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Hello, my name is Serena Avery. I am from Hawaii and currently a student at Kapiolani Community College's in Associate Degree Nursing Program. I work full time as a Certified Nursing Assistant at Queens Medical Center (since 5/2020).

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I decided to go into nursing as I enjoy being able to connect with people and help them in times where they might not be able to care for themselves. I believe a great nurse is one who is responsible and cares about the patient holistically. I think we have to care for not only the patient's physical health but try to help with their mental and emotional health as well. I wanted to go more into nursing after working as an aide for a senior care facility. I enjoyed connecting with my residents and being able to not only take care of them but socialize and keep up with them every day I went to work.

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Short-Term Goal: My goal is before graduation to get a CNA job in acute care with one of the major hospitals on Hawaii. I want to be able to build my skills in acute care and see more acute cases than in senior care.
Long-Term Goal: My long term goal in 3 years is to successfully get into a nurse residency program on the mainland. I want to spend 2 years at a hospital to get my base down and then do travel nursing across the country and maybe even internationally. I want to be able to travel and see a lot of the world while do a job that can support me and I enjoy.

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- CNA : Experience working as a CNA at Queens Medical Center Punchbowl. I frequently float to different floors and units all ranging in specialty and acuity. My job entails assisting the nurses, ensuring patient's ADLs are complete, charting patients intake and output, and also performing as a sitter for high risk patients.

- Nursing School Clinical:
(210) Had 6 week online simulation clinical with Kapiolani Community College Nursing Program.  During these clinical rotations had experience with charting, documenting, completing incident reports, care plans, pathophysiology sheets, and medication sheets.
(220) Has 6 weeks of in-person clinical at Hale Pulama Mau - Queens Medical Center. Was given 1 new patient for each week of clinical. With the help of the nurse I gave my patients their medication (oral, topical, subcutaneous, GT tube), performed wound changes, changed and set up a new IV ABX bag, and assisted with care of a GT tube. Performed role of student leader.
(320) Kapiolani Medical Center - Family Birth Center/Mother Baby Care Unit - 81 hours. Had 6 weeks of in-person clinical at KMCWC on the FBC and MBCU. I was able to perform newborn, postpartum, and antepartum assessments and vital signs. I was also able to assist with placing a foley catheter for a patient who received an epidural.
(360) Kekela and Family Treatment Center - 6 weeks of in-person clinical rotating between the Adult Psychiatric Unit and Pediatric Psychiatric Unit at Queens Medical Center. Interviewed and assessed multiple psychiatric patients utilizing therapeutic communication and skills.
(360) Queens Medical Center: Orthopedic Unit - 6 weeks of in-person clinical at the Queens Medical Center orthopedic unit. Cared for multiple patients during the clinical day passing oral, IV push, and IV piggyback medications. Acted as role of student leader to assist and organize my peers care for the clinical day.

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Certified Nurse Aide - Licensed for the State of Hawaii
Basic Life Support (BLS) - EXP: 4/2022

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Performed blood pressure checks for members of the public at the Hawaiian Health Fair.

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Watched an hour-long webinar on the topic of nursing and COVID-19.

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Analyze ethical and legal issues while practicing nursing within the health care system.

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Evaluate professional behaviors and self-care to improve nursing practice.

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Provide nursing care that incorporates evidence supported by research.

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Demonstrate leadership in nursing practice.

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Collaborate with multidisciplinary health care team members.

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Participates in making recommendations for improving patient care within the health care system.

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Advocate for the delivery of client-centered care

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Communicate effectively with clients, families, and health care team.

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Demonstrate effective clinical decision making in the delivery of nursing care.

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Completed 15 minute online learning module at Queens Medical Center for sitter training.

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Completed online learning module, in-person class, and validation at Queens Medical Center for training in being a 1:1 Max Sitter. Now trained and able to be a Max Sitter for patients with high suicide risk.

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"Identify the legal and professional standards and ethical concepts while delivering basic nursing care."

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"Identify own responsibility for reflective practice in the role of a professional nurse."

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"Learn how to seek and evaluate information to support promotion of health based on current evidence."

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"Identify nursing care situations that require delegation and leadership decisions."

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"Identify roles and functions of members of the health care team."

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"Utilizes the nursing process to develop and deliver a plan of care."

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"Discuss the elements of client-centered care in promoting health across the lifespan."

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"Practice effective oral and written communication."

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"Describe the components of the health care delivery system."

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210: There are many parts of the health care system that both directly and indirectly effect the care of the client. I displayed understanding of the health care system as I had to collaborate and work with many parts of the team. For example during clinical we had to work with the HCP, physical therapy, dietician, home health, social worker, etc.

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As we lead into professional nursing it is important to follow ethical and legal standards so that we provide care that is best for our client and their rights. I displayed this behavior in NURS 210 during our virtual clinical. In clinical we had a client with an advance directive, acting legally, professionally, and ethically I followed that advanced directive as that is what the client wants.

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I applied ethics in my clinical days by incorporating my patient into their care. For example, I had to hold a drug because the patient refused to take it. I knew that legally and ethically the patient had the right not to take the medication so I worked with my nurse to put a note in the chart that the patient refused said medication. Attached below is an excerpt from my weekly professionalism reflection where I discussed about ethics that week.

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210: Reflection is important as a nurse and as a nursing student to help improve our care. I displayed reflection during this semester of NURS 210 through the weekly reflection assignment we had for each week of clinical. Reflecting on my work and how I cared for my client that week was helpful for me to recognize my mistakes and how I should fix it. However I don't only reflect on my mistakes but also what I did good that week to acknowledge my accomplishments as well.

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During clinical there was a lot of interaction between the different components of the health care delivery system. For example, it was not only the patient and the nursing team but also included the social work team. For multiple of my patients they needed to meet with the social worker to discuss their needs. For example, one of my patients needed to talk to the social worker and a lawyer to deal with custody issues about their children while in the hospital. There was also involvement of patient's family that day as well. Attached below I have an excerpt from the PMH assignment talking about the patients psychosocial life which is what the social worker bases their care off of.

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220: I completed a weekly self-reflection for ever week I had clinical at Hale Pulama Mau. The weekly self reflections helped me see what I did at clinical for that week and how I could improve my next clinical days. For example, I did a weekly self reflection about patient safety where I reflected on the measures I implemented to reduce the risk of falls. My patient that week was high risk for falls and impulsive, setting off the bed alarm many times we were there. I used the reflection to see what I did right and how I could have further improved the safety of my patient. Attached below is an excerpt of my reflection from that clinical week.

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210: Using evidenced-based practiced is an important part of providing safe patient care. I displayed using evidence in my care during clinical. I had a client that needed a procedure done that I was not familiar with so I researched and found evidence about the best way to approach the condition and procedure.

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I exampled the SLO of using evidence based practice a lot during our TBL activities in lecture. For example, I was put into a group where we had to research about urinary incontinence. I was tasked with finding a treatment for urinary incontinence that was supported by current evidence. I made sure to research and choose a credible source that was within a recent year. I ended up talking about a newer technology that improved patient's abilities to be continent. Attached below is my slides related to this presentation and evidenced- based practice.

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210: Leadership is important as with leadership and delegation everyone will be able to know their role and what they are supposed to be doing. I displayed leadership in the first week of clinical. The first week of clinical I was the student leader and our work was very team-based and included working together closely. I effectively lead my team and organized our work and delegated tasks to my team members.

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At clinical I was presented with the role of student leader multiple times throughout the weeks. I displayed leadership especially well with my peers by helping them organize the care they needed to provide to the patient that day. I helped them recognize which tasks could be done together and which tasks were better to do at a certain time. In addition to this, I also sought out opportunities for my peers when I was student leader. If I heard the nurse was going to do a procedure or skill that I know my peer had not been able to do yet I tried to set up where my classmate could go and participate in that opportunity with the nurse. Attached below is an excerpt from my weekly reflection on one of the weeks that I was student leader.

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210: There is a lot of collaboration in the healthcare team and effective collaboration is needed for patient safety. I displayed collaboration during clinical when writing my hand-odd reports. I created a SBAR for every clinical day, SBARs are critical fro collaboration to effectively communicate the client's status, needs, and condition to the next healthcare team member.

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At Hale Pulama Mau there were many different staff and components of the health care system that we had to work with. For example, there was physical therapy where I had to coordinate care with as they had their scheduled appointment times. There was dietary which I worked with to help deliver the meal for my patient. There was housekeeping which helped me clean a spill in the room and empty my patients trash can as it got to full. There was also the wound nurse that came from the main hospital to do rounds on multiple patients receiving wound care. Attached is notes from the wound care rounds that is a result from the collaboration of the nurse, wound nurse, and physician.

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210: Communication is important for the health care team. Communication is essential for safe patient care, especially during hand-offs and transfers. I exampled communication during clinical rotations. I made sure to keep my SBARs concise and to the point while still conveying all the information I need to give to the next nurse.

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I was able to practice effective communication at clinical by writing DARs for my patients. For example, my patient had a wound care round with the physician and wound nurse that day. The wound nurse listed many new orders for the wound care of my patient. I made sure in my DAR to include those new orders and the actions the wound nurse did to the patient. This is helpful communication to following shifts. I attached a picture of my DAR below. In addition to writing DARs I used effective communication with staff on the floor. I had to talk and coordinate with my nurse about the care of my patient. For example, I communicated with the nurse to have her help me grab the medicine for my patient and when I was going to give it to the patient.

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210: I displayed client centered care during clinical rotations. I made sure to personalize my care plans to the client so that the interventions are most effective and will promote the best adherence.

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During clinical I showed that I was providing client centered care to my patient by setting up practices that worked best for them and their schedule. Some of my patients had wants and needs that conflicted with the schedule of the floor. I adapted to these different needs by rearranging my tasks for that patient so that it can work for both of us. For example, one of my patients did not like to be awaken early and usually slept in. However, that patient had an antidiabetic medication that was due early. I attached an example of nursing diagnosis and care plans that I made for my patient.

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210: I displayed clinical judgement during our clinical rotations. When we would receive updates about changes to our clients situation and condition I would use clinical judgement to assess and identify any needed changes to care plans or additional interventions that should be implemented.

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I used clinical judgment during our clinical days at Hale Pulama Mau. I applied clinical judgement when developing care plans for my patient that week. I utilized the information given to me about my patient and their medications and tried to see how the effects of those medications could effect the care I give that day. For example, I created a care plan to ambulate my patient that day and give them a shower. However they had an IV antibiotic scheduled to be delivered for most of the time we were on the floor. Using my clinical judgment I found that it would be better to wait on the other care while the IV was running. Attached below is an example of one of the care plans I created for my patient.

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I was able to apply ethics to clinical by assisting my nurse with obtaining informed consent from my patient about the circumcision of her baby. I was able to see how the nurse made sure to answer any questions and check that the patient understood what the procedure in full meant and the details of the procedure. It is legally and ethically right that we as the nurses fully inform our patients to the best of our ability so they can make healthcare decisions best suited to themself.

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I applied reflection to this clinical during the first week. I used active reflection during the clinical day to be able to get the most out of that day. I recognized that I was being very shy and hesitant with my patient and I felt that it was holding back on my experience. I recognized that I was not communicating enough with my patient and reflected halfway through my day. I came back trying to be more communicative with my patient and my patients partner.

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I applied evidenced based practice every week by researching a new evidenced-based article that could be used at clinical. I also shared the article with my peers every week. For example, for one of the weeks I read an article about the use of non-pharmological pain relief for newborns such as parents singing to their infant. I was able to use this article and research during my clinical days to educate my patients on how they can help soothe their baby before, during, and after painful procedures.

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I was able to apply leadership this semester during sim lab. During my sim lab scenario I had a partner and when the emergency situation started I was showing leadership by helping my partner. I delegated certain tasks like starting a new IV or taking the blood pressure again while I was setting up her IV medications. In addition to this, I was student leader for one of the week at clinical. I enjoy keeping track of my classmates and seeing if they need any help with their patients.

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At Kapiolani Medical Center I was able to collaborate and be part of the health care team on the floor. For example, when my nurse was not available the charge nurse gave me some information about the patients vital signs. This led to me following up and retaking the vital signs before going to find my nurse to relay the information. It felt that I was really a part of the care team for that patient.

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At Kapiolani Medical Center there was a lot of different parts of the health care system. For example, with my patient she had the lactation consultant come in and assist her so I was able to observe that. In addition to the lactation consultant there was those who did the hearing tests, the L&D nurse, the nursery nurse, the MDs, dietary, etc. Just in that floor there was a very diverse team that was working with each patient.

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I was able to practice effective communication during my clinical day by writing DARs for my patient. DAR is an important form of written communication to talk about the main focus of the day for the patient and what we did. I attached below a picture of a DAR I did about pain. In addition, I used therapeutic communication with my patients during clinical. As I was doing my nursing assessment on the post-partum mom I used therapeutic communication to ask questions about home and her social support system. For example, I said “Tell me about the support you will have after leaving the hospital.” Instead of “you have people who will help you when you leave, right?”. This made the conversation easy and effective for the both of us as I was able to get the information I needed.

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I was able to provide client centered care this semester during my clinical. For example, one week my patient and her husband had their first child. I got to care for both the mom and the baby and help with education as they had a lot  of questions. My patients were discharging that day so my nurse asked me to help with the discharge education. I made sure to include the mother and father and deliver family-centered care. While the mom was eating the dad of the baby was watching us to see how we do it and asking us questions on how to care for his new baby girl. I was able to see the family unit and work with them.

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I was able to use clinical judgment during clinical at Kapiolani Medical Center. For example, my nurse was with another patient and the charge told me she took my patients vitals for me while I was away and gave me the readings. She noted to me how one level was abnormally low, the BP was 93/54 (61). I used my clinical judgment to go retake the blood pressure to ensure this was an accurate reading and asked the patient if she was having any symptoms of hypotension such as lightheadedness, which she said no to. After this I left the room and went to my nurse to relay the information who told me it was an okay reading because of the MAP and that’s how she was trending that day. I thought it was a good idea to recheck the BP while me and the charge nurse waited for my nurse to come out of the other patients room. I used my clinical judgment to decide what was an appropriate way to follow up and still ensure patient safety by keeping my nurse involved.

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Participated in a postpartum hemorrhage simulation as the role of nurse aide/assistive personal.

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In this artifact of a reflection after my 4th clinical day I was able to identify an ethical and legal dilemma that I experienced that day at clinical. It revolved around the patient being concerned about their confidentiality and the nursing students. There was distrust of the students but I was able to reassure that the students are held to the same standards of staff of HIPAA.

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This is an example of me demonstrating reflection following my first clinical week at Queens Medical Center's Orthopedic Floor. I had a full reflection about my week going over the decisions I made for my patients and the ways I can better my care for the next week. Identifying my strengths and weaknesses helps me provide better nursing care for my patients.

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I exampled the SLO of using evidenced based practice during this presentation I made as a group for the class. As exampled in this artifact, my group studied about family dysfunction and we looked into an article about COVID's effect on the family unit and its possible results of family dysfunction. We talked about interventions we could apply as a nurse for the family units affected by the COVID pandemic ,for example, education programs. I used articles like these and others presented to us in class during my practice at clinical. Using these evidence based articles helps me keep my skills current.

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I was able to apply leadership during my clinical day by being the role of student leader for my clinical group. I assisted my peers during the day by meeting with them individually to ask them about their patient and their needs for the day. I then organized all of their needs of the day to fit the schedule of the clinical instructor and looked at where I could assist my peers. I helped make it where everyone could get everything done for their patients in a timely matter and helped my peers be prepared to provide care for their patients.

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I showed collaboration with the multidisciplinary team to advocate for my patient on one of my clinical days for Psychiatric Mental Health. I showed collaboration by working with the care team to promote patient safety. The patient disclosed to me a safety risk and I responded correctly by alerting the staff. This would help the patient keep themself safe and prevent from harming themselves. As shown in my example, I asked more questions about teh safety risk to ensure the patient was safe at the moment and to get a deeper understanding as well before going to staff.

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At Family Treatment Center in Queens Medical Center, I was able to see the working of their unit and their staff. They had multiple different roles involved every day with the patients that were all interacting with each other throughout the day. For example, there was the psychiatric assistant, the activity coordinator, the nurse, the doctors, etc. I got to work with all of these members of staff and this artifact is talking about my experience watching them throughout the day.

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At Queens Medical Center clinical I was able to practice client-centered care. I tailored my day to the preferences of the client the best I can, for example, what time the patient wanted to do their wound care that day as it can be a painful procedure. As detailed in this weekly reflection I had to plan my day out to center my care to both of my patients. This shows me developing therapeutic relationships based on mutual respect and collaboration.

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At Queens Medical Center's Kekela Unit I was able to practice the SLO Communication. I demonstrated professional clear therapeutic communication through my assessment and interview of my patient. This is shown in my Process Recording where I go over my conversation and see which parts were therapeutic or not. I used therapeutic communication skills during my interview to help better understand my patient and do a proper assessment.

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I was able to practice Clinical Judgement at Queens Medical Center on my Med-Surg rotation. My patient was becoming increasingly anxious throughout the shift so I started to read more into his chart. I saw that he had an order to assess him with a CIWA score for his alcohol withdrawal. Using my clinical judgment I assessed his symptoms and then went to my professor to ask about administering PRNs ordered for an assessment score of this range. This artifact talks briefly about my reflection of using PRNs this clinical week.