Running head: PRACTICE SUMMARY 1

Practice Summary Paper

Kenneth L. Combs, Jr.

Old Dominion University School of Nursing

PRACTICE SUMMARY 2

Practice Summary Paper

My time as a student in Old Dominion University’s Registered Nurse (RN) to Bachelor

of Science in Nursing (BSN) program is ending. I enrolled in the program in 2017 while I was

completing Rappahannock Community College’s Licensed Practical Nurse (LPN) to Registered

Nurse (RN) program. I enrolled in the RN to BSN program to expand my knowledge within the

field of nursing as well as have the opportunity to specialize in the field of nursing. My plan is

to become a certified registered nurse anesthetist. From the beginning of this program, I hoped

to enhance my writing skills and learn new information related to the field of nursing that I could

use to provide better patient care. Throughout this program, my goals never changed.

Critical Thinking

Nurses constantly use critical thinking skills. We must be able to react and critically

think quick. As a nurse, I have to constantly monitor patients to detect changes in their health

status by completing assessments and monitoring their vitals, labs, and other factors.

Completing the BSN program and my experience practicing as a nurse are two factors that have

enhanced my critical thinking skills. The Practice Summary assignment in Nursing 403 has

helped me critically think and reflect on my entire time in the BSN program. The enhancement

of my critical thinking skills has helped me better understand how the care I provide and the

nursing interventions that I perform improve my patients’ health status.

One example of me demonstrating attainment of critical thinking behavior was when I

first started working as a nurse in the neurological intensive care unit I started “evaluating

nursing care outcomes through the acquisition of data and the questioning of inconsistencies.”

One way I did this was through making the connection that patients who have subarachnoid

hemorrhages are at an increased risk for headaches which is caused by vasospasms of the arteries
PRACTICE SUMMARY 3

in the brain. This is because the blood irritates the brain tissue and the walls of the arteries which

causes the arteries to narrow. This narrowing is what causes the patients to have headaches.

Verapamil is prescribed to help prevent vasospasms. This is because verapamil helps to relax the

arteries which causes the arterial walls to dilate. This dilation increases blood flow. Therefore,

if verapamil is not effective when taken orally, sometimes the patient may require intraarterial

verapamil to reduce the vasospasms.

I use “decision-making skills in making clinical or professional judgments” by knowing

patients who have surgeries are at a much higher risk for infection. I provided care for a patient

who had a fever of 102.4 °F. However, there were no signs of infection at the surgical site. The

patient had a Foley catheter which I knew increased their risk for a urinary tract infection.

Because of the 102.4 °F fever, the patient having the Foley catheter, I assessed the flow of the

urine and the urine characteristics. From my assessment I found the tubing was kinked, and the

urine was cloudy. Because of this, and my knowledge from nursing school and practicing, I was

almost certain the patient had a urinary tract infection. I notified the nurse practitioner, and she

ordered a urine analysis. The urine analysis confirmed the patient had a urinary tract infection.

Because the patient had a urinary tract infection, I knew from my education and experience from

practicing as a nurse the patient would be prescribed antibiotics for the infection and

acetaminophen for the fever. Once the orders were placed, I completed the interventions.

Nursing Practice

Nursing practice has many different domains. These include the cognitive, affective, and

psychomotor domains. As a nurse, I frequently “demonstrate an awareness of complementary

modalities and their usefulness in promoting health.” One way that I do this is by educating my

patients on the need try alternative interventions for pain management. For example, I had a
PRACTICE SUMMARY 4

patient who was complaining of pain. I informed the patient that it would be another hour before

they could receive another dose of pain medication. To help them manage their pain until it was

time for them to receive another dose, I educated them on the importance of using diversion

techniques and nonpharmacological techniques to help reduce their pain. One

nonpharmacological technique that I educated them on was the importance of turning while in

bed to help reduce their pain. Other diversion techniques that I educated them about included the

use of ice packs and heat packs as well as diversion techniques such as watching television,

listening to music, and using guided imagery.

Communication

Nurses must have good written and verbal communication skills with patients and

healthcare providers. Completing the BSN papers and group assignments have helped my

written communication skills through the use of text messaging and emailing. An example is

when I took care of a patient and the patient’s monitor alarm sounded because of the systolic

blood pressure (BP) reading 198 mmHg. The patient asked, “Why is it going off?” I replied to

the patient, “It is because of your blood pressure.” The patient asked, “What is the blood

pressure?” I told the patient, “It is too high. It is 198/103 mmHg.” When I was in the patient’s

chart, they asked, “What was the blood pressure last time?” I told them, “170/98 mmHg.”

As a nurse, I clarify any order that I receive by reading it back to the provider for

confirmation. For instance, I paged the nurse practitioner about my patient having a systolic

(BP) of 198 mmHg. She asked when the last dose of labetalol was given and I told her, “1:03

a.m.” She ordered a 10-mg dose of labetalol intravenous (IV) push for my patient. I clarified the

order by asking, “So give the patient a 10-mg dose of labetalol IV push?” The nurse practitioner

confirmed that was the dose. After confirming the dose, I gave the patient the labetalol.
PRACTICE SUMMARY 5

Another way that I met this competency was when I used the text messaging system at

work to page the neurosurgeon about my patient’s external ventricular drain not dripping when I

lowered it. The neurosurgeon called back on the work cell phone and asked what the patient’s

output was for the previous shift. I checked the output over the previous shift and told the

neurosurgeon that the highest output was 5 milliliters. These are how I met the communication

objective of “Accesses and utilizes data and information from a wide range of sources to enhance

patient and professional communication.”

Teaching

Nurses are constantly teaching patients and their families. ODU’s RN to BSN program

helped me enhance my teaching skills. I provided education to my learners through the

completion of my community services assignment with my community aggregate in my

Community Nursing class. I fulfilled the characteristic of “provides relevant and sensitive health

education information and counseling to patients, and families” by educating a patient on why

they had an infection. I explained to the patient that when I provided care the previous night, I

provided education about their medications and the need to take them, and they still refused their

medications. I explained to them that cefazolin which they refused the previous night, is an

antibiotic that is used in post-surgical patients prophylactically to help prevent an infection.

They asked why they have a fever and I explained to them that their body is trying to fight the

infection. I explained that their refusal to take their medications and the cefazolin were likely

causes of them having an infection. I explained the importance of taking all of their medications

including the antibiotics.

I fulfilled the “provides teaching to patients and/or professionals about health care

procedures and technologies in preparation for and following nursing or medical interventions”
PRACTICE SUMMARY 6

objective when I provided preprocedural education to my patient about the purpose of a magnetic

resonance imaging (MRI) and the need remove all metal objects including jewelry. Before I

obtained their consent, I explained and read the information on the MRI consent form and

answered any questions. Due to the patient being claustrophobic, the nurse practitioner

prescribed midazolam to help them relax during the MRI. Before I administered the midazolam,

I provided education about midazolam to the patient including an explanation that the purpose of

the medication is to help them relax during the MRI. This reassurance helped reduce the

patient’s anxiety.

I fulfilled the “uses informatics to enhance one’s own knowledge base to support

teaching” characteristic when I administered a mirtazapine to my patient. Mirtazapine is a

medication that I rarely administer. Because of this, I used Micromedex which is an online

database that provides information about drugs, to educate myself and the patient about the

medication. Through the use of Micromedex, I was able to explain to the patient that the drug is

an antidepressant and that it is commonly used to treat depression. Through the use of

Micromedex, I will remember the classification of mirtazapine and its common use.

Research

The field of nursing always involves research. My nursing practice is constantly guided

by research and evidence based practice. I completed the Therapeutic Nursing Interventions

assignment about delirium in my Nursing 403 class. I applied research-based knowledge from

the arts, humanities, and sciences to complement nursing practice by including interventions on

how to manage and prevent delirium within my paper. The arts domain was fulfilled through the

use of interventions such as face mask, ear plugs, and turning off the television and lights to

reduce the risks of delirium. Educating family members to stay with the patient to help reduce
PRACTICE SUMMARY 7

the risks of delirium fulfills the humanities part because the patient has someone they know and

trust with them which can help them rest better by reducing anxiety. Administering melatonin at

night to help the patient sleep fulfills the science part because the use of melatonin is a

pharmacological intervention.

Leadership

Nurses fill the leadership role in many aspects. I fulfilled the leadership role by sending

my group websites to look at for with information that could pertain to our policy brief

assignment. Every day I work, I fulfill the leadership role in many different ways. In my

nursing practice I delegate and supervise the nursing care given by others while retaining

accountability for the quality of care provided when I delegate patients’ baths to nurse care

partners. For example, I delegated a patient’s bath to the nurse care partners because I had a

patient who had a BP of 88/52 mmHg. Because of this, the nurse practitioner prescribed a 500

ml bolus of IV fluids. I had to administer the bolus, so because of time, the patient’s bath was

delegated to the nurse care partners. I asked the nurse care partner to report back once the bath

was completed. Once the nurse care partner reported back that the bath was complete, I went

into my patient’s room to make sure the patient was clean, their bed was locked and in the lowest

position, and their monitors were hooked up.

Professionalism

Professionalism was demonstrated through communication with my instructors about any

assignments within this program. I demonstrated accountability for one’s own professional

practice as well as limits to one’s own scope of practice when I administered a patient their

prescribed hydromorphone for pain. After I administered the medication, I had the vial in my

hand that contained the leftover medication. The patient asked, “What’s that?” I replied, “It is
PRACTICE SUMMARY 8

the leftover medication.” The patient said, “Just give it to me.” I told the patient I could not give

it to them because I gave them the prescribed dose. The patient said, “Put it in that red bin over

there!” I informed the patient that I would not, and that I have to waste the leftover medication.

Once I left the room, I wasted the medication with a coworker and notified the charge nurse of

the situation. This is an example because I was staying within my scope of practice by following

the doctor’s orders and not giving the extra medication to the patient.

Culture

Since I have been a nurse, I have had patients from many different backgrounds and

cultures. Nurses must always respect and be sensitive of patients’ cultural needs. In my BSN

program I completed a Cultural Exploration Table assignment in my Introduction to Professional

Development for Baccalaureate Nursing Practice class. I assessed the Muslim culture. In order

to complete this assignment, I had to research the culture, and fill in the table with the

corresponding information. Some of the things that I learned while completing this assignment

is that the nurse must never touch a patient of opposite sex unless providing direct care, and the

family often times has a spokesperson which is usually an older male.

Summary of Progress

My learning throughout this program has provided me a more in-depth analysis about the

field of nursing. I am satisfied with my BSN education I have received. Because the program

was online, it enhanced my writing, technology, and computer skills. It has helped me become

more familiar with computer software such as Microsoft Word. Completing this program will

allow me to continue to provide better quality care for my patients. I also feel I am more

prepared for the CRNA program. This program has taught me better time management skills and

how to be well disciplined since it is online.

PRACTICE SUMMARY 9

The knowledge of nursing theory has influenced my overall philosophy of nursing and

nursing practice because I am able to incorporate and make connections about theories I learned

about, patients, and their environment. Learning about King’s Theory of Goal Attainment and

how a positive nurse-patient relationship can help a patient attain a goal has helped me have a

positive relationship with my patients. This positive relationship builds trust between the patient

and me. Nightingale’s theory about the environment and how a clean environment can help heal

a patient has increased my awareness of my patients and their environment. It has emphasized

the importance of making sure they receive a bath, have fresh food, and fresh water.

My practice as a nurse has changed through my completion of the BSN program. I

emphasize the importance of my patients’ environment and the importance of a resting

environment at night to help them get adequate rest and their body heal. I also advocate more for

nonpharmacological interventions for pain management.

Conclusion

From the start of my nursing journey up until now, I have grown as a person and an adult.

I started out as an LPN where I struggled because of many personal reasons. However, living on

my own, working fulltime, and completing this degree has taught me time management,

organization, and other factors. These factors help me throughout my day at work by focusing

on the most important tasks and interventions first. In many ways my practice has evolved

entirely throughout this program.

PRACTICE SUMMARY 10

“I pledge to support the Honor System of Old Dominion University. I will refrain from any form
of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a
member of the academic community it is responsibility to turn in all suspected violators of the
Honor Code. I will report to a hearing if summoned.”
Name: __Kenneth Combs, Jr.___________________________
Signature: ___Kenneth Combs, Jr._______________________
Date: _____04/09/2021______________________________