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PGC Reflection Paper

Emily Rittenhouse

Delaware Technical Community College

NUR 460 Nursing Capstone

Dr. Sokola

April 21, 2024

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PGC Reflection Paper

My time at Delaware Technical Community College in the RN to BSN nursing program

has added several skills and experiences to incorporate into my professional nursing practice.

Each class and practicum experience had a unique perspective and challenged me to grow in my

personal nursing philosophy and goals for the future. In NUR 330, I was able to learn about case

management with a focus on community health. For NUR 460, I was able to learn about being a

unit manager with a focus on leadership skills. My personal nursing philosophy is a blend of

Jean Watson’s Caring theory and Virginia Henderson’s Needs theory. It is important that I

provide compassionate, empathetic care in a way that addresses my patients’ needs. I have

developed further knowledge and skills in general education, leadership, evidence-based

practice, information technology, policy, advocacy, health promotion, ethics, and lifelong

learning. This paper will reflect on my experiences with these competencies and how they have

improved my professional practice.

PGC 1

The competency for PGC 1 is in relation to developing general knowledge, skills, and

aptitudes in my practice. As I have added new skills and knowledge throughout this program, I

am able to incorporate what I have learned to strengthen my nursing philosophy of better

addressing my patients’ needs. In my 330 practicum and class, I was able to narrow my focus on

the elderly population in Delaware and specifically look into how case managers best support

this population. Utilizing a general knowledge of statistical analysis became important as I began

looking into identified issues for my chosen population of the elderly in Delaware. My preceptor,

Kelly, has a wealth of knowledge and support to provide to her patients and the community. She

was able to draw from her previous experiences and jobs to aid her patients. For instance, my
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preceptor worked in case management for several years. She has a strong foundation of

knowledge to help guide patients and their families with decisions as well as her experience as a

nursing liaison gave her invaluable knowledge and resources to support her patients. My NUR

460 practicum added to my general knowledge by providing me with the experience of a service

recovery class. The class was intended for those in a leadership position, but I found it to be

applicable to all nursing practice. Incorporating conflict resolution into nursing fosters positive

communication and trusting relationships (Gerardi, 2021). The class discussed the need for

self-awareness and getting to know staff better, such as how each likes to be appreciated. There

are several times when there may be a disagreement with a patient, family member, or coworker

when the nurse needs to have strong communication and conflict resolution skills to preserve

trust with the interdisciplinary teams and the organization.

PGC 2

This competency addresses leadership skills to promote quality healthcare. Growing in

leadership skills was identified as a course goal developed after my SWOT analysis. To

effectively address PGC 2, leadership skills were learned through observation of the manager of

the endoscopy unit as well as through the NUR 460 class. According to González García et al.

(2020), it is imperative that nurse managers possess qualities in regard to communication,

making decisions, addressing conflict, managing a team, building relationships, and providing

ethical leadership. My preceptor effectively demonstrated these core values throughout my

practicum. She met with a few manometry nurses to discuss current issues and ways to improve

efficiency and patient satisfaction. My preceptor also spends time fostering positive relationships

with the interdisciplinary teams. Doctors, nurses, nurse technicians, respiratory therapists, and

the anesthesia team are all directly together in the endoscopy unit. My manager has several
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meetings with each group and encourages open communication. She was also able to address

conflict management with some nurses who had a disagreement, as well as a difficult

conversation with a staff member who had been reported multiple times for unprofessional

behavior. Specchia et al. (2021) mention that staff trust and satisfaction is achieved through

transparency, openness, positive communication, encouraging diligent work, and teamwork.

Healthy work environments, excellent and timely patient care, as well as staff and patient

satisfaction are linked with effective leadership (Specchia et al., 2021). My SWOT analysis

determined that I wanted to work on leadership qualities and skills. In my NUR 460 class, I was

able to demonstrate leadership qualities. It was important to me to take the initiative and start a

group email chain with all the group members. Through the first email, I established connections

with the group, fostered open communication and teamwork, and started the collaboration

process. As I embrace these leadership skills, I am able to better practice within my personal

nursing philosophy as I can serve as a caring leader with my patients and on my unit.

PGC 3

PGC 3 involves evidence-based practice and involves skills of inquiry, analysis, and

information literacy. One of my course goals from the beginning of the semester was identified

as adding evidence-based practice or other learned information to my practice. The more I am

able to incorporate evidence-based practice into patient care, the more I will be able to meet my

patients' needs with best practices. One article noted that evidence-based practice is critical for

evolving healthcare and promoting positive patient safety and outcomes (Alqahtani et al., 2022).

The authors also found that nurses with education that went to a bachelor's degree or beyond

positively added to these nurses' overall skills and knowledge (Alqahtani et al., 2022). In my

NUR 460 practicum, my preceptor had the opportunity to research policy and evidence-based
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practice on fecal transplants. That Friday morning, one of the physicians came to my preceptor

and asked if it was possible to have a fecal transplant completed that day. This procedure had

been done in the endoscopy unit years before but has not been performed in some time. My

preceptor needed to look into the equipment needed, staff knowledge of the procedure, and

policies and research surrounding this procedure. After completing some research and speaking

with other leaders and nurses, it was determined that this request was not able to be completed

due to a lack of equipment and policy review. In my practice, it is crucial to research anything

that I need to familiarize myself with or need more information. There are always changes in

healthcare, and it is important to ensure nurses follow policy and best practices to promote

patient safety and positive outcomes.

PGC 4

The next competency addressed is information management technology, which improves

patient outcomes. The nursing practice has utilized technology to improve patient care. Kirsten et

al. (2020) discuss how the utilization of technology in nursing not only creates the opportunity

for better patient care and outcomes but also improves nursing efficiency. My preceptor in my

NUR 330 practicum was able to show me how there are various screening tools that case

management utilized through the electronic health program that can help determine and

anticipate patient needs. There is a particular screening called the Social Determinants of Health

Screening that my preceptor told me was new to case management and was helpful for

identifying potential barriers, like paying for medications or transportation needs, when the

patient goes home. One article mentions the results of technology utilization include increased

patient safety as well as decision-making (Kirsten et al., 2020). In my NUR 460 practicum, my

preceptor was responsible for overseeing the trial of the new robotic bronchoscopy equipment
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and discussing the benefits or issues with the new robot equipment with the team. Maintaining

proficiency with technology and staying up to date with changes will ensure that I can provide

quality patient care.

PGC 5

The competency for PGC 5 entails advocacy for the nursing profession and patients

regarding local, state, national, and global healthcare policy. Addressing this PGC meets my

course goal regarding advocacy. NUR 420 has given me a great foundation for policy and the

legislative process to expand for this semester. One article discusses how nurses are to protect

and support patients in regard to their treatment and nursing care, as patients are more vulnerable

and at risk at the hospital (Abbasinia et al., 2020). I observed that my nurse manager preceptor

had two opportunities to advocate for nursing policy during my practicum experience. The first

time was regarding the nursing policy for the manometry procedure. This procedure requires a

doctor’s order but is performed by a nurse. It was identified in a meeting with the manometry

nurses that there was not an established order or protocol for patients receiving local lidocaine

for this procedure. Another opportunity presented itself when my preceptor was asked about a

fecal transplant, which was able to be completed that day. Both of these cases affected local

policy, and it was imperative to ensure that patient safety was maintained and that nurses felt

supported in their practice. O’Rourke and Outly (2024) discuss how, although nursing advocacy

is taught and encouraged, it is not being implemented by many nurses on levels past the local

level. As nurses, it is important not only to advocate for policy changes in our organizations but

also to be active at the state, national, and global levels for opportunities to provide better patient

care and work environments. This is important for me to incorporate into my nursing philosophy.
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As I build trusting, caring nurse to patient relationships, I can determine what the patient needs

and seek to better advocate on multiple levels to result in improved healthcare.

PGC 6
The next competency is in regard to providing patient-centered care through patient

advocacy and utilization of teamwork skills such as communication, collaboration, and

delegation. Meeting this competency is directly in line with my nursing philosophy.

Patient-centered care necessitates a healthy working environment and a team that works together

cohesively. During my SWOT analysis, I identified interprofessional communication and

collaboration as strengths and delegation as a weakness. This is a course goal I had identified for

my NUR 460 class was to utilize and observe delegation, collaboration, and communication

skills in my practicum and group project. Vaseghi et al. (2022) mention how vital

interprofessional communication and collaboration are when it comes to overcoming obstacles

and achieving established goals for patients and the team. I was able to see all these skills

utilized to better patient care in both of my practicum experiences. In NUR 330, as a case

manager, my preceptor works closely with the physicians, nurses, physical therapists, and other

interdisciplinary team members to discuss care for their patients. She was able to advocate for

the need for physical therapy consults, walkers, and other home equipment. They worked

together as a team to determine what the patients needed to be ready for discharge as well as

what they needed when they went home.

In NUR 460, my preceptor worked with the physicians, nurses, respiratory therapists, and

the anesthesia team to discuss procedure equipment and supplies to ensure the best patient

outcomes as well as use resources wisely. She also utilized delegation with the unit nurses and

her assistant nurse manager. Every day, my preceptor would prioritize what needed to get done

and what could be delegated to another member of the interdisciplinary team. There was a
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borrowed endoscopy scope that was reported as lost and needed to be replaced, but my preceptor

was able to delegate the investigation of this task to her assistant nurse manager. She made sure

to follow up later that day regarding what the assistant nurse manager was able to discover.

Bednarski and Painter (2023) emphasize that it is the responsibility of the nurse to follow up on

any delegated task. During my group project this semester, the team leader delegated each of the

sections that our group was responsible for incorporating into our project. Then, each of the team

members collaborated on a topic and agreed upon specific aspects used, such as the colors,

graphics, and media. It was key for the success of the project that roles were clearly defined,

each team member used clear communication, and expectations were established for the project.

When the team functions well together to achieve excellence, I have learned that each of these

aspects of communication, collaboration, and delegation are key to the success of the team.

PGC 7

The competency for PGC 7 involves health promotion and disease prevention practices to

help provide care for diverse populations. As part of my nursing philosophy, the best way I can

care for vulnerable populations is to be able to provide support and offer resources that would

facilitate improved health outcomes. This encourages patient independence, which is in line with

Henderson’s Needs theory (Petiprin, 2016). Fracso et al. (2021) list three vulnerable groups that

would benefit from chronic disease management, including the elderly, minority groups, and

individuals with a lower income. The authors also state that deaths related to chronic diseases are

around 60% (Fracso et al., 2021). NUR 330 focused primarily on health promotion and disease

prevention in the community, and NUR 310 focused on health promotion and disease prevention

on a global scale. Each class had an emphasis on vulnerable populations and ways nurses could

be involved to promote better health. Nurses can make an impact through education and
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connection to community resources. My preceptor in NUR 330 was proactive in providing

education and connecting patients to resources in the community. She would organize her day in

the morning, look into case management consults assigned to her, and then she would go to each

floor to meet with patients and their families. After asking a few open-ended questions to gather

some information regarding their needs, she would inquire about the support these patients have

going home. Some of these questions were in regard to whether they had stairs in the patient’s

home, if the family lived with the patient or close by, what city they lived in, and what insurance

they had. She was able to connect patients with different home health services and offer

suggestions for acute care facilities as well as other identified resources. Case managers are able

to advocate and encourage choices that result in patient safety, satisfaction, and overall better

healthcare results (Mota et al., 2022).

PGC 8

The next program competency entails practicing professional nursing within an ethical

framework. This competency was identified as strength through my SWOT evaluation as it

directly relates to my personal nursing philosophy. Every patient has the right to be treated with

care, have their needs addressed, and have their wishes respected. It is the nurses' priority and

responsibility to practice in a way that is in the best interest of the patient (Goranova-Spasova et

al., 2023). My preceptor in NUR 330 discusses two documents with the patients about their

rights in relation to the care they receive. One document that states the patient's first and second

choice of facility for treatment or supplier for equipment, such as a walker, hospital beds, or

home oxygen. This gives the patient autonomy and seeks to match the need with the patient's

preference. Another document regards the right to repeal discharge if they feel they are being

discharged too soon. The code of ethics guides the nursing practice, and nurses must be mindful
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that their duty is always to the patient (Goranova-Spasova et al., 2023). In NUR 460, my

preceptor utilizes ethical leadership in her care for the staff. There are several difficult

conversations and sensitive discussions she must have with her staff members. She provides

confidentiality and respects the privacy of her staff members when it comes to discipline or

difficult personal situations that arise. One source validates that managers who practice an ethical

framework yield a team that is more willing to stay and be dedicated to work for their

organization (Jandaghian-Bidgoli et al., 2023). Treating patients with respect and maintaining

autonomy is in line with my nursing philosophy as it meets Watson’s theory to treat patients in a

caring manner and Henderson’s theory to meet the patients most basic needs and maximize

independence (Petiprin, 2016).

PGC 9

The final competency in this nursing program involves a plan for lifelong learning to

ensure continued personal and professional growth. This was identified as a potential threat in

my SWOT analysis and was incorporated into my course goals for this class. Professional

growth can be threatened by a busy schedule. Mlambo et al. (2021) discuss how crucial the

pursuit of knowledge and skills is for the nurse to grow in proficiency. When this program is

finished, it will be my responsibility to continue seeking out opportunities to foster growth that

will make me a better nurse for my patients. Both of my preceptors in my practicum experience

were role models for professional growth and encouraged it as well. My case manager preceptor

has a master’s degree, and she discussed with me how the various roles she has had as a nurse

have helped to provide quality patient care. She would seek out knowledge on anything she came

across in her practice that she felt was a learning opportunity. My preceptor, who was a nurse
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manager, also pursued her master’s degree and worked in various nursing positions that all added

to her skills and knowledge to better support her team and unit. This semester, my preceptor was

also involved in developing a project with one of the other perioperative nursing leaders.

Together, they are heading a program to bring float nurses to the perioperative area. These nurses

would be able to work on each of the procedural areas to support staffing needs that arise

specifically in the perioperative area. This demonstrates a commitment to learning and

professional development and is an excellent example of collaboration that will benefit the

nursing practice and patients. Mlambo et al. (2021) report that nurses seeking knowledge and

skills to enhance their practice had more confidence, better collaboration, improved patient care,

less anxiety, and more job opportunities. Committing to lifelong learning ensures that I will

continue to grow and continue finding ways to provide excellent patient care in a caring manner.
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