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Running head: PRACTICE SUMMARY PAPER

Practice Summary Paper: An Analysis of the Attainment

of the “Great Eight” Core Competencies

Kevin Gross

Old Dominion University

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PRACTICE SUMMARY PAPER

Practice Summary Paper: An Analysis of the Attainment

of the “Great Eight” Core Competencies

The path to becoming a nurse is difficult to say the least. It is filled with various obstacles

ranging from grueling class schedules, an overabundance of course work, and a rigorous clinical

schedule. For some, it becomes even more difficult when they have to work on top of going to

school. So, why do we do it? Why would one subject themselves to such a strenuous feat to

overcome? For me, the answer is simple. I chose to become a nurse because I love to help

people. I enjoy being there for my patients when they endure some of the toughest battles they

must face like end-of-life decisions or when they celebrate the greatest joys such as the birth of a

child. Knowing my actions can impact these moments for my patients brings me great joy and

keeps me coming back to the job. With that said, the decision to enroll in the RN to BSN

program at ODU was an easy one to make. I chose to further my degree because I want to be

able to share my passion for nursing with the future generation of nurses. I want to be able to

teach them and help them to gain or enhance their compassion and to not lose sight that we, as

nurses, are care providers and not simply task completers. We are taking care people not lists.

Obtaining my BSN will enable me to achieve this goal by becoming a clinical instructor so I can

work with future nursing students. It will also serve as a segue to my MSN so that I can

eventually become a teacher at the nursing school that I attended.

Thinking back on my BSN journey, my thoughts were drawn to one of the assignments

that I completed in the first class I took, nursing 401. In that assignment I can recall answering

the question of what I hoped to accomplish by completing the BSN program. One of the main

things that I hoped to achieve through the course work of the BSN curricula was to improve

upon my time management skills. I entered the program the same time I began my coursework
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for my associate degree in nursing (ADN) to obtain my RN license. I was also working full time

as a paramedic in the emergency department. Time management is essential not only to complete

the assignments in school, it is essential to be a competent and effective nurse. You must be able

to care for multiple patients at one time that require different things of you, often at the same

time. You must be able to prioritize appropriately so that you can ensure that you are providing

the best care possible and that is where time management proves to be beneficial. The second

goal I hoped to accomplish through the BSN program was to become more proficient with APA

formatting. Through the course work I was able to develop a strong understanding of the APA

style manual and as such I am now, more than ever, able to formulate a solid, easy to understand

manuscript to share my knowledge and thoughts with my peers. This will prove to be beneficial

as I progress toward my MSN.

As I moved through the program, I noticed that my career goals began to change. I no

longer wanted to work in the surgical intensive care unit, I decided to obtain a position within the

emergency department where I currently worked. Emergency medicine is what I knew best and it

is where I feel most comfortable. I also changed from a desire to become a certified nurse

anesthetist to wanting to obtain my MSN and become a nurse educator. I love teaching and I feel

that there is no better way to solidify personal knowledge than to share that knowledge with

others.

The “Great Eight”

Successful completion of the BSN program at Old Dominion University requires one to

adequately demonstrate the ability to carry out 8 core competencies dubbed the “Great Eight”.

These competencies consist of critical thinking, nursing practice, communication, teaching,

research, leadership, professionalism, and culture. Through evaluation of this paper, the reader
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will be able to ascertain the author’s successful completion of these competencies through the

examples of course work that were provided.

Critical Thinking

The ability to think critically is essential in almost every aspect of daily life, but it is an

even more important skill to have for someone working as a nurse. We are faced with patients

not only with varying complaints but varying ages, races, cultures, and medical histories. As

such we are faced with the task to decipher the signs and symptoms presented by the patients to

help determine nursing diagnoses and develop appropriate care plans for them. One example of

critical thinking is the ability to creatively problem solve situations that challenge us. I was able

to hone this skill in my Nurs 490W, nursing leadership course. We had an assignment where we

had to identify a safety concern within our workplace and develop ways to improve upon it using

one of The Joint Commission’s 2019 safety goals. We utilized brainstorming, diagramming, and

thorough research to decide which safety measure from The Joint Commission’s 2019 safety

goals to address and apply to our work environment. We then applied our improvements and re-

evaluated the process. My group worked on improving critical alarm fatigue and think of ways

that had not been implemented before to help the interventions be more successful. Another

example of this ability from my clinical practice was when I was caring for an overdose patient

in the ED. The pt had ingested a large quantity of pills and was provided activated charcoal

through a nasogastric tube. The tube was then connected to suction to evacuate the contents from

his stomach. At one point the suction stopped working and my peers couldn’t figure out the

problem. They tried repositioning the pt, increasing the suction pressure, and even withdrew the

tube slightly but it still didn’t work. I had the thought that due to the curvature of the tube, the

distal port came to rest on the stomach wall. As such, it was not able to suction. I had the idea to
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gently twist the tube to cause it to rotate within the stomach a little which resulted in the tip to

curve away from the stomach wall and almost instantaneously suction was restored, and contents

began emptying again.

Nursing Practice

Nursing practice is the carrying out of interventions that we have been educated on,

trained in, and have successfully demonstrated competency in. These are the things we

implement for our patients with each interaction we have with them. One way that nursing

practice can be displayed is by demonstrating an awareness of complementary and alternative

medicine (CAM) treatment modalities and how they can be used to promote health. This concept

was taught during my Nurs 403, Transition to Baccalaureate Nursing Practice class by using a

power point lecture and online readings. The teachings taught us that there are more ways to

provide a healing and caring environment than providing medicine. Therapeutic massage is an

example of a CAM. I utilized therapeutic massage to ease the pain and discomfort that had

chronic leg cramps/muscle spasms that did not seem to respond to medication therapy. I utilized

a technique that I personally use at home which involved the application of moist heat followed

by a deep tissue massage. This technique did not completely remove her pain, but it was enough

to make her comfortable. My clinical practice provided another example of nursing practice

being used. Being in the emergency department we see patients throughout all stages of the life

span. As such we need to be able to provide holistic care and treatment to any age category

treating not only their physical ailments but their psychological and spiritual complaints as well.

One patient I cared for was being treated for suicidal ideations. She was a teenage girl that was

struggling with a recent break-up as well failing grades in school. It became too much for her to

handle which resulted in her trying to harm herself. I was able to therapeutically communicate
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with the patient and arrange both a psychological screening evaluation for her and had the

chaplain visit her to provide comforting prayer to her. Looking beyond the physical problems at

hand enabled the patient to get on the path to healing quicker.

Communication

Effective communication skills are an essential attribute that all nurses should possess.

But to be effective, one must be versed in all forms of communication including verbal, non-

verbal, and written communication and must be able to carry it out with all patient populations

including those with special needs like language barriers. We often get non-English speaking

patients in the emergency department. Leininger’s Transcultural Theory covered in Nurs 306

discusses the concept of culturally congruent care. This states that the care that is provided

should appropriately fit the cultural values, beliefs, and lifestyle of the patient to enhance their

health and well-being. Because of such, the hospital had to implement a way to communicate

with people with language barriers to ensure proper and adequate care is provided to them. They

use an interpreter phone line to help with this task. Over the years I have developed a limited

medical Spanish vocabulary with terms that inquire about bathroom needs, pain level, and basic

assessment questions. However, I cannot rely on that alone for patient care. The language line

proved to be useful when I cared for a patient with chest pain that only spoke Spanish. It

connects a translator that speaks the patient’s native language to serve as a mediator to help

complete the focused assessments, provide instructions/explanations of necessary treatments, and

ultimately provide results of said treatments and discharge instructions. It typically involves

several phone calls throughout the patient’s visit and can be time consuming. However, it is vital

to take every step needed to provide safe, effective treatment to every patient we encounter.

Teaching
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I had no idea that when I chose to become a nurse, I chose to become a teacher as well. I

now know that teaching is a critical component to our profession. We find ourselves responsible

for providing teaching to our patients every day while at work about their medications,

treatments, lifestyle changes, and diagnoses that they may receive. One way to ensure that

teaching is effective is to evaluate the efficacy of health promotion and education modalities.

This skill was enhanced when I learned about the ASSURE Model in my Nurs 402, nurse

educator course. This model informed us of the education process where we analyze the learner,

state objectives, select instructional methods and materials, use teaching materials, require

learner performance, and evaluate/revise the teaching/learning process. I accomplished this by

using the teach back method. For any instruction provided to the patient, you have them teach it

back to you to ensure they have thorough and proper comprehension of the material. If they

falter on repeating any of the information to you, you can then go over it again to make sure that

they completely understand it and that the education was successful. I utilized this technique

when I cared for an elderly patient that could not read. When the written instructions were

provided to him, he had a blank stare come across his face. I then asked him if he understood

what was provided to him and he said yes, I asked him to identify on his paper where his

medications were listed and what it said about them. After several minutes, he was not able to do

so. I in turn, restated the instructions to him and did so repeatedly to make sure that he fully

understood what was expected of him when he returned home. Doing so ensured that he was safe

and helped to minimize a return visit by him for the same complaints.

Research

As mentioned earlier, nursing practice is the carrying out of nursing interventions.

Applying research findings from evidenced base practice (EBP) drives us to which interventions
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to implement for our patients. My Nurs 363, Principle of Practice: Research as Foundation for

Practice class is where I acquired the ability to effectively use research and EBP findings to drive

my interventions chosen for my patient through the completion of several group discussion posts

and an EBP group project utilizing the skill. The EBP project utilized Lewin’s Change Theory,

to demonstrate the effectiveness of ultrasound assisted IV cannulation. Another example using

EBP to guide interventions is when I used knowledge that I gained from the arts, humanities, and

sciences when I researched the benefits of a pacifier induced lullaby for a project I had in my

ADN program. It showed that the music (arts) that was triggered by the infants sucking, helped

soothe and calm (humanities) the premature infant, which improved upon their feeding regimen

(sciences) and led to a quicker discharge from the facility.

Leadership

Being an effective leader is vital to the role of a nurse. I learned what constitutes and

effective leader during my Nurs 490W course. I learned from my readings that there are

different styles that leaders follow and traits that they possess. Traits of a leader include being

self-directed, accountable for your actions, and an advocate for your patients. After completing

the readings, I was able to determine the type of leader that I most closely resemble. In this

example it was more of a Laissez-Faire approach, giving authority to my teammates to

accomplish the assigned task as they felt appropriate. An example of this is being able to

delegate and supervise care being given by others while retaining accountability for the quality

of care provided. This task is carried out regularly while at work when I utilize other nurses in

the department to establish IVs and draw blood from my patients when I am unable to do so

myself. I request that they report back to me when completed because I do not supervise them

during the task. However, I need to ensure that it is done correctly and secured properly prior to
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using them for medication administration. In the end, if something goes wrong, it is my patient

and I am accountable for it.

Professionalism

Understanding the effect of legal and regulatory processes on nursing practice and health

care delivery is an important characteristic to possess as a nurse. Legal and regulatory processes

were a topic of discussion in my Nurs 412 class. It was in that class that I became more familiar

with the concepts of negligence and nonmaleficence. These terms came into play in a situation

where I witnessed a medication error. The patient was to receive 750 mg of Robaxin along with

1 mg of Valium. The Robaxin was 1.5 tablets. The RN gave two tablets by mistake and didn’t

want to tell anyone about it. I said that it needed to be reported but she refused to. I therefore,

reported it to the charge nurse so that it could be documented and monitored appropriately. The

RN was provided a coaching for the error and is being closely monitored now. It was a simple

mistake, and could have had poor outcomes, this time she was lucky. Future errors, if any, could

result in loss of her license.

Culture

Demonstration of my ability to understand how human behavior is affected by culture,

race, religion, gender, lifestyle and age was provided by the cultural exploration exercise

completed in nursing 401. In that assignment I explored the Ethiopian culture. I learned how

valuable eye contact is to patients of that culture. Failing to do so meant that you were not honest

and were hiding something. I also learned that for them illnesses were acts of God in response to

the person’s sins and that mental illness was tied to evil spirits invading the body.

Summary
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Reflecting on my course work I can honestly say that I am happy and proud of what I

have accomplished. I set out on the journey of my ADN and my BSN at the same time with the

goal of improving upon my time management skills and my overall knowledge of APA

formatting. I feel that I have accomplished both tasks. Time management is essential to being an

effective and efficient nurse so that you can provide anticipatory care for your patients by staying

ahead of their needs. Knowledge of APA enables me to develop clear and concise documentation

in my patient charts. Through the completion of group projects throughout the BSN program I

feel I have developed strong leadership skills that will help me toward my goal of becoming a

nurse educator.

The BSN program afforded me the opportunity to dive deeper into nursing theories that

serve as the backbone of our profession. One theorist that has had an impact on me is Virginia

Henderson. Her three levels of nurse-patient relationships caused a shift in my practice which

helped me see that we are there to work with not primarily for the patient to help them gain their

independence back as quickly as possible. In total the BSN program resulted in an overall change

on how I provide care for my patients. I now view them more holistically and try to encompass

their total care (mind, body, and spirit) in my daily practice.

As mentioned, enrollment in the BSN program resulted in me becoming more familiar

with nursing theories. These theories have given me a stronger foundation for me to grow as a

new nurse. They enabled me to view my patients more thoroughly and treat them holistically by

giving me a new understanding of what comfort is and how it can be achieved in different ways

for different people. I have more confidence now and as such feel more comfortable in my new

profession.

Conclusion
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I had no idea the impact the BSN program would have on my personal nursing

philosophy when I first began the process. However, through the completion of this assignment I

now realize the profound effect it has had. I knew with each class I took I was gaining new

knowledge, and as such the way I did things changed ever so slightly. The changes were subtle

and hard to notice. Through reflection, I have now seen that the attainment of the “Great Eight”

has taught me to think critically in all settings to effectively problem solve. It enabled me to

perform therapeutic nursing in all patient domains and helped me to apply the knowledge of

major health problems to guide my nursing practice. It showed me the importance of

transcultural care and to become more aware of how people can respond differently to the types

of care provided. Overall, the BSN program has made me become a stronger, more confident,

and more compassionate nurse that is prepared to face a variety of challenges that we are faced

with in this profession.

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Appendix A

Practice Summary Paper

Nurs 403 – Transition to Baccalaureate Nursing Practice
Purpose of Assignment
The purpose of this assignment is to guide you through a process of self-reflection and
self-evaluation to discover the scope of your personal and professional development while
enrolled in the RN to BSN nursing program at Old Dominion University. This assignment is
designed to help you prepare for your Portfolio. The Practice Summary Paper is designed to
demonstrate the attainment of the 8 core competencies in general. The portfolio demonstrates the
achievement of the Core Competencies through the attainment of specific elements (the bullets)
within the Core Competencies.
Student Approach to Assignment
The first step I took to complete this assignment was to view the grading rubric for it.
Doing so enabled me to become familiar with the critical components to the paper so that I
address each one of them within the paper. I then went through my portfolio assignment to
determine which bullet points I was unable to discuss within the portfolio and made sure to
discuss them within the progress summary paper. By completing the assignment, it became
evident to me that the BSN program had a profound impact on my practice as a RN. I had the
opportunity to reflect on completed assignments throughout the program and brought key
concepts back into thought and therefore, back into use. The assignment reflects my desire to
learn, to grow, and provide complete and holistic care to my patients which is evidenced by the
examples provided within the paper. I approached the assignment in the manner that I did so that
I was certain that every component on the grading rubric was included in the paper and that key
elements were not overlooked.
Reason for Inclusion of this Assignment in the Portfolio
I included this assignment in the portfolio because it shows that I have successfully
obtained the competency bullet points outlined in the “Great Eight” Old Dominion University
BSN portfolio assignment. The paper shows the growth that I have since I entered the program
not only as a person, but as a care provider as well. This assignment also highlights some of my
strengths such as attention to detail, my ability to follow directions, and the ability to provide
thorough self-analysis on previous works.

• Critical Thinking
o Engages in creative problem solving.
In the progress summary paper, I discussed a situation where I had to think
creatively to solve a problem with nasogastric suctioning on an overdose patient. The
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suction failed, and despite efforts by my co-workers, it would not start working again. In
lieu of removing it and starting again, I envisioned the way the tube could possibly be
resting inside the stomach due to the curvature of the tube itself. I figured that it was
curved toward the wall of the stomach and was getting plugged by the tissue. I gently
twisted the tube resulting in the curvature moving away from the stomach lining and the
suction was restored. Creative problem solving was honed through an assignment that I
completed during my Nurs 490W course where we had to identify a safety concern
within our workplace and think of ways to improve upon it. We utilized brainstorming,
diagramming, and thorough research to decide which safety measure from The Joint
Commission’s 2019 safety goals to address and apply to our work environment. We then
applied our improvements and re-evaluated the process. These same steps were used in
the case with the suctioning issue and proved to be successful.
• Nursing Practice
o Demonstrates an awareness of complementary modalities and their usefulness in
promoting health.
The concept of complementary and alternative medicine (CAM) was taught
during my Nurs 403, Transition to Baccalaureate Nursing Practice class using a power
point lecture and online readings. It outlined that there is more than one way to provide
comfort to your patients besides using pharmaceuticals. An example of where I used
CAM is in the progress summary paper when the use of therapeutic massage was
discussed. I talked about an elderly patient that suffered from severe leg cramps and was
not receiving relief with medications. I utilized moist heat followed by several minutes of
deep tissue massage to alleviate her discomfort. As a result, the patient was able to rest
more comfortably while she waited for the medication to take effect.
• Communication
o Adapts communication methods to patients with special needs.
Leininger’s Transcultural Theory covered in Nurs 306 discusses the concept of
culturally congruent care. This states that the care that is provided should appropriately fit
the cultural values, beliefs, and lifestyle of the patient to enhance their health and well-
being. This bullet was highlighted during the discussion about a patient I cared for that
was Spanish speaking only. In the progress summary paper, I mentioned the tools I
utilized to help communicate with this patient due to the language barrier so that I could
ensure that his needs were met and that his care was tailored to fit his cultural values and
that it is complete and accurate. I mentioned that I used my limited Spanish vocabulary
coupled with the hospital language interpreter line to handle his special needs of not
being an English language speaker.
• Teaching
o Evaluates the efficacy of health promotion and education modalities.
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In the progress summary paper, I discussed a situation where I encountered a

patient that could not read during a teach back session during his discharge process. As I
was going over his discharge papers, I asked him to point out where the dosages and
scheduling was for the new medications he was prescribed. The pt stood there with a
blank stare on his face. I then I realized he could not adequately read the papers. I utilized
the repeat back method of teaching to ensure that he fully understood the instructions
prior to leaving. I would read the instructions to the patient and he would repeat them
back to me. This occurred several of times until we both felt comfortable with his
understanding. This skill was enhanced during my Nurs 402, Nurse as Educator course.
In that class I learned the ASSURE model which proved to be beneficial during this
patient encounter. I was able to analyze the learner and state my objective to him, I
selected the appropriate learning material (discharge instructions), I used the papers to
help solidify the teaching instructions, I required him to participate by showing my on the
instructions his medication regimen, and evaluated the learning and adjusted the teaching
when I found out he could not read.
• Research
o Applies research-based knowledge from the arts, humanities, and sciences to
complement nursing practice.
My Nurs 363, Principle of Practice: Research as Foundation for Practice class is
where I acquired the ability to effectively use research and evidenced based practice
findings to drive my interventions chosen for my patients. This was accomplished by
learning Lewin’s Change Theory. This skill was demonstrated in a project that was
completed during my associate of nursing program that dealt with premature infants and
the use of a pacifier induced lullaby to help soothe them. The project discussed poor
feeding schedules along with inadequate rest and slow healing due to the environment
with the neonatal intensive care unit. The pacifier involved had sensors in it that were
preprogramed to a set sucking pressure that the baby had to achieve in order to trigger the
lullaby/music to play. It would only play for a short period and turn off which would
cause the baby to have to suck harder to trigger the music to play again. This in turn
resulted in the improved feeding and a more relaxed baby.
• Leadership
o Delegates and supervises the nursing care given by others while retaining
accountability for the quality of care provided.
I learned the different styles of leadership during my Nurs 490W course and was
able to determine based on what I read, the type of leader that I most closely resemble. In
this example it was more of a Laissez-Faire approach, giving authority to my teammates
to accomplish the assigned task as they felt appropriate. This was highlighted when I
discussed the utilization of co-workers to establish an IV and draw blood samples from
my patients. I don’t directly supervise them while they perform the task, however, I must
verify that the task is completed and that the IV is patent prior to the administration of
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medications through it. If an error occurred, it is ultimately my responsibility to correct it

because I am accountable for my patient.
• Professionalism
o Understands the effect of legal and regulatory processes on nursing practice and
health care delivery.
Legal and regulatory processes were the topic of discussion in my Nurs 412 class.
It was in that class that I became more familiar with the concepts of negligence and
nonmaleficence. These terms came into play in a situation where I witnessed a
medication error. The provider did not want to report the error, however, it resulted in the
overdose of a medication that has a sedative effect on the patient. The provider was
negligent because he didn’t follow appropriate guidelines for medication administration
and violated the code of nonmaleficence by causing harm to the pt, although minor in this
example. Hiding the error could have resulted in an adverse outcome for the patient, not
to mention that it is legally and ethically wrong to not report it. Since it was reported, the
pt was able to be more closely monitored to ensure that they maintained adequate
ventilatory effort.
• Culture
o Articulates an understanding of how human behavior is affected by culture, race, age,
gender, lifestyle, and age.
This was demonstrated during the discussion about the project that was completed
in my Nurs 401 class. The assignment involved the exploration of a culture other than my
own. I researched the Ethiopian culture. I talked about the importance of eye contact for
them and how they perceive an individual gets sick. For example, they believe that an
individual gets sick as a result of God and how much they sin. They also believe that
mental illness is the result of evil spirits.