Community-Based Practicum Reflective Journal Guidelines

Bon Secours Memorial College of Nursing

NUR 4143 - Clinical Immersion
Community-Based Practicum

Professional nursing meeting experience (4 hours)

Guide for Reflection Using Tanners (2006) Clinical Judgment Model
Introduction

What professional nursing meeting(s) did you attend and where was it located?
1.) Nursing Quality Outcomes Council at St. Francis Medical Center on February 1, 2017 at 8am
2.) Nursing Research and Evidence Based Practice Council at St. Francis Medical Center on February 1, 2017 at
10am
Background

Describe the purpose of this professional nursing meeting? Describe the agendas of the group and subgroup. What
type of issues did they address?

1. Nursing Quality Outcomes Council

a. Purpose: This council discusses issues that are nursing controlled regarding quality outcomes for
patients and ways to improve hospital scores.

i. Nursing policies have to go through this committee to be approved before moving up the
ladder.

b. Agenda: Welcome and call to order, prayer, review of minutes and approval, discussion of policy
PAT-122, co-chair nomination, nurses week, committee goals reviewed/revised where needed,
round table and adjournment.

c. No subgroups

d. Issues discussed included:

i. Site access (internet) who has it and who does not and who should have it.

ii. Dashboards need to be available to RNs when surveyors visit and staff needs to be able
to know how to address them (unofficial business)

iii. Co-chair election and placement (ongoing discussion)

iv. Policy PAT-122: Nursing Process and Interdisciplinary Plan of Care

1. This policy provides guidelines for hourly rounding, shift change report, patient
and family education, documentation guidelines, plan of care, and
multidisciplinary rounding for each unit. It provides extensive instructions on
requirements for assessment, data collection, diagnosis, planning, and
implementation following the nursing process.

2. Conversation on this policy included adding buttons in Connect Care for auto-
population in order to reduce double documentation.

3. Verbiage discussed regarding the use of the term hourly rounding and how the
patients respond to it.

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4. Guidelines for initial assessments for each unit being done within 2 hours of
admittance. Question asked about when the 2 hours begins and decided that it
was once the patient is on the unit.

5. The policy needs to be put on the agenda for approval of a higher committee
now that this committee has approved it.

v. Physicians are concerned about wording on discharge medication list regarding when to
stop taking medications.

1. Clarification about side effects not being the same as allergies was discussed and
new verbiage was decided upon.

2. Overall physician feedback on medication flyers was positive

vi. New Goals for 2017

1. Discussion to change some of the wording in reduce device days to be in the

top 10% of VA and MD hospitals. Ten percent will change to tenth percentile
and VA and MD hospitals will change to NHSM.

2. Assist with existing efforts and participate on teams to improve hourly rounding
to reach goal of 80% house wide. Not much discussion about this.

3. Develop process to decrease discharge times

a. The goal is to improve discharge time by 30 minutes

b. Length-of-stay and discharge time goals are not being met. Nurses
cannot control length-of-stay, but they can impact discharge times.

c. Discussion about patients who are leaving against medical advice

(AMA). Some are not being seen to a physician prior to discharge and
this needs to change. This issue is mostly an ED issue due to wait
times. The global length of stay goal is 3.71

vii. Volunteer utilization on each unit was discussed. How to get more volunteers.

viii. Reports from infection control, wound care, nutrition services, and HCAHPS will
continue to occur on a quarterly basis.

ix. Getting more membership from units and night shift is needed and there is a need for
more consistent representation from ICU, PCC, Cath lab, and 5th floor.

x. Wrapped up with splash of the quarter and verbal round table.

2. Nursing Research and Evidence Based Practice Council

a. Purpose: To support the development and implementation of research and evidence-based clinical
and administrative practice to promote high quality patient care process and outcomes and add to
the body of nursing knowledge.

b. Agenda: Call to order, prayer, minutes, new nursing research, nurses week, review of current
nursing research (2 topics), co-chair nomination, new goals, round table, and adjournment.

c. No subgroups

d. Issues discussed included:

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i. Nurses week a subcommittee of volunteers was established to do something for nurses

week and a chairperson and co-chair were decided on.

ii. No new information was discussed on the review of current nursing research topics.

iii. A new co-chair of the council was nominated, voted on, and accepted.

iv. New goals were discussed and minor changes were made in wording.

v. Round table:

1. Interdisciplinary rounds (IDR) trials were discussed. This rolled out in three
different teams, A, B, and C.

a. Who was present during rounds? Pharmacy, nurse, physician, PT, OT,
etc.

b. Rounding was done consistently on 50% of the patients.

c. This affects the hospitals scores in a positive way and is being

measured by surveys.

d. From the nurses point of view it is going well.

2. Discussion of the need for a symposium. This is put on hold until information is
available from a liaison.

3. A flyer was given out about the J. Patrick Barnes Grant for Nursing Research
Evidence Based Projects. This flyer has information about applying for grant
funds.

4. The question was asked about what is happening on each unit and one person
talked about the reorganization of the Par Ex room. Getting rid of old stuff and
arranging equipment by body system.

5. Time was given for the nursing students to ask questions.

Noticing

What did you notice about the professional nursing meeting initially? Describe what you saw, heard and did during
the meeting?

1. Nursing Quality Outcomes Council

a. Initial noticing: The council was a small group of 12 women. A nurse runs the meeting. It was
difficult to follow at first because we were not given an agenda and were unsure of what the
committee does.

b. What I saw: Everyone was attentive for the most part. There was one woman who was
momentarily distracted by her phone. There were 2 people with computers. Everyone was taking
notes. Some of the women were in scrubs and some were in professional attire. The group gets
along really well and everyone has a voice and all opinions are important.

c. What I heard: The language on patient forms is extremely important and difficult to come up
with. Wording has to be at a fourth grade level. Nurses from different units speak up on behalf of
their co-workers. A lot of hold-ups for the council are physician related.

d. What I did: Took notes and paid close attention to what was being discussed.

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2. Nursing Research and Evidence Based Practice Council

a. Initial noticing: Again the room was full of women. One person from the previous meeting was
there. A total of 8 people were in attendance when the meeting started and 11 people were in
attendance by the end. Two people arrived 35 minutes late and one arrived an hour late. Two of
the late arrivals were male.

b. What I saw: Only one person had a computer. No one looked at his or her phone during the
meeting. They were very excited to have us and introduced themselves to us and had us give
introductions as well.

c. What I heard: Nursing research is very important and participation is not always easy to get. A lot
of the research being done is the same as what we discuss in our classes.

d. What I did: I took notes and listened. We participated in discussion as well.

Interpreting

Describe what you thought about the information being discussed. Have you been involved in similar discussion
during your previous student nurse experiences? Describe the similarities and/or differences to those encounters.

The information discussed during the first meeting was more interesting to me. I enjoyed seeing first-hand how
policies are created and discussed. When we are in the classroom discussing these things, they are very abstract.
Being in a council meeting makes it real and applicable to what we are studying. It also is a great way to show us
that we can make an impact and when changes need to be made, we can take part in making those changes. The
only discussion similar to this that I have previously experienced is in the classroom. The nurses on the council are
serious about the changes they want to make and how they want to impact future nursing the way we are serious
about it in the classroom the difference is that they are already out there making a difference.

The information in the second meeting was interesting. We learned a lot about how research works through our
research class, so the information the council gave us was not new. Some of the research projects discussed were
new; however, not that interesting.

Responding

Describe stresses (both positive & negative) you experienced as you responded to the new learning or the
challenge.

Stresses experienced: in meeting one, not knowing what the meeting was about or what they were discussing when
they changed topics was difficult and annoying. In meeting two, they didnt have a lot to talk about until they got to
the round table.

I felt comfortable in both meetings. The members of the council made us feel welcome and seemed to really enjoy
having us there.

Reflection-in-Action

What role would you take being assigned to represent your unit in this group?

I would like to be a part of the Nursing Quality Outcomes Council. I would be a liaison for my unit and would serve
to inform my co-workers of the councils policy changes. I would also bring information to the council from my
unit as to what changes my co-workers would like to see.

What subcommittee would you like to participate with and why?

There were no subcommittees. If there were, I would probably be on the one that goes over verbiage of patient
forms because I love that kind of thing.

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Reflection-on-Action and Clinical Learning

What written evidence is available to support professional nursing groups and their impact on the development of
evidence based practice and improved patient outcomes. Cite/reference all journal articles that contributed to the
evidence.
Evidence-based practice (EBP) is used to standardize healthcare practices in order to reduce unnecessary
mistakes and to streamline processes in patient care. In her article, The Impact of Evidence-Based
Practice in Nursing and the Next Big Ideas, Katherine R. Stevens states, EBP is aimed at hardwiring
current knowledge into common care decisions to improve care processes and patient outcomes (2). In
order to know what the best EBP is, research must be done. Nursing research focuses on finding the
practices, devices, and services that provide the best possible patient outcomes through the establishment of
nursing committees or councils. Nurses are at the forefront of development of EBP because they are the
ones at the bedside. When a group of nurses are brought together to discuss what is working and what is
not, changes can be made and solutions can be found.

Reference
Stevens, K., (May 31, 2013) "The impact of evidence-based practice in nursing and the next big
ideas. OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 4.

What is the value of professional nursing meetings both as a part of a healthcare system and within a professional
organization?
Professional nursing meetings are an important part of the healthcare system as a whole because they can
serve to improve not only patient outcomes, but the work environment as well. If each organization has the
same nursing councils, those councils can compare what is working in one and implement it in the other if
it will help them out. They are also an important part of professional organizations because it is important
to know what is going on within each unit. The meetings serve to answer the questions such as: Are the
employees happy? If not, why not? Are the patients happy and being cared for in the best possible way?
The nurses who attend these meetings have a vested interest in making improvements.
Describe any changes in your values or feelings as a result of this experience.

Prior to going to these meetings, I thought that I would not want to be a part of any council. I thought that
it would be too much responsibility and take up too much time. After going to the meetings, however, my
feelings have changed. I see now that it doesnt take much to be a part of one of these councils and that
having a voice is very important. The meetings were actually very informative and enjoyable.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment

Model. Journal of Nursing Education, 46(11), p. 513-516.

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