Running head: PROFESSIONAL PROGRESS SUMMARY 1

Professional Progress Summary

Elizabeth Luther

Old Dominion University

PROFESSIONAL PROGRESS SUMMARY 2

Professional Progress Summary

The purpose of this paper is to provide an overview of the attainment of all eight

behaviors that are outcomes of the Old Dominion University BSN Nursing program including:

critical thinking, nursing practice, communication, teaching, research, leadership,

professionalism, and culture. This process of self-reflection and self-evaluation is vital to

discover the scope of the student nurses personal and professional development while enrolled

in the undergraduate nursing program.

Critical Thinking

Sophomore & Junior Year

The student nurse was challenged to demonstrate critical thinking very early in the

program to facilitate nursing practice through inquiry, problem solving, and synthesis. In Adult

Health I, my weaknesses consisted of being comfortable with the medications and having

confidence in administration of medications. I made progress by passing multiple meds and felt

more comfortable in my knowledge since I was able to research them the night before.

Psychiatric and Mental Health Nursing required working through what the patients were saying

with their body language when talking to each other, the student nurse, and other members of the

care team on the unit.

Senior Year

In Role Transition, the use of decision-making skills in making clinical or professional

judgments was a vital part of the experience. An example of a clinical scenario that requires

meaningful decision making is triaging patients that come into the ED. Acuity is a combination

of patient physical presentation, verbal complaint, and duration of symptoms. While these factors

drive acuity, there are also factors that the nurse may let effect their view of acuity such as length
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of time in the waiting room, language/communication barriers, ED management leadership, and

patient volume (Wolf, 2013). At times with low staffing and rushed sense of time, the decision-

making strategy is satisficing. On a low-staffed code black shift I have seen a triage nurse make

the decision to spare time with the first available alternative and admit into the ED patients who

came in complaining of chest pain in order for them to get an EKG in a room instead of in triage.

That decision making process lead to an alternative that is not ideal, and one that I (and the

charge nurse) did not agree with when I made the decision to preform an EKG in triage. The

nursing process must be supported by the rational decision-making model in order to account for

the probability of all outcomes; an AMI could go untreated for a longer period of time with the

decision that the triage nurse made in the aforementioned experience. The action that yields the

highest probability of achieving the best possible outcome would be to staff another tech solely

to preform EKGs in triage during high volume time periods.

Research in Community Health was done to evaluate the nursing care outcomes through

the acquisition of data and the questioning of inconsistencies. While doing research on the trends

of alcohol abuse, a study was found based on the premise of alcohol effects over time. This study

followed a group of approximately 15,000 people with follow ups 30 years after the study. To

compare the results, a control group was naturally created by selecting and studying trends in

same-sex monozygotic twins with no overt comorbidities, in which one twin self reported heavy-

drinking status and one reported low- to no-drinking status. Measurements for drinking status

included the number of heavy drinking occasions and alcohol-induced blackouts. Their findings

suggested that more of these related to a higher all-cause mortality rate that could not be

explained through genetic or familial means. This shows that alcohol cessation therapy is truly a

need, as alcohol consumption increases mortality significantly. Michigan State University

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conducted a study over 6 years into the factors affecting the sustainability of self-run recovery

homes in the United States and the effects on the members of the rehabilitation programs. To

sustain a program such as this, it needs affordable housing nearby and continual incomes for

their members. This is important for adherence to program requirements, but they also need

institutional and community support. Over the course of the 6-year study, approximately a third

of the programs shut down. The major reason reported for these programs shutting their doors

was the insufficient income of the program members and their inability to therefore adhere to the

program rules. One of the members of the Norfolk program, Joe, is in this similar situation and

trying to resolve this before being forced to leave the program. This is a trend that other

institutions have experienced and have lead those institutions down the path of closing.

Nursing Practice

Sophomore & Junior Year

I began to perform therapeutic nursing and interdisciplinary interventions to deliver

nursing care in the cognitive, affective, and psychomotor domains. Adult Health I helped me to

become more familiar with IV management and checking lines before and after medication

administration, as well as the administration of IV flushes. I became comfortable with

assessment of patients and fluent with the review of systems. Psychiatric and Mental Health

Nursing required more time focused on discussion and listening than previous patients had.

Important goals for Psychiatric and Mental Health Nursing were focused on establishing a

therapeutic environment for patients to begin the healing process and to continue the discussion

in order to keep communication open.

Senior Year
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The application of prior knowledge to guide nursing practice with major

health problems was seen in both Role Transition and Critical Care. The first trauma I saw was

an 80 year old male splenic laceration from a fall in the bathtub. He was brought to Leigh,

intubated, given 4 units of blood, and coded once there. In the Nightingale, he coded twice and

was given 4 more units for 8 total on arrival. Vasopressin, Levo, and Epi were running.

Massive transfusion protocol was put in place, and his vitals were: temp 94.1 pH 6.9 HR 125 BP

82/40. RUQ, RLQ, and pelvis were all positive on FAST. He had a right subclavian central line

and a femoral A-line placed in the trauma room at SNGH. After assessment in the trauma room,

he was taken to interventional radiology where I followed and observed. While the patient did

not code during the femoral catheterization procedure, I was able to predict and subsequently see

runs of ventricular tachycardia intermittently.

In Critical Care during my ICU rotation, my patient came into the ED two

days prior to assumption of care with status asthmaticus. He had a PMH of severe asthma and

HTN (steroid induced per pt). Pt was given bipap in ED but did not tolerate, was then intubated

in ED. Came to ICU with ARDS, pneumonia, anemia, HTN (254/158), with wheezes and rales
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present. He was given propofol which was d/c due to lactic acidosis (more likely caused by the

continuous albuterol nebulizer tx). Pt placed on IV Precedex for BP and sedation as well as low

dose Versed. D/c fentanyl to decrease RASS score to wakening. Pt had steroid induced

hyperglycemia, was on IV regular insulin, with q2h BGL checks. Placed on spontaneous vent

setting, lung sounds became clear bilaterally, writing to communicate, d/c tube feeding and

suctioning gastric secretions to prevent aspiration on extubation, 9/20 planned extubation 12:00.

Pt was calling his friends on the phone, lung sounds were clear. Pt became nauseas, given 60 of

Zofran over two hours. Pt increasingly nauseas, approximately 100mL emesis. Pt then requested

to lay HOB flat. Pt went into respiratory distress caused by bronchospasm, sat upright holding

bed side rails leaning forward, air hungry. Became ashen, could no longer speak or move air

through mouth, syncope, code blue called. While a nurse was bagging the patient, he bradyd

down until femoral pulse was lost and CPR was initiated by nurse. Pt was given bolus doses of

propofol and versed, MD established airway with CASS ET tube. Before atropine was given, pt

gained back sinus rhythm. CMV was initiated through vent. I inserted OG tube per direction of

nurse. Wheezing lung sounds heard bilaterally, pt VS stabilized on vent. 9/21 pt was weaned off

fentanyl and down to low dose versed. Pt communicating by writing. No tube feeding given,

suctioning gastric secretions all day to prevent aspiration on extubation. Plan to insert PICC line,

abdominal x-rays, and the decision was made to wait a longer period of time for extubation the

second interval.
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I was able to implement traditional nursing care practices as appropriate to

provide holistic health care to diverse populations across the lifespan both in Role Transition and

in Critical Care. Norfolk General raised the model by Jean Watson in Role Transition. It relates

to a humanistic model of patient care concerned with promoting health, preventing illness, caring

for the sick and restoring health. Watsons model states that holistic health care is central to the

practice of nursing, and evaluates nursing as a human science of persons and human health-

illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical

human transactions. The acuity of patients coming into Norfolk General is constantly higher than

other area hospitals. While many patients are trauma that cannot be prevented by a healthy

lifestyle, many more patients are being seen due to a lack of continued healthcare to a preexisting

condition. This could be caused by a disregard, a lack of PCP/insurance, or a lack of resources in

general. Something to focus on was the patient population. Many of the regulars that I see at

work come into the ED at Sentara Leigh known for conditions such as alcoholism where in

comparison, many of the regulars at SNGH are known for being homeless. The lower acuity

(and even some of the higher acuity) patient population is a population that does not have readily

available healthcare. Illness prevention, which is a core of the nursing health model, is near non-

existent in a solid percentage of that patient population.

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I was also able to provide holistic health care to diverse populations across

the lifespan through a DNR/DNI patient for which I was present for the extubation and

withdrawal of care. Grief concerns were evident in this patients family. Spiritual concerns

impacted care we had to wait for the chaplain to become available and come up to the patient

room before withdrawal of care could take place. Their spiritual needs were addressed with the

chaplain in the form of prayers and their presence during the withdrawal of care process. Special

nursing care needs for this patient revolve around monitoring and care of the family. Since she

had a code status of DNR after extubation she was monitored on the screen outside of the room;

the monitor in patient room was turned to comfort care setting, showing the patients family

nothing.

Communication

Sophomore & Junior Year

Verbal, non-verbal, and written communication techniques appropriate for clients and

professionals were developed. Most of the communication in Adult Health I relied on the student

nurse-patient relationship, as the line of communication between the student nurse and other

members of the healthcare team was not as open as it would become. However, the attending

physician was always available for questions. Communication in Psychiatric and Mental Health

Nursing was more open to the nursing staff and care team members than previously. Student

nurses and staff communicated about the uniqueness of the unit, protocol distinctions, and
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patients in particular regarding care techniques.

Senior Year

I was able to adapt communication methods to patients with special needs in Critical

Care. During my ICU rotation one week my patient was very calm while awake and still on the

ventilator. After the MD commenting on how he would not be as calm if awake and on a vent,

the patient was asked if/why he was calm. He responded through writing after I had provided a

notepad from the charge desk and a pen (for which I had to support his hand) in the affirmative

when culture was suggested as a factor in the patients quiet demeanor.

Teaching

Sophomore & Junior Year

Teaching strategies to maximize client health and enhance professional development

were established. Teaching in Adult Health I was towards the patient and consisted of flu and

pneumococcal vaccine information. In Fundamentals of Nursing, learning readiness of a clinical

patient was assessed through a patient teaching analysis. A 57-year-old male patient was selected

who was brought into the ED for seizure activity and postictal combativeness. After admission,

the patient reported a year long history of unassessed seizure activity. Through imaging it was

determined that because of his noncompliance with a HTN medication regimen prescribed to

him 3 years prior, the patient had extensive chronic microvascular ischemia, atrophy, and

moderate diffuse volume loss. The damage done through noncompliance of his HTN medication

regimen is evidence that this patient had a learning need. The patient had deficient knowledge of

HTN and needed to be taught the importance of medication adherence. This information will

help the client know why he must take his prescribed medication and the risks of not taking his

prescribed medication. Factors pertaining to the patients condition that focus his learning need
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are: inaccurate follow through of instruction, questioning members of the health care team,

uncontrolled blood pressure, lack of resources, conflicting patient-provider relationships, health

care system barriers, financial limitations, development of complications, evidence of

exacerbation of symptoms, and therapeutic effect not achieved or maintained (Gulanick 2014). In

order to assess his learning needs, data was obtained about and from the patient using both

informal conversations and a structured interview. The assessment of the patient learner was

through the PEEK model. Step-by-step instructions were utilized in teaching with frequent

repetition due to diminished cognitive ability. Written word supplies and documents about HTN,

compliance, and medications were present during teaching because read/write was his learning

style.

Senior Year

I was able to provide relevant and sensitive health education information and counseling

to patients, and families, in a variety of situations and settings in Role Transition. A trauma

patient I saw the first week who came in for a liver laceration had family teaching weigh heavily

on the topic of end of life care and DNR/DNI teaching. Another patient who came in for bilateral

weeping leg ulcers with a history of DM, HTN, and CRD had teaching focus on the importance

of adherence to a medication/healthcare regimen. Another trauma patient who came in for an

ATV accident leading to broken ribs and a le Fort fracture had teaching focus on the effects of

alcohol on operating machinery, and the importance of a helmet.

Research

Sophomore & Junior Year

Through every course, primary nursing research findings were incorporated as a basis for

therapeutic nursing interventions. The Professional Outlook Project completed in Nursing

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Theories and Concepts displayed research findings and nursing practice that I believed would

guide my personal model of professional practice in the future. I based it on Sister Callista Roys

Theory of Environment and Adaptation model. To accompany the research as a visual aid, I grew

a plant during the progression of the semester. In order to holistically care for a patient, I believe

that we need to constantly re-assess the situation to meet a patients basic care and psychological

needs. I wanted to showcase an adaptive system, with health being the outcome realized. Patient

health is a bio-psycho-social system that is in steady interaction with the constant changing

environment.

Senior Year

Through research in Role Transition for my personal nursing philosophy, I wanted to

showcase an adaptive system with health being the visible outcome. I have come to see that the

ideas that will guide my practice are ones shown by Sister Callista Roy and her theory of

environment, as originally stated in my Professional Outlook Project completed in Nursing

Theories and Concepts. Roys Adaptation Model is an involved influence in my own definition

of nursing. I believe that patients can overcome nearly any situation, and the resiliency of man is

a legitimate factor in healing. To assist a patient in a recovery process and to help them develop,

we must utilize the environment and adversity of that patient. ANA Standards of Professional

Practice incorporated in my personal philosophy include sections from the Standards of Holistic

Nursing Practice that guide nursing care which enhances healing of the whole person across a

lifespan. It is not described as a client type or disease grouping and is therefore practiced in all

forms of care. Holistic Communication, Therapeutic Environment, and Cultural Competence

alongside the Holistic Caring Process is the basis of my personal nursing definition (Frisch,

2001). Assessment of the patient is a strong provision in holistic care, as the identification of
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interrelating factors and communicating dimensions of health all interact with each other in the

span of one patient. Identification of the environment and evaluation of the environments effect

on health is essential. Nurses need to constantly re-assess the situation to meet a patients basic

care and psychological needs. If given the best possible avenue of success, I believe that a patient

will adapt and succeed. My personal philosophy is that nursing centers around giving every

patient that avenue of success.

Leadership

Sophomore & Junior Year

In a new environment with little health experience, I was challenged to demonstrate self-

direction, professional accountability, and advocacy adhering to legal and ethical nursing

practice as a novice nurse. I was always the first to initiate conversation with my patients

whenever anyone walked into or out of the patient room with me and was comfortable in

conversing without accompaniment in the patients room. I became comfortable with patient

communication, which opened the door to perform a complete review of systems while the

patients were at ease.

Senior Year

In Rehab I assumed a leadership role within my scope of practice as a designer, manager,

and coordinator of health care to meet the special needs of a vulnerable population. With a blood

pressure of 102/52 and a heart rate 56, a patient received Atenolol. When I brought the patients

vitals to the attention of the RN before administration, the RN said that no alert popped up on the

computer so she did not notice and furthermore did not feel uncomfortable giving that

medication. That morning, the patient received their medication in the gym. At that time, PT had

that patient get up and walk from their wheelchair to a designated point and back with the
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assistance of a walker. Minutes after that, morning medication was administered. Later in the

day, the patient was back in the gym for a second round of PT. At that time (11:15 AM, 3 hours

post morning medications) the patient could not take forward steps immediately after standing

like he could that morning. When the PT asked if they patient was dizzy, the patient answered

yes, very dizzy. The patient then took a significant amount of time before trying to move

forward, after which he could only walk a few steps before stopping. I assumed the task of

bringing this to the attention of the RN the second day as well as bringing it to the attention of

the physician who gave a verbal order to the RN to hold BP meds. I was also able to articulate

the values of the profession and the role of the nurse as member of the interdisciplinary health

care team. I set a goal of talking to the therapists more in order to obtain a larger view of

everything the job of a PT/OT entails. Through that, I was able to observe PT/OT preforming

passive and active therapy such as stacking cones, picking up and tossing beanbags, use of

parallel bars, resistance exercises such as pushing against the armrest of a wheelchair while

seated, squeezing a ball between affected and unaffected hands, walking up and down stairs,

passive stretching with the therapist straightening a pts knees, tilt table used to stand, and

weightlifting. I was also able to talk to them more about which muscle groups the exercises were

helping and how the process of stretching and toning worked in this patient population

In Critical Care I was able to delegate and supervise the nursing care given by others

while retaining accountability for the quality of care given to a patient. I am in a position of

comfort in establishing a therapeutic relationship and communicating with the patient and family

due to previous experience in healthcare job positions. Working in hospice and home care have

both really prepared me for family need care. Working and communicating with staff is

comfortable through preparation while working in the ED at Leigh in the capacity as an ED

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Tech. I was therefore able to delegate the acquisition of and explanation of a DNR/DNI to a Tech

on the floor while I was operating as a student nurse. I followed through to find that the Tech had

called the chaplain and the attending physician in order to complete the task, and had answered

any questions the family had that could be answered by the Tech.

Professionalism

Sophomore & Junior Year

While still learning the legal and ethical principles of nursing, I demonstrated advocacy,

accountability, and adherence to standards of practice. Assessment was a large portion of

professionalism through Adult Health I, and standards of practice were focused on gaining data

pertinent to either the situation at hand or the assigned patients health. In Psychiatric and Mental

Health Nursing, assessment was fulfilled through thorough questioning. Coping impacts on

perceived mental health were discussed with current evidence-based practice and research.

Environmental health was vital in Psychiatric and Mental Health Nursing with the unit locked

down and strategies in place to stabilize patients.

Senior Year

Rehab allowed me to advocate for professional standards of practice using organizational

and political processes within my nursing program and beyond that, reaching into the facilitys

organization. Though they seem to be worried about HIPAA on the surface, I have personally

observed the nursing staff discussing their practice of giving medications (and

removing/applying hip & sacrum Mepilexes) in the public dinning room and was told that you

would think its a HIPAA violation, but weve always done it that way. When dispensing

medications, the nursing staff opens, removes, and cuts PO meds without gloves. Nystatin oral

suspension was administered via a toothette without gloves. A patient with a known infection and
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a large incision running vertically down their right leg had a previous dressing of only

SteriStrips. While assessing the patients incision for wound healing, a physician without

gloves palpated the wound site along the edges of the incision by manually approximating the

edges with both hands, pushing on the wound. They then ran the back of their hand along the

incision line. The physician without preforming hand hygiene then brushed the hair in her

face behind her ear, picked up her clipboard and pen, and moved on to assessing the next patient.

These concerns were brought up with the clinical instructor, who then passed the information on

to the nursing course coordinator.

Culture

Sophomore & Junior Year

Throughout each semester, cultural awareness and sensitivity was demonstrated through

an understanding of personal and cultural definitions of health. Adult Health I focused culture

care towards support systems of patients who could not care for themselves after discharge from

the hospital and the impact that had on patient care. Medication regimen adherence and

rehabilitation PT/OT scheduling are impacted directly by support systems, but so is overall

health and wellness. Psychiatric and Mental Health Nursing culture often involved the culture of

homelessness, drug use, and a culture of aggression. This impacts teaching strategies and had to

be considered when interacting with and providing teaching to patient to ensure adequate time is

allotted for any questions the patient may have.

Senior Year

In Critical Care, I was able to articulate an understanding of how human behavior is

affected by culture, race, religion, gender, lifestyle, and age. The experience of having a patient

who was vented but alert and oriented was an interesting and uncommon experience in the ICU.
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Culture and ethnicity impacted care in the way that my patient was very calm while awake and

still on the ventilator. After the MD commenting on how he would not be as calm if awake and

on a vent, the patient was asked if/why he was calm. He responded through writing after I had

provided a notepad from the charge desk and a pen (for which I had to support his hand) in the

affirmative when culture was suggested as a factor in the patients quiet demeanor.

Conclusion

Overall, the growth obtained in studying for the role of a registered nurse was more labor

intensive and in-depth than I had anticipated. While the nursing diagnoses and nursing language

separates this role from that of a physician and places a more holistic sense on the role, that in no

way creates a simpler task. The preparation for taking on the role of a RN embodies a strong

development of understanding for every role in a medical environment. Skills that students had

the opportunities to learn were every skill any student could see. Every opportunity found was an

opportunity utilized and a skill gained. I now have strengths in hands-on nursing and the

knowledge base to understand why those interventions are being implemented. Many common

weaknesses of new graduate RNs such as EMR documentation and time management were

addressed by the students in our clinical environments. Through assignments that required us to

spend hours pouring over EMRs of specific patients, we gained familiarity with multiple systems

implemented at various hospitals. Through the experiences of being assigned a nurse and in role

transition, we were able to feel the weight of a full patient load before the full responsibility was

set on our shoulders. While time management skills were ingrained into us through the three

years in the program, I feel that the only future learning need I have is the ability to delegate

since as a student nurse I wanted to personally preform every task that was available. I feel

exceptionally prepared to step into the role of a registered nurse.

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References

Frisch, N. (May 31, 2001). "Standards for Holistic Nursing Practice: A Way to Think About Our

Care That Includes Complementary and Alternative Modalities". Online Journal of

Issues in Nursing. Vol. 6 No. 2, Manuscript 4. Available:

www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/T

ableofContents/Volume62001/No2May01/HolisticNursingPractice.aspx

Gulanick, M., & Myers, J. (2014). Nursing Care Plans: Diagnoses, Interventions, and Outcomes

(8th ed., p. 339). St. Louis, MO: Elsevier Mosby.

Wolf, L. (2013). An Integrated, Ethically Driven Environmental Model of Clinical Decision

Making in Emergency Settings. International Journal Of Nursing Knowledge, 24(1), 49-

53. doi:10.1111/j.2047-3095.2012.01229.x
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Honor Code:

I pledge to support the Honor System of Old Dominion University. I will refrain from any form

of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a

member of the academic community it is responsibility to turn in all suspected violators of the

Honor Code. I will report to a hearing if summoned.

Name: Elizabeth Luther

Signature: Elizabeth Luther

Date: 14 April 2016