Community-Based Practicum Reflective Journal Guidelines

Instructions:
You will submit one community-based reflective journal and one meeting-based reflective
journal by the end of week fourteen using the reflective journals guidelines below.
An unsatisfactory reflective journal must be revised and resubmitted in order to receive a PASS
for the course.

Community-based nursing precepted experience (16 hours)

Guide for Reflection Using Tanners (2006) Clinical Judgment Model
Introduction

Describe a recent new learning (e.g., new skills, new ways of doing things, new information, a new role, an
awesome moment) or challenging moment or event you and/or your preceptor experienced in the community-based
practicum.
In all honesty this community experience did not bring many challenges. It did however challenge my skill and
understanding of manual blood pressure measurements. Cardiopulmonary rehab consists of patients who either have
cardiac issues, pulmonary issues, or both. The premise of their rehab is to strengthen the heart gradually to improve
EF, cardiac output, and perfusion. Therefore, it is very important to accurately assess and interpret their vital signs.
Each patients needs differed depending on how far they had progressed in the program. All patients, except the
patient on maintenance (who completed the program and came back at their leisure to work out), needed blood
pressures at check in, during activity, and at check out. I can confidently say I took over 150 blood pressures during
my two days there.
Background

Describe where you completed your community-based practicum. What is the patient population that you are
seeing? What types of nursing experiences are most frequently practiced?

I went to the Cardiopulmonary Rehab Center at MRMC. The patient population includes patients who have cardiac
issues, pulmonary issues, or both. The unit is staffed with the nursing manager, 2-3 RNs, 1 RT, 1 exercise
physiologist, and 1-2 interns. The nurses general focus is checking the patients in, monitoring the telemetry
monitor, and checking the patients out. The nurses document on their vital signs, current weight, and other factors
that relate to their physical exertion. The exercise physiologists and interns focus on obtaining vital signs. The RT
focuses on the patients who have pulmonary issues and oversees their care, including all documentation. My role as
the students was to focus on assessments and vital signs. I helped with the check-in and check-out process by taking
vitals, obtaining weights, and helping place or remove telemetry monitor. I also assisted with obtaining blood
pressures during exercise. I helped prepare the paper work for the patients to use during their exercise to documents
data such as exertion level, resistance and speed of machine, etc. I also helped file charts away.

Noticing

What did you notice about the community-based environment initially? Describe what you noticed as you spent
more time with the patient and/or family.

I noticed it looked exactly like a gym with a nurses station attached to it. You wouldnt think it was anything
special, but it was really neat actually. I noticed that all the patients had different reasons for being enrolled in the
program and that they all had very specific needs. I noticed that the patients had a sense of security to increase their
intensity of the workout because of the staff presence. I noticed that many of the patients have built relationships
with other patients and the staff. On my second day there they even had a visitor that had already completed the
program and came back to say hi and give hugs.

Interpreting

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Describe what you thought about the new learning or challenge. Describe any similarities and differences you have
encountered in clinical practice before. What other information did you need as you considered the situation? What
help with problem solving did you get from your preceptor?

The challenge I encountered was remembering how to accurately take a manual blood pressure. It took a few tries
before I was able to feel comfortable with it again. Even just what to do with which hand, how to place the
stethoscope, and angle my machine posed a challenge at first. Once I got the hang of it and built my confidence
back up I was doing blood pressures very accurately and in less time.

Responding

What actions did you and/or your preceptor take and what would you have liked to do/see differently? Describe
stresses (both positive & negative) you experienced as you responded to the new learning or the challenge.

Honestly, I hardly saw my designated preceptor. Suzie, the nurse manager was my official preceptor; however, she
remained in her office most of the day. So the entirety of my clinical ours there I was floating around doing
whatever was needed by any staff member. I would have preferred to be assigned to one staff member and follow
her throughout the shift to completely understand her role instead of just going around and getting vital signs on
everyone, it was very repetitive and not realistic to the role of a nurse in that environment. In addition I would have
like to follow a nurse one day and the exercise physiologist the second day (or vice versa). The exercise
physiologist had so much insight on the patients and they are the ones who plan their care, it was very interesting to
see how they individualized each patients care and helped them throughout the program. I also would have
preferred to only go on either Mondays or Fridays. Thursday was so boring and very unnecessary to be there for an
entire 8 hour day. However, Friday was so busy that I felt much more appreciated for being there because they
really needed the help. I was informed by the staff that Mondays and Fridays are their busiest days and the best days
for students to come.

Reflection-in-Action

What happened? How did the patient, family, and/or staff respond?

The family responded to my lack of a designated preceptor by always informing me on tasks that I can complete and
supporting me. I do believe it hindered my understanding of the rehab facility because I was not fully able to grasp
the entire process because I was not assigned to a preceptor to teach me and instead was told to complete tasks.

Reflection-on-Action and Clinical Learning

What written evidence is available to draw upon for the care of patients in the community-based practicum setting?
Cite/reference all journal articles that contributed to the evidence.
Describe any changes in your values or feelings as a result of this experience.

The article, Cardiac Rehabilitation after Heart Valve Surgery: Comparison with Coronary Artery Bypass Grafting
Patients was very interesting and provided current evidence of practice. This article was very relevant to this
community experience and supported the implementation of a cardiopulmonary program. They have both post-op
heart valve patients and post-CABG patients who participate in the rehab program at MRMC. However, while both
individuals benefits from the program, as evidence exemplifies, their care is very individualized. Therefore, it is the
staffs responsibility that they are evaluated and progressing properly through the program and that all their needs
are met.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment
Model. Journal of Nursing Education, 46(11), p. 513-516.
Savage, P. D., Rengo, J. L., Menzies, K. E., & Ades, P. A. (2015). Cardiac Rehabilitation after Heart
Valve Surgery: Comparison with Coronary Artery Bypass Grafting Patients. Journal of
Cardiopulmonary Rehabilitation and Prevention, 35(4), 231237.
http://doi.org/10.1097/HCR.0000000000000104

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