Clinical Reflection: Clinical Observation

There, I worked with a variety of surgical and medical cardiac patients, including pre- and post-operative open heart surgery, congestive heart failure, arrhythmias, and myocardial infarctions. I was immediately fascinated with the various technical support options for the heart, such as left ventricular assist devices, and have continued to be amazed at the progress of these devices over the years. One of the biggest lessons I learned during my time at Hershey Medical Center was that educating and encouraging patients to command their illness is essential, because empowered patients better manage their disease and prevent progression. When I moved to California, I started as a travel nurse to learn more about the various hospitals in Los Angeles, and I completed assignments at Kaiser Downey and UCLA Santa Monica. Shortly after, I was hired at UCLA Ronald Reagan in the Cardiac Observation Unit.

Throughout my clinical experiences, there have been quite a few circumstances I have been placed in that have remained with me whether good or bad. All of them have been learning experiences for me whether it is how to improve and to do better next time from a mistake, for me to learn that this is or is not how a patient should be treated, how to handle family situations, and many others. One experience that I was able to participate in that will remain with me because I had not experienced this before was during my critical care rotation in the fall of 2015. This patient was dying and we were implementing comfort care for him.

Training for residency in a busy inner city hospital in Newark, which caters to the less privileged and ever growing uninsured population of New Jersey had its own advantages, as there was always a large population of patients admitted as inpatients in addition to outpatient services. I was also fortunate to have strong and dedicated mentors who simultaneously exuded compassion and confidence, and taught me to appreciate the beauty of medicine. During our cardiology service months, we had the opportunity to attend many cardiology didactic lectures and conferences. We were also trained to read EKGs, stress tests, and to interpret echocardiography basics. In addition we had the chance to witness numerous cardiac catheterizations, angioplasties, and transesophageal echocardiograms. During my close interaction with cardiology team, I loved the personalities of the cardiology fellows and attendings who mentored me. They seemed brilliant, energetic and vibrant, and there discussion and debate on rounds was always challenging and thought

My educational fear in the past was during my first week off ICU orientation, I was assigned an admission from the ER of a post cardiac arrest middle aged patient who was placed on a therapeutic hypothermia. I verbalized to the Charge Nurse of being hesitant to accept the admission since I’m fresh off orientation. She told me “this would be a good experience for you”. I want to keep good positive impression to my colleague being a new nurse of my new unit and took on the mission to accept the assignment. After receiving a report, the unconscious patient arrived on our unit on a ventilator with hypothermic jacket and with multiple drips. My heart started to pound and said to myself “what am I getting into, transferring here in ICU is a mistake, and I just want to cry”. While being shaky, I took good long deep breaths. After the patient was situated the on the bed, I carried on the task according to the doctors’ orders and the protocols. I stayed in communication with my charge nurse for assistance, questions and moral support. I succeeded the patient care uneventfully on a 12 gruesome hours by working and collaborating with the charge nurse, the senior RNs as a

S: How was your clinical experience this week? This week was an okay week. I spent most of my time trying to get back into the swing of things. I was a little rusty at the beginning of the week but it got better as the week went on.

On September 28, when we went to Tripler Army Medical Center, I was placed in the Cardiac Ward. At that time, I was able to learn so many diagnosis dealing with the patients. The nurse had briefly explained what was going on with each individual patient and the type of treatments they are doing to help. She had also neatly clarified each medication she was giving them and told me exactly what it was used for. I was able to get an experience of hands on by taking a patient’s temperature. I had shadowed as she did so many things to make the patient feel comfortable and did everything to the best of her ability to make them happy. She had taught me how to record every piece of information about the patients on the computer by showing me what

Third week into clinical. So far, things are slowly improving, however I do need to work on critical thinking and being less task oriented. I had my very own patient. The clinical objective was to be able to perform a successful health assessment on a patient and to identify factors in the environment that would impact patient care. Hopefully from there, my critical thinking skills will develop through experience and to fill my concept map thoroughly. On Tuesday, my patient was an older gentleman who came in with destruction of the liver due to medication. When caring for my patient, I made sure that he received everything that he wanted. I felt that I did well in that aspect for seeking good for the patient. I was told to get his good and make his bed. I don’t know why making his bed didn’t occur in the beginning. But, I learned that in the beginning, it’s important to make sure that the environment is clean, their bed is made, and ask if they needed a show. The important thing that I received from this is asking yourself what would you want the nurse to do if you were the patient. One thing I do realize is that my ability to work with patients and communicate with them with some baseline knowledge is good. With these, I am able to be more confident in my work. But, I do need to work on looking at the full picture when gathering information from the patient. I tend to overlook things but I will improve by realizing my failures.

This ethnographic study will explore how new cardiac catheterization laboratory nurses learn the local knowledge necessary to communicate effectively in the workplace. The data collected during this study came from face-to-face interviews with three nurses with different levels of cardiac catheterization laboratory experience. First, Mary is a clinical manager of the cardiac catheterization laboratory with twenty years of expertise in the department, as well as cardiovascular critical care experience. Second, John is a staff nurse with ten years of expertise in the cardiac catheterization laboratory, as well as experience in the ADD his other experience. Third, Susan is a staff nurse with four months of cardiac catheterization laboratory experience, who previously worked in the emergency department. Each interview had participants respond to predetermined open-ended questions and dealt with medical knowledge and communication skills (See Appendix

An hour or so into my first day at my internship and my mentor gets a call from the Emergency Room about an elderly patient who came in complaining of chest pain. After running some tests and EKGs, the ER staff finds some abnormal results which slightly suggest that the patient might be having a heart attack. The patient is rushed into the cath lab while my mentor has to leave to attend a case at another facility so he leaves me with his partner Dr. Fernandez to watch the case. Dr. Fernandez starts the procedure of cardiac catheterization in which he plants a stent in the patient’s heart in roughly 30 minutes. Although the patient suffered no heart attack, Dr. Fernandez found some narrowing the patient’s heart. That was my first day of my

My clinical week was very interesting because I removed a Foley catheter. I was helping the nurse give medications, and he asked me if I would like to remove the catheter with him. I felt an adrenaline rush. I was excited but also worried I was not going to do it right. Nevertheless, I still took the opportunity. The patient was complaining that she would love the catheter removed as soon as possible because she had a bowel movement the night before, and the CNAs did not do a good job at cleaning her. The nurse and I reassured her that we would remove the catheter and help her clean up. At that point, I started regaining confidence, probably due the patient’s lack of comfort. In my mind, I was thinking “oh I will exactly as they taught us in

The purpose of this journal is to reflect on my experience and skills gained during my clinical placement at Ben Taub Hospital. On my first clinical day, I was excited and nervous at the same time. My first placement was in the PREOP/PACU area. I was assigned to help a patient who had been in the PACU area going on 2 days. Normally, once the patient comes from surgery they are only in the PACU area for a short period of time before they are discharged home or given a bed in another area of the hospital. This particular patient still had not received an assignment for a bed. The physicians would make their rounds to come check on him daily. The patient was a 28-year-old Hispanic male, non-English speaking, he had a hemicolectomy. He had a NG tube, urinary Foley catheter, and a wound vac. My preceptor had just clocked in and she needed to check on the patient’s vitals and notes from the previous nurse. Once she introduced me to the patient and explained while I was there, she then asked me to check his vitals. (Vital signs indicate the body’s ability to regulate body temperature, maintain blood flow, and oxygenate body tissues. Vital signs are important indicators of a client’s overall health status (Hogan, 2014). I froze for a quick second. I have practiced taking vitals numerous of times and I knew I could do it correctly. I started with the temperature first, when I was quickly corrected on a major mistake I had made by my preceptor. I HAD FORGOT TO WASH MY HANDS and PUT

My reflective clinical practice experience was based on my eight weeks placement in an acute mental health ward in a hospital. I was not sure of what to expect because I have never worked or placed in an acute ward and this was my second placement. Before starting my placement, I visited the ward and was inducted around the ward. This gave me a bit of confidence and reassurance about working in an acute ward.

This Friday, September 29th, I had my second clinical observation experience in the Cardiac Cath Lab. I was there from 7:00 a.m. till noon, viewing the flow and duties of the nursing staff on the unit, learning about the procedures done on this specialized unit. Throughout most of the morning I followed Sara, an RN, who had been in the unit for eight years. It was an impressive experience that broadened my previously limited knowledge of the roles and experience of a Cath Lab nurse.

This Friday, September 15th, I had my clinical observation experience in the ED. I was there from 7:00 am till noon, viewing the flow and duties of the nursing staff on the unit, as well as practicing the skills I have thus learned in school. Throughout most of the morning, I followed Jessica, who had been a nurse in the ER for ten years. It was an insightful experience that broadened my previously limited knowledge of the roles and experience of an emergency nurse.

During our return demonstration, we all felt like we needed to look to our instructor for guidance in what we should do. The reason for this was because we all lacked the confidence to feel like we knew what we were doing. If I could do it again, I would have liked to have been more knowledgeable about the scenario so that I could be more confident.