Running head: ACHIEVED OBJECTIVES

Achieved Objectives for Best Practice

Diana C. Pulido
Old Dominion University

Running head: ACHIEVED OBJECTIVES

Culture Exploration Assignment

401- Career Pathway Assessment
Purpose of Assignment
To develop in the learner an awareness of the health beliefs / practices of a culture different from
their own.
Approach to Assignment
This assignment was approach by performing a technological research regarding the Filipino
Culture. The usage of seven objectives provided the framework, these addressed the cultural and
health practices, belief, and appropriate way of communication, current population, origin and
rituals. It presents the effect in nursing; how the nurse is perceived, restriction of care. It provides
a self-reflection on provision of nursing care after granted knowledge.
Reason for Inclusion
Caring for this population requires nurses to have basic knowledge on culture diversity. This
assignment focuses on a culture that is very popular in the U.S. and often seen in inpatient
facilities. It provides based-knowledge on culture sensitivity practice. This assignment provides
the viewer accurate information for the purpose of sharing knowledge to others.
Professionalism
Demonstrates accountability for ones own professional practice
This assignment allowed me to research on any culture of my preference, but since I work in a
community where a great part of the population is Filipino decent, I decided to increase my
knowledge and become more sensitive to their culture in order to provide best care practice.
Research

Applies research-based knowledge from nursing as the basis for culturally sensitive
practice
In this assignment, I provided examples in how to care for Filipino patients based on what I had
learned, I obtain our computer translator, I asked for any preference they may have that I need
to know about (meals, certain times to provide medications, or prayer times), I ask for any
medical interference due to beliefs we need to be aware of (blood transfusion, DNR status and if
there is any living will), I ask if there is a restriction in caregiver gender and if so I notify the
attending MD.
Culture
Demonstrates sensitivity to personal and cultural definitions of health, and how these
beliefs influence an individuals reactions to the illness experience and end of life
I became aware of their end life practice and reactions such as before the sick person dies, the
priest comes and provides spiritual guidance and forgives for all the sins, immediate family
member stays with patient until the patient departs. The funeral is seen as a sad reminisce,
everyone wears black as a sign of grieving, women cry, hug the coffin, touch the decease, vigils,
and prays the man is seen as more strong and self-controlled with his emotions. Food and coffee
is offered to visitors.

Running head: ACHIEVED OBJECTIVES

Achieved Objectives for Best Practice

Learning is the key of advancement, the more I learn, the more doors I open. Nursing, an
unrecognized practice in the past, was finally considered a profession gratefully to all the
sacrifice and commitment our nursing funders performed. The fight and persistency through
years from our nursing leaders has warranted nursing to expand horizons by widening its scope
of practice and adopting new practices. After exploring how this strength remains currently
active, it was concluded that certain underground elements must exist. These, identified as
nurture, empathy, humility, justice and love, are my foundation of why I decide to advance my
career and obtain my Bachelors. My nursing career has been a ticket to see the real world,
things such as mistreatment, medical errors, unfairness, disorganization, lack of motivation, and
mediocracy are the product of poor leadership. Seeing this imbalance everywhere I go, the fear
to speak up, and the buildup of my frustration finally pressured me to act and to not change my
plan. Society placed a stigma in which if people do not have a high degree, they are not capable
of providing good visions. Since I cannot remove this stigma on my own, I decided to follow
along and further my education which permitted me to grant competency in the follow cores:
Critical Thinking
I was introduced to several brilliant nursing theorist, but only connected with one, Faye
Abdellah. Her theory influence the importance of providing nursing care using her holistic
framework, which it congruent to my theory holistic care provides a balanced life. During my
care, I ensure to offer a spiritual consult as part of my admission questions. A way I realized my
critical thinking expanded was the reduction of stress at work due to my efficiency. I became
better organized and confident with my decision making process. I can identify when my patient
needs to be transfer to a higher level of care and follow chain of command when I feel patients

Running head: ACHIEVED OBJECTIVES

life is in danger. A stable and oriented dialysis patient became lethargic, developed a fib and
remarkably hypotensive couple of hours before change of my shift. I recommended the adequate
medications and suggested transfer to greater level of care, but I only received give him
albumin and watch him, we will transfer him if it gets worse, I felt it was not right plan of
treatment. I spoke to the nurse in charge and supervisor as for back up support, but all I received
was there is nothing we can do if the doc dont want to move him, I felt on my own. I engaged
my creative problem solving and decided to call a Rapid Respond Team (RRT) to overpass the
physicians orders, RRT placed pressure to the attending physician and the patient was
transferred to ICU.
Nursing Practice
One of the ways I have applied the appropriate knowledge in nursing was by immediately
researching on the virus as soon as I heard there was an outbreak. I recently was assigned to two
patients diagnosed with Hepatitis A (an uncommon diagnosis in the U.S.), I explained the
discoloration, the instability of blood sugar (I requested blood sugar monitoring, as there were
not ordered), the reason for neurovascular assessment every four hours, the importance of
staying away from medications taken by mouth and avoidance of narcotics, the reason for
intravenous fluids going, the length (about six months) this virus can stay in the system, the
importance of hand hygiene to avoid its spread, I felt confident of my education due to the early
performed research. During my first year in Old Dominion, I had the opportunity to incorporate a
change at my work to decrease the length of stay in patients with heart failure. This informal
meeting consisted of the Quality Improvement Nurse (creates and guides the activity), a bedside
nurse from ICU, Telemetry and Stepdown unit (provide information on current practice), a Case
Manager (in charge of explaining the discharge transition process), a Heart Failure Certified

Running head: ACHIEVED OBJECTIVES

Nurse Navigator (provide most current information on medical treatment and care), and a leader
from administration (present the finish plan to superiors to stimulate the change). We met twice a
month to evaluate and modify the trial plan. Three months after, the working plan was presented
to superiors and the approval for change was obtained and patients remained safe. In 2015, I
volunteered to implement traditional nursing care practices such as obtaining vital signs, weight,
height, medical history and medications for diverse ethnicity and ages during a free clinic drive
in North Carolina. I had a patient who was newly started on metoprolol Extended Release for
uncontrolled atrial fibrillation, despite the medication, patients heart rate was150-160. I notified
the hospitalist and he ordered Cardizem 5mg IV once, post administration, heart rate
maintained 115-130s, but four hours later, it went back to 150-160s, the medication was not
effective. I updated the hospitalist with findings but this time, I recommended to restart the
amiodarone drip that was discontinued the night before by other physician as he was preparing
the patient for discharge. The drip was restarted and a few minutes later, patients heart rate was
controlled and converted into sinus rhythm.
Communication
Part of my objectives when providing care is to build a trusty relationship with my
patient. One of the ways I practice this is via therapeutic communication. At the starting of my
shift, I introduce myself, explain the expected goals and current plan of care, I evaluate for
misunderstandings and correct them as necessary. Once all my patients are taken care off, I sit
down for about 10 minutes to allow them to share their current feelings and thoughts, I use my
active listening skills and paraphrase for accuracy of thought. I often found myself providing
some personal experience as a form to provide comfort and empathy. I became more competent
at using the Situation, Background, Assessment, Recommendation method (SBAR). Prior to

Running head: ACHIEVED OBJECTIVES

calling the MD, I ensure no one else needs to communicate with him/her. Then I say Doctor K,
This is Diana from Laulima, calling about patient in room 222 Mr. X, who was admitted for
Hepatitis A, currently receiving maintenance fluids, VS are stable. Patient is requesting a
sleeping aid, she stated she takes Ambien 5mg at home every night and is effective once I
received the order, I always ask are you putting this order in? that way I reduce errors in case I
misplace the telephone order. In Nursing 40, I was required to identify any errors such as
incorrect grammar, punctuation, spelling and then to provide the appropriate form using APA
format. One of the errors I found was an in citation error (1994, Perkins), which according to
APA format, the author last name goes first, then the year published. I identified all of them
which ultimately gave me a 100%.
Teaching
To provide comfort and reduce anxiety for my patients going to cardiac catheterizations, I
ensure to reinforce pre-op and post-op care at every state. I ask them to repeat back the reason
for the procedure, the technology been use, the plan, expected outcomes and possible
consequences. I provide all the information at their educational level. During off peak hours of
my shift, one of my routines to enhance my knowledge is to read all the doctors notes, and
research for new diagnosis or plan of treatment I am not familiar with. This also aids the fluency
of the report at the change of shift.
Research
The Therapeutic Nursing Intervention (TNI) assignment required to identify a nursing
care problem, current practice, and solution based on current literature and based from a research
study. I use Medication error as the problem, the current practice is the usage of scanner for
identification of patient and medication and second nurse signature is used. One of the literature

Running head: ACHIEVED OBJECTIVES

provided was obtained from a journal published by Vanderveen in which supported the usage of
smart pumps with the integration of a closed-loop medication administration safety system, on
the other hand, a published research report from a controlled trial concluded that Intravenous
medication errors and adverse drug events were frequent and could be detected using smart
pumps. We found no measurable impact on the serious medication error rate, likely in part due to
poor compliance. Although smart pumps have great promise, technological and nursing
behavioral factors must be addressed if these pumps are to achieve their potential for improving
medication safety (Rothschild, 2005). Part of my bedside care practice is to deliver cultural and
linguistic competent nursing care to all population. When caring for a diverse cultural patient, I
always ensure to apply research base knowledge such as maintenance of religious practices and
beliefs in the hospital and to communicate care in their native language for a better decision. Last
week, I had a patient who only speak Spanish. During his pharmaceutical stress test, it was found
the need for an immediate cardiac catheterization, I was called to come and explain what was
happening and he said Lets do it now.
Leadership
One of the requirement for health nursing 492 was to initiate a proposal that provides
strategies in partnership with the community to stimulate health promotion and reduction of
negative coping mechanisms such as the usage of heroin and crime. One of the strategies
proposed to establish healthy lifestyles is via stimulation of employment opportunities from local
organizations of Portsmouth,VA. One of the ways our team suggested to evaluate the
effectiveness of the implemented strategies was by the usage of non-biased case studies,
statistical reports and surveys. In my second semester, for the first time, I was granted the
position of charge nurse due to the shortage of staff members. I was in charge of 36 patients, four

Running head: ACHIEVED OBJECTIVES

nurses, two nurses assistant and a monitor technician. The pressure of accountability taught me
to learn how to delegate. Part of my leadership duty was to supervise compliance with
departmental regulations, assistance to all staff members, ensure efficiency of care, safety and
overall satisfaction.
Professionalism
I demonstrate accountability for my own professional practice by working on my
bachelor degree, implementing the reviewed nursing practice literature, and maintaining my
nursing certifications active. At work, by reviewing evidence base practice policy and procedures
prior to performing an uncommon care such as the removal of a T band after cardiac
catheterization.
I advocated for the nursing profession by learning how to write a professional letter to the
Senator of Hawaii, Brian Schatz. I formally asked for support on bill SB 2672 relating to
Advanced Practice Registered Nurses (APRN), and also provided my perspective As a nurse, as
a patient, as a citizen and as a devoted advocate to the advancement in Nursing profession, I feel
our nation leaders are not showing validation to the education, exposure, compassion and love
we have for the U.S. population and also provided the benefits of supporting this policy by
placing APRN in these areas increase health awareness, identification of community resources to
increase healthcare compliance especially in our lower income population, and providing
alternative measures allowing our patients to feel in control of their own health.
Culture
During my second semester, I maintained awareness of global factor that influence health
and its delivery by developing a Wikkipage on the country of China. Some of those identified

Running head: ACHIEVED OBJECTIVES

factors include economy imbalance, illiteracy (due to early labor), religious beliefs (Buddhism)
and cultural practices such as the Ying Yang.
Overall, nursing has made a great impact in my life, from teaching me in how to
appropriately advocate to the importance of maintaining a connection of body, mind and spirit.
Prior to nursing, I used to perceive nursing was a list of skills I had to learn, I had a concrete
vision. I used to see sickness as lack on noncompliance with healthy practices, but as I became
expose to what I call reality, I learned being sick is also part of life. Once I accepted this thought,
I learned to accept human mortality. Thanks to nursing, I was finally able to see the difference
between sympathy and empathy.
While working with my Associates as a nurse, I became competent of several nursing
skills, learning and communication styles, life balance and self-affection, however, after I started
working on my Bachelors of Nursing, I became able to appropriately organize, plan and motivate
others to achieve objectives. Another way I decided to recognize this achievement was by
becoming a Zumba instructor. Learning these skill helped me become independent, increased my
confidence during decision making process, and is assisting me in embracing getting older.
Learning different theories of nursing gradually influenced my current practice. It
allowed me to identify and reflect my thoughts and views with experts and provided comfort to
my own beliefs. As an addition to my philosophy, it also ensures my patients are receiving the
appropriate care. I occasionally receive thank you cards and chocolates for helping them get back
to their homes. Furthering my education has allowed me to work more often as charge nurse
rather than as frontline. I often receive complements from my coworkers in thriving for clinical
coordinator position but I feel my passion is education because I finally was able to achieve a

Running head: ACHIEVED OBJECTIVES

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balanced lifestyle and I want to influence the same feeling to others, which is why I decided to
further my education and obtain my Master degree in Nursing.
In conclusion, Education is the key for a healthy wellbeing. It is important to analyze and
identify the elements that are providing the foundation of our own practice in order to reapply
those that have been omitted. The expansion of learning has increase my natural ability, has help
me understand the reason of my failures and success, has allowed me to understands humans
insight, has enrich my self-fulfill, and has helps me overcome barriers. Besides enduring my
nursing practice via the implementation of research studies, this bachelors degree in nursing
provided me the necessary tools to help others increase their humans natural strength to achieve
the purpose.

Running head: ACHIEVED OBJECTIVES

References
Rotschild, J. (2005, March). A controlled trial of smart infusion pumps to improve medication
safety in critically ill patients*. InCritical Care Medicine. Retrieved from
http://journals.lww.com/ccmjournal/pages/articleviewer.aspx?
year=2005&issue=03000&article=00010&type=abstrac

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