MPTC

Clinical Across the Lifespan

Student Progress Notes

Student’s name Lynn Muesch

Week (Please circle or underline) 1 2 3 4 5 6 7 8

Date and Time Assignment Submitted ________________________________

Date(s) of Client Care or Alternative Experience(s) 11/16 & 11/18/10

In reviewing clinical performance, refer to relevant: 1) Target Competencies of the course, 2) Performance
Standards in the Learning Plans, 3) Core Abilities & Indicators, and 4) Performance Assessment Tasks.

Brief description of student’s progress in meeting or not meeting the course requirements:

Overall clinical performance at this time: Satisfactory / Unsatisfactory

• Action Plan (description of actions needed in order to achieve a satisfactory clinical performance)
 Clinical Journal for Non-Clinical Days
(Use this form for the weeks of Alternative/Off-Site Experiences)

Student Lynn Muesch

Date (s) 11/16 & 11/18/10

Week 5

1. What were my strengths this week? I always have a willingness to learn. I was able to observe the ways
many different things were done and then be able to perform them myself, some with guidance and some
without guidance. I was responsible for my actions and was able to lend a helping hand when needed. I blended
in as part of the team as best as I could and showed compassion in each situation. I showed interest in all the
areas that were presented to me and asked questions if I did not understand something.

2. What areas do I need to improve on? After being in ICU, I felt pretty dumb. There are so many
responsibilities and a great deal of knowledge that comes with this area. The RNs reassured me that even they
felt the same way when they started out. I hate to sound like I’m repeating myself each week but my knowledge
and confidence in the nursing field continues to need improvement. I am starting to see how some things work
and for this I am grateful. It keeps me wanting to learn more. I also need to remember that others are there to
help you and that I shouldn’t feel as if I’m bothering them by asking questions.

3. How do I feel things are going for me? I think things are going well for me. I really am enjoying this
clinical experience. I am starting to comprehend how the nursing process applies to real live situations. Being
involved in these situations has helped me to apply some of the knowledge that I already have to these
situations. This helps me recognize that I am more capable than I may think and that means a lot to me.

4. Is there anything that the instructor should know about? This was a really fun week. I enjoyed going to
the free clinic, even though I was a bit intimidated by all the people in the waiting room that needed to be seen.
Once I got into the flow of things and became a bit more comfortable, it turned out to be a great experience. As
far as the ICU is concerned, I’m so thankful that I was with an RN that was so knowledgeable and so willing to
answer my many questions. I only wish I could shadow her some more, I would learn so much more and so
well. All I can say is what great individuals there are out there caring and taking care of those in need.
 MORAINE PARK TECHNICAL COLLEGE
Alternative Experience Analysis Assignment

Student Lynn Muesch

Date (s) 11/16/10

Week 5

Clinical Agency: Dr. Albrecht Free Clinic

Please complete collaboratively with RN mentor.

Clinical Outcome Met (Support with Evidence) Unmet (Support with Evidence)
Report to clinical setting
prepared.

Maintains safety standards.

Participates in assessments.

Participates in teaching.

Correlates interventions to
nursing theory.

____________________________________ __________________________________
Student Signature Date RN Mentor Signature Date

Please review your alternative experience in composing short answers to these questions/statements.
Answers must be typed, written in complete sentences and rules of proper grammar applied.

1. Summarize the nursing care you participated in and observed during your experience. My
experience took place at the Dr. Albrecht Free Clinic. I observed how the registration process worked and
taking the patient back to the room, which is when weight was checked as well as all vitals. The client was
asked what the chief complaint was and what meds, if any, were taken. Any pending orders for labs, tests were
checked as well as the amount of money left on the voucher if this wasn’t a first time visit. I was involved with
the communication to the doctor before he would see the client. I also would go back into the client’s room,
after being seen by the doctor, with the RN for discharge write up and directions as what was to take place. I
saw how the chart system works in order to run the clinic in a systematic approach.

2. Identify the roles of the RN and LPN in this setting giving examples. There were no LPNs in this
setting while I was there; however, a MA was called in and was responsible for taking some clients back
and rooming them (getting the weight and vitals). The RNs would document the chief complaint, take care
of any paperwork or orders needed, and communicate with the doctor regarding all of these areas. The MA
and RN would prep the rooms for the next client. The RN would provide any teaching as necessary and go
over the discharge papers with the client.

3. Describe examples of collaborative behavior you observed. There was a fascinating amount of
collaboration at this clinic. Everyone who worked there, from the office volunteers all the way up to the
doctor, communicated efficiently with one another. They all understood how things were to flow and worked
effectively. The RN communicated with the person that needed to write out the vouchers for prescriptions.
 If at the interview process someone was denied services because of earning too much income, this would
be communicated to the RN immediately. This client could still receive a courtesy visit in which the client
would get to see the doctor and the doctor could write a prescription for the client; however, there would be
no vouchers given for meds or any other procedures. The doctor would update the RN as to what the plan
of action was when he would be through seeing a client. The RN relayed any pertinent information to the
correct people. I even was able to be involved in delivering information to the doctor about a client's chief
complaint and I was able to room a client myself.

4. Describe how you saw the nursing process being used. One particular client comes to mind. The RN
and I brought him back to the room and the RN began assessing the situation. This client had a great deal
of health issues and it was important to find out what he had done about past orders/tests and what meds
he was currently on and which ones he needed to start again or simply refill. His health concerns were
blood in the stool, having a hard time starting and stopping urination, eye issues, diabetes, high blood
pressure and depression. The plan was to get a colonoscopy and a lab workup setup by Monday,
November 22. This gentleman had a lot to remember, but things were all written down for him and the RN
knew this man well, so she was going to make sure things would get taken care of. Assess=got all his
pertinent information; Diagnose=ongoing history of health concerns; Plan=set time lines in which to get
tests/labs set up; Interventions=will be in touch with this client if the orders don’t come through that his tests
are set up; Evaluate=I will not be there; however, follow-up to see if everything has taken place in the
previously set time frames would be done. If this hasn’t happened, then one must go through the entire
process again and formulate a plan that will work.

5. Describe the emotional aspects of being a patient in this setting. I can only imagine that there would
be feelings of frustration because of the long waits and all the paper work one needs to go through to see if
one is eligible. Some individuals were angered because they were unable to get the meds they wanted.
There would be anxiety issues and fear, not knowing what is wrong with you and the pain these people are
in. Some people showed signs of depression. I’m sure this comes from many aspects such as maybe not
having any gainful employment, having a lot of health issues/concerns, and possibly just from having to
come to a free clinic (some may feel that they are on a different level than others).

6. Discuss the most prominent patient education needs you encountered and any interventions you
implemented in order to meet them. I don’t think I can really answer this properly. It was made very clear
to me that I was not to say anything regarding the client’s health status and what was to happen. What I did
do is let the client’s I was with know the normal parameters of the vitals I took on them. I also did let them
know what would be taking place next and acknowledged them before and after each encounter.

7. What was the most significant learning experience for you in this setting? Why? I can’t believe all
the paperwork that is involved in this type of setting! I know there is a lot of paperwork in all settings, but
here it is a very involved process. Just getting the information to see if a person is even eligible is very time
consuming. Then, all the continual updates that need to be made on a voucher, seeing which prescriptions
are eligible and where and how much they will cost, and figuring out how much time a client has before
benefits run out are just some of the areas that need to be covered on each client. The paperwork takes up
so much time and this makes for a very long waiting time for the client that is being seen.

8. What did you most enjoy about this area? What did you least enjoy? Why? I enjoyed taking the
client’s back to the room and getting them prepped. I like interacting with the clients which helps me to
build my confidence. I like letting them know what is going to happen and smiling at them while they are in
the waiting room. This all helps to make them more comfortable and know you care. I least enjoyed
keeping all that paperwork straight. It takes time away from the interaction between client/nurse. It also
keeps the client waiting for a long time.
 MORAINE PARK TECHNICAL COLLEGE
Alternative Experience Analysis Assignment

Student Lynn Muesch

Date (s) 11/18/10

Week 5

Clinical Agency: ICU

Please complete collaboratively with RN mentor.

Clinical Outcome Met (Support with Evidence) Unmet (Support with Evidence)
Report to clinical setting
prepared.

Maintains safety standards.

Participates in assessments.

Participates in teaching.

Correlates interventions to
nursing theory.

____________________________________ __________________________________
Student Signature Date RN Mentor Signature Date

Please review your alternative experience in composing short answers to these questions/statements.
Answers must be typed, written in complete sentences and rules of proper grammar applied.

1. Summarize the nursing care you participated in and observed during your experience. Today I
participated in ICU. I was with an awesome RN whom had extra certification in ICU.I was in awe right from the
beginning and overwhelmed. It was so neat to see the nurse coming off shift give report to the nurse coming
on shift. In the ICU there are critical cases which entail a lot of knowledge. I give these nurses lots of credit
because they have to be quick in their thinking and deciding what route is best at the time. I was overwhelmed
because there is so much to remember in regards to what affects other things and just keeping track of IVs and
knowing what meds are compatible in which lines. It was interesting seeing how to check CVPs, the insertion
area of the ABG line and the pressure on the PICC lines.

2. Identify the roles of the RN and LPN in this setting giving examples. There were no LPNs in this
setting that I was aware of. The RN in this setting was responsible for the total care of the patient. For
example, the RN not only did the assessing (checking blood pressure), diagnosing (blood pressure is low),
planning (the need to get blood pressure in normal range), implementing (increasing the rate at which
dopamine is infused), and evaluating (did the increase of dopamine help to put the blood pressure in
normal range) but also gave that extra care and time to address and explain any concerns to the patient as
well as the family. It was so great to see this all come together so smoothly.

3. Describe examples of collaborative behavior you observed. All the ICU nurses worked well together.
My nurse referred to them as “my friends”. Each nurse on the unit this day was responsible for one patient,
however, the nurse on the shift before ours, had extra time and had already given our patient a bed bath.
This was extremely helpful and it was neat to see that it was taken care of even if it didn’t need to be done
 until the next shift. If a nurse was in the middle of something and the IV pump would be alarming, the other
nurse would immediately be there to check on the situation. And if a nurse needed assistance, it would be
followed through without delay. When the doctors were on the floor, the nurses updated them and vice
versa. The ICU assistant and the pharmacist also communicated well with everyone any pertinent
information that was necessary.

4. Describe how you saw the nursing process being used. Of course, before anything would be done, the
situation would be assessed. There were certain meds that had definite parameters and it was important
that what needed to be assessed was done so proper administration of the med could take place. Analysis
took place so the doctor could be informed of any changes in the current situation. The nurse had to make
plans as to how the situation could be improved such as trying to keep a blood pressure up when the
patient was trying to be weaned from dopamine. The nurse would implement lowering the amount of
dopamine the patient was receiving through IV and then would evaluate this by observing the blood
pressure when the amount of dopamine was lowered. While I was there, each time we would lower the
dopamine, the blood pressure would slowly begin to fall. Working as an RN in the ICU involves a lot of
evaluating because these patients are critically ill, and in order to get them better, it seems like the RN may
need to make many different plans because the situation can change drastically and quickly.

5. Describe the emotional aspects of being a patient in this setting. This is an overwhelming time for the
patient. I would refer to this as sensory overload. First, the patient doesn’t know what is going to happen to
him/her. The patient may not also understand why he/she has this problem and just wants it to get better.
Second, there may be a lot of staff around at any given time, all doing different things and possibly at a fast
pace. Third, there are tubes/lines/drains coming out of you from all different areas. Fourth, you have pain
and feel awful. With just these few things I mentioned, fear, anxiety, and even depression would be some
of the emotional aspects of being a patient in ICU.

6. Discuss the most prominent patient education needs you encountered and any interventions you
implemented in order to meet them. Well, my RN was on top of everything. When a situation would
arise, such as low blood pressure, the nurse would check the ABCs, check meds and check the position of
the patient. Because the monitor has so many features on it, the nurse would make sure the family knew
what it all meant to help alleviate any anxiety for the family as well as the patient. I was not able to do any
teaching in this situation, but it was neat to see the RN handle any situation that came upon us by using the
nursing process and informing the patient as well as the family of what was happening.

7. What was the most significant learning experience for you in this setting? Why? Learning how to
check to see if certain meds were compatible with one another when given through an IV line and flushing
the line with saline before and after a med was administered. I guess this was a big deal to me since I
never experienced this before. It seemed overwhelming just this aspect of ICU. Setting the pumps and the
IV maintenance in general seemed like a big enough deal to me. I guess that is because I’m not used to
this yet. In general, it is of the utmost significance to do thorough assessments because so much of this
depends on what type of interventions you will be applying to a patient.

8. What did you most enjoy about this area? What did you least enjoy? Why? I most enjoyed that as a
RN in ICU you are responsible for one or two patients at the most, we just had one this day. I like the
thought of being able to focus on the patient for the entire shift. I just feel like the care is extremely patient
centered and you have the time to explain and stay with the family as needed which helps alleviate
everyone’s anxiety or fear. I least enjoyed the great amount of knowledge one must have because I’m no
where near having that and it is critical to have this when working in this area.