Essay about My Clinical Experience

Learning plans are a key component of student learning in professional practice settings. The learning plan is a dynamic document that informs the learner, preceptor, and faculty advisor in relation to selecting learning opportunities. The idea is that learning evolves over the course of the practical experience as students’ learning needs unfold, therefore these plans are revisited and revised throughout the semester. The student is to reflect on their own personal knowledge base from past courses and clinical experiences to identify their knowledge gaps related to the needs of the practice setting and the Entry to Practice Competencies by the CNO. Consider the community of practice you are entering and identify the knowledge you will need to acquire in this setting to provide safe and effective care. It is important to set both short-term and long-term goals using SMART criteria.

Accountability, i.e. organization and time management: By midterm, I will be more organized with my daily schedule. I would like to develop a realistic time management list of duties that need to be performed throughout my shift organized in a priority manner.

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1. Starting week 2, I will make a schedule with a breakdown of every 15 minutes of my shift to organize the activities that I have planned for the day, such as medications and vital signs. By creating a schedule with my daily activities, I will be able to keep track of what I have to do and ensure I am accountable to my patients by allocating time for all of them. (Windsor, 1987)
2. By October 20th I will be taking on more patients and will be improving my time management skills to be able to prioritize patient care to be able to complete my duties in a timely manner and complete required documentation. “In a study surveying the perception of preceptors on the newly hired nurses’ competencies, it was revealed that most lack competencies in psychomotor and assessment skills, critical thinking, time management, communication, and teamwork” (AlThiga, 2017) By improving my time management skills early on I will get in the habit of keeping track of my to-do activities and not risk forgetting or leaving anything to the last minute and rushing to complete them.
3. By the end of the semester, I will maintain my competence, and I will refrain from completing any activities in which I am not competent and confident. I will keep my preceptor informed on the activities I am not competent in completing but will work on becoming competent by reviewing procedures and learning from my preceptor. “The action that you take in response to this situation is guided by your sense of accountability. The patient, the institution, and society rely on your judgment and trust you to take action in response to this situation”. (Potter and Perry, 2014) Thus it is my responsibility to act accountable and only act in skills that I am confident in.

Knowledge, i.e. knowledge related to your specific clinical unit: The unit is called a short-term rehab unit, however, most patients are more long-term rehab waiting for long-term care. By week 4 I will be moving to more of an orthopedic acute care unit. By week 7, I will have a better knowledge of the process of recovery after orthopedic surgery. I will become more attuned to signs and symptoms to watch for to insure patient safety and comfort. I will become more familiar with medications often used for patients recovering from surgery.

1. By the end of the semester, I will “increase my knowledge about the diagnosis, side effects, nursing considerations, medications, and treatments, read patient’s charts to connect and understand the diagnoses, medications, and therapies.” (Lewis, 2017) During nursing school, students study in a specific way for their exams; however, during clinical, the objective is to be able to think and care for our patients critically. Thus, I need to make reviews and connections differently from school time. (Hosseini, 2011)
2. Throughout the semester, I will use the Medical Surgical textbook and my instructors as reliable resources for learning. With the amount of information we have available to us today, it is easy to get misleading information on the internet. Therefore, it is essential to use reliable sources to get information such as textbooks, instructors, checklists, agency protocols, and materials developed by the university as reliable sources of information (although, 2017).
3. Throughout the semester, I will review all drugs related to my patients and get familiar with side effects to watch for. Also for situations when you would hold certain medications depending on the patient's condition. By week 3 I will also review the Semester 3 theory topic Post surgery to get myself more familiar with the procedures and interventions for common post-surgery complications. “nursing interns thought they are not adequately prepared with knowledge base and skills while faculty indicated that they prepare their students with the knowledge base and skills. These results represent a gap between what occurred in the clinical setting and what is considered important by students and faculty” (AlThiga, 2017).

Knowledge Application, i.e. nursing assessment and critical thinking: By week 9 until the end of the semester, I will be more confident in my abilities to thoroughly complete a head-to-toe assessment with more consideration regarding pain. I will be watching for verbal and non-verbal cues from my patients regarding pain. I will be performing the assessments in a more fluid manner without missing assessments or body systems.

1. Starting week 2, every shift I will practice my head-to-toe assessment on the more stable patients, in my current unit, when I approach them to complete their vital signs. Knowledge is the basis of everything, patient care, and critical thinking, but the desired outcomes will never be reached; the knowledge is not applied to the situation. (Potter and Perry, 2014) Knowledge application is the integration of information from several sources to understand and explain what is happening in the present case.
2. Throughout the semester, I will observe the way the other nurses on the unit perform their head-to-toe assessments to help develop my own strategy that works best for me. “Teaching is an interactive process that promotes learning. Teaching and learning generally begin when a person identifies a need for knowing or acquiring an ability to do something. A nurse-teacher provides information that prompts the patient to engage in activities that lead to the desired change” (Potter and Perry, 2014). Working with more seasoned nurses helps develop a more seamless routine to be able to get a proper, thorough, and timely assessment.
3. Throughout the semester, I will use the Physical Examination & Health Assessment text by Jarvis (2nd Ed.) and the Health Assessment labs checklist to approach the assessment in a logical order to make sure I don’t fail to assess a critical system. According to Popovich (2011) “the importance of a standardized system during shift changes reduce errors and achieve accurate, consistent communication. Students also reported that using the tool and reviewing it with instructors helped them overcome initial feelings of anxiety and fostered confidence.” Having a reliable resource is vital in reducing errors and making sure nothing is forgotten or misinterpreted when conducting a patient’s assessment.

Continuing Competence, i.e. skills related to your specific unit including documentation: By the end of the semester I will seek to expand my knowledge with as many opportunities made available to me. I will seek situations and patients with diagnoses’ that I have not worked with to maximize my clinical experience. I will also learn from constructive feedback given to me and through constant personal reflection.

1. By the end of the semester, I will take the initiative to learn new skills and get new experiences from my colleagues and other health care members in the hospital, and volunteer to watch or participate in skills that I have not had a chance to practice in a hospital setting. There are several opportunities for learning, and we should take advantage of them when “assuming responsibility for her/his professional development and for sharing knowledge with others” ( Lewis, 2017). It is my responsibility to grow by taking opportunities to learn. This requires “investing time, effort and other resources to improve knowledge, skills and judgment” where I need to seek resources to learn and grow.
2. Once a week I will seek feedback from my preceptor and other nurses on the unit and reflect on my practice based on their feedback and constructive criticism. My unit works very closely together so I am able to assist and receive feedback from many nurses. According to Potter and Perry (2014), “Teaching is an interactive process that promotes learning. Teaching and learning generally begin when a person identifies a need for knowing or acquiring an ability to do something. A nurse-teacher provides information that prompts the patient to engage in activities that lead to the desired change”.
3. I will reflect on my practice after each shift and have weekly meetings with my instructor to get her feedback and constructive criticism on my practice and ways for improvement. According to Popovich (2011) “Clinical instructors can impact students’ confidence and independence. Also, respondents have mentioned the relationship between the nurse preceptor and the student, which can decrease or increase the feeling of fear and the communication between the parties.” Constant communication is vital for learning development, thus having clear communication with my preceptor in a timely manner is important. Therefore, I will be able to get timely feedback and set clear expectations for my clinical experience.

Ethics, i.e. ethical principles, cultural competence, confidentiality: Starting immediately, I will be mindful that each patient does not feel the same and may want their care performed differently than other patients. I will do my best to encourage their independence in the duties they are able to perform themselves to maintain their privacy and dignity.

1. Throughout the semester will take time to involve each patient in their care and ensure they are comfortable with the duties I will be performing and always ask permission. According to Potter and Perry (2014), “Development of trusting relationships with clients, capacity building, and collaboration are central to effective case management.” By just talking with the patients and asking for their permission builds a more trusting relationship.
2. When able to, I will teach patients duties within their capability, even if it does slow their care down. I will also give the clients the choice of care and respect their wishes if they do not wish to have the care I am there to provide. According to Potter and Perry (2014) “The ethical responsibility of advocacy includes protecting the patient’s right to choice by providing information, obtaining informed consent for all nursing care, and respecting patients’ decisions.” Allowing the patient to choose, gives them participation in their care, and creates a therapeutic relationship between the nurse and the patient, which is based on trust, and there is no judgment.
3. Throughout the semester I will only discuss each patient’s condition progress with those included in their circle of care. “His right is usually violated unconsciously because medical personnel does not realize that the patient’s basic right to confidentiality is violated even during a ward round when individual patients and their conditions are discussed. Conversations between medical personnel in the social room, in hospital corridors, lifts or buses also constitute a violation of medical confidentiality. On the part of medical personnel, it is unprofessional behavior” (Belowska, 2014). Confidentiality is crucial in healthcare. It is always important to be mindful of your surroundings when discussing patients

Relationships, i.e. therapeutic nurse-client relationships: By midterm, I will apply my therapeutic relationship skills with clients and families by constantly communicating with them. I will also use my professional communication skills to work on my relationships with the healthcare team.

1. Starting immediately, I will work on my professional relationships with my colleagues by trying to work collaboratively with others instead of alone. By working with others, I can develop my communication skills and improve on my teamwork skills. “the importance of developing a good relationship with mutual respect and trust between faculty and training hospitals including nurses’ staff and instructors to provide a positive learning experience for them.” (although, 2017)
2. Starting immediately, I will apply my therapeutic relationship skills with my patients and take the time to listen and get to know their needs. “However, the nurse’s role at the end of life is holistic and complex; the role involves offering not only physical care, but also the emotional, spiritual, and sociocultural support necessary to meet the needs of the patient…” (Heise, 2016) Building on the nurse/patient relationship will help me develop a better plan of care that is more tailored to the specific needs of each patient.
3. Throughout the semester I will take the time to develop relationships with the family members of each of the patients. Showing the family that you are engaging with them will help them feel better at ease that their loved ones are being cared for and listened to. “Nurses are responsible for giving holistic support not only to the dying patient but also to the patient’s family.” (Heise, 2016) Being in the hospital is a stressful time for both patient and the family. Listening to family wishes for their loved ones will better help you care for the patients as the family knows more about the patient than you do, especially if the patient isn't able to communicate directly themselves.

Leadership, i.e. working as a team member: By the end of the semester, I will take part in more leadership activities and take more initiative to be a more active member of the healthcare team.

1. Each shift I will seek opportunities to work with other members of the health care team so I can become known as someone that wants to assist and be included as a regular member of the nursing staff. According to Potter and Perry (2014), “nurses must provide leadership to ensure that nursing care takes place in quality practice environments and that these work environments are essential for health, high-quality patient care, and patient safety.”
2. Throughout the semester I will watch for opportunities to teach other members of the health team anything that I have experience in doing. There are many other nursing students working in the unit so the opportunity to help other students should arise. According to Windsor (1987), “The quality of learning was reportedly affected by …the variety of clinical opportunities to which students have exposed” “the clinical experiences that hindered learning is an unnecessary amount of paperwork, practicing more basic procedures such as vital signs and bed making rather than advanced nursing skills such as wound care, cannulation and managing respiratory cases.” (although, 2017)
3. Effective immediately I will open myself to communicating with the entire unit staff to build an effective working relationship. This will demonstrate my willingness to learn and be involved and will help me gain my independence by the end of the semester. “students become more comfortable with performing nursing tasks and become interested in expanding their role and becoming more independent. As the students strived for independence, they identified more closely with staff nurses and withdrew from instructors.” (Windsor, 1987)

References

1. although, H., Mohidin, S., Park, Y. S., & Tekin, A. (2017). Preparing for practice: Nursing intern and faculty perceptions on clinical experiences. Medical teacher, 39(sup1), S55-S62.
2. Belowska, J., Panczyk, M., Sienkiewicz, Z., Kaczyńska, A., Zarzeka, A., & Gotlib, J. (2014). The Analysis of Opinions and Attitudes of Students of Nursing with Respect to the Observance of Patient's Rights in Poland. Polish Journal of Public Health, 124(4), 209-214.
3. College of Nurses of Ontario. (2002). Professional Standards, Revised 2002. Retrieved August 2018, from http://www.cno.org/globalassets/docs/prac/41006_profstds.pdf
4. Godbey, K. L., & Courage, M. M. (1994). Stress-management program: intervention in nursing student performance anxiety. Archives of Psychiatric Nursing, 8(3), 190-199.
5. Heise, B. A., & Gilpin, L. C. (2016). Nursing students’ clinical experience with death: A pilot study. Nursing education perspectives, 37(2), 104-106.
6. Hosseini, S. A., Fatehi, N., Eslamian, J., & Zamani, M. (2011). Reviewing the nursing students’ views toward the OSCE test. Iranian Journal of Nursing & Midwifery Research, 16(4), 318–320. Retrieved from https://search-ebscohost-com.gbcprx01.georgebrown.ca/login.aspx?direct=true&db=a9h&AN=100679129&site=ehost-live&scope=site
7. Lewis, S. M., Collier, I. C., & Heitkemper, M. M. (2017). Medical-surgical nursing: assessment and management of clinical problems. Elsevier, Incorporated.
8. Popovich, D. (2011). 30-Second Head-to-Toe Tool in Pediatric Nursing: Cultivating Safety in Handoff Communication. Pediatric Nursing, 37(2), 55–60. Retrieved from https://search-ebscohost-com.gbcprx01.georgebrown.ca/login.aspx?direct=true&db=a9h&AN=63168935&site=ehost-live&scope=site
9. Windsor, A. (1987). Nursing students' perceptions of clinical experience. Journal of Nursing Education, 26(4), 150-154.