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Elizabeth Luther
The purpose of this paper is to provide an overview of the attainment of all eight
behaviors that are outcomes of the Old Dominion University BSN Nursing program including:
discover the scope of the student nurses personal and professional development while enrolled
Critical Thinking
The student nurse was challenged to demonstrate critical thinking very early in the
program to facilitate nursing practice through inquiry, problem solving, and synthesis. In Adult
Health I, my weaknesses consisted of being comfortable with the medications and having
confidence in administration of medications. I made progress by passing multiple meds and felt
more comfortable in my knowledge since I was able to research them the night before.
Psychiatric and Mental Health Nursing required working through what the patients were saying
with their body language when talking to each other, the student nurse, and other members of the
Senior Year
judgments was a vital part of the experience. An example of a clinical scenario that requires
meaningful decision making is triaging patients that come into the ED. Acuity is a combination
of patient physical presentation, verbal complaint, and duration of symptoms. While these factors
drive acuity, there are also factors that the nurse may let effect their view of acuity such as length
PROFESSIONAL PROGRESS SUMMARY 3
patient volume (Wolf, 2013). At times with low staffing and rushed sense of time, the decision-
making strategy is satisficing. On a low-staffed code black shift I have seen a triage nurse make
the decision to spare time with the first available alternative and admit into the ED patients who
came in complaining of chest pain in order for them to get an EKG in a room instead of in triage.
That decision making process lead to an alternative that is not ideal, and one that I (and the
charge nurse) did not agree with when I made the decision to preform an EKG in triage. The
nursing process must be supported by the rational decision-making model in order to account for
the probability of all outcomes; an AMI could go untreated for a longer period of time with the
decision that the triage nurse made in the aforementioned experience. The action that yields the
highest probability of achieving the best possible outcome would be to staff another tech solely
Research in Community Health was done to evaluate the nursing care outcomes through
the acquisition of data and the questioning of inconsistencies. While doing research on the trends
of alcohol abuse, a study was found based on the premise of alcohol effects over time. This study
followed a group of approximately 15,000 people with follow ups 30 years after the study. To
compare the results, a control group was naturally created by selecting and studying trends in
same-sex monozygotic twins with no overt comorbidities, in which one twin self reported heavy-
drinking status and one reported low- to no-drinking status. Measurements for drinking status
included the number of heavy drinking occasions and alcohol-induced blackouts. Their findings
suggested that more of these related to a higher all-cause mortality rate that could not be
explained through genetic or familial means. This shows that alcohol cessation therapy is truly a
conducted a study over 6 years into the factors affecting the sustainability of self-run recovery
homes in the United States and the effects on the members of the rehabilitation programs. To
sustain a program such as this, it needs affordable housing nearby and continual incomes for
their members. This is important for adherence to program requirements, but they also need
institutional and community support. Over the course of the 6-year study, approximately a third
of the programs shut down. The major reason reported for these programs shutting their doors
was the insufficient income of the program members and their inability to therefore adhere to the
program rules. One of the members of the Norfolk program, Joe, is in this similar situation and
trying to resolve this before being forced to leave the program. This is a trend that other
institutions have experienced and have lead those institutions down the path of closing.
Nursing Practice
nursing care in the cognitive, affective, and psychomotor domains. Adult Health I helped me to
become more familiar with IV management and checking lines before and after medication
assessment of patients and fluent with the review of systems. Psychiatric and Mental Health
Nursing required more time focused on discussion and listening than previous patients had.
Important goals for Psychiatric and Mental Health Nursing were focused on establishing a
therapeutic environment for patients to begin the healing process and to continue the discussion
Senior Year
PROFESSIONAL PROGRESS SUMMARY 5
health problems was seen in both Role Transition and Critical Care. The first trauma I saw was
an 80 year old male splenic laceration from a fall in the bathtub. He was brought to Leigh,
intubated, given 4 units of blood, and coded once there. In the Nightingale, he coded twice and
was given 4 more units for 8 total on arrival. Vasopressin, Levo, and Epi were running.
Massive transfusion protocol was put in place, and his vitals were: temp 94.1 pH 6.9 HR 125 BP
82/40. RUQ, RLQ, and pelvis were all positive on FAST. He had a right subclavian central line
and a femoral A-line placed in the trauma room at SNGH. After assessment in the trauma room,
he was taken to interventional radiology where I followed and observed. While the patient did
not code during the femoral catheterization procedure, I was able to predict and subsequently see
In Critical Care during my ICU rotation, my patient came into the ED two
days prior to assumption of care with status asthmaticus. He had a PMH of severe asthma and
HTN (steroid induced per pt). Pt was given bipap in ED but did not tolerate, was then intubated
in ED. Came to ICU with ARDS, pneumonia, anemia, HTN (254/158), with wheezes and rales
PROFESSIONAL PROGRESS SUMMARY 6
present. He was given propofol which was d/c due to lactic acidosis (more likely caused by the
continuous albuterol nebulizer tx). Pt placed on IV Precedex for BP and sedation as well as low
dose Versed. D/c fentanyl to decrease RASS score to wakening. Pt had steroid induced
hyperglycemia, was on IV regular insulin, with q2h BGL checks. Placed on spontaneous vent
setting, lung sounds became clear bilaterally, writing to communicate, d/c tube feeding and
suctioning gastric secretions to prevent aspiration on extubation, 9/20 planned extubation 12:00.
Pt was calling his friends on the phone, lung sounds were clear. Pt became nauseas, given 60 of
Zofran over two hours. Pt increasingly nauseas, approximately 100mL emesis. Pt then requested
to lay HOB flat. Pt went into respiratory distress caused by bronchospasm, sat upright holding
bed side rails leaning forward, air hungry. Became ashen, could no longer speak or move air
through mouth, syncope, code blue called. While a nurse was bagging the patient, he bradyd
down until femoral pulse was lost and CPR was initiated by nurse. Pt was given bolus doses of
propofol and versed, MD established airway with CASS ET tube. Before atropine was given, pt
gained back sinus rhythm. CMV was initiated through vent. I inserted OG tube per direction of
nurse. Wheezing lung sounds heard bilaterally, pt VS stabilized on vent. 9/21 pt was weaned off
fentanyl and down to low dose versed. Pt communicating by writing. No tube feeding given,
suctioning gastric secretions all day to prevent aspiration on extubation. Plan to insert PICC line,
abdominal x-rays, and the decision was made to wait a longer period of time for extubation the
second interval.
PROFESSIONAL PROGRESS SUMMARY 7
provide holistic health care to diverse populations across the lifespan both in Role Transition and
in Critical Care. Norfolk General raised the model by Jean Watson in Role Transition. It relates
to a humanistic model of patient care concerned with promoting health, preventing illness, caring
for the sick and restoring health. Watsons model states that holistic health care is central to the
practice of nursing, and evaluates nursing as a human science of persons and human health-
illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical
human transactions. The acuity of patients coming into Norfolk General is constantly higher than
other area hospitals. While many patients are trauma that cannot be prevented by a healthy
lifestyle, many more patients are being seen due to a lack of continued healthcare to a preexisting
general. Something to focus on was the patient population. Many of the regulars that I see at
work come into the ED at Sentara Leigh known for conditions such as alcoholism where in
comparison, many of the regulars at SNGH are known for being homeless. The lower acuity
(and even some of the higher acuity) patient population is a population that does not have readily
available healthcare. Illness prevention, which is a core of the nursing health model, is near non-
I was also able to provide holistic health care to diverse populations across
the lifespan through a DNR/DNI patient for which I was present for the extubation and
withdrawal of care. Grief concerns were evident in this patients family. Spiritual concerns
impacted care we had to wait for the chaplain to become available and come up to the patient
room before withdrawal of care could take place. Their spiritual needs were addressed with the
chaplain in the form of prayers and their presence during the withdrawal of care process. Special
nursing care needs for this patient revolve around monitoring and care of the family. Since she
had a code status of DNR after extubation she was monitored on the screen outside of the room;
the monitor in patient room was turned to comfort care setting, showing the patients family
nothing.
Communication
Verbal, non-verbal, and written communication techniques appropriate for clients and
professionals were developed. Most of the communication in Adult Health I relied on the student
nurse-patient relationship, as the line of communication between the student nurse and other
members of the healthcare team was not as open as it would become. However, the attending
physician was always available for questions. Communication in Psychiatric and Mental Health
Nursing was more open to the nursing staff and care team members than previously. Student
nurses and staff communicated about the uniqueness of the unit, protocol distinctions, and
PROFESSIONAL PROGRESS SUMMARY 9
Senior Year
I was able to adapt communication methods to patients with special needs in Critical
Care. During my ICU rotation one week my patient was very calm while awake and still on the
ventilator. After the MD commenting on how he would not be as calm if awake and on a vent,
the patient was asked if/why he was calm. He responded through writing after I had provided a
notepad from the charge desk and a pen (for which I had to support his hand) in the affirmative
Teaching
were established. Teaching in Adult Health I was towards the patient and consisted of flu and
patient was assessed through a patient teaching analysis. A 57-year-old male patient was selected
who was brought into the ED for seizure activity and postictal combativeness. After admission,
the patient reported a year long history of unassessed seizure activity. Through imaging it was
determined that because of his noncompliance with a HTN medication regimen prescribed to
him 3 years prior, the patient had extensive chronic microvascular ischemia, atrophy, and
moderate diffuse volume loss. The damage done through noncompliance of his HTN medication
regimen is evidence that this patient had a learning need. The patient had deficient knowledge of
HTN and needed to be taught the importance of medication adherence. This information will
help the client know why he must take his prescribed medication and the risks of not taking his
prescribed medication. Factors pertaining to the patients condition that focus his learning need
PROFESSIONAL PROGRESS SUMMARY 10
are: inaccurate follow through of instruction, questioning members of the health care team,
exacerbation of symptoms, and therapeutic effect not achieved or maintained (Gulanick 2014). In
order to assess his learning needs, data was obtained about and from the patient using both
informal conversations and a structured interview. The assessment of the patient learner was
through the PEEK model. Step-by-step instructions were utilized in teaching with frequent
repetition due to diminished cognitive ability. Written word supplies and documents about HTN,
compliance, and medications were present during teaching because read/write was his learning
style.
Senior Year
I was able to provide relevant and sensitive health education information and counseling
to patients, and families, in a variety of situations and settings in Role Transition. A trauma
patient I saw the first week who came in for a liver laceration had family teaching weigh heavily
on the topic of end of life care and DNR/DNI teaching. Another patient who came in for bilateral
weeping leg ulcers with a history of DM, HTN, and CRD had teaching focus on the importance
ATV accident leading to broken ribs and a le Fort fracture had teaching focus on the effects of
Research
Through every course, primary nursing research findings were incorporated as a basis for
Theories and Concepts displayed research findings and nursing practice that I believed would
guide my personal model of professional practice in the future. I based it on Sister Callista Roys
Theory of Environment and Adaptation model. To accompany the research as a visual aid, I grew
a plant during the progression of the semester. In order to holistically care for a patient, I believe
that we need to constantly re-assess the situation to meet a patients basic care and psychological
needs. I wanted to showcase an adaptive system, with health being the outcome realized. Patient
health is a bio-psycho-social system that is in steady interaction with the constant changing
environment.
Senior Year
showcase an adaptive system with health being the visible outcome. I have come to see that the
ideas that will guide my practice are ones shown by Sister Callista Roy and her theory of
Theories and Concepts. Roys Adaptation Model is an involved influence in my own definition
of nursing. I believe that patients can overcome nearly any situation, and the resiliency of man is
a legitimate factor in healing. To assist a patient in a recovery process and to help them develop,
we must utilize the environment and adversity of that patient. ANA Standards of Professional
Practice incorporated in my personal philosophy include sections from the Standards of Holistic
Nursing Practice that guide nursing care which enhances healing of the whole person across a
lifespan. It is not described as a client type or disease grouping and is therefore practiced in all
alongside the Holistic Caring Process is the basis of my personal nursing definition (Frisch,
2001). Assessment of the patient is a strong provision in holistic care, as the identification of
PROFESSIONAL PROGRESS SUMMARY 12
interrelating factors and communicating dimensions of health all interact with each other in the
span of one patient. Identification of the environment and evaluation of the environments effect
on health is essential. Nurses need to constantly re-assess the situation to meet a patients basic
care and psychological needs. If given the best possible avenue of success, I believe that a patient
will adapt and succeed. My personal philosophy is that nursing centers around giving every
Leadership
In a new environment with little health experience, I was challenged to demonstrate self-
direction, professional accountability, and advocacy adhering to legal and ethical nursing
practice as a novice nurse. I was always the first to initiate conversation with my patients
whenever anyone walked into or out of the patient room with me and was comfortable in
conversing without accompaniment in the patients room. I became comfortable with patient
communication, which opened the door to perform a complete review of systems while the
Senior Year
and coordinator of health care to meet the special needs of a vulnerable population. With a blood
pressure of 102/52 and a heart rate 56, a patient received Atenolol. When I brought the patients
vitals to the attention of the RN before administration, the RN said that no alert popped up on the
computer so she did not notice and furthermore did not feel uncomfortable giving that
medication. That morning, the patient received their medication in the gym. At that time, PT had
that patient get up and walk from their wheelchair to a designated point and back with the
PROFESSIONAL PROGRESS SUMMARY 13
assistance of a walker. Minutes after that, morning medication was administered. Later in the
day, the patient was back in the gym for a second round of PT. At that time (11:15 AM, 3 hours
post morning medications) the patient could not take forward steps immediately after standing
like he could that morning. When the PT asked if they patient was dizzy, the patient answered
yes, very dizzy. The patient then took a significant amount of time before trying to move
forward, after which he could only walk a few steps before stopping. I assumed the task of
bringing this to the attention of the RN the second day as well as bringing it to the attention of
the physician who gave a verbal order to the RN to hold BP meds. I was also able to articulate
the values of the profession and the role of the nurse as member of the interdisciplinary health
care team. I set a goal of talking to the therapists more in order to obtain a larger view of
everything the job of a PT/OT entails. Through that, I was able to observe PT/OT preforming
passive and active therapy such as stacking cones, picking up and tossing beanbags, use of
parallel bars, resistance exercises such as pushing against the armrest of a wheelchair while
seated, squeezing a ball between affected and unaffected hands, walking up and down stairs,
passive stretching with the therapist straightening a pts knees, tilt table used to stand, and
weightlifting. I was also able to talk to them more about which muscle groups the exercises were
helping and how the process of stretching and toning worked in this patient population
In Critical Care I was able to delegate and supervise the nursing care given by others
while retaining accountability for the quality of care given to a patient. I am in a position of
comfort in establishing a therapeutic relationship and communicating with the patient and family
due to previous experience in healthcare job positions. Working in hospice and home care have
both really prepared me for family need care. Working and communicating with staff is
Tech. I was therefore able to delegate the acquisition of and explanation of a DNR/DNI to a Tech
on the floor while I was operating as a student nurse. I followed through to find that the Tech had
called the chaplain and the attending physician in order to complete the task, and had answered
any questions the family had that could be answered by the Tech.
Professionalism
While still learning the legal and ethical principles of nursing, I demonstrated advocacy,
professionalism through Adult Health I, and standards of practice were focused on gaining data
pertinent to either the situation at hand or the assigned patients health. In Psychiatric and Mental
Health Nursing, assessment was fulfilled through thorough questioning. Coping impacts on
perceived mental health were discussed with current evidence-based practice and research.
Environmental health was vital in Psychiatric and Mental Health Nursing with the unit locked
Senior Year
and political processes within my nursing program and beyond that, reaching into the facilitys
organization. Though they seem to be worried about HIPAA on the surface, I have personally
observed the nursing staff discussing their practice of giving medications (and
removing/applying hip & sacrum Mepilexes) in the public dinning room and was told that you
would think its a HIPAA violation, but weve always done it that way. When dispensing
medications, the nursing staff opens, removes, and cuts PO meds without gloves. Nystatin oral
suspension was administered via a toothette without gloves. A patient with a known infection and
PROFESSIONAL PROGRESS SUMMARY 15
a large incision running vertically down their right leg had a previous dressing of only
SteriStrips. While assessing the patients incision for wound healing, a physician without
gloves palpated the wound site along the edges of the incision by manually approximating the
edges with both hands, pushing on the wound. They then ran the back of their hand along the
incision line. The physician without preforming hand hygiene then brushed the hair in her
face behind her ear, picked up her clipboard and pen, and moved on to assessing the next patient.
These concerns were brought up with the clinical instructor, who then passed the information on
Culture
Throughout each semester, cultural awareness and sensitivity was demonstrated through
an understanding of personal and cultural definitions of health. Adult Health I focused culture
care towards support systems of patients who could not care for themselves after discharge from
the hospital and the impact that had on patient care. Medication regimen adherence and
rehabilitation PT/OT scheduling are impacted directly by support systems, but so is overall
health and wellness. Psychiatric and Mental Health Nursing culture often involved the culture of
homelessness, drug use, and a culture of aggression. This impacts teaching strategies and had to
be considered when interacting with and providing teaching to patient to ensure adequate time is
Senior Year
affected by culture, race, religion, gender, lifestyle, and age. The experience of having a patient
who was vented but alert and oriented was an interesting and uncommon experience in the ICU.
PROFESSIONAL PROGRESS SUMMARY 16
Culture and ethnicity impacted care in the way that my patient was very calm while awake and
still on the ventilator. After the MD commenting on how he would not be as calm if awake and
on a vent, the patient was asked if/why he was calm. He responded through writing after I had
provided a notepad from the charge desk and a pen (for which I had to support his hand) in the
affirmative when culture was suggested as a factor in the patients quiet demeanor.
Conclusion
Overall, the growth obtained in studying for the role of a registered nurse was more labor
intensive and in-depth than I had anticipated. While the nursing diagnoses and nursing language
separates this role from that of a physician and places a more holistic sense on the role, that in no
way creates a simpler task. The preparation for taking on the role of a RN embodies a strong
development of understanding for every role in a medical environment. Skills that students had
the opportunities to learn were every skill any student could see. Every opportunity found was an
opportunity utilized and a skill gained. I now have strengths in hands-on nursing and the
knowledge base to understand why those interventions are being implemented. Many common
weaknesses of new graduate RNs such as EMR documentation and time management were
addressed by the students in our clinical environments. Through assignments that required us to
spend hours pouring over EMRs of specific patients, we gained familiarity with multiple systems
implemented at various hospitals. Through the experiences of being assigned a nurse and in role
transition, we were able to feel the weight of a full patient load before the full responsibility was
set on our shoulders. While time management skills were ingrained into us through the three
years in the program, I feel that the only future learning need I have is the ability to delegate
since as a student nurse I wanted to personally preform every task that was available. I feel
References
Frisch, N. (May 31, 2001). "Standards for Holistic Nursing Practice: A Way to Think About Our
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/T
ableofContents/Volume62001/No2May01/HolisticNursingPractice.aspx
Gulanick, M., & Myers, J. (2014). Nursing Care Plans: Diagnoses, Interventions, and Outcomes
53. doi:10.1111/j.2047-3095.2012.01229.x
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Honor Code:
I pledge to support the Honor System of Old Dominion University. I will refrain from any form
member of the academic community it is responsibility to turn in all suspected violators of the