Running Head: A NURSING STUDENTS DEVELOPMENT

A Nursing Students Development from Know-Nothing to Educated Novice Kayla Vadney Old Dominion University

A NURSING STUDENTS DEVELOPMENT A Nursing Students Development from Know-Nothing to Educated Novice It is true that the acquisition of safe skills and technique, and a rich knowledge base, are essential at the start of any successful nursing career. However, reflection of personal growth and development through the course of ones nursing education is just as important because it provides the opportunity to recall and appreciate the progress from stranger to educated novice. The purpose of this summary is to evaluate learning, skills acquired, strengths and weaknesses, and otherwise reflect on personal growth and development attained over the course of my personal nursing education. Through this summary, the eight core competencies that guide Old Dominion Universitys undergraduate nursing curriculum will be discussed as they developed from sophomore to senior year. Additionally, future learning needs to focus on during the beginning of my professional career will be analyzed. Critical Thinking Sophomore Year Perhaps the core competency that has shown the most development over the last few years is critical thinking. In the beginning, I had virtually no concept of what critical thinking is or how to use it to provide appropriate patient care. One specific shortcoming was the ability to take patient information and formulate appropriate nursing diagnoses and a plan of care. The only diagnoses that I seemed to have an adequate understanding of included Risk for Falls and Pain. In fact, I tried to stretch them in to any and every care plan that I made. For example, nearly every patient in the hospital must be having some sort of pain and if they are prescribed narcotics or are elderly they are a fall risk. It used to be so time consuming to write a care plan because I simply did not possess the critical

A NURSING STUDENTS DEVELOPMENT thinking capacity, nor the knowledge base, to write them without researching every disease process extensively and copying the care plan book criteria and related factors verbatim. One aspect of critical care that came easily from the start was evaluating nursing care outcomes through the acquisition of data. In other words, I was able to use the intended outcomes and outcome criteria that I copied from the care plan book and compare it to assessment data on my patients to determine whether healthcare goals were met. For example, if I wrote from the book that the outcome criteria for a fall risk patient is to refrain from falling for the remainder of the hospital stay, I had enough common sense to determine that if my patient did not fall, the goal was met. Junior Year Junior year was a unique challenge because I had a growing theoretical knowledge base, however I did not yet have enough critical thinking skills to apply hardly any of it to practice. One way in which I began to develop critical thinking was through the understanding of how illness and injury affect quality of life for the patient. For example, I cared for a patient who suffered from uncontrolled seizures. Although at the time I did not understand what caused seizures or the difference between one type or another, I did understand that seizures caused brain damage and had the potential to cause other injuries. Therefore, I watched that patient almost constantly to avoid the infliction of harm. I quickly understood that this constant supervision was seriously impinging his privacy and visiting time with his friends and family. In order to appeal to the patients wishes and keep safety a priority, the patient was monitored less frequently when family members were present and more frequently when he was otherwise alone in his room.

A NURSING STUDENTS DEVELOPMENT Senior Year During senior year I was finally able to put together individualized and appropriate concept maps in no time at all. At this point, I have a true understanding of common disease processes and what that means as far as making decisions independently. For example, during role transition I cared for a postpartum woman and her newborn. Utilizing knowledge that newborns cannot adequately control body temperature, I made sure to check the babys temperature every hour for the first few hours of life independently without prompting from my preceptor. At the point when this babys axillary temperature dropped below 98.0 degrees Fahrenheit, I used my critical thinking to revise my actions and try to avoid the trauma associated with taking a rectal temperature by first wrapping the baby in an extra layer instead. I had also memorized a number of different nursing theories and used them in practice regularly. Madeleine Leiningers Transcultural Nursing Theory embodies the idea that nurses have a responsibility to provide care that is congruent to each patients cultural beliefs and practices. I utilized this during role transition for a patient who was a Muslim woman who did not want her husband or any male staff to view her exposed body during the birth process. I made accommodations to make sure no males entered her room while she was exposed and kept the curtain in front of the door drawn at all times. Fortunately, over the course of my nursing education, my critical thinking capabilities blossomed quickly and exponentially and now I feel competent to think critically and make healthcare decisions regarding my patients. Nursing Practice Sophomore Year

A NURSING STUDENTS DEVELOPMENT My assessments began very rudimentary and I frequently forgot to assess some vital components because I had not yet established a systematic routine. In other words, sometimes I would begin with skin and move to abdomen and then chest and so on, and other times I would begin with the abdomen. The first patient that I ever had was admitted for an exacerbation of COPD, and while completing an assessment, I forgot to assess the respiratory status. With the lungs being so important to proper functioning of any organ system, and with an obvious reduction in capacity related to COPD, it was crucial that I had assessed this patients respiratory status that day. Although my own techniques were flawed, I was very aware of the way in which other nurses practice from the beginning. With being so concerned of doing everything by the book I noticed when nurses deviated from the way I was taught to do something, which made me very anxious at the possibility that there could be more than one correct way. For example, while watching a nurse hang clear IV fluids, it was uncomfortable to watch her spike the bag while holding it upside down in her arms rather than as it hung upright. This anxiety of there being more than one way to perform an intervention also made me very hesitant to dive in and offer to complete many tasks for the nurses out of fear of being unsafe. Junior Year At this point I had a better understanding of the consequences of nursing actions and the importance of thorough assessments and monitoring in order to make accurate and safe care decisions. While giving medications once to a patient who had a history of hives due to a codeine allergy, I made sure to complete all of the safety checks very carefully in order to make sure that she was not prescribed Tylenol with codeine, for

A NURSING STUDENTS DEVELOPMENT example. I really enjoyed giving medications and performing other interventions by junior year because I felt that I was much safer and more knowledgeable. However, there were some interventions that no matter how many times I attempted it, I could not complete correctly because I could not grasp the idea of normal variations in human anatomy. For example, putting in catheters was a nightmare for me in females because the anatomy did not look like the textbook pictures. Senior Year After role transition, my nursing practice has come a long way. With so many opportunities on a labor unit, I finally mastered catheter insertion, which is really exciting. I have also developed a sincere understanding of what it means to provide holistic care. In role transition I was very conscious to cater to emotional health by providing the individual birth experience that each of my patients desired. For example, one patients spouse requested to give their baby his first bath. My preceptor allowed me to make the decision myself and I actually supervised and instructed the father as he bathed his baby in the room. Another example is during a pediatric rotation when I cared for a 4-year-old girl and her family. Although her cancer was well managed with chemotherapy, the hospital experience was very traumatic for the little girl. Therefore, in order to decrease some of her fears of me as a stranger, I let her use my stethoscope to listen to my heart before I listened to hers and completed the rest of her assessment. With these examples, it is evident that by senior year I was able to eagerly provide safe and holistic care across the lifespan. Communication Sophomore Year

A NURSING STUDENTS DEVELOPMENT My communication with patients, families and staff was definitely lacking during sophomore year. I was afraid of my patients and even more afraid of the physicians. At the start of each clinical day, it would take me a few long minutes to collect myself before I entered a patients room, and thereafter I still avoided entering the room as much as possible. Fortunately, this irrational fear did allow me to learn cluster care very early on because since I did not go in the room often, I did whatever I could while I was in there. Junior Year Junior year was a transitioning stage in regard to communication. I became a lot more comfortable with interacting with patients and their families. I still dreaded meeting each patient for the first time, however, after that initial encounter, it was exponentially more comfortable to interact with them the rest of the day. Staff on the other hand was a different issue. It was not until the end of junior year that I truly became comfortable arriving each clinical day and approaching the nurse assigned to my patient. Before then, I felt like a huge inconvenience for the nurses and I was afraid to get in their way or seem stupid to them. However, by the end of the year after forcing myself to do it time and time again it began to feel natural approaching the nurses at clinical with confidence. I still avoided communicating with the physicians though because I truly felt that I never had any valuable information to offer them. Senior Year It was not until halfway through role transition that I truly felt comfortable and confident interacting with patients, physicians and other staff. This may be because it was not until that time that I felt I had enough knowledge to offer them. Since I spent much

A NURSING STUDENTS DEVELOPMENT more time with the patients during role transition than my preceptor did, I actually had new and relevant information to tell her, and therefore the physicians. I also gained an increased ability to communicate professionally by using information from a range of sources and with diverse groups. For example, during role transition I researched information regularly on interventions that I participated in or observed and discussed the rationale at length with my preceptor in order to answer questions I had in which she could not communicate the answer. Another example includes the work that I did for community health. I worked with Noahs Ark daycare and as part of my community health project I helped to screen the enrolled children for developmental delays using the Denver II Developmental Screening. During these screenings, I communicated with the children, ranging in age from one to four years, using toys such as a ball to illicit the developmental milestone I was testing, like the ability to throw overhand, for example. I also relayed the results of these screenings to the staff on paper and explained their meanings before helping to teach them how to screen the children themselves with demonstrations. Teaching Sophomore Year Initially I did not feel comfortable teaching patients much of anything because I did not feel I knew enough to have anything valuable to teach. Whenever patients would ask me questions I would always have to ask the nurse for the answer. Due to weeklyrequired medication sheets, one thing that I could always educate patients on was medications. I spent hours each week researching patient medications to the point that I knew them by heart. For example, even just on my first clinical day I was able to teach

A NURSING STUDENTS DEVELOPMENT my patient about his prescribed Kayexalate, which works as a laxative by excreting his elevated potassium through his bowels. Junior Year During junior year, it was definitely easier to find new information to teach patients. For example, I counseled a patient with a history and primary diagnosis of uncontrolled seizures and noncompliance with medications of the importance of notifying someone before ambulating because there was a lot of cords and equipment that he could injure himself on if he seized and no one was there to stabilize him. It became increasingly more apparent just how important it is before teaching patients anything to determine their readiness to learn the material. During sophomore year if my patients nodded or provided any positive gesture I evaluated teaching as effective and never looked to see that they actually understood. During junior year I evaluated more effectively any teaching I did by taking the time to ask the aforementioned patient, for example, to repeat in his own words why it is important to call before ambulating. Senior Year By senior year I had no problem effectively teaching patients. I even had the opportunity to teach a group of healthy children between 10 and 13 years old about healthy eating and exercise for a pediatric teaching assignment. During this teaching session, my group and I utilized the Internet and primary research to support eating healthy and exercising regularly in order to reduce the risk of obesity, cancer, diabetes and other illnesses. The children were very receptive to the game format of the teaching session and it was a great opportunity to promote health across the lifespan. It was easy to evaluate the efficacy of using games to teach children in this age group about these topics

A NURSING STUDENTS DEVELOPMENT because it was obviously effective in helping the children to retain the information. For example, during one game of guessing which was healthy between two foods, after first hearing a short lecture on what kinds of food are healthy, each child answered correctly 100% of the time. Research Sophomore Year Research was probably the most difficult competency to grasp initially because I did not have prior experience of what was considered scholarly or primary research as opposed to literature. I constantly wanted to use Wikipedia and whatever came up in Google searches and call it research because that is what sufficed before nursing school. Once it was obvious that these previous notions were no longer accurate, trying to find research that was relevant to the idea that needed support was very difficult. There are so many articles in so many journals and I did not know where to start. I could spend hours searching for one research article to support only part of a sentence. The associated frustration so was severe that it actually made me question how bad I wanted to be a nurse. Junior Year Junior year required the attendance of a formal nursing research course, which educated on quick and effective ways to search for relevant research, as well as the key differences between primary research, literature reviews, and other types. This class was a turning point in my nursing education because I learned from it a true appreciation of the value of nursing research to support practice. Since day one, evidence-based practice was emphasized, but I never really knew what it meant until this research

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A NURSING STUDENTS DEVELOPMENT course. I even learned to enjoy researching different topics and feeling very well versed with the support of significant research studies. Senior Year By the end of my nursing education I could find relevant research to support any argument I had or answer any question I posed very quickly and efficiently. I even shared interesting research with my role transition preceptor every shift to support some of the interventions we administered. Not only is researching literature support so satisfying and easy, the importance of having supported opinions has never been more clear. During junior year it may have been understood that one needs evidence to perform an intervention because it should be clear it works before risking lives. However, by the end of my education I understood that one needs significant research to support every single aspect of nursing care, including a particular way of doing something versus another, because nursing is truly a science and although there may be several ways to do the same thing, it saves money, time, and spares quality of life by using the best supported technique. Leadership Sophomore Year I have always thought of myself as a leader, but being a leader in the healthcare setting was a subtle challenge. I did not want to take initiative because I was not always quite sure what to do myself. I spent much of sophomore year as more of a follower, observing, asking questions, and waiting to be invited to perform interventions by the nurse. Junior Year

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A NURSING STUDENTS DEVELOPMENT By junior year I was practically forced to take on more of a leadership role. During second semester, after confiding to my clinical instructor that I have a difficult time being a leader and delegator, she invited me to take on the challenge of caring for three patients at once with the implication that I would be forced to ask for help and delegate to my classmates. The experiment was a huge success and really taught me the value of trust and teamwork between healthcare professionals. Through this opportunity, I was able to assume a leadership role as the designer, manager and coordinator of the healthcare of those three patients. I completed care maps for each one and with it I had a list of interventions that I felt needed to get done during our shift. I then took all of my classmates, who were each only assigned one patient, and delegated to each of them a particular task. For example, I had asked one classmate to obtain vitals on all of my patients after she obtained them on her patient so that I may get started on assessments. Not only did this teach me the value of help, but I also gained a lot of trust and appreciation for my classmates in particular. Senior Year After that experiment during junior year, I was a shining star when it came to leadership. I had no difficulties taking initiative during clinicals, delegating to classmates and even to nursing assistants, or otherwise functioning as a care coordinator for my patients. One day during role transition while I was inserting a catheter into an epidural patient, the father of the baby passed out onto the floor. I was in there by myself, and already had the catheter in the patient. I called for help while simultaneously inflating the catheter balloon and telling the patient not to move. Then as help arrived I instructed them to check on the father of the baby as I through over there an alcohol swab to help

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A NURSING STUDENTS DEVELOPMENT arouse him as I attempted to comfort the now frantic laboring mother. After the patient was calm, I took ultimate responsibility for the condition of the father of the baby by then going to check on him. This is just one of many examples of my developed leadership role as an almost new grad nurse. Professionalism Sophomore Year The one competency that was never difficult to meet is professionalism. Even from day one I have always maintained a professional demeanor and taken responsibility for my professional practice as a nursing student. For example, during my first clinical after realizing that I had forgotten to assess the respiratory status of the COPD patient and realizing how important that was, I took initiative by asking for help from my clinical instructor regarding a better way to assess patients and asking several questions when appropriate because I understood even then that it was my responsibility to accurately assess my patients in order to care for them properly. Junior Year After having some experience under my belt and establishing a routine for nursing care, I began to realize the importance of knowing and applying the American Nurses Association (ANA) Nursing Standards in order to provide quality care for each patient. For example, after establishing a routine assessment technique, I could confidently utilize SOP1 by starting off each shift with assessing every patient that I am responsible for. Senior Year Between junior and senior year, my professionalism did not develop significantly because I had already almost fully grasped professionalism long ago. However, one

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A NURSING STUDENTS DEVELOPMENT addition to my ability to carry out this competency would be the addition of specialty and institution-specific standards and policies. During junior year I was very much concerned with abiding by the ANA standards. However, with senior year, especially during role transition, I gained an appreciation for knowing and utilizing the specific standards of the hospital I was working in and for specialties, such as obstetrics. For example, while working on a family maternity suite and being responsible for monitoring fetal status during labor, I made sure to know that for active labor, fetal heart rate and variability needs to be documented every 15 minutes per institution and specialty standards. Culture Sophomore Year I have always been a culturally sensitive nursing student, however it took awhile to grasp that there is more to culture than race and religion. It was also a new concept that because culture is not always necessarily obvious, it is important to ask each patient about his or her culture in order to provide culturally sensitive care. This is something that I began to grasp only by the end of sophomore year. It took awhile to make asking about culture part of my typical assessment. However, I did eventually achieve this goal. For example, one patient I cared for was a Caucasian female who did not appear that her culture would be any different than mine. However, after asking her out of habit about her culture, she expressed that she did not eat red meat and would like her meal trays to exclude it. Even dietary concerns such as these are important to accommodate when practical because it makes all the difference in the world to the patients experience. Junior Year

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A NURSING STUDENTS DEVELOPMENT While working on an orthopedic postoperative unit, I had the opportunity to care for a variety of patients from diverse backgrounds who received knee replacements, hip replacements, spinal surgeries and other similar procedures. Considering the research outcomes that support that early ambulation has the best postoperative results and that limited movement can cause complications, it was difficult to look at these patients who, although were all from different backgrounds and expressed pain in a variety of way, were all part of a culture of pain and did not want to participate in therapies. I saw throughout this entire clinical rotation how these research findings impacted the patients because on one hand it caused the therapists and other staff members to be very adamant about ambulating all of the patients quickly. On the other hand these patients did not want to move and so based on research outcomes this was going to negatively impact their recovery. Senior Year By senior year I had a pretty good understanding of what can be classified as a culture and how culture affects the care required of the patient. I realized that no matter what culture a patient identifies with, they each have their own definition and expectations of health and react to illness and death in different ways. For example, I cared for a patient in role transition that had a history of elective abortions, however, her current pregnancy was desired. She was admitted with spontaneous rupture of membranes at 18 weeks and the baby was deemed nonviable and delivered vaginally. At this time, it was clear that the baby was not going to survive. However, the mother was not overwhelmingly distraught. She held the baby in her arms for several hours, but did not appear sad. Instead, she was angry with herself because she felt she was being

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A NURSING STUDENTS DEVELOPMENT punished for electing to have abortions earlier in her life. To me, that was a very sad way to look at the death of her baby. However, at this point in my nursing education I had significant experience interacting with patients with differing beliefs than my own. I was very successful at respecting the beliefs of this patient and offering approval of the lack of emotion that she displayed. If there is one thing regarding culture that I have learned over the course of my education it is that no matter what a patients culture might be, it is important to respect the way in which they respond to illness and death. Conclusion The past three years have been full of significant growth and development as a professional nurse, but also of personal character. I have learned so much about myself and my own biases and character flaws, and learned to put those aside in order to provide nonjudgmental patient care. Although it surprises me how gradual the growth and development of each of the eight core competencies was, I believe that I have met each one thoroughly. I did not expect that it would take me so long to develop adequate critical thinking skills, however I now understand that this is because I essentially had to completely reprogram the way I think and problem-solve. Although I do feel that I have learned everything I was meant to during my nursing education, I still do not feel adequately equipped to care for patients on my own. I am very afraid for my first day of work as a professional nurse where I will not longer have the blanket of a preceptor to take the actual responsibility. I feel that I am a strong and effective communicator, so I will be able to ask plenty of questions from coworkers and superiors when I am unsure of myself. Another strength I possess is cultural awareness and sensitivity. I sincerely want to provide an individualized care experience

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A NURSING STUDENTS DEVELOPMENT for each one of my patients so I make it a point to ask about cultural considerations and accommodate them when appropriate. In the future, I need to work on my technique with all nursing interventions. I cannot start IVs successfully which, depending on the unit, may be a crucial skill. I think that everything really does come with practice and when I am a professional nurse I will quickly improve my skills just with daily repetition of the same interventions. At this point, I really thought that I would be more knowledgeable and confident in nursing. I guess I just have to remember what I do not know and ask questions along the way.

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