Alternative Experience: NUR 3112P

Adult Nursing Science II Practicum

Reflection:
1. Describe a situation when you were unsure of what to do today. How did you feel? What additional
knowledge or skills do you need in order to handle a similar situation in the future and how do you plan to
acquire that knowledge? Describe any changes in your values or feelings as a result of this experience.
(Minimum 1 paragraph.)
The event which I will be writing on is not one that I was directly involved in. Rather, I was able to observe the
event as it unfolded. During my experience I was able to observe and at times participate in the care in VCUs trauma
room. As a result I was able to see multiple trauma events. However, the most unique one was what appeared to be an
attempted suicide by a 9 year old boy. He had hung himself with a telephone wire. By the time the boy arrived he was
seizing and posturing. His heart rate was in 150s and respirations were in the 40s. He was unresponsive. While I found
the event very disturbing to observe the ability to function effectively under pressure was key to possibly saving the boys
life.
2. What have you observed or learned about nursing roles in the given experience? What have you
observed or learned about the intraprofessional team in this setting? What did you observe about the
communication and collaboration amongst the intraprofessional team members? (Minimum 2
paragraphs.)
Watching the medical team in the trauma room was very impressive. They had a team of doctors,
medics, nurses and other healthcare workers ready to go by the time the patient arrived. By the time the patient
did arrive a whole process of events had begun. The doctor (a resident I believe) working the trauma would yell
out their assessment findings while a nursing supervisor and other residents and attendees would document the
findings and if necessary communicate any suggestions or directions to the doctor working the trauma. The
nursing supervisor aided by coordinating the nursing staff while the attendee coordinated doctors.
The attendee and nursing supervisor worked together to streamline the care provided to the patient.
They appeared to work as equals and bother coordinated alongside each other. Also, doctors and nursing staff
regularly communicated their needs and/or concerns with one another. It was apparent that the task of patient
care was the primary goal of both the staff. The intraprofessional team system also showed that the primary goal
was working together to help the patients.
3. Provide an example of holistic care that you observed. (Minimum 1 paragraph.)
During my time I did not often see holistic care as taught in school. Most of the patients were unresponsive and
the primary concern of providing lifesaving care was in the forefront. While holistic care is important in certain
circumstances I find that when a patients life is at risk holistic care falls by the wayside. Prioritization becomes the vital
focus. While some nurses thrive in providing holistic care it is important to realize that sometimes the best nursing care
can be the one that saved the patients life.
4. Identify the National Patient Safety Goals that were observed throughout the day. Discuss the effect of
the Goals on the patients outcome. (Minimum 2 paragraphs.)
At the trauma center one of the National Patient Safety Goals I observed was to get important lab results to the
right person at the right time. While working the trauma the doctor would order certain labs which would be drawn
immediately and ran to the lab to be ran STAT. Upon completion the labs would then be immediately communicated to
the healthcare team and doctor. They could then maintain or alter their method of care based on that information
provided.
The other National Patient Safety Goals I observed was the prevention of mistaken surgeries. At each trauma a
general surgeon was present. At the request of the working physician they would consult with the surgeon who would
then gown up and assess the patient. They would then mark on the patient or document their findings on the trauma
patient. They would immediately be transferred to the OR where the surgery would be completed. As a result there was
very little chance for error regarding doing the incorrect surgery. The surgeon was with the patient from the point of
assessment to the point of surgery.

Rev. 12/03/2013

Alternative Experience: NUR 3112P

Adult Nursing Science II Practicum
5. Compare and contrast a patient issue that you observed today with an evidence-based nursing journal
article from the Nursing Reference Center (NRC). (Minimum 2 paragraphs.)
At VCU the child who hung himself was eventually vented due to subsequent ARF. Due to the patients
injuries he was no longer able to ventilate. When EMS arrived on scene his O2 sat was ~50%. It is unknown how
long his O2 sats had been at such a low rate. In order to keep his O2 as an appropriate level and to attempt to
save what brain tissue they could they opted to mechanically ventilate. As stated in the article Mechanical
ventilation of children there are many risks associate with ventilating children such as atelectasia, VAP and
pneumothorax to name a few. As a result careful consideration of settings and care is vital to providing safe
mechanical ventilation.
At VCU the patient was first intubated then x-rayed to ensure proper placement. Shortly afterward the
vent settings were determined. The settings were then reassessed to ensure that they were the proper settings
for the child. Given that that the patient was already in a critical state reassessment was vital to makings sure the
settings were correct. Because children have a wide range of physiologies it would be easy for a simple error to
cause catastrophic consequences.

Rev. 12/03/2013

Alternative Experience: NUR 3112P

Adult Nursing Science II Practicum
References
Kendirli T, Kavaz A, Yalaki Z, ztrk-Himi B, Derelli E, nce E. (2009) Mechanical ventilation in children. The
Turkish Journal of Pediatrics. 48: 323-327.

Rev. 12/03/2013