Hospital Trips

For my seventh clinical shift at the Loma Linda Veterans Affairs Medical Center, my assigned preceptor Filipina Gumangan assigned me three patients on the 4NW unit. The unit where I precept is an intensive care step down unit. Filipina’s objective for giving me three patients this shift was to give me an opportunity to continue exercising my time management skills and to practice my reporting and charting skills, and wound care. This shift I was responsible for many clinical duties corresponding to the care of these patients. My patients this shift were Mr. B, a 72 year-old Vietnam War veteran newly diagnosed with colon cancer, Mr. S, a 65 year-old Vietnam War veteran in the hospital for complicated urinary tract infection, Mr. R, a 90 year-old Korean and Vietnam War veteran. Caring for these patients taught me more about the humanbecoming perspective of nursing and showed me about multidisciplinary coordination with peers, colleagues, and more.

Healing hospitals focus on patients on a holistic manner. To build this type of care for a healing hospital starts with something as simple as the hospital design. The design of the hospital is very important. Weather there will be a lot of light or not, spacing, and how that space it utilized. “Historically, healthcare

Human factors are a serious reason to approach building design from several different angles. Understanding regulatory requirements will help the planning team meet the different codes required to build or remodel. Color selection and noise control affect the environment for both patients and employees so this must be selected carefully to impact the health and wellness of those who are interacting in the health care space. Purchasing the correct the equipment for the space and the employees to use on a daily basis is imperative to the budget of the facility planning process. Identifying the

Mrs. Newman arrives at the outpatient surgical department at 6:30 am and is escorted to her room. The admitting nurse begins her assessment;

1. Approximately how many patient records does your department or facility handle in a typical day?

Your typical work day will begin with an informational meeting so the nurses and doctors can receive their daily reports; this occurs twenty

3. Dr. Maio was not in today. Dr. Stormont said that it was slow and I could go

1. The square and compass facility setting provided a neutral and calm environment to incorporate excellent patient care. Starting in the waiting room, a playful set up was encompassed to direct to the pediatric patient population. Back in the treatment area, the walls obtained neutral tones with calming artwork throughout the environment. The noise was appropriate for the setting and smell was clean with an absence of any foul odors. Lighting throughout the facility was appropriate and not too overwhelming for the patients. The temperature was warm and comfortable for all individuals in the facility. Privacy and personal items for the patients were maintained in their individual rooms with a door for separation. This form of privacy contributed to the excellent patient care provided by the healthcare professionals. Overall, the square and compass primary care facility obtained an effective environment to ensure the well-being of the patients.

The hospital decorated in flat screen televisions, which will be what is directing you to where you need to go. On the 3rd floor, which is the women’s and children’s unit. This unit has the patient rooms superficially soothing the patient by facing the traffic of 280. While this may not seem all that soothing, the stunning view will literally take your breath away. Miles and miles of trees and looping interstates seem to be the most famous attraction when coming into the patients’ room. The large windows make it extremely easy to get lost in your thoughts while staring at the outside world, but in case that is not your style, there are two 42” flat screen televisions in each patients’ room. On the television in the room you may order movies or even watch Netflix. One of the televisions will inform you of everything you need to know about the patient, including nurse and doctor names, labs, and goals for the day. Have you ever had to sleep in those uncomfortable chairs in the hospital rooms? The sofas in the women and children rooms have pullout beds which will once again make you forget where you

I arrived at clinical 0630 and picked up patient information the morning of. I reviewed all assigned diagnoses, medications, labs, and orders with my assigned students, and we discussed our plan for the day. We both took report from the patient's nurse and then Elizabeth presented at preconference. Kala shadowed the Nurse Lead and I helped Elizabeth with brief changes, pericare, and vital signs. I continued to check on both Elizabeth and Kala throughout the day. Last, lunch and then post-conferance.

Jean Watson’s Caring theory has been used in the development of many nursing conceptual models (Fawcett & DeSanto Madeya 2013). One of the tools derived from this theory is the daily goals sheet used in a variety of ICU’s around the country (Fawcett & DeSanto Madeya 2013). The daily goals sheet was derived as a way to improve patient care by keeping the patient safe, provide reliable care, improve communication between doctors and nurses, and help the nurse plan for the day (Rehder, Uhl, & Mistry, 2012). According to Fawcett and DeSanto Maydeya (2013), the goal of Watson’s theory is to help nurses become more “nursing-qua-medicine,” where nursing “needs to emerge as mature health profession, capable of interfacing with the medical profession” (2013 p. 405-406). An interdisciplinary care team was used to implement a time with no interruptions between providers. This time was used to discuss the care of the patient, include families, and ensure that all members agree of the care to be provided (Rehder, Uhl, & Mistry 2012). By having the nurses be a part of this team, they are able to interact and be a member of the team, which is the goal of Watson’s caring theory (Rehder, Uhl, &Mistry 2012). If there is teamwork, and all the members of the team understand the goals, then the daily goals can help decrease length of stay (LOS) in ICU’s, decrease hospital acquired infections

I started my day by attending bed unit meeting. Afterwards I attended a pre-surgery meeting with my site coordinator. The rest of my day was spent filling isolation carts and creating welcome packets.

In the LTAC hospital, I hope to work a day shift schedule from 8.00 am to 5.30pm Monday through Friday and according to organization requirements. The population in the in the organization includes acutely and critically ill patients experiencing sporadic ailment, exacerbation of chronic illness, or terminal illness that would require long term acute care. The NP will provide hourly rounding and work with physicians, staff nurses, wound certified nurse, dietician, and other healthcare professionals to achieve optimum patient care management. Nurse practitioner will collaborate with physicians to develop protocols and guidelines used in management of wounds and skin

"A RN's day is never typical or predictable. 12 hour shifts, 3 days a work week, and sometimes they would go through the night. Always have to be critically thinking to be prepared for any and all new situations to arise. Never always one on one with someone for the whole shift but a good portion was in direct patient care for about 90% of the time and the rest was paperwork."

Providing views of the outdoors from every patient bed, and elsewhere wherever possible; photo murals of nature scenes are helpful where outdoor views are not available