Im 546 Capstone Practicum : Reflective Clinical Journal

This interview was conducted on October 12, 2016, with Judy Hayes, RN. Ms. Hayes began her nursing career in 1981 as a primary nurse at New England Medical Center (NEMC). During her tenure there she held various positions ultimately becoming the manager of the Surgical Intensive Care Unit (SICU). Over the years Ms. Hayes has worked for private consulting firms and attained the Directorship of Utilization and Care Management at St. Elizabeth’s Medical Center (St. E’s). In 1999 Ms. Hayes joined Brigham and Women’s Hospital (BWH) as Director of Professional Practice and Staff Development. From 2005 through the present Ms. Hayes has been the Vice President of Nursing and Chief Nursing Officer (CNO) at the Brigham and Women’s Faulkner Hospital (BWFH).

Bedside reporting has the primary function of sharing patient information between nurses, as they change shifts. The nurse ending their shift would report all the changes that have occurred in the state of the patient and all measures which have been taken for the respective patient. This information would be transmitted to the nurse commencing her shift, who would then write and further transmit all patient information occurring during their shift, to the nurse coming to replace them.

Traditionally nurses delivered clinical information about the patient, the clinical events on their shift and the plan of care to the oncoming shift to ensure continuity of care and to make sure that their colleagues were informed about tasks or instructions that needed to be completed by the next shift. This process had a variety of names; report, handover or handoff. The format was often different from unit to unit. It usually took place in an off stage room or office or at a charting station from away from the

This paper explores the scenario of a client and looks at the presenting problem from an ecological and strengths perspective. It will also explore advanced clinical skills, intervention strategies and ethical dilemmas encountered. Methods for evaluating progress will be discussed within the social context of the case. Termination and follow-up approaches, and any ethical dilemmas will be included. Any problems with oppressed populations will also be discussed. Finally, the limits of the chosen model and limits of the practitioner, evolution of client and practitioner identities, any ethical or social justice issues for the agency, and an evaluation of the practitioner’s effectiveness will conclude the paper.

Standard 16 of the American Nurses Association (ANA) Scope and Standards Practice, directs nurse leaders to advocate not only for patients but for all members of our healthcare community. As a discharge planner, I am in a unique position to advocate not only for patients but for caregivers as well. As part of my responsibilities, I participate in daily multi-disciplinary team rounds. The meetings take place so that all disciplines can openly discuss patient care needs. They provide the perfect opportunity for anyone to bring to light problems or concerns.

Janice is responsible for the staffing of her unit (Palliative/Hospice) which has been named “The Light House” with 70 staff members working various shifts. As a manager of any unit within the Veterans Affairs Medical center, managers are expected to attend or review meetings minutes; meetings like the Nursing Council and Nurse Manager’s meetings as well as others committees. Managers are to hold staff meetings and communicate the minutes to all staff via email, or written form. Managers make sure all changes in policies, documentation, and other situations are reported to staff members. Managers are accountable for compliance of all regulatory standards, such as OSHA, CARF, and JC standards. Managers are to have an approved staffing plan, review expenditures affecting its cost, such as overtime, leave, and compensation time. Complete quarterly report/data, staffing effectiveness analysis reports, staffing updates, and FMLA information. As a manager, communication, performance improvement, staffing/recruitment, time and leave, safety/environment of care, controlled substances, adverse events/patient complaints, employee accidents/injuries, employee performance, performance appraisals and proficiencies, and staff development are all part of her duties.

Hello everyone. My name is John Smith. I am a RN here at the Hospital and I am the Director of Nursing Informatics. As I’m sure all of you know to be successful in the care of our Patients you have to work as an interdisciplinary team and timely COMMUNICATION is key! As you can see I have capitalized communication to emphasize how important it is. As a Nurse on the unit a big part of communication is reporting a patient’s condition after you have

The second week of my preceptorship brought many new experiences for me, and I can honestly say that each day I spend with my preceptor is better than the last. This week I focused on time management of a full patient load with continued documentation practice as well as admission and discharge procedures. I’ve had brief experiences in my past rotations assisting with discharge teaching and admission assessments however I have never been able to fully take charge and complete the process from start to finish, so this was a great learning opportunity for me.

Bedside shift report is the process of completing patient handoff at the bedside with the oncoming

Over the past seven years as a clinical nurse on the McKeen Pavilion (the medical-surgical amenities unit at New York Presbyterian/Columbia Medical Center), I have committed to excelling in a clinical bedside capacity, as well as a member of the NYP community. This combination has allowed me to be a true advocate for my patients, their families, and my colleagues. The unit has afforded me a tremendous amount of hands on nursing experience, as

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

Several of the roles which I observed this morning were expected: the nurses took vitals for incoming patients, performed focused assessments, and were the main communicators between family, the patient, and the physician. I realized when the first patient came in around 10:00 am, the RN’s role in assessments, gathering blood work, and carrying out all the necessary steps to situate and stabilize the patient as soon as possible. It was incredible seeing the nurses work together, in sync, in those first moments when the patient was brought in. And though expected, I appreciated seeing just how much communication was held and information was gathered from the patient or family members by the nurse. Jessica asked the right questions from both parties, while still showing incredible empathy and not making the whole situation seem rushed and flustering. I understood this as another essential role of the nurse in the ED; he or she must maintain even in such a fast-paced environment empathy and focus in each interaction.

It was a pleasure to have Nurse Manager Denise Grobelny come and talk to the KIP students today. Her lecture taught us many things about her job in the Special Procedure Unit at Einstein Medical Center. She is very responsible because she comforts the patient and takes care of them. She impacts the lives of her patients and families by putting them in a relaxed situation. For instance, Denise can take a patient’s blood pressure or updating their medical records. Nurses are with patients most of the time and they work really hard to aid them to become happier.

Upon starting her shift, she assessed any patients already in care for vital signs and needs. As patients came in she would assess the client and continue to provide care for the new client

Nurses often wonder what happened to their patients after discharge. Did they go for follow up care as advised? How is their disease progressing? What were the results of their testing and how are they coping with the prognosis? Nurses bond with patients at the bedside and our concern extends long past discharge. The ability to provide support, advice, and education to patients in their own environment would help them maintain control while allowing the nurse to fulfill their professional role with autonomy.