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The Report of 1 Semester Nursing Practice

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This semester I made it my goal to integrate and build on my knowledge in holistically caring for patients by demonstrating leadership capabilities and using effective knowledge and judgment utilizing evidence based practice. I wanted this semester to having the courage to advocate for my patients by communicating with the interdisciplinary team on a daily basis.

Mr. H is an 84 year old man who had a cholecystectomy and biliary tube inserted. I had this patient for 3 days and he was a very pleasant and sweet man. One day after coming back from break I was told that Mr. H tried attacking the PCA, and was being violent that security had to come in. There was already a planned family meeting the same day about the status of Mr. H and next plans for care.

Having had him for 3 days I was surprised to hear this. During the meeting, I acted with courage by advocating for my patient, I stated that the times I have had him he was very pleasant. And there could have been underlying issues to the story. As I sat on the meeting with the psychology team, social worker, dietician, and his family, and told them about the 3 days I had with him they all got a better opinion of what he is like. I was also asked whether I think he would do better in a nursing home or a rehab and I gave my opinion saying rehab.

A month later I saw the wife on the unit and she specifically came to me and thanked me because they were going to send her husband to a nursing home but decided to try rehab and he ended up doing really good there. And she thanked me for standing up for her husband about the abnormal behavior he portrayed in the hospital.

This was a great learning opportunity for me, I experienced a fulfillment in my practice. I realized how important it is and the impact I can be for a patient’s voice who is unable to advocate for themselves. I saw the growth I have made in my practice. My past semesters I was not ready to advocate especially being independent and around a room full with family and health care professionals. In my current practice I have achieved such an important skill that is needed for nursing, and for my future practice I will continue to advocate and stand for what I think is morally right.

Because after all nursing is the ideal profession to practice advocacy on behalf of our patients, mainly because of the intimate nature of the relationships nurses have with their patients.

Advocating is viewed as an essential component of nursing ethics where the actions of the nurse supports the autonomy of their patients.

Speaking up is our duty. There is no better feeling than advocating for our patient. I learned two powerful lessons: addressing concerns gets results, and you always need to be a voice for your patients, whether it is for their physical health or for something small like when I had a vegetarian patient who received meat on her dinner tray.

This lesson I learned connects to my CP because as a public health nurse I will share resources and expertise with my client. I will practice in a client centered manner and incorporate strategies of empowering, enabling, advocating, cooperating, and collaboration. I will address any concerns and be the voice of my client if needed.

Relational practice is a respectful and authentically interested inquiry into into patients’ live experiences and health care needs. To practice relationally nurses should involve the active concern for the patients; be able to share and acknowledge differences; understand uncertainty; be able to question and step out of the taken-for-granted values and assumptions shaping their practice; and be able to help patients transform their health experiences.

Ms. K a 68-year-old patient anxiously tells me what there were two nurses laughing at her there were disco lights and big spiders throughout the night. Using relational practice, I sat next to her and listened to her concerns, after discussing the matter with my preceptor and realizing she was experiencing delirium. I educated my patient. I shared my knowledge, acknowledged her feelings and provided psychosocial support. She was thankful of my help and taking the time to educate her. She then continued to share with me that she is scared to go home because her daughter never visits, her husband passed away and she might need some help with care at home.

My relational practice revealed the importance of context in nursing practice and patient care outcome. Without this inquiry, she would have been discharged home with anxiety and not understanding what happened to her. Without inquiry, she wouldn’t have felt comfortable to share that she needed home care support. My relational practice established therapeutic nurse patient relationships, appropriate arrangement of her health care needs, and patient satisfaction of nursing care.

In relation to my culminating performance from the perspective of relational practice: I will examine how personal capacities and health concerns impact the lived experiences of my client, decision making, and management of issues raised. My first goal will be to build trust and then practice relationally with my client to prioritize and contextually understand the social structures, interpersonal factors and elements that need to be considered.

Relational practice has and will always be the foundation of my nursing practice. To me it refers to an inquiry where as a nurse I am in conscious participation with my patients. I use skills like empathizing, listening, observing, and asking questions to understand the experiences of my patients and families. Doing this helps me provide optimal care leading to patient centered and holistic care.

To practice relationally I used Peplau’s Theory of Interpersonal Relations which articulates that nursing involves the interconnectedness of the nurse and the client, who both want to reach the same goal. Peplau’s theory acknowledges and portrays the importance of a nurse’s role beyond the physical tasks.

Watsons theory mainly concerns on how nurses care for their patients, and how that caring progresses into better plans to promote health and wellness, prevent illness and restores health.

Mrs. H had a pancreatectomy surgery done. Using Peplau’s theory the first phase was the orientation- while assessing and getting to know Ms. H she tells me she is anxious about going home because of her new onset diabetes and she was seeking support. The second phase is identification- I educated my patient about diabetes, and gave her resources. I then talked to the dietician about this issue. 3rd phase is exploitation- when I came in two days after she was not as nervous, and she told me the dietician educated her and referred her to an education workshop too.

I guided my practice using Paplaus and Watson’s theory. Using Paplaus theory I looked at the four phases of her work and using Watson’s theory of caring I went beyond procedures and tasks I had to do as a nursing student. The patient was my focus of practice, I listened and communicated and collaborated with her. Using these two theories is a reminder that my primary purpose as a health care professional is not only assessing vital signs, documenting, priming lines, but also to help real, living people heal and provide comfort.

Using those theories in my culminating performance; trust will be the foundation of my interaction. There will be difficult personal questions to ask regarding intimate partner violence and safe sleep. Without providing a safe space, collaboration, and empathy then I will not be able to help my client. Because after all a significant amount of a nurses’ knowledge of their clients comes from relational work and collaboration with their clients.

Implementing these theories in my practice helped me gain a deeper nursing perspective on how to help and honor and my patients. Everyone is unique in this life; when caring for patients, the focus should be on their narrative and lived experiences. It is through listening and understanding our patients that we can promote their well-being beyond physical healing. While it is important to accomplish tasks in our practice, there is a greater need to also understand our patients through forming collaborative relationships with them.

As I finish off this placement I am amazed and happy on the growth I have seen in myself. I started off this semester not feeling like I am ready for consolidation. Having a tough but a great preceptor she pushed me to be independent, which increased my confidence ability. I have found the area of nursing that I love and want to continue practicing in. Advocacy has been the theme of my semester that I will continue to take on for my future practice. I now feel like I am ready to move on to the next step of my nursing practice

This was my timeline in semester 1, as you can see I have almost achieved one of my wishes. I now can add another great and amazing achievement to my timeline. I have had such an amazing journey and would not have wanted to experience this journey at any other school. I have made lasting friendships with students and instructors and gained valuable experiences and knowledge through classes and placements that I will carry into my future career as a nurse.

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