Running Head: PRACTICE SUMMARY 1
Running Head: PRACTICE SUMMARY 1
Running Head: PRACTICE SUMMARY 1
Laura G. Stewart
very well-prepared clinically with a solid knowledge base regarding pathophysiology and disease
process. I gained leadership experience through operations and education positions, when a
Bachelor of Science in Nursing (BSN) was not required for these types of positions. As the trend
for requiring BSN prepared nurses became apparent, I pursued completion of my BSN for job
security and flexibility as I progress through my career. At the start of this endeavor, I felt a pull
toward education. I feel that strong clinical skills are paramount to early success as a nurse. As I
navigated the RN-BSN program, I discovered a particular interest in research and as I approach
Analysis of Outcomes
Several areas exist to support attainment of the outcome behaviors as set forth by the RN-
BSN program. These behaviors, termed “The Great Eights,” describe end-of-program outcomes
Critical Thinking
through inquiry, problem solving, and synthesis. Critical thinking skills are essential to problem
solving for the best possible outcome. This was developed by applying the Christian values and
philosophies that I live by in my every-day life to my practice. Critical thinking skills were
applied in the practice setting to aid decision-making for clinical and professional judgements.
The MORAL model was utilized to drive decision-making when considering whether or not to
solicit parental involvement (professional judgement) when I felt that reported concerns over
clinical assessment changes (clinical judgement) were being overlooked. The model guided me
PRACTICE SUMMARY 3
through three options that included deferring to the medical team, following the chain of
command to express concerns, or enlisting parental assistance in support of family centered care.
The model drove the decision to follow the chain of command as a first step, with enlisting
parental help as a last resort. This successful decision resulted in maintaining both the integrity
Nursing Practice
interventions to deliver nursing care in the cognitive, affective, and psychomotor domains.
Interventions that address all three of these domains will guarantee the promotion of health with
a holistic approach. A person is more than just their disease process. Care of the pediatric
population requires that I include the family in every aspect of care. Providing holistic care to
diverse populations across the lifespan was accomplished in the practice setting when caring for
a Muslim family with limited English proficiency, where explorations of culture and theory
assisted with addressing the language barrier to facilitate holistic nursing care. Holistic care
support through social work consult, and evaluation of available resources. Explorations of
culture and theory also re-enforced holistic care practices that served to facilitate the use of
complementary modalities such as teaching parents and family therapeutic touch or infant
massage and including them in every-day basic care, which can be useful in promoting the health
Nursing care practices to provide holistic health care to diverse populations across the
lifespan were also explored through a group research proposal for NURS 363 (Research as a
Foundation for Practice). This involved providing therapeutic interventions to adults of all
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ethnicities post cardiac surgery to prevent intensive care unit delirium. A holistic approach
addressed the physical, functional, and neurological needs to prevent delirium. Interventions
providing ear plugs, and therapeutic pharmacology for pain management rather than sedation.
Communication
techniques appropriate for clients and professionals. Without effective communication skills,
exploitation, and resolution) were addressed in a theory application paper for NURS 306
(Theoretical Foundations) in relation to family-centered care in the NICU. Each phase requires
therapeutic communication within the nurse-parent relationship that builds upon itself to achieve
the next level. The special needs of this population require identification, clarification, and
verification, and must be adapted based on which phase the family presents from.
skill with using technology and evaluating different communication techniques to support safe
and Reporting Technology (SMART) cards in healthcare, evaluating data breeches, and
comparing educational websites utilizing the Patient Education Materials Assessment Tool
Teaching
Attainment involves utilizing teaching strategies to maximize client health and enhance
different stages of acceptance and knowledge level. Using the nursing process to formulate a
teaching plan has helped me take a more systematic approach to assessing need and tailoring
education when providing teaching to patients and other professionals about health care
procedures and technologies in preparation for and following nursing or medical intervention.
Clinically, a situation was encountered regarding an infant’s need for a gastrostomy tube to be
placed for poor feeding. Family preparation before and teaching post-procedural care of tube
placement required individualized teaching plans based on assessment of knowledge level and
learning style of each family member. One family member had prior medical knowledge, the
other did not. Also, professionally, I precepted two nurses with different levels of experience.
Both situations required an assessment of prior knowledge and preferred learning style in order
to maximize teaching of care procedures (such as for taking a ventilated child to the operating
room) and technologies (such as our hospital-specific pumps and cardiorespiratory monitors).
Sensitive and relevant health education information and counseling to patients and
families was accomplished in clinical practice. Sensitivity is understanding that each person
brings with them a unique perspective, different levels of understanding, and varying
expectations. Sensitivity was shown during a conversation with a drug addicted mother
regarding the challenges her infant will likely experience as a result of her drug use. By
presenting the information in a factual but compassionate, non-judgmental way, sensitivity was
exemplified. With this same situation, offering social and emotional support and resources
specific to her addiction accomplishes relevant counseling and information to help her maintain
her own health. These concepts have been supported through study of teaching strategies.
Research
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nursing interventions. Without evidence to support our stance on any given subject or practice,
we cannot guarantee that we are offering the best, most appropriate care to our patients and
knowledge to develop a teaching plan for a Hispanic mother faced with a newborn diagnosed
with Down’s Syndrome. Research supported that this culture is more likely to have decreased
access to support and genetic services, and that family decisions are typically deferred to
authority, which makes this group less likely to ask for help or question what they do not
understand (which is exacerbated by language barrier). Using this knowledge to assess her
available resources, her understanding of Down’s Syndrome, and ensuring she understands the
Leadership
advocacy adhering to legal and ethical nursing practice as a novice nurse. Not every nurse
possesses the qualities that define a great leader, yet it is important to be able to recognize these
qualities and apply them to specific situations in your practice. In NURS 401 (Introduction to
articulated the values of the profession and the role of the nurse as part of the interdisciplinary
team. The Professional Image of the Nurse was a discussion of the progression of the values of
the profession from a historical perspective, from the time of Christ through history to the
present. The teachings of Jesus encouraged holistic, compassionate care as the work of God and
not for selfish ambitions. Caregivers were members of the church and family who held these
Christian ideals. Later, as secular women entered the profession, the ideals remained, though
PRACTICE SUMMARY 7
credit for these ideals was not often given to these Biblical concepts. In this presentation, there
was discussion about how your view and strength of self will carry over into your practice and
professional identity and we must ask ourselves if we exemplify the long-held values of nursing.
In order to be a valuable member of the interdisciplinary team, one must always take strides to be
familiar with their patients’ conditions and treatment options so that they may contribute in a
useful way to the care plan. To be effective, we must be mindful of our approach to ensure that
interactions are respectful. We always have something to offer and do not need to be territorial
with our knowledge. As a teaching hospital, nursing staff often has more knowledge than
a charge nurse, I assist staff with the admission process. During an admission, I must safely and
appropriately delegate position-specific tasks to nurses, care partners, and other support staff. I
also make rounds to each nurse multiple times throughout my shift to supervise the nursing care
given by others to ensure that patient needs are being met, and to evaluate the knowledge-level
of the staff. Retaining accountability to staff and patient/family for the quality of care is
provided through follow-up of assigned task completion and through addressing staff and parent
Professionalism
of practice and legal and ethical principles. Utilizing these criteria in everyday practice can
make a significant difference in your ability to advocate and deliver safe care. These concepts
were explored through the analysis of a video regarding delegation and understanding was
the legal standard differentiating between assignment and delegation, and evaluation of the
actions of those in the video exemplified understanding of the regulatory standards set forth by
the Virginia State Nursing Practice Acts and the National Guidelines of Nursing Delegation.
Demonstrating accountability for my own professional practice involves using the five rights of
of these concepts was demonstrated when delegating tasks during an admission. A particular
NCP was new and unsure, and I found assigning tasks to her inappropriate and ineffective. I
called for a more experienced NCP to assist her, which enhanced her learning while maintaining
an effective team. Often in the NICU, several tasks are being carried out simultaneously, which
requires assignment of these tasks to multiple nurses during the admission. I was accountable for
using the five rights of delegation to choose the most appropriate person for each task. Though
many tasks are standard to most admissions, I demonstrated knowledge of the limits to my own
practice by confirming these tasks with the medical practitioner first before carrying them out or
Aspects of this outcome were also met through application of an ethical decision-making
framework and legal guidelines to a clinical situation that incorporated moral concepts,
professional ethics, and advocacy for patient well-being and preference. A group exploration of
these concepts was applied to an ethical and professional dilemma regarding family dynamics
responsibilities provided an ethical decision-making framework for this case where a patient
diagnosed with Huntington’s Disease refuses to notify potentially affected family members.
Legal guidelines were explored through the Health Insurance Portability and Accountability Act
PRACTICE SUMMARY 9
(HIPAA). Moral concepts discussed included the repercussions of not telling the patients’
family members about a diagnosis that could potentially impact them. Professional ethics were
explored through the duty to warn versus confidentiality and HIPAA regulations. Advocacy for
well-being and preference were explored, and a plan was formulated for providing genetic
counseling to the patient, with emphasis on the familial tendencies of the disease of the
responsibility to notify family, while respecting patient wishes to not share his diagnosis.
Culture
awareness of different cultures present in our practice is essential to providing equal levels of
care to all. Certain aspects of this outcome were met in a case study on Hispanic culture and a
diagnosis of Down’s Syndrome in NURS 455 (Genetics). Through the application of research
findings regarding Hispanic culture and their views of Down’s Syndrome, integrating knowledge
of cultural diversity into nursing interventions would lead us to assess her current knowledge of
Down’s Syndrome and its’ genetic implications, as well as advocate for providing proper
accept that I may not understand why illness or death occurs, but I have a peace that there is a far
sensitivity helped me accept the end-of-life response of a parent that does not believe this, and
Summary
PRACTICE SUMMARY 10
Having been away from a formal educational environment for nearly two decades, I had
no basis of comparison for my expectations of learning from the program. The reality for me
was simply the realization that my past motivations and desires to deliver competent care over
and above what was required of me exposed me to nearly every aspect of the program goals, to
some degree. This, greatly influenced by my Christian value system, afforded me a strong
foundation for success in this program. Rather than the acquisition of any particular skill that I
feel was acquired or not acquired, I feel that my growth and development was most influenced
by learning the importance of research and how cultural awareness can improve practice. In my
current role, I experience change in practice on a regular basis, with little support offered as to
why. My learning from the program has influenced me to be pro-active in determining the why.
The explorations of nursing theory lead me to the conclusion that, while I appreciate the
concept of formal nursing theory, the basis of most theories have a clear association with
Christianity. These are all concepts with a direct correlation to the belief system I try to live by:
caring for humankind, the giving of yourself for the benefit of another, care of the mind, body
and spirit, doing all things to the absolute best of your ability without prejudice. It has been
My enrollment and completion of the baccalaureate nursing program has resulted in both
subtle and significant changes in my practice. More subtly, I have found myself striving to add
cultural sensitivity during my interactions with the families of my patients. I make more of an
effort to ensure understanding of the interventions being performed and take strides to connect
them with any resources available to them. More significant is my desire to research the
foundations for practice change: more than just broad internet searches, but sound, reliable
research. This will prove fundamental to any aspirations I may have for my future practice.
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Conclusion
As the program comes to completion for me, I am confident that the end-of-program
outcomes were successfully met. Self-reflection has afforded me the ability to evaluate how my
experiences as a nurse correlate with my belief system, and how that correlates with nursing
theory. Self-evaluation has left me with a confidence that certain aspects of my learning have,
and will continue to, influence my future practice, regardless of the path I may follow in my
future endeavors. The flexibility and stability for the future that my BSN will afford me makes