Running head: PRACTICE SUMMARY PAPER 1

Practice Summary Paper

Mary Davidson
Old Dominion University




PRACTICE SUMMARY PAPER 2

Practice Summary Paper
Attaining a BSN has been a goal of mine since finishing my ADN six year ago. I knew I
would need to further my nursing education in order to meet the minimum requirements for
career advancement. My plan was to gain a few years of clinical experience before starting a
BSN program. In hindsight I think this was a very good decision, as I found my clinical practice
was the foundation in which to apply the various concepts I have learned, and provided a
measurable basis of my progress. My goal of furthering my nursing education will soon be met,
and my experience in the BSN program has prompted me to explore further educational options
for the future.
Critical Thinking
Every course in the BSN program enhanced my critical thinking ability, which positively
impacted my clinical practice. Theoretical Foundations of Professional Nursing Practice was
predominantly instrumental in the refinement of my own philosophy of nursing, specifically the
theory paper assignment. Through exploration of several theories, I discovered that my nursing
practice was most aligned with Benners theory of novice to expert. This is especially applicable
to perioperative nursing, which is the only area of nursing I have worked in. I identified with the
novice component, as I was a new graduate nurse when I began in the O.R. Perioperative
nursing is dynamic, challenging, and requires nurses to spend nine to twelve months training
before becoming proficient. An important skill as a circulating RN is anticipating the needs of
the patient, surgeon, and anesthesiologist, and this requires many years in the O.R. to master.
For example, hemostasis is a major consideration for all surgeries. If uncontrolled bleeding
occurs, the RN must be ready to act quickly. The blood consent must be verified, a requisition
form completed, and then the blood bank is called to order blood products. Once blood is
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delivered to the O.R., it must be verified with the anesthesia provider before infusion begins.
Generally this process happens within five minutes. In the meantime, the RN is adding sponges
and sutures to the sterile field and accounting for them on the count sheet, thus preventing the
occurrence of a retained surgical item when closing begins. The RN may also be retrieving
medications, equipment and supplies as the surgeon attempt to control the bleeding. Critical
thinking is essential in preparing for these types of high stress scenarios, and as I have become
more on the expert spectrum of Benners theory, this is how I would handle that situation:
Before transporting the patient to the O.R. I would check the labs for any complications of
potential bleeding (low H & H), as well as verify the signed blood consent. Once in the O.R., I
would ask the surgeon about any patient concerns, including bleeding issues associated with the
procedure. If so, I would fill out the request & contact the blood bank before incision is made to
have units of blood placed on hold. When the surgery begins I stand near the sterile field so I
can observe as well as hear the surgeon. I know immediately if an artery has been severed, or
other unanticipated bleeding occurs. Beforehand I would have gathered extra sutures, lap
sponges, medications and supplies so I did not have to leave the room to retrieve them. I would
also be cognizant of other general surgeons in house who may be needed to assist, as well as
locate the code cart in case it is needed. By increasing my critical thinking ability, I have
elevated my nursing practice, which has a direct impact on the patient care I provide.
Nursing Practice
My nursing practice has changed as a result of the BSN program. I have become more
aware of the whole patient, and include this in my daily practice. When a patient comes in for
surgery, they likely have family members with them. Although the patient is my primary focus,
I have come to realize that easing the anxiety of family members is just as important. I work
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primarily in the ENT surgical service, and there are many pediatric patients I care for. I have
discovered that parents of these patients must have a clear understanding of the procedure and
recovery in order to care for their child afterwards. I have also integrated more complementary
modalities with my pediatric patients and their families, such as guided imagery, role-playing,
breathing exercises, and music therapy in the O.R. Conversely, elderly patients who come in
with caretaking spouses or children must also be informed of what to expect when the patient is
recovering. Preparing the patient and family for the procedure and post-operative period is
essential in planning and setting realistic expectations. Although I have limited time in the
preoperative phase, I have found that spending extra time addressing the needs of the whole
patient has resulted in better surgical outcomes for my patients.
Communication
Effective communication is essential in my job, and this program has enabled me to
recognize my strengths and weaknesses in this area. Just about every patient who undergoes
surgery is anxious beforehand. Part of my responsibility is to address their concerns and put
them at ease. Unfortunately I do not have a lot of time beyond my initial assessment to spend
with the patient, so I have learned to convey care and concern with my body language and
approachability in addition to verbal communication. I have also had to be creative in learning
how to communicate with special populations, such as babies, vented patients, Alzheimers
patients, non-English speaking patients, and those who are hearing or visually impaired.
Effective communication among staff in the O.R. is also important, and this is where I have
improved greatly. The O.R. can be noisy, chaotic and full of distractions, so it is imperative that
the RN communicates effectively. I have learned to be more direct, approachable and calm
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when communicating with my colleagues, especially in emergency situations. This has
improved my nursing practice considerably.
Teaching
The teaching project in Career Pathway Assessment was the first time I had ever
produced a plan of that magnitude. I developed skills in assessing learning needs, developing a
teaching plan, implementing a teaching presentation, and evaluating learning outcomes. I
presented an in-service to my O.R. colleagues, and it contributed to changing our policies and the
way we perform skin asepsis. This was a direct result of my experience in the BSN program! I
have become more comfortable teaching my peers in a formal setting as a result of the teaching
project, and I will be conducting another staff in-service later this year. I am proud of
accomplishing my goal of becoming more confident in presenting to my peers, and look forward
to challenging myself in the future.
In addition, I enhanced my patient teaching by using more creative resources, such as
utilizing websites and games, which was especially helpful with my pediatric patients.
Conversely, I have modified technological teaching methods with my elderly patients, as I have
discovered that many are resistant to computer based teaching tools. I also learned to spend
more time on evaluating learning outcomes with my patients, to ensure my teaching was
effective.
Research
During the program, I acquired knowledge and skills about incorporating nursing
research into my daily nursing practice. I learned how to differentiate between quantitative and
qualitative studies, as well as determine levels of evidence and strength of evidence based
research. The majority of these skills were attained in Nursing Science. The evidence based
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practice assignment required my group to research a clinical problem and develop strategies to
improve clinical practice. Our topic was surgical smoke evacuation and we developed nursing
interventions to use in our daily practice, thus increasing patient and staff safety in the O.R.
Obtaining skills in nursing research has directly impacted my nursing practice. I have
acquired skills needed to evaluate evidence-based studies and apply findings to enhance patient
care. Through coursework in the program, I have learned to question why we do things the way
we do and seek alternatives to improve patient care and outcomes. For example, I have changed
the way I apply surgical skin antiseptic agents, which decreases the risk for developing a surgical
site infection, and results in better patient outcomes.
Leadership
I have gained tremendous leadership skills, particularly from Nursing Leadership
coursework. The root cause analysis assignment taught me how to evaluate a clinical problem
and analyze contributing factors. The business case analysis assignment required me to research
and present solutions to common staffing issues. Additionally, I obtained knowledge about
leadership styles, organization, accountability, and management skills. This course was
especially impactful, as I am currently a staff nurse and was unaware of the responsibilities of
nursing leadership where I work. I have a greater understanding and appreciation of managing
an O.R., and recognize the many legal, ethical and professional considerations that factor in to a
leadership role. This program has provided the foundation for further development of leadership
skills, and will help prepare me for opportunities in the future.
Professionalism
Much of the coursework in the BSN program has contributed to enhancing my
professionalism. I have developed a greater understanding of standards of practice and
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accountability, as well as explore legal and ethical aspect of nursing care. One aspect of
professionalism, advocacy, has had a great impact on my nursing practice. My journey through
the BSN program has inspired me to find an even greater voice. I have become more
courageous and advocated for changes in our O.R. to enhance the culture of safety in my
workplace. Recent issues include communication, staff education, and on call practices. I have
volunteered my time to assist in evaluating and changing current practices in order to increase
patient care and satisfaction.
Culture
My knowledge and exposure to providing culturally competent care has increased
throughout the program. The patient population at my workplace is becoming more diverse, so I
have benefitted from the integration of cultural awareness in many of the BSN courses. Most
significantly was the online cultural training certificate program completed in the capstone
course. This program was extremely informative and comprehensive, so much so that I would
have preferred to have it sooner in the BSN program. I found it so impactful that I shared the
website with my colleagues and several of them completed the program as well.
Additionally, the cultural viewpoint of end of life assignment in Palliative Care, provided
an opportunity to explore another cultures view on death and dying. I chose the Chinese culture
to explore, and found it extremely interesting. There is a large Chinese immigrant population in
our community, and understanding their views has assisted me in providing more sensitive
patient care.
Summary
Discovering nursing theories and the legendary nurses who paved the way for todays
RNs has affected the way I practice nursing. Learning about different approaches to caring for
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patients has caused me to think outside of the box and provide more personalized care. My
personal philosophy of nursing has expanded to include parts of many of the theorists, which has
resulted in more comprehensive care for my patients. As my practice continues to evolve, I will
continue to incorporate various thoughts and ideas I have been exposed to on my educational
journey.
The BSN program has most assuredly made me a better nurse. In reflecting upon the end
of program outcomes, I realize that all of the criteria have impacted my daily practice. Not only
the way I do things, but also the way I reason, approach obstacles and solve problems. I have
benefitted from exposure to nursing research, leadership, teaching, and professionalism.
Furthermore, increasing my knowledge in critical thinking, nursing practice, communication, and
culture has positively influenced my ability to care for patients. Many skills I learned before
even opening a textbook, including all aspects of distance learning and online format. I also
became proficient at juggling several things at once, including work, family and school. I am
confident that the BSN program has provided me a solid foundation for future career and
educational endeavors, and that Ive acquired knowledge and skills that enrich my professional
abilities.