Clinical Situation Selected
About 14 years ago, I had transferred from OR nursing to bedside medical surgical nursing. Using Benner’s level of nursing experience (2013), I felt that I had gone from an expert OR nurse to an advanced beginner medical surgical nurse. A seasoned nurse who was my preceptor had shown little affection for teaching me anything. She felt that I should know everything. A 57-year-old patient arrived on our floor after being admitted for a thoracentesis planned for the next day. She was also a dialysis patient with a new AV fistula that appeared infected as the site was very red, warm and edematous.
At the beginning of the shift, I questioned my preceptor after looking at her x-ray and ABGs; I was concerned that
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As a new process is presented, the nurse can move from expert down to competent or proficient for a short time during the learning curve. My personal experience was not unique, many nurses who change specialties feel very vulnerable as their existing knowledge is tested. I listen to my intuition more since that fateful day, drawing on this skill to improve patient care. There have been many discussions on how intuition in nursing enhances clinical judgment (Robert, Tilley, & Petersen, 2014).
Today, after my medical surgical certification and work to improve patient care in this field, I feel confident that this patient would not have the same outcome. I have advanced all the three P’s of physiology, pharmacology, and pathophysiology. There have been several times that I have assisted other nurses who need a new set of eyes to review care. It was during these times I found my passion for
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I reviewed all his labs and his reported progression of pain that crescendo after he had a late dinner. I noted his triglycerides were 1574, and that level can cause pancreatic issues. Cardiology was ready to sign off as all his cardiac testing was negative, and I whispered to my preceptor “I think he has pancreatitis.” She asked me what made me think that, and I listed my reasoning. She then called the attending asking him to order an amylase and lipase level, but he blew her off, stating that the GI consult can handle the
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
My research paper is on the healthcare occupation, in particularly,the field of licensed practical nursing, also called licensed vocational nurses. In my paper, I will cover such things as the definition of career choice, certain requirements, the expected job duties and responsibilities, any additional licensure that is required. After discussing these topics, I will then point out the potential of finding a job, the ranges of salary, as well as the environment I would be working in. Finally, I will talk about the potential growth in this field and legal requirements. Now i will start with the definition of my career choice.
Once upon a time, my best friend, Bryan Martinez, often heard his mother’s medical conversations with friends. One day at school, our teacher confronted Mrs. Martinez and told her that she was able tell that Bryan was a son from a nurse. Apparently there was an incident at school where a little boy was acting out and Bryan told our teacher that the little boy was agitated, and to give him some medication to calm him down. As demonstrated by Bryan, nursing is ongoing profession that promotes the health and well-being of individuals.
I wasn’t quite sure what to believe. I knew I wanted to assess the patient and speak with him first before jumping to conclusions. My preceptor and I went to go let the patient know we were going to be his nurses for the day. Once we entered and started doing our assessment on the patient, he seemed like he was fine. When I asked him to rate his pain on a scale of 1-10, he stated it was 10. I asked him where he was experiencing the pain, he stated it was where the incision site was (upper chest) and all over his body. He demanded the best pain medications we have immediately. Other than what he subjectively told us, he seemed okay. His vitals were normal, his blood work came back with nothing alarming and a urine culture was negative. He was a previous drug abuser in the past from the past medical report. I started to think he just wanted pain medication just to abuse them again. I do admit after assessing the patient, I did in fact jumped to conclusions. Was I starting to be biased towards my
The University of Texas Health Science Center at Houston as Health Science Center at Houston
As a medical / surgical RN, I provided care for the elderly, the infirm, the mentally challenged, the young, and the psychologically disturbed. The wide variety of patients exposed me to the effects of life style choices, health care choices, and the resulting impacts to the patient as well as to the family of the patient. This experience has fully matured my view of the awesome responsibility that we, as health care professionals, have been charged with, and it has furthered my desire to obtain the skills necessary to provide more advanced care for my patients. In addition to exposure, maturity and experience, my career as a medical / surgical RN has also sharpened my critical thinking abilities and provided insight on observing signs and symptoms that a patient may be unware of. Furthermore, as a charge nurse I learned the importance of collaborating with other health care professionals in order to provide the highest level of care available. In summary, my career as an RN has provided valuable experience, maturity, exposure to impact and outcome, enhanced my critical thinking abilities, and improved my collaboration
During the assessment, the patient would answer questions appropriately then often had a blank stare during questioning. At times he would answer all questions appropriate and accurately then the blank stare would return. In review of the patient’s history his spouse told me he had a history of depression, DM, and HTN. His history was negative for CHF and CVA. The patient was on Metformin, Lisinopril, and Effexor. He had no recent medication changed. In the review of systems, the patient denied all other symptoms including headache, fever, signs of UTI, signs of stroke, and all other pertinent complaints. He denies any new stressors.
Life’s experiences, work, and education have prepared me to further my education. I will achieve this goal with the ability to analyze situations, make informed decisions, and provide my patients with the best evidence based care possible. I will also have the ability to impact change in quality improvement, policy and procedure, and overall patient care with evidence based
I had known for years that I wanted to work in the health care field, but I always believed it would be as a doctor. I watched for the first few years of my brother’s life as he struggled with different health challenges such as being born premature, having croup and breathing difficulty, and speech impairment. Watching my brother struggle and then being able to overcome these difficulties, as well as seeing other children around him who were not as fortunate, really pushed me even at a young age to make a difference. My family, both immediate and extended, were very supportive, and I felt a real positive push towards working hard to achieve that goal of working in health care. In high school, I was fortunate enough to do a cooperative placement at the Peterborough Regional Health Center’s Intensive Care Unit. Through observing rounds and being in the medical setting, I truly knew this is where I wanted to
Clinical reasoning has been defined by Tanner (2006) as ‘a process by which nurses make clinical judgements by selecting from alternatives, weighing evidence, using intuition and by pattern recognition’. It involves the judgements of what is wrong and clinical decision-making of what to do (Levett-Jones et al.,
INTRODUCTION There are many things that affect a student’s enrolment as a nurse the student must be competent in the many registration standards that the Nursing Midwifery Board of Australia have set. The stigmas attached to students with Impairments and or Criminal histories and the ineligibility to register. Nursing is defined by the International Council of Nursing (2014) as collaborative care of individual’s any age health or ill of all communities, groups, in all situations. Health promotion, illness prevention and the care of unwell, disabled and dying people are included in the nursing practice. Encouraging a safe environment, research, contributing to shape health policies and health systems management, and education are also key nursing
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
Unpredictable situations arise on a day-to-day basis for nurses. Whether it be in a hospital, clinic, or office setting, nurses have to have the knowledge and understanding critically think. Barbara Carper states (Carper, 1978, p. 23) “Such an understanding does not extend the range of knowledge, but rather involves critical attention to the question of what it means to know and what kinds of knowledge are held to be of most value in the discipline of nursing”. There are four ways of knowing concepts Carper describes, empirical, personal, ethical, and aesthetic. These four concepts are utilized daily, sometimes by instinct, or intuition. I can relate these four concepts with situations I have encountered working in the ICU or during my clinical
My nursing career began 7 years ago at SSM on Medical Oncology Unit. I was certified in Chemotherapy and Wound Care. Although there were thirty staff nurses, only two of us were certified in wound care and five were chemotherapy certified. Besides caring for my medical-surgical patients, I was also responsible for administering chemotherapy and monitoring cancer patients as well as assessing, documenting, and recommend the appropriate treatments for different types of types of wounds, including surgical openings, ulcers, bed sores, feeding tube sites, and abscesses. I gained a diverse range of clinical skills in Emergency Department, Cardiology, Neurosurgery, and Orthopedic Surgery as floating was a staff nurse's requirement. Every nursing
First, I would like to start by stating that my expectation of a nurse is that he or she must be a good communicator, emotionally strong, empathetic, patient and calm, pay attention to detail and have good physical endurance. I feel that I possess these qualities which would make me very successful as nurse in the future. I have dream about being a nurse since I was a little girl and as a young adult, I still have the desire to be a nurse so I can help others. My desire to become a nurse evolves from past experiences that have taken place in my life; for example, my father’s death, my illness, personal experience and interaction with the hospital staff, specifically, the nurses.