duty; those are significant omissions. The board is a way for patients to

remain oriented to the month and date. Each patient should know which nurse is caring for him

or her on the current shift.

3) The two lists are more similar in this journal than in the previous journal. To increase my

observational skills, the next time I will try to recall the more obvious items and critical items

first; that may help me to be able to list more items the second time that I enter the room for

observation.

C. On a scale of one (1) to five (5), with one (1) being the least organized and five (5) being the most
organized, how would you rate your organization of nursing care during the last two (2) clinical days?
Explain the reason for the rating you gave your care.

I would rate my organization of care a 3 on the scale. Although I am not the least

organized, I am not the most organized; that is why I would rate myself in the middle. Although

I have noticed that the way in which I organize my nursing care has greatly improved, there is

always room for additional improvement. There are still things to learn from and on which to

work. At first, I was unsure of myself and how to go about organizing my days. I observed the
Dec-21 40854806.docx
different ways in which other nurses remained organized. I found it helpful to try to organize my

notes in ways similar to theirs. Soon, I began to adapt the skills that I needed and apply them to

my own patient care. I have noticed that, since I have learned better ways to organize my

nursing care, I have been able to better manage my time.

D.Describe a caring moment that you created for a patient, family member or significant support person
during the last two (2) clinical days. Go the second mile. What feelings did you experience as you created
this caring moment? How did you perceive the feelings of the individual receiving the caring moment? How
have you changed as a result of this caring moment?

A caring moment that I created happened while I was caring for my patient who had a

left-sided transient ischemic attack or stroke. The caring moment did not happen with my

patient; it was actually with his frantic daughter. When receiving report on the status of the

patient, his situation really hit home because my father had suffered the same type of stoke last

month. It is frightening to see a parent who you have viewed all of you life in one way as

possibly losing movement in the right side of the body and having difficulty speaking; it can be a

lot to take in at first. I remember that the first two weeks were tough on my dad, but, with a lot

of determination, he worked with the therapists and slowly made progress; now he is recovering.

His right side is still weak and he still requires therapy, but it’s only been a month, and he is

already driving again.

While working with my patient, I saw that same stubborn resilience that my dad had. In

the morning, when I came into his room to assist him, he insisted that he at least try to do some

of the things himself. When he got tired, he let me know; however, since it was only two day out

from his stroke, he was eager to return to his independent lifestyle. After I finished ambulating

him from his bedside commode and doing a linen change, my patient fell back asleep because he

was exhausted from all of the movement. While I was making him comfortable in his bed, I

looked up and saw his worried daughter’s face; she was observing his progress from the corner

of the room. I tried not to speak because I did not want to disturb my patient and was warned by

the other nurses that his daughter was known to be difficult with the nurses on our floor. Then

Dec-21 40854806.docx
she said to me, “You know, it’s so hard to see my father this way; he is very independent and he

is too proud to ask for help. I’m scared he won’t be the same”

I then realized that, since my patient was comfortable and taken care of, my new priority

was to be there for his daughter. I said to her, “I really can relate to how you are feeling. I just

went through the same thing with my father; he had the same type of stroke last month.”

She looked up and made eye contact with me. I could that tell she was reassured that someone

understood the worries that she felt for her father. “Really? And how is your dad doing now?”

she asked.

“Well, the first few weeks, his right side was weak; he still needs assistance, but, with

therapy, he slowly began recovering. Even though it’s been a month, the doctors said he worked

hard in therapy, and they gave him the ok to start driving again. I’m not sure what the doctors

have told you yet, but your father is in great hands and they are going to provide the best care to

help him recover. When I was getting him ready this morning, I saw that your dad is working

hard to try to do things himself. I have to check on another patient, but, if you need anything, let

me know. I will be back to check on your dad in 30 minutes,” I said as I smiled.

“That’s my dad: too stubborn and proud to admit when he needs help. Thank you so

much. It’s comforting to know that someone else knows how I am feeling and what I am going

through. I feel more hopeful and I know your hospital staff will do their best to help rehabilitate

him as best as possible. Thank you so much; you have no idea what kind of peace that brought

me,” she said as she smiled back at me.

Did you go the second mile? What feelings did you experience as you created this caring
moment?

I feel that I went the second mile after taking care of my patient because I was also

offering support to the patient’s daughter. I felt very connected to the patient, but even more

connected to the daughter since I had recently experienced very similar circumstances. I really

could relate to how worried and helpless she felt; I felt compelled to tell her she wasn’t alone.

Dec-21 40854806.docx
How did you perceive the feelings of the individual receiving the caring moment? How have you changed as a
result of this caring moment?

I perceived the feelings of the daughter as unsure, overwhelmed, and alone, but, once I

spoke to her, she became more optimistic and perhaps had more trust in the fact that the hospital

staff was going to provide the best care for her father. I think I have changed as a result of this

caring moment due to the fact that empathy allowed me to put myself in someone else’s shoes,

and that positively affected someone.

E. Discuss a patient care experience where the patient’s beliefs and values affected a health care
decision (action) made by the patient.

My patient care experience in which a patient’s beliefs and values affected a health care

decision made by the patient had to deal with a preference for bloodless medicine. Some people

elect not to receive blood transfusions or blood products during surgery. This approach is known

as "bloodless medicine." There are a number of medical and ethical reasons why patients make

this decision. Some may choose this protocol because of religious convictions, most notably

Jehovah's Witnesses, who believe that blood "stands for life, has special significance and should

not be misused." Their belief and ethical principles state that blood should not be removed from

the body and stored, nor should it be taken in by another person. Therefore, Witnesses do not

accept blood products containing plasma, red blood cells, white blood cells, or platelets. Another

reason for patients to request bloodless medicine involves fear for contamination in the blood

supply; this concern arose in the 1980s, when a number of hemophiliacs contracted HIV through

blood transfusions. Since then, public concern about infectious material transmitted through

blood transfusions has increased.

Dec-21 40854806.docx
Are your beliefs and values similar to or different from those of the patient in this situation? Would you have
made the same health care decision? Why or why not?

Although, I respect the religious and ethical beliefs and values of others, I do not share

the same views as the patient in this situation. Blood transfusions are safe, but, as with any

procedure, they do carry risks. Depending on the circumstances and assuming that the benefits

outweigh the risks, I would be willing to accept a blood transfusion.

Course Objective 3: Use evidence based practice to deliver optimal nursing care that reflects sound
decision making and quality improvement consistent with the PN and ADN dimensions of practice:

A. Choose one complex patient who interests you and review the patient’s chart carefully. Explain
how your knowledge about this patient’s pathophysiology, medications and treatment of a medical
condition influence your decisions about nursing care during the last two (2) clinical days. Include
diagnostic studies as well as lab values.

The patient who interested me was an 85-year-old Caucasian female brought by EMS to

the emergency room for weakness on 6/6/10. Her gait was ataxic with tremors and she had a

rapid pulse. When EMS personnel checked her refrigerator for medications, roaches came out.

They reported possible elder abuse and neglect to the South Carolina Adult Protective Services

due to the woman’s dirty and unfit living conditions. She was allergic to eggs and the flu

vaccine. Patient’s sacrum was red and her right heel was starting to blanche. When her glucose

was drawn, it was 656; her diagnosis was listed as hyperglycemia hyperosmolar nonketosis

(HONKS). I had never heard of the term HONKS; a doctor explained that HONKS is similar to

diabetic ketoacidosis (DKA); however, with HONKS, the patient is lacking ketones, so her or his

blood will not be as acidic compared to a patient with DKA. HONKS occurs in patients with

type II DM or there may be no previous symptoms of DM. People who have not been able to

control their diabetes are susceptible to it. Symptoms are commonly seen among older individuals.

It is manifested by dehydration, hypotension, changed consciousness, or coma. Due to high

levels of glucose, it, along with vitals, was monitored, every four hours.

Dec-21 40854806.docx
 The patient’s past medical history included pyelonephritic UTI, hypertension, and

hyperglycemia. The patient’s diet was a consistent carbohydrate diet that was GI soft and low

residue. She required assistance only to set up for meals and she had a Foley catheter. Test

results ordered included BMP; the results were as follows: NA: 138; K: 4.2; CL: 103; Co2: 30;

Glucose: 57 (low); BUN level was at 34, which was high. The results of her CBC test WBC:

9.2; RBC: 4.02 (low); HGB: 13.1; HCT: 37.2; MCHC- 32.6 (high).

I realized that the goal of treatment for this patient that influenced my decision about

nursing care was to correct the dehydration and get her glucose under control. It was also

important to improve her blood pressure, urine output, and circulation; fluids and potassium were

given intravenously. High glucose levels were treated by nurses through subcutaneous insulin

aspart (Lispro), fast acting insulin along with human isophane insulin, which was an

intermediate-acting insulin. Human isophane insulin works more slowly than regular insulin, but

it lasts longer. Isophane insulin is often used in combination with a shorter-acting insulin. In

some people with diabetes, insulin may be used alone or with other diabetes drugs, which are fast

acting insulin that are controlled over time. Due to the patient’s condition and risk for skin

impairment and breakdown, integrity was a concern; it was important to keep her skin clean and

dry. It was also important to reposition the patient at least once every two hours

B. Select one of the clinical nursing policies used on the nursing unit where you are assigned. Discuss the
scientific evidence (not clinical opinion) that is the basis for this policy.

The nursing unit to which I was assigned has policies on hand hygiene and infection

control. Hand hygiene is a method that is used to prevent person-to person transfer of

microorganisms. Hand washing, the use of an antiseptic hand wash, antiseptic hand rubs, and

surgical hand antisepsis are ways to maintain hand hygiene. Maintaining good hand hygiene is

the single most important procedure for preventing the transmission of microorganisms,

Dec-21 40854806.docx
including multi-drug resistant organisms such as MRSA and VRE. When working with patients

who have Clostridium difficile who are on Modified Contact Isolation, hands must be washed

with soap and water. Evidence-based recommendations for implementation and assessment of

hand-hygiene programs in healthcare settings have been published (Boyce & Pittet, 2008).

There is an area of controversy: there are concerns regarding reliance on alcohol-based

hand-hygiene products because alcohol is not sporicidal. Conversely, hand washing with soap

and water is associated with much lower compliance. In settings where CDI is endemic, it

appears that the potential decrease in efficacy of alcohol-based hand-hygiene products for

removing spores, compared with hand washing, may be offset by increases in hand-hygiene

adherence with alcohol-based hand-hygiene products, if contact precautions are followed (i.e., if

gloves and gowns are worn) when caring for patients with CDI (Boyce et al., 2008). In addition,

visitors and healthcare workers should be instructed to wash their hands with soap and water

after caring for or coming into contact with patients with Clostridium difficile.

C. Describe an event that occurred during your last two (2) clinical days that raised a question, posed a
problem or caused you to think about it after it occurred. What was it about the event that made it stand out
in your mind? Select a relevant evidence-based professional journal article that can be applied to the
situation. The article must be no older than five (5) years old. Cite the article using APA format. What did
you learn from the article that helped you to resolve your concerns?

An event that occurred during my last two clinical days that raised a question and caused

me to think about after it occurred happened while I was assisting a patient to the bathroom. A

nurse had come in to give him his morning medications. She had just pulled his five

medications, placed them in a cup, and handed it to him. The patient then told her that he really

needed to use the bathroom, and asked whether she would mind coming back. Instead of telling

the patient that she would come back and due to the fact that her workload was heavy, she placed

the medication on his meal tray, unattended, and told him to take the medication when he

returned. After assisting the patient back to bed after he had used the bathroom, another patient

Dec-21 40854806.docx
needed assistance, so I went to help out. When I returned an hour later to check on the first

patient, I noticed that his medication was still sitting on his tray. Knowing that medication

administration was out of my scope of practice, I notified the nurse, telling her that the patient

had not taken his medication.

I found a relevant evidence-based article that could be applied to this situation; the title was

“Nurses Relate the Contributing Factors Involved in Medication Errors.” (pubmed.gov) Nurses

are primarily involved in the administration of medications across settings. Nurses can also be

involved in both the dispensing and preparation of medications. Early research on medication

administration errors (MAEs) reported an error rate of 60 percent, mainly in terms of wrong

time, wrong rate, or wrong dose. In other studies, approximately one out of every three adverse

drug events could be attributed to nurses administering medications to patients.1

Understanding the processes by which nurses administer medication is critical to the

minimization of medication errors. This study investigates nurses' views on the factors

contributing to medication errors in the hope of facilitating improvements to medication

administration processes.

The evidence base indicates that, after being surveyed, registered nurses discussed

medication errors with which they were familiar from both their own experiences and on the

basis of literature reviews. The group of 9 nurses , along with other researchers, then developed

a semi-structured questionnaire consisting of three parts: narrative description of the error, the

nurse's background, and contributing factors. Evidence revealed that of the 72 female nurses who

responded, 55 (76.4%) believed that more than one factor contributed to medication errors.

“Personal neglect” (86.1%), “heavy workload” (37.5%), and “new staff” (37.5%) were the three

main factors causing ADE. Although the majority of respondents considered personal neglect

Dec-21 40854806.docx
on the part of nurses to be the leading factor in medication errors, an analysis of the answers

indicated that additional factors involving the health care system, patients' conditions, and

doctors' prescriptions all contributed to administration errors. What should be taken from this

study is that the identification of the main factors that contribute to medication errors allows

clinical nurses and administration systems to eliminate situations that promote errors and to

incorporate changes that minimize them, creating safer patient environments. Leaving

medication for patients to take unattended is an unacceptable and unsafe practice.

Course Objective 4: Use effective verbal, non-verbal and written communication with patients, patients’
families and members of the health care team consistent with the PN and ADN dimensions
of practice

A. Describe an example of communication with a patient or family in which you experienced a block in
therapeutic communication. What might you have done to eliminate the block?

An example of communication with a patient or family during which I experienced a block

in therapeutic communication was during my assessment of a patient’s pain. At first, I used

closed question that did not provide me with much indication of what was going on: “Are you in

pain?” Although this type of question does not encourage patients to express themselves or give

them the lead, it can be useful in eliciting specific information needed to determine what is

occurring. Once I realized that my questions were too vague, I followed up with open-ended

questions to eliminate the block and to get my patient to reveal more. For example, I asked him

“Where does it hurt the most and is the pain moving anywhere else?”

B. Discuss an example of communication with a patient or family who did not speak English. What were you
attempting to communicate? How did you attempt to convey this information? Were you successful? How
do you know?

I have not have any patients who are unable to speak English. However, I know that,

when dealing with a patient or family that does not speak English, the best thing to do is to

Dec-21 40854806.docx
provide assistance so as to eliminate the barriers related to communication. A communication

barrier includes individuals who know only a foreign language and problems related to hearing,

seeing, or speech. The hospital offers resources that are maintained and made available to aid

patients with communication barriers. Resources include foreign language interpreters, hearing

impaired telephone volume enhancers, telephone devices for the deaf, and the Community

Resource Center for the Deaf and Blind.

C. Discuss an example of ineffective written communication that you observed in a patient’s

chart. Why was the communication ineffective? What would have made it effective?

An example of ineffective written communication involves a patient’s chart. The nurse I

observed had given insulin to a patient. While reviewing the medication history chart , I saw that

it still showed that the patient had not received his insulin. The nurse had, in fact, given the

insulin; however, she failed to scan the patient’s bracelet; therefore, the documentation showed it

as overdue instead of current. The written communication was ineffective due to the nurse’s

omitting to up- date the insulin administration information. The written communication would

have been more effective and correct if, before leaving the patient’s room, she would have

verified that all medications were up-to-date and made sure it showed that way on the patient’s

chart.

Course Objective 5: Demonstrate a working knowledge of the concepts related to collaboration,

communication, decision-making and delegation in the role of member of the interdisciplinary health
care team consistent with the PN and ADN dimensions of practice.

A. Describe an observation of teamwork on the nursing unit where you are assigned. What worked well?
What worked poorly? What would you have changed to improve the teamwork?

A great example of teamwork on the nursing unit to which I was assigned involved the

patient care technicians. I saw a patient care tech who finished vitals early and then handed out

food trays; after that, she asked another patient care tech whether she needed any help. They

Dec-21 40854806.docx
also worked well together and communicated immediately with the nurses if patients needed

pain medication or insulin. Their style of teamwork and communication worked well; I did not

see anything that was done poorly because everyone on the team wanted to help out the others.

If one person was done with her or his patient care tasks early, she or he would immediately

check to see whether anyone else needed help. I would not change anything about the way in

which they work. I think that all of the people in the nursing unit worked extremely well

together.

B.Describe a caring moment that you created for a health team member during the last two (2) clinical days.
Go the second mile. Describe the feelings you experienced as you were creating this caring moment. How did
you experience and perceive the feelings of the individual receiving the caring moment? How have you
changed as a result of this caring moment?

A caring moment that I created for a health team member occurred while walking past a

patient’s room, when a strong smell of fecal matter filled the air. A couple of nurses complained

about the smell, but they did not get up to check where or from which patient’s room it was

coming. As I poked my head into the room, I realized that it was one of patients to whom my

classmate was assigned. The patient had Alzheimer’s disease, and she was resisting help and

insisting that she did not need to be changed. During that experience, my instincts kicked in

right away; I wanted to help both the patient and my fellow nursing student. Her patient suffered

from fecal incontinence; it was all over her and the sheets on her bed. I could tell that my

classmate was overwhelmed by this large task, as well as by the pungent odor that filled the

room. My next instinct was not to waste time to ask her whether she wanted some help; that was

obvious. Instead, I asked her to tell me what supplies she needed me to gather. An expression of

relief and gratitude that someone was coming to her aid washed over my classmate’s face. Once

I returned with the supplies, we coordinated how we were going to take on this messy challenge.

We worked bathed the patient, dressed her in a new gown, and put clean sheets on the bed in no

Dec-21 40854806.docx
time. This caring moment made me feel so empowered because I had been able to help turn a

stressful situation into a carefully executed solution to a problem.

Course Objective 6: Uphold the legal standards and ethical frameworks of the nursing profession by demonstrating
accountability and competence consistent with the PN and ADN dimensions of practice when providing care for a
group of patients and their families.

A. Describe one ethical dilemma that you experienced during the last two (2) clinical days. How does the
ANA Code of Ethics apply to this situation?

One ethical dilemma that I experienced during the last two (2) clinical days occurred while

caring for an elderly patient. Her son had been caring for her and now was under investigation

for possible abuse and neglect. When EMS responders arrived, the temperature in the patient’s

trailer was 102 degrees; there was no working air conditioning and cockroaches infested the

refrigerator. The patient showed evidence that personal care was lacking; she displayed signs of

malnourishment and had sunken eyes. She had chronic pressure sores on her sacrum and

blanching on her heels. EMS reported the situation to Adult Protective Services. An

investigator cleared the son of abuse and neglect; however, it declared him mentally incapable

and unfit to care for his mother.

The nurse case manager must now find care alternatives for the patient. Placement in an

assisted living facility can be challenging due to limited availability. If no facility can accept

her, the patient will go to a women’s shelter for care. The son was the only family she had, so

there is the ethical dilemma of trying find care for the woman and explaining to her son that she

will not be returning home under his care.

How does the ANA Code of Ethics apply to this situation?

According to the ANA Code of Ethics, the nurse is responsible for promoting, advocating

for, and striving to protect the health, safety, and rights of the patient. The nurse is the advocate

Dec-21 40854806.docx
for the patient and must make sure that, once the patient is discharged, she will be cared for in a

healthful, safe, and suitable environment.

B. Describe one example of how you exhibited professionalism during the last two (2) clinical days.

One example of professionalism that I exhibited occurred while I was doing patient vitals;

one of the family members was snippy with me and rudely complained about the nurse, saying

that he had paged for pain medication, and the nurse had not come to the room. I knew that the

nurse had her hands full that morning and that she that she had, in fact, gotten the patient’s pain

medication and had been on her way to the room when another patient’s needs took a higher

priority. I wanted to tell the family, “Look, you are a patient, but you aren’t her only patients;

give her a break.” Instead, I assured the patient and family that the nurse had not forgotten about

them and would be with them shortly. I then asked the patient whether he needed anything in the

meanwhile; he requested ice water. Once I returned with the ice water, the patient and family

member seemed to have calmed down. A few minutes later, the nurse was had come in and

administered the pain medication; then she was out the door again. The patient and family were

worried that the nurse had forgotten about them. I feel that I demonstrated professionalism by

not being snippy back, instead focusing on how I could make the patient comfortable until he

could have his pain medication.

Dec-21 40854806.docx
 References

1. Tang, F., Sheu, S. J., Yu, S., Wei, I. L., & Chen, C. H. (2008, September 17). Nurses relate
the contributing factors involved in medication errors. pubmed.gov. Retrieved
June 10, 2010, from http://www.ncbi.nlm.nih.gov/pubmed/17335520

2. Boyce & Pittet. (2008). Strategies to prevent Clostridium difficile infections in acute care
hospitals., Retrieved June 10, 2010, from
http://http://www.guideline.gov/summary/summary.aspx?
doc_id=13398

Dec-21 40854806.docx