Community-Based Practicum Reflective Journal Guidelines

Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion
Community-Based Practicum

Professional nursing meeting experience (4 hours)

Guide for Reflection Using Tanner’s (2006) Clinical Judgment Model
Introduction

What professional nursing meeting(s) did you attend and where was it located?
- I attended the Nursing Quality Outcome Council meeting at St. Mary’s Hospital.
Background

Describe the purpose of this professional nursing meeting? Describe the agendas of the group and subgroup. What
type of issues did they address?

- The purpose of this meeting was “to identify and establish priorities for the Nursing Division to advance
professional nursing practice and impact outcomes. To empower Unit Councils by providing a mechanism
for their chairpersons to share and receive information”. The group as a whole were nurses representing
their units, typical those in charge of the Unit Based Councils (UCBs). There were subgroups within the
larger group. These consisted of committees related to Night Shift and Falls. Individuals representing
Professional Nursing Council and Aramark discussed issues and changes that needed to be implemented. In
addition, safety and infection control topics were discussed.

Noticing

What did you notice about the professional nursing meeting initially? Describe what you saw, heard and did during
the meeting?

- Initially, I was unsure of what to expect from this meeting. I thought the title of the group was a bit vague
and was unsure of what I would be walking into. I was interested in most of the topics that were discussed
and how every nurse present was there to help implement change for the hospital that would not only
benefit nurses, but patients as well.
- There were two incidences that seemed fairly tense during the meeting. The first occurred when the
gentleman from Aramark spoke. It seemed that they were present to discuss ongoing issues with bed and
equipment malfunctioning and replacement. It was fascinating to hear their point of view. It was also
obvious that these situations did not happen often. The second incidence was when the Professional
Nursing committee ladies came to speak. They were present to discuss Informed Consent and the various
issues surrounding that. I listened avidly during all of these discussions and it was obvious that these were
ongoing issues that were not going to be resolved on this day.
- In addition to listening and taking notes on the meeting, I observed the nurses in the room. There was some
diversity in the age range of the nurses present but that was about the limit of the diversity present. I
watched how various nurses asked questions or gave responses and also observed their body language.

Interpreting

Describe what you thought about the information being discussed. Have you been involved in similar discussion
during your previous student nurse experiences? Describe the similarities and/or differences to those encounters.

- I thought the information that was being discussed was all important. Going into nursing school, I would
never have imagined how serious of an issue bed/stretcher availability would be even though it is so crucial
to a patient stay. If the patient’s bed is broken or unsafe, why is it too much to ask to have a replacement
available or an understanding of when that bed would be fixed. I’ve never had this discussion as a nursing

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student, but I have been part of this process in my work experience as a secretary and a patient care tech.
When the hospital is full, there are no beds, and patients are being held down in the Emergency Department
(ED). Management wants these patients to be on hospital beds to decrease the risk of pressure ulcers and
increase patient satisfaction. However, this is sometimes an unrealistic request when the ED is holding 20
patients. I feel like the ED is expected to make do with what they have and typical we do. This discussion
paralleled discussions I have heard at work which typically provide more questions than answers. I realized
at this meeting that although there are policies written to the “t” about certain aspects of care, there are still
many processes that go on in the hospital that have no set policy.

Responding

Describe stresses (both positive & negative) you experienced as you responded to the new learning or the challenge.

- I have always loved learning, so it was nice to see nurses of different levels of their career learning and
working with one another. I understand the importance of these meetings to move along information onto
different units. This allows for parallel disbursement of information.
- One major stressor that I felt was when the nurses came to discuss the “Informed Consent” policy and the
survey results they had. I think it could have been better approached to the group as a problem and future
needs, whereas this was approached as something that needed to be changed at that moment. We learn in
school that what happens on NCLEX and what happens in real-life nursing are not necessarily the same.
This situation seemed pretty surprising to me because it is always emphasized how much it is the doctors
role to get the consent form signed. I felt that every nurse was defending their nurses needs at this time and
trying to protect them from retaliation by the providers.

Reflection-in-Action

What role would you take being assigned to represent your unit in this group? What subcommittee would you like to
participate with and why?

- I would love to work on a team as a researcher or someone who is providing education but likely not as a
leader. I would want to be on a subcommittee for Sepsis as I feel that this is working towards the most
positive outcome. It seems less like politics and policies and more emphasis is put on early treatment and
prevention. Working in the ED, we have been pushing for Code Sepsis (or Code Purple) for the last few
years. I am always interested in hearing the latest changes or statics on our septic patients. At the same
time, one nurse asked if the fluid resuscitation would be different for kidney/HF or other chronic patients
with fluid restrictions. The nurse leader in charge of the Sepsis team responded that if any fluid overload
occurred the fluid could be pulled off with diuretics because the benefits of that fluid resuscitation would
outweigh the risks. I can see both sides of this argument but the idea of throwing the patient from one
extreme to the other does not make much sense to me either. I believe this is moving in the right direction,
however, care should still be individualized.

Reflection-on-Action and Clinical Learning

What written evidence is available to support professional nursing groups and their impact on the development of
evidence based practice and improved patient outcomes. Cite/reference all journal articles that contributed to the
evidence.
- Professional nursing groups help to support and impact the development of evidence-based practices.
Organizations such as American Nurses Association (ANA), help to define standards of practice across the
country. An organization is important in allowing a nurse’s voice to be heard and help to maintain an
optimal work environment (Adams, Zimmerman, Cipriano, Pappas & Batcheller, 2018). Nurses who have
an optimal work environment are set up to provide the best possible care they can give.
What is the value of professional nursing meetings both as a part of a healthcare system and within a professional
organization? Describe any changes in your values or feelings as a result of this experience.

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- I think professional nursing meetings are excellent in helping bring nurses together to work on common
goals to better the practice of nursing for all. It helps to bring up needs and priorities that might not
necessarily be heard otherwise.
- I do not think any of my values changes as a result of this experience. I felt it was interesting to attend a
professional meeting and observe all of those present. I enjoyed this experience for what it was, but I also
believe attending this monthly would inevitably be exhausting.

Adams, J. M., Zimmermann, D., Cipriano, P. F., Pappas, S., & Batcheller, J. (2018). Improving the Work Life of

Health Care Workers. Medical Care, 56(1), 1-3. doi:10.1097/mlr.0000000000000839

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment

Model. Journal of Nursing Education, 46(11), p. 513-516.

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