Ashley Chow's ePortfolio

My journey throughout the baccalaureate Nursing Program has provided a completely different perspective of the professional role of nursing. After being accustomed to studying the medical aspect of nursing, there is a different insight to nursing leadership and community advocacy. There is a reason why nursing is called the “science of caring”: it incorporates how a professional cares for clients’ medical needs with dignity and grace.

In this course, students explore professional nursing issues evident in todays’ and future practice. Rather than simply identifying career challenges, students explore how these issues require awareness supported with evidence. Throughout the semester, students begin to discover the issues they were passionate about as different discussions were prompted. First, students were asked to develop a personal nursing philosophy in order for students to reflect their thoughts of why nursing matters. Students were assigned with weekly discussion board questions for various professional issues of nursing. Debate teams were created to understand the different sides of sensitive topics in nursing. Finally, students were assigned to develop an extensive research paper on a particular issue that is of importance to them. In my experience, developing the term paper was an insightful assignment because I found a professional nursing issue that was important to my practice: the rising occurrence of medical errors. After completing research, I was more shocked to see how it is not seen as concerning as it should be. This will be something I will carry throughout my career and I want to continue advocating safe medication administration as this is a crucial part of our nursing profession.

Professional Nursing Issues is one of the courses that provided a different perspective of nursing that allowed me to continue my growth. While I understood the importance of obtaining a baccalaureate degree, these courses only provided more reasons for every nurse to continue their education throughout their career.

As a professional, we are always asked to question on how we can improve in our career. But in order to meaningfully reflect on ourselves, we need to acknowledge the strengths we carry that make us unique from others. After reflecting on my experiences as a new graduate nurse, I also carry qualities at work that I should appreciate.

The first strength I carry is perseverance. This was first evident when finishing the Associates Nursing Program because it required much of my time studying and practicing for the NCLEX. Even after many failed exams and classes, I had the drive to continue forward. With each class I overcame, the light at the end of the tunnel grew brighter and it only motivated me to continue strong and make it to pinning. But once I finished my Associates Program and passed the NCLEX, the journey did not stop there. There were different challenges when entering the Baccalaureate Nursing Program, including finding part time positons that accept only an Associate Degree. I utilized all the resources available and eventually found two positions that accepted me to practice my nursing skills and work with other professionals at the work level. My first day working after orientation was nerve-wracking as any new position should be. But just like the Associates Program, there was a light at the end of the tunnel that grew brighter the more I continued the process.

The second strength I found in myself was keeping me leveled at stressful situations. I found myself staying calm because the first thing I do is listen. When a client or family member is anxious, I always ask them to explain to me what is on their mind. I also know when to redirect them when they go off tangent with their thoughts that would not be necessary at the time of the conversation. By giving that time for the client and/or family to speak their mind, it also alleviates some of the anxiety. This also helps when a client and/or family is upset about a situation. I always give them the opportunity to explain how they are feeling and I listen to their concerns. I speak with a matter-of-fact tone so they can also take me seriously and see that I care about their concerns and that I am here to make sure something is resolved or they are guided to someone who can resolve their concern.

Finally, the third strength I carry is my responsiveness to a critical situation. I would have to thank my running abilities because I am able to respond to an emergency situation at my facility without losing my breath. In the facility I work at, there are six floors with two slow elevators. A rapid response was required for the top floor and I was working at the second floor. When I heard the speaker say “Code Blue Unit Five”, I bolted up from the second floor to the top floor using the stairs and aided my colleague with CPR. After the incident, my team was joking that they had never seen someone run that quickly and appreciated that I was able to do so. Keeping a healthy lifestyle is important for a professional nurse because it is a laborious job since we need to keep on our feet and tend to different clients from rooms that are on opposite ends.

In the world of health care, people are hung up with confusing medical jargon, rushing from patient to patient, getting ready to do the next procedure. Our patients are caught in the midst of this and too often they feel like their voices are not heard when they are cared for. As nurses, we are taught how to effectively communicate with our patients. Sometimes we forget it is not just about speaking with our patients. Effective communication requires listening. Often times a patient’s healing can be expedited when we stop and listen.

As a nurse, I will always listen before I act. I will listen to my patient to what he or she has to say. I will listen for the things my patient might not say out loud. I will listen to their concerns and make sure they know that I am here to listen. I know when I interact with my patients I might not even have to say a word to them because listening is truly therapeutic.

While I promise to listen to my patients, I also need to take time to listen to myself. I need to listen to my body so I know I am optimally able to care for my patients. I need to listen to my heart if something is out of place. I will also listen to those who want to help me. I will listen to those who want to offer education and experience. I will listen to the founding mothers of nursing and their beliefs because they paved the road of nursing care for us. I aim to stay humble and grounded and I believe the best way to do that is to listen more.

For this semester, I was enrolled in Community Health Nursing and completed my clinical rotations at Woodhull Hospital. Specifically, I was assigned at their off-site clinic Cumberland Diagnostic Treatment Center. Community Health Nursing focuses on public health issues and how to raise awareness of such issues. Throughout the semester, I completed the course’s objectives it was required of me which include the following:

Objective 1: Demonstrated individual professionalism through personal behaviors and appearance.

As a community health nurse, the most important thing to do is uphold a professional image. While a registered nurse should always maintain a professional image, it is more imperative that a community health nurse do so because he/she is a public figure of the organization. Throughout my clinical rotation, I obeyed the dress code required being a white dress shirt, blue/black slacks and comfortable work shoes. When interacting with clients, I greet them and ask permission to shadow the head nurse with assessments. I made sure to arrive the clinical site on time and have all due assignments prepared. During post conferences, I made sure to either actively participate in discussions or actively listen to my peers.

Objective 2: Employ analytical reasoning and critical thinking skills when providing care to individuals and families in the community setting.

At Cumberland Diagnostics Treatment Center, I was placed on the OB/GYN unit so most of the clients I interacted with were women of child bearing age or transitioning to menopause. I obtained client information by being present in the client-nurse interviews and reading electronic medical records. Because of this unique client group, every client is assessed for depression or risk of depression. They are given a questionnaire to fill out and if they score a ten or above, they are referred to a specialist for further evaluation. We ensured care was given at a timely manner and privacy was endorsed. A complete physical assessment is done for brand new clients visiting the clinic for the first time. At the beginning of each appointment, I observed the nurse asking the client the reason for the visit to know the client’s priorities. If the client is transferred from the nurse exam room to the physician’s office, the nurse ensures that the client see her before the end of each visit for continued education, summarization of the visit and verify follow up appointments.

Objective 3: Effectively communicate with diverse groups and disciplines using a variety of strategies regarding the health needs of individuals and families in the community setting.

At Cumberland Diagnostics Treatment Center, they follow PCMH: Patient Care Medical Home. The providers want their patients to feel like at home when handling medical issues. This includes having the patient follow the same provider at every visit, unless it is an emergency and the provider is not there at the time. At the obstetrics clinic, the nurses communicate with the mother and social worker to have the infant enrolled in the adjacent pediatrics clinic. By following this philosophy, it encourages consistent care so the patient is familiar with the members involved. This helps build a meaningful relationship with the staff and patient. At the start of each clinical meeting, I observe the nursing staff on both OB/GYN and pediatrics conducting huddles to update everyone the daily census.

Objective 4: Establish environment conductive to learning and use a plan for learners based on evidence based practice.

At the clinic, providing education to the patients is critical because we want to ensure the patients know how to care for themselves and prevent any unwanted events. We emphasize and encourage the all patients to attend their follow up appointments, perform monthly breast exams, and demonstrate proper breast exams, daily moderate exercise, and safe sex practices. The clinic has an abundance of pamphlets about various material such as information about different contraceptives, pregnancy fitness, and information about each trimester in pregnancy. At the end of each meeting, the nurse reinforces to the patient the next plan of action such as the date of next appointment or diagnostic tests that need to be done.

Objective 5: Utilize informational technology when managing individuals and families in the community.

All medical records are organized electronically through Woodhull’s EMAR and each nurse has a login/password. The nurse documents the notes in the patient’s chart and saved appropriately. When the nurse is transitioning between one patient to the next, the nurse ensures the note is completed before calling in the next patient. This promotes confidentiality of the patient’s records and reduce the chances of incorrect documentation.

Objective 6: Demonstrate a commitment to professional development.

Keeping up with current events about client care is necessary when educating the community. My nurse preceptor and I exchange current events about obstetrics care and how to reach out to low income families who may be reluctant to attending medical appointments. When we have client interactions, we ask each other whether we missed anything that the client needs to be aware about and review what was taught when documenting in the EMAR.

Objective 7: Incorporate professional nursing standards and accountability into practice.

As a registered nurse, I should be following the American Nurses Association Standards whether it be at work or in the clinical setting. I maintain respect with the patients and ask permission to sit in their interviews with my nurse preceptor. According the hospital policy, all staff and visitors must show proof of flu vaccination and wear it on their IDs. Cumberland also follows the same mission statement as Woodhull Hospital. The mission statement states:

The mission of Woodhull Medical and Mental Health Center is to provide comprehensive and compassionate health services of the highest quality to all those needing care in an atmosphere of dignity and respect. We strive to promote and ensure wellness, serving as advocates, innovators, and educators in partnership with the diverse communities we serve.

Objective 8: Collaborate with clients, significant support persons and members of the health care team.

I attend the morning huddles with both OB/GYN and pediatrics to update the census for the day and whether walk-ins are available. During interviews with the clients, I work with the preceptor nurse to see if there are any opportunities for education with the client. For example, if a client is present for a OB revisit and is not having her first baby, we would review certain aspects that the client is unsure of rather than repeating information she already knows. The nurse also ensures that the client has met with her social worker and nutritionist so her baby is insured and healthy for delivery.

Objective 9: Recognize the impact of economic, political, social and demographic forces that affect the delivery of health care services.

This semester was during the time of the inauguration of the new 45^th President of the United States and the public has expressed issues regarding immigration status and the uncertainty of whether they themselves or their loved ones will be deported. The head nurse has noticed a trend that there are occasions when the clinic has been particularly quiet despite the prime time for clients to arrive for their appointments. A theory suggested was fear of attending medical appointments. Even though some clients have doubts of public health care facilities, the nurses and providers still strongly encourage their clients to continue attending their scheduled appointments. There are messages at the clinic emphasizing privacy of their records and counselors to reach out to discuss this fear.