NURSING OUTCOMES

These detail how I have accomplished the objectives set by the Auburn University School of Nursing during my two years as a nursing student. Click on the button to jump to that section.

Communication

Communication and Collaboration Skills

Collaborate and communicate effectively with health care team members, patients, and patients’ support networks to implement patient-centered care, including appropriate teaching for developmental stage, age, culture, and health literacy to ensure high quality outcomes.

Effective communication is necessary for nurses. They have to coordinate care for patients and act as an advocate for the patient to other health professions. One instance that comes to mind that allowed me to practice collaboration of care was a patient who expressed to me that she was finally ready to quit smoking. I educated her about the importance of quitting and told her some of the strategies we had learned about in school. I also talked to her caregiver, who was at the bedside with her and would be able to aid my patient in her goals. After this, I informed the nurse, who had education orders put in for this patient and printed a smoking cessation packet. Quitting a long time habit is incredibly difficult and is not as simple as telling someone why they need to quit. After this encounter, I felt confident that by involving her nurse and her caregiver alongside the written materials, I had provided my patient with the framework she needed to stop smoking.

Use information technologies to assist in effective communication, facilitate patient care, and integrate evidence from all relevant resources to promote high quality patient outcomes within microsystems and greater healthcare systems.

Auburn's Nursing Program has given me multiple chances to practice presentation and teaching skills in front of my class. Knowing the most up-to-date procedures and practice cannot help anyone if you cannot effectively share that information with others, so learning how to present information well is essential. One time I practiced this was when I and three other students presented to my class an overview of critical care units, challenges facing critical care units, and finances of the units. For this presentation, we researched average costs of an Intensive Care Unit (ICU) and included only peer-reviewed sources. We reviewed in the PowerPoint how the Affordable Care Act (ACA) impacts hospitals and nurses in practical ways. Teaching a group of young, soon-to-be nursing graduates about major policy change is of paramount importance, because they may be working in ICUs and will impact patient care, their unit, and the healthcare system as a whole.

Critical Thinking and Clinical Judgment in Clinical Practice

Demonstrate clinical judgment grounded in theories and concepts from liberal and nursing education in the delivery of efficient, safe, compassionate, and evidence-based care.

Often in school, as we were learning a concept, our instructor would mention that the way we were learning to do something was different from what she learned or what was generally practiced. Evidence based practice (EBP) is always evolving and updating, and if nurses are not vigilant and active, they can fall behind on EBP. One practical area of new EBP is in intramuscular (IM) injections. When I prepared to give my first intramuscular injection, my nurse began to show me the dorsogluteal site. In class, we learned that the dorsogluteal site has the sciatic nerve and the superior gluteal artery in it, as well as other major vessels. On the other hand, the ventrogluteal site has very few major vessels and is thus safer. I asked the nurse if she was familiar with the ventrogluteal site and if it would be acceptable for me to give it there instead. She said she was familiar with the site and we discussed the differences between the two sites. She then helped me find the ventrogluteal site and I was able to safely give the injection.

Exhibit ethics, caring, and accountability for patient outcomes in all aspects of professional nursing practice

Nurses are often faced with ethical decisions as they work. I have been encouraged by my professors to reflect on what I believe about controversial topics so that, should they ever come up in patient care, I will know if I am able to provide excellent, unbiased care to my patients. An assignment I had one semester was to make a pamphlet on birth control and bring the pamphlet to a clinical site to present to patients. One of the patients I saw when I presented my pamphlet was a young, unmarried female who learned that day that she was pregnant. I have personal convictions about birth control and pregnancy outside of marriage, but I was able to talk to this patient and demonstrate that I cared for her by listening to her concerns, talking to her about her pregnancy and her next steps, and discussing birth control options after pregnancy. Because I had already reflected on what I believed about birth control and how I would react in a situation such as this, I was able to care for this patient without reservation.

Critical Thinking

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Evidence Based Practice

Scholarship for Evidenced Based Practice Skills

Implement evidence-based interventions to promote health, prevent disease, and manage acute and chronic care of patients across the lifespan.

Healthcare research is a rapidly changing, fascinating field. New therapies and drugs are always surfacing, and it is in the nurse's best interest to stay on top of new, proven research. This benefits patients, as they receive multidimensional care that is based upon evidence based practice. During one class I took, students were divided into groups of six and chose topics to research and present at Auburn's Research Day. My group decided to research alternative therapies for chronically ill children. We chose this topic because alternative therapies have been getting a lot of press recently, so we were interested to find out if they make a proven difference. In every study we looked at, children received the most benefit when alternative therapies were combined with traditional treatments. We were able to make a clinical recommendation based upon this research. This project taught me how to look in to relevent research and derive solid practice from that research. That knowledge will help me take better care of my patients.

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Demonstrate consistent self reflection techniques to identify learning needs, especially in areas where knowledge is complex and changing rapidly.

Nurses encounter difficult situations on a daily basis. Reflecting on the things that happened at the hospital is necessary to promote emotional well-being and learning from good and bad situations. At the beginning of nursing school, I was given a patient who was HIV+. As I was caring for this patient, I realized that I had generally negative thoughts about HIV at that time because of the way it is transmitted. However, this patient and her family did not fit the idea I had of an HIV patient. As I thought about this situation later, I realized that I had a bias about HIV patients that was unfair to patients, and many of my preconceived notions about HIV patients were untrue anyway. I resolved that I would be very careful to never judge a patient based on his diagnosis, which is unfair and not an accurate representation of that person. I have also learned much more about HIV, which is very complex, and about the current knowledge base for HIV, which has disproven many of my assumptions about HIV.

Clinical Prevention and Population Health Skills

Implement patient-centered care emphasizing health promotion and disease prevention to individuals, families, and populations, reflecting an understanding of human growth and development, psychobiological factors, pathophysiology, pharmacology, and management across the health–illness continuum.

The biggest project of Professional Nursing Concepts Across Populations was the Community Assessment Project. During this project, my team members and I visited our community, Millbrook, AL, and assessed the need for health teaching as well as medical resources of this community. The culmination of our project was a presentation we gave at a community meeting. We taught about stroke prevention and signs and symptoms of a stroke. Community members who participated ranged from older couples who were aware of their risk factors and were interested in decreasing them to young children who had never heard of strokes before. Even though it did not seem like we were making a huge difference, I thought at the meeting that perhaps one person's life would be saved from the information we presented there–whether by recognizing signs of a stroke or by reducing their risk factors for a stroke. This showed me the nurse's role in prevention and promotion of a healthy life.

Prevention and Health

Our project was featured in the local newspaper in Millbrook, AL

Use clinical judgment with attention to effectiveness, efficacy, and equality in providing nursing care during disaster, mass casualty, and other emergency situations.

As part of our Leadership course, five of my classmates and I prepared a seminar on disaster preparedness. We organized a speaker to teach us and the class about the Community Emergency Response Teams (CERT) program, which is open to citizens and teaches how to safely respond and help in a disaster. We also talked about specific nursing roles during disasters, mentioning the American Nurses Association's stance on nurse preparedness and duty. Before researching for and giving this presentation, I did not understand how nursing fit in to disaster response. Now I know that there are programs in place to allow nurses to provide aid during disaster without receiving penalties from their job. There are also certifications available to nurses to better prepare them to respond during a disaster. Nurses have the skills needed to provide aid in emergency situations and are an integral component of disaster and emergency response.

Diversity

Diversity Skills

Demonstrate a wide range of knowledge, skills, and attitudes including cultural awareness, humility, sensitivity, and competency.

One of the things that all people have in common is that they will get sick at some time or another. Nurses thus see patients from every background and age range imaginable. It is vastly important that nurses be able to demonstrate sensitivity to all people in order to create and maintain a trusting nurse-patient relationship. Cultural awareness and diversity skills have been woven throughout Auburn's Nursing Program so that its graduates can competently care for any patient. One emphasis during my time in school has been providing care for veterans and their families, who often present with unique psychological, as well as physical, needs. For one assignment, I was able to research, write a paper on, and prepare a teaching poster for post-partum depression (PPD) amongst military wives, who have an increased chance of developing PPD. I and my nursing class also attended a Mental Health Summit that focused on providing care to veterans. This summit featured veterans who taught us about their needs in healthcare and challenges they face in healthcare. Because of these experiences, I know better how to approach veterans even though I do not come from a military background.

We used a poster and the attached flyer to teach effectively

Incorporate holistic assessments, awareness of values, and spiritual beliefs in the delivery of quality patient and family centered, evidence-based care of diverse and vulnerable populations.

In talking to and assessing patients, it quickly becomes apparent that you must consider the person as a whole. You cannot address any physical aspect of a person without also assessing the thoughts or reasons behind it. During one clinical, a peer and I conducted a teaching session on sleep to a group of psychiatric patients. We conducted a question and answer period afterwards, and it was during this time that I realized that you have to incorporate the patient's beliefs and values into your assessment to care for him in the best way. For example, a patient asked me about herbal sleep supplements, and he revealed after I questioned him further that he valued natural remedies as opposed to pharmaceutical drugs. If I had not asked more questions and instead dismissed natural remedies in favor of over-the-counter medicines, I could have lost rapport and trust with him. To convey a caring attitude, I had to respectfully listen to and consider these patients values and beliefs. In return, the patients trusted me more and listened to my thoughts.

Leadership

Leadership Skills

Demonstrate ethical and critical decision making skills, mutually respectful communication, collaboration, delegation, and conflict resolution techniques.

One's ability to make good decisions, communicate well, and work with others is tested in critical situations. A patient may be coding or going downhill rapidly, and nurses must work with other professions efficiently and rapidly in order to save the patient. I practiced these skills during a simulation at the Baptist Sim Center. The situations were designed to hijack our emotions so that we could practice keeping focus on the patient. In one simulation, I was a member of the rapid response team called in to a patient's room. When I got there, the primary nurse was very flustered and told me that she had not called the physician or done other key things to pinpoint the problem with the patient. I assumed the role of team leader and directed the other students on what to do next and sent someone to call the physician. The physician came in very angry, but I redirected her attention to the patient, as we had been taught in class. This situation helped me practice communication, delegation, and conflict resolution, as well as several other skills, in a situation very much like real life.

Facilitate patient-centered transitions of care using leadership skills based on current evidence, ongoing assessment of outcome measures, quality improvement, and safety initiatives.

I have experienced firsthand the conflict that comes when you see someone complete some aspect of patient care in a way that is not safe. It is often difficult to not fall in to bad habits that you see around you, like skipping contact precaution gowns or not observing sterile technique when inserting an IV. However, as a nurse and a leader, one has to speak up and observe best practice for the safety of the patient. As a student, I do not have many areas to lead in. However, I have practiced principles of leadership, particularly modeling the way. One patient I had on the floor had a possible Clostridium difficile infection, which required gowns and gloves when entering the room. Most people skipped it when entering the room. The nurse I was with told me that it was not a problem to skip the gown. Having just learned EBP on contact precautions and the importance of following them in order to prevent hospital acquired infections in other patients, I chose to wear a gown every time I entered the patient's room. A simulation I participated in later taught me the importance of this, when we looked at germs under a blacklight and saw that even if you do not touch the patient directly, germs can be contaminating every surface of the room.

Coordinate and manage care for diverse individuals, families, groups, and populations in order to maximize health, independence, and quality of life at the mircosystem level.

Many patients have told me that they feel overwhelmed by all of the healthcare disciplines and that it seems that they do not share information with one another. Nurses are in a position to coordinate care amongst all of the professions and funnel it down to the patient in a coherent way. Of all of the clinicals I have had, no one has coordinated care as well as the hospice nurses I followed. During my days with the hospice nurse, we called various doctors on behalf of patients, taught patients' caregivers how to better take care of the patient, and equipped patients with the tools they needed to maximize their independence. I learned to appreciate the hospice care system, as I saw terminally ill patients given the ability to live in their own homes at the end of their lives. I hope to take the principles I learned during my hospice clinicals to promote independence and well-being in my patients.

Demonstrate an understanding of the ambiguity and unpredictability of complex factors affecting health care such as health care policy, finance, and regulatory environments including local, national, and global trend on equitable care of vulnerable populations.

A large portion of my last semester has been spent learning about the complexity of the health care system as a whole. Nurses can influence change at the macrosystem level by raising awareness of issues and actively reaching out to politicians who vote on healthcare policy. As part of an assignment, I chose to write a letter on safe staffing to my state representative. In this letter I discussed how hospital finances would be impacted by using safe staffing practices and how the Affordable Care Act is changing the way hospitals operate. While one letter may not make a difference, if many nurses and citizens write letters and raise awareness, change can be effected. Before this last semester, I viewed change at the macro level as something unattainable by me. However, I have learned how to begin to take on bigger changes. I do not have to be helplessly tossed about by the waves of policy and regulations; I can actively take part in working with others for the greater good of my patients.