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Student Learning Outcomes: Upon successful completion of NURS 320 the student should be able to:

1.       Apply the ANA Code of Ethics to the care of clients and families

2.       Reflect on nursing practice in caring for clients and families, to be able to identify areas of strength and those requiring development.

3.       Utilize evidence-based information to develop a plan of care for clients and families.

4.       Apply leadership attributes to the care of clients and families.

5.       Practice as a member of a multidisciplinary healthcare team.

6.        Identify available community resources for clients and families.

7.        Deliver family-centered care.

8.       Utilize therapeutic communication skills in interactions with clients and families.

9.       Practice clinical judgement in the delivery of nursing care to clients and families.

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Student Learning Outcomes: Upon successful completion of NURS 210, the student should be able to:

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

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

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

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

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

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

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

8.      Practice effective oral and written communication.

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

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The standards of moral conduct within a society. The main concepts in nursing ethics are accountability, advocacy, autonomy, beneficence, confidentiality, fidelity, justice, nonmaleficence, responsibility, and veracity (Giddens, 2020).

This first week of clinical was very new experience to me because I was able to advocate for my resident regarding her pain. The resident complained with her bilateral knees pain from the first day. Her legs were always flexed and was unable to extend. She has verbalized her pain scale as 6 out of 10 and grimaces were noted whenever she had a pain. The report was given to instructor and the nurse-in-charge, but facility people considered as a “fake pain.” When the resident had a telehealth with her doctor, the nurse-in-charge was advocate for her since she cannot specify her pain. However, the nurse was not advocating for the resident’s pain. I was hoping that the nurse would mention the resident’s pain scale of 6 and facial grimaces upon movement, but she did not. I believe that nursing advocacy plays a key role in this situation, where the resident’s pain may worsen if she does not get treated. The resident seemed restless, which may indicate the sign of pain, and her verbal and nonverbal both indicated that she is in pain. If I were my resident’s advocate, I would have explained her signs and symptoms for past two days to the doctor during the telehealth, and request for PRN medication for pain. If the pain does not go away, referral to orthopedics may be necessary for further evaluation.

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The process of contemplating experiences, sometimes even life-changing experiences, and searching for meaning in those events (Yoost & Crawford, 2020).

I need to improve on my communication skills, especially, trying to be more assertive. My previous residents were very cooperative and did not show and negative behaviors towards me throughout clinicals. However, for this week’s resident, it was different than previous weeks. Whenever I tried to wake her up, she would say negative comments about me. It was hard to be assertive because I was afraid that the resident may get more aggressive. But I should try to be more assertive with confidence and encourage the resident to do participate in more activities because I am there to help resident and provide her comfort, not to just watch her being restless and angry.

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The integration of best research
evidence with clinical expertise, patient values and needs, and the
delivery of quality, cost-effective health care (Giddens, 2020).

Health Promotion: Opioid Used Disorder

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The ability to influence, guide, or direct others. Leadership focuses on relationships, using interpersonal skills to persuade others to work toward a common goal (Yoost & Crawford, 2020).

During the leadership presentation preparation, I was able to discuss with the team members about specific topics to address during the presentation. Prior to meeting with team members, I have reviewed and clarified some topics with the clinical instructor. So, during our discussion, I was able to provide some ideas and specific examples from my research. Since the time management is critical in this group presentation, time was equally divided for each team members and zoom meeting date for practicing presentation was discussed and confirmed.

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Two or more people work together toward a common goal. In nursing, collaboration occurs when RNs, UAP, LPN/LVNs, primary care providers, pharmacists, social workers, clergy, and therapists all interact productively to provide quality patient care (Yoost & Crawford, 2020).

To prevent resident’s hypothermia, signs and symptoms such as shivering, slurred speech, confusion, fatigue, bradycardia, hypotension, or hypoventilation was assessed. To provide a gradual warming of the body, regulating environment temperature and relocating the resident to warmer setting was done by providing extra jackets and completely drying her hands after washing them. In order to get an idea of resident’s baseline temperature, collaboration with CNA was done and was able to receive resident’s chart regarding her previous temperature. Due to resident’s extreme of age and physical weakness, resident was encouraged to participate in group activities or individual activities. The resident kept falling asleep during group activity, so she was encouraged to move to her room and do individual activities. The resident enjoyed catch ball for at least 30 minutes and was alert during the activity. Since the resident finished 90-100% of her meal most of days, consulting with dietician was not needed. The resident had slight weakness in her range of motion (4/5) and needed minimal of assistance to decrease risk of fall. Range of Motion exercises such as chest expansion and knee bending were taught to maintain muscle strength, but the resident was not able to return demonstrate due to cognitive deficiency (Alzheimer Disease).

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A purposefully designed, structured social system developed for the delivery of healthcare services by specialized workforces to defined communities, populations, or markets (Giddens, 2020).

Before getting to meet the resident on week 2, I accessed her chart on week 1 and was able to get her medical history and other information regarding her condition. However, on her visit to ophthalmologist, there was a note stating that the resident is allergic to Alphagan (Brimonidine). When I saw the facility’s admission note, it was noted that the resident does not have any known allergies. So, I immediately let the clinical instructor know about this situation, and she instructed me to let the charge nurse know about it. I went to charge nurse and showed her the notes from her visit to ophthalmologist and indicated her Alphagan allergy. The nurse seemed to be surprised to find out about the resident’s allergy. On the second week, when I had enough time to work on my papers, I checked the resident’s chart again to make sure they added her allergy. Thankfully, they added her Alphagan allergy to her chart. As a nurse, I think the priority should be the patient’s safety. It is critical for nurses to check patient’s allergies and past medical history to prevent any allergic reactions or if worse, anaphylaxis. I am glad that her allergy is added to chart and hope they will be more careful when administering medications.

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Responsive to individual patient preferences, need, and values to treat patients with respect and dignity using clinical decisions (Yoost & Crawford, 2020).

Since the resident has constipation that is related to decreased physical activities and peristalsis abnormality (diverticular disease), it is important for the resident to keep herself hydrated with frequent intake of fluids. Using the heal of the hand to massage the resident’s abdomen with firm pressure was one of the planned nursing interventions so that the resident can defecate better. Also, teaching the resident exercises (leg-lifting, knee-bending) that can increase abdominal tone and increase peristalsis, and encouraging the resident to drink at least 2 cups of water or other fluids with every meal was done. Due to alteration in peristalsis (diverticular disease), the resident is at risk of infection. Therefore, monitoring the resident’s signs/symptoms of infection and vital sign was done. To reduce the risk of cross-contamination, the resident was encouraged to return demonstration of hand washing technique.

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A process of interaction between people in which symbols are used to create, exchange, and interpret messages about ideas, emotions, and mind states (Yoost & Crawford, 2020).

The resident seemed alert but occasionally tired and sleepy on previous weeks. However, on the last week, the resident showed difference when the classmate spoke Japanese to her. The resident hold on the student’s hand and seemed relaxed and happy when the student spoke Japanese. When I saw that moment, I thought speaking Japanese to the resident may help her to be more alert and engaged with other people. So, I tried to learn some basic Japanese phrase to help the resident such as, “I’m sorry to bother you in the morning,” “How is you condition,” “can you tell me you name,” and “are you in pain.” On the first day, when I said good morning to the resident, she did not reply. But, when I said good morning in Japanese, the resident opened her eyes, smiled, and nodded.

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An interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improve new ones as deemed appropriate by patient's response (Yoost & Crawford, 2020).

The resident’s BMI is 15.99 kg/m2 which is lower than the normal range of 18.5 to 24.9 kg/m². The resident’s pertinent past medical history includes osteopenia, chronic gastritis, constipation, acute encephalopathy, choledocholithiasis, and diverticular disease. She has family history of lung cancer from her parents and sister, and lymphoma from her brother. The resident’s Morse Fall Risk score was 17 on the admission date, which indicates low fall risk (high risk >50). The resident’s last blood test and urine test was on 12/08/2019, which showed elevated glucose level (123 mg/dL), and positive nitrites in the urine sample. Other lab values for kidney function (BUN, creatinine), liver studies (Albumin, Bilirubin) and CBC (WBC, Hemoglobin, Hematocrit, Platelets) were in normal range.

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Oct, 2022 - Dec, 2022
Nursing student at Queen's Medical Center Tower 8 Ewa 270  (112 hours)

Sept, 2022 - Oct, 2022
Nursing student at Queen's Medical Center Kekela Psychiatric Inpatient Unit (48 hours)

Jan, 2022 - March, 2022
Nursing student at Queen's Medical Center Emma Tower 10 Labor & Delivery Unit (48 hours)

Sept, 2021 - Nov, 2021
Nursing student at Queen's Medical Center Emma Tower 5 Ewa Neuro-telemetry Unit (48 hours)

Mar, 2021 - April, 2021
Nursing student at Manoa Cottage Nursing Home (48 hours)

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June, 2021 - current
Medical Assistant at Pacific Primary Care- Dr. Philip Suh M.D.

June, 2020 - May, 2021
Lead Medical Assistant at Fast Walk-in Medical Clinic

May, 2019 - May, 2020
Medical Assistant at Glaucoma center of Hawaii

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April, 2021
Global Seal of Biliteracy: Korean Working Fluency Award

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In March 2010, I moved from Seoul, South Korea to Kailua, Oahu. I graduated from Kalaheo high school in Fall 2015 and started college at the University of Hawaii at Mānoa in Fall 2015. At the beginning of college, I was not sure about my major. The major changed from chemistry, microbiology, and then finally, biology. After graduating with a biology degree in Fall 2019, I started working as a medical assistant at a private ophthalmologist's office. When I visited California to see my family, my uncle and cousin told me stories of how they started pursuing their career in the medical field. I got interested in the nursing field, so I decided to apply for Kapiolani Community College for an Associate's in Nursing degree. While working as a medical assistant, I grew my passion for caring for patients and the desire to expand my career to a professional level. In Spring 2021, I finally got into the KCC ADN program. Currently, I am pursuing my dream to become an honest and modest nurse.

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Nursing is to respect individual patient's dignity and provide high-quality patient care for health enhancement, disease prevention, wellness, and pain management. The values of compassion, honesty, persistence, and competency should be in everyday practice for retaining trust and showing confidence to patients. For better quality of patient care, communication between patients, nurses, and other interdisciplinary team members are essential since individual patient's race, culture, age, gender, and background differ.

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Graduation
After graduation, my goal is to pass the NCLEX and obtain a job as a registered nurse (acute care or emergency). I will apply to University of Hawaii at Mānoa for Master's in Nursing degree and achieve a variety of advanced nursing skills to assist patients for their health and comfort.

3-year
In three years, I would like to gain more experience and improve my leadership skill. I'll be growing from a novice nurse to competent nurse, where I am able to perform nursing skills confidently and efficiently in timely manner. I'd like to practice and learn more about leadership once I become a competent nurse.

5- year
Within 5 years of nursing practice, I would like to become a transformational nurse leader who motivates other coworkers and perform beyond expectations. I'd like to grow to proficient nurse and be able to improve on my decision making  for patient's better quality of care.

10-year
In 10 years, my goal is to become expert nurse who can perform highly proficient skills and provide high quality of care. I would like to gain more experiences and become expert nurse in other settings such as pediatrics, gynecology, geriatrics, and psychology.

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HLTH 125: Survey of Medical Terminology

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Became member as since May, 2021

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Aug, 2015 - May, 2019
Graduated with Biology degree

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Dec, 2020 - Dec, 2022
Fast CPR: BLS Provider

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Volunteer at Chef Hui facilities to prepare food on May, 2021

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Student Learning Outcomes: Upon successful completion of NURS 220 the student should be able to:

1.       Examine potential legal and ethical issues in the delivery of nursing care.

2.       Use a structured plan to reflect on personal nursing practice.

3.       Utilize reliable sources of information to support nursing care decisions to individuals.

4.       Recognize leadership attributes to the care of adult clients.

5.       Practice in the role of professional nurse as part of the health care team.

6.       Identify factors that influence access and continuity of health care.

7.       Deliver client-centered care.

8.       Utilize therapeutic communication skills with adult clients.

9.       Practice clinical judgment in the delivery of nursing care to the adult client.

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Utilize ANA standards of practice and code of ethics to identify potential legal and ethical issues in the delivery of nursing care.

According to the ANA code of ethics provision 5, the nurse owes the same duties to self as to others, including the responsibility to promote health and safety, maintain competence, and continue personal and professional growth. The registered nurse should always keep in mind that in delegating a task to an assistive individual, transfers the responsibility for the performance of the task but retains professional accountability for the overall care. After CNA assisted the patient for his breakfast, the primary nurse grabbed the food tray and cleared up the area. The primary nurse said that patient’s personal care and health is responsibility for all healthcare professionals and that we should all help each other to promote good quality of patient care

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Use a structured plan to reflect on personal nursing practice.

The one clinical skill that I performed well was removing foley catheter and inserting new one on a female patient. A 63-year-old patient’s lab showed indication of infection (increased WBC), which may be due to Catheter-associated Urinary Tract Infections (CAUTI). The foley was removed safely and perineal care was done before inserting new foley catheter. Then using sterile technique, new foley was inserted and another perineal care was done after insertion. One clinical skill that I need to improve is performing blood glucose meter. The patient was due for blood glucose check and insulin administration if needed. The patient was poked 3 times because I had difficulty using the glucometer. However, after this mistake, I was able to perform blood glucose check on another patient successfully. I should get more familiarize with medical equipment for efficiency and patient’s safety.

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Utilize reliable sources of information to support nursing care decisions to individuals.

Before notifying the clinical instructor about each patient’s medication schedule, unfamiliar medication names were searched using the technology resources to understand the indication of that drug. Since I couldn’t get any information regarding the patient on preclinical day, I accessed the healthcare technology system before the morning shift to look up any new or unfamiliar diagnosis or testing. I used the standard technology resources efficiently and effectively to promote the higher quality of patient care.

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Kay, Han- Mobility (Rheumatoid Arthritis)

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Identify nursing care situations requiring the need for delegation and leadership.

There were some modifications of patient care due to newly added order from the provider. Medication administration schedule was updated to the clinical instructor each time when the new order or procedure was added to the patient’s schedule. The leadership was provided by communicating between students and the clinical instructor, which promoted higher quality of patient care.

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Practice in the role of professional nurse as part of the interprofessional health care team.

One of patients was a 91-years-old patient who was admitted to the hospital due to left MCA stroke. Patient had weakness on the right side and had history of nasal fracture. She was NPO for 3 days and was showing signs and symptoms of dehydration such as thirsty, dry lips, eyes, and skin. The provider ordered a NG-Tube placement but due to fractured nose, the patient had pain during the process of tube insertion. She attempted to take out the tube multiple times and when speech language pathologist was there for her, she started crying and saying that she does not want NG-tube. The report was given immediately to the provider and the order for swallowing test was scheduled to see if the patient is able discontinue NG-tube and get a nutrition orally. I was able to collaborate with my primary nurse, sleech language pathologist, and the doctor to improve patient’s quality of care.

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Identify factors that influence access and continuity of health care.

One of patients was getting discharged to nursing home so when rounding started, discharge plan was discussed with other healthcare professionals such as physician, social worker, nurse, physical therapist, and occupational therapist. Some discussion included about getting physician’s signature for discharge report, type of nursing home that patient will be discharged to, patient’s insurance, family, living situation, and capability of ADL. I was involved into the patient’s discharge plan and was able to witness patient getting transported to the nursing home.

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Deliver client centered care.

Commitment to nursing implies commitment to provide an optimal patient care and promote the nursing profession. When the patient was being anxious, I was able to have therapeutic communication with the patient such as approaching the interest, showing empathy, providing comfort, and using touch (holding hands, back rubbing). I spend enough time to get to know the patient and was there for her to reduce her anxiety and provide support. I have learned how to communicate with the patient, and some communication techniques that will help establish rapport with patients.

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Use therapeutic communication skills in the development of relationships with clients and families.

The patient who was admitted to the hospital due to spinal compression fracture seemed very anxious and agitation. She was alert and oriented to the person, place, and time, but during conversation, she constantly said, “Oh, God. Please take me, just let me die. I miss my family.” The patient was hitting herself on the head when she was upset and anxious. So, I tried to relax her by having conversation regarding her family and rubbing her back to prove comfort. When she was relaxed, she told me about her family and herself, which distracted the patient from the pain and anxiety.

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Develop a plan of care for clients that incorporates evidence based strategies and clinical judgments using assessments data from information and patient care technologies and an understanding of the client’s perspective and illness experience to support safe, quality nursing care.

A 63-year-old patient was admitted on 11/18/2021 and was not evaluated by the doctor yet. The change-of-shift report was given by another nurse, and she reported that the medication order was held so it can be administered after the physician evaluates during rounding. The patient’s held medication included IVPB potassium. After patient assessment with the primary nurse, speech language therapist came to evaluate patient for swallowing capabilities. The patient successfully passes the swallowing test and was able to take medication by mouth. During rounding with the physician and other healthcare professionals, the primary nurse asked the physician if medication route can be switched to PO instead of IVPB and reported that the patient just passed the swallowing test that was done by SLP. I was able to collaborate with the primary nurse, SLP, and physician and changed potassium administration from IVPB to PO, which will decrease the use of invasive procedure (IV).

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The standards of moral conduct within a society. The main concepts in nursing ethics are accountability, advocacy, autonomy, beneficence, confidentiality, fidelity, justice, nonmaleficence, responsibility, and veracity (Giddens, 2020).

According to the ANA code of ethics provision 5, the nurse owes the same duties to self as to others, including the responsibility to promote health and safety, maintain competence, and continue personal and professional growth. The nurse should always keep in mind that in delegating a task to an assistive individual, transfers the responsibility for the performance of the task but retains professional accountability for the overall care. Since the unit we’re in is labor and delivery unit, there was a lot of radiant warmers for newborns to maintain the body temperature. In the nursery unit, there were couple empty radiant warmers so the primary nurse asked students if we can go over the checklists to confirm that every equipment is in place. Some checklists included newborn diapers, suction bulbs, hats, forceps, lights, and many other tools to prepare for the newborn. The nurse explained that going over the checklists and preparing equipment are one of nurse’s responsibility for safe patient care. It is nurse’s responsibility to check stocks for medical supplies, and also check if the radiant warmer is working properly along with oxygen and suction devices. Even though the primary nurse asked (delegated) to students to go over the checklists, she still went over the checklists with each student to make sure all supplies are there, and signed her initial, which denotes that she still retained her professional accountability for medical equipment (radiant warmer).

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The process of contemplating experiences, sometimes even life-changing experiences, and searching for meaning in those events (Yoost & Crawford, 2020).

Since it was my first-time providing discharge teaching to the patient, I was very nervous but excited. The primary nurse handed the printed copy of the discharge form, so I was able to read thoroughly before going into the patient’s room for teaching. The discharge teaching for the mother included the prescribed medications, follow-up appointments, when to call the doctor (s/s of infection, hemorrhage, pneumonia, depression), pelvic exercises, how to do perineal care, laceration care, breast care, and many educations. I also remember the recommendation for the patient from the lactation consultants (15 minutes breastfeeding, 15 minutes pumping), so I reminded patient to not to forget. However, I forgot to mention some stuffs to the patient, but the primary nurse was able to help me on the side for discharge teaching. After teaching, we asked the patient if she has any questions and received the signature for the discharge form. Later, I also did discharge teaching about the newborn such as when to call doctor (s/s of infection, hypoglycemia, cyanosis, jaundice …), how to swaddle the baby, feeding schedules, and many other educations that parents need to know. The father was also active engaged into the discharge teaching. Since it was my second time providing teaching, I felt more confident and was able to thoroughly go over the discharge teachings. Before going over the baby’s discharge teaching, the primary nurse made sure that the mother makes appointment with pediatrician within 1-2 days for follow-up. After confirming the appointment, we were able to provide the teaching and get the discharge form signed.

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The integration of best research
evidence with clinical expertise, patient values and needs, and the
delivery of quality, cost-effective health care (Giddens, 2020).

Pediatrics Psychiatric Mental Health - Generalized Anxiety Disorder

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The ability to influence, guide, or direct others. Leadership focuses on relationships, using interpersonal skills to persuade others to work toward a common goal (Yoost & Crawford, 2020).

The patient was 5 months old infant, born on 11/05/2021 (54w6d PMA), born premature 31 weeks. The patient was admitted to the hospital on 04/20/22 due to fever (100.5F), bilious emesis since last evening, and poor feeding. From abdominal x-ray, multiple moderate dilated gas filled bowel loops with gas filled liquid was noted. For further investigation, abdominal ultrasound (limited) was done, and small bowel obstruction was diagnosed from secondary of persistent omphalomesenteric duct with cystic abscess. When I was introduced to the primary nurse, she gave me couple things to focus on the patient. To take vital signs every 4 hours, measure abdominal girth (at umbilicus level), check NG-tube, weigh diaper, strict I/O’s, and to assess IV site. I went into the patient’s room and assessed the patient and took vital signs. The patient was very irritable and fussy, which increased the vital signs including pulse, RR, and BP. Since the patient was consolable, I was able to practice clinical judgement in delivery of care to take the vital signs when the patient is more relaxed and quieter. As an advocate of the patient, I notified the primary nurse, and she was able to come into the room and help taking vital signs. The nurse tried not to stimulate the baby as possible to get accurate vital signs, and we were able to get normal range vital signs: T= 37.6 C, P= 133, BP= 114/67 (78), RR= 35, O2= 100%.

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Two or more people work together toward a common goal. In nursing, collaboration occurs when RNs, UAP, LPN/LVNs, primary care providers, pharmacists, social workers, clergy, and therapists all interact productively to provide quality patient care (Yoost & Crawford, 2020).

On the day of the third clinical day, I was not feeling so well from the beginning. I was able to take care patient for about 3 hours but had to leave due to worsening of condition. According to American Nurse Association Code of Ethics Provision #8, the nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. The primary nurse was with other patient, so I was not able to verbally give her report. Before I left the facility, I wrote every assessment of patient into one note and wrote a thank you to the primary nurse. Also, my classmates were able to check IV drip rate and do diaper change and gave me report about it. I was able to collaborate with my classmates (get help from classmates) and promote patient’s care. Even though I had to leave early, not finishing with my patient’s care, I was able to practice responsible behavior by leaving notes to primary nurse about the patient’s assessment.

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A purposefully designed, structured social system developed for the delivery of healthcare services by specialized workforces to defined communities, populations, or markets (Giddens, 2020).

It was very excited to see lactation consultants educating the patient regarding the good latch. They tried with different positions such as football hold or cradle hold, but the newborn still had difficulty latching on the mother’s nipple. The baby already has lost 7% of the total weight so the baby’s nutritional status was a big concern. The lactation consultant team recommended the patient to do 15 minutes breastfeeding and then try 15 minutes pumping or feeding formula. If the baby is able to have good latch and swallow the milk, then feeding can be switched to the only breastfeeding. They also explained to the patient that if the baby does not have good latch and try to suck nipple, then there will be more pain to the patient’s breast and will be exhausting for the newborn also. When the patient felt bad for her baby, they encouraged the patient that she is doing what she can do, and that they don’t want her to stress out. The patient also didn’t know about different sizes for flange, so they were able to educate the patient about correct flange size and where to buy those supplies. They recommended to go to Hawaii Mothers Milk that is located in Kapiolani Medical Center for Women & Children, and also provided with phone number and the address. After lactation consultant’s team, the patient was able to repeat how she should be breastfeeding the baby and decided to stop by Hawaii Mothers Milk after hospital discharge.

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A purposefully designed, structured social system developed for the delivery of healthcare services by specialized workforces to defined communities, populations, or markets (Giddens, 2020).

The patient was admitted to the hospital on 04/05/2022 due to intermittent periumbilical abdominal pain with vomiting and diarrhea for 2 days. Per patient’s mother, their family had a sushi platter the day before and the patient started have abdominal pain since then. Upon admissions to ER, the patient had abdominal ultrasound which showed mildly prominent lymph nodes on RLQ (mesenteric adenitis). The patient also had her stool sample cultured, and it was found that the patient had positive Norovirus GI/GII. When I first encountered the patient, it was very nervous because her mother was there too. However, I was able to calmly introduce myself to them and let them know I’ll be their student nurse for today. I was able to competently take the patient’s vital signs and the pain level and reported to the primary nurse. The patient was admitted to hospital for 4 days as of 04/08/2022 and had plans for discharge. The primary nurse printed out patient education forms prior to the discharge, and I was able to see how the nurse educates the patient and her mother, family-centered care. Discharge teaching included signs and symptoms of Norovirus and when to call the doctor or go to emergency room. Since the patient missed a week of school due to illness, they needed a doctor’s note, so the nurse printed out and I was able to deliver it to the patient. After the patient was discharged, one of the classmates and I was able to clear out the room; removing used bed linens, disinfect area, discard patient’s BP cuff. Then we also discarded the patient’s ID bands and tags. When we reported to the primary nurse that the room is clear, she called for maintenance (disinfection) for further sterilization and sanitization because the patient had active Norovirus which is very contagious.

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A process of interaction between people in which symbols are used to create, exchange, and interpret messages about ideas, emotions, and mind states (Yoost & Crawford, 2020).

The patient was 7 weeks old infant who was admitted to the hospital due to active Respiratory Syncytial Virus infection. She was in respiratory contact isolation, and her parents were at work during the shift. The patient was in care of another nurse, but when she started crying, the nurse asked me to watch for baby while she finishes other stuffs. When I entered room with PPEs on, the baby was constantly crying. I therapeutic communication such as swaddling her and lifting her up to lull. The baby stopped crying, but she started coughing and turned little red due to effort to cough. She had other symptoms of RSV, which included slight grunting and nasal flaring. I immediately notified the nurse and asked if I can suction baby nose due to baby’s effort of breathing. She allowed me to suction the baby’s nose and white slimy mucous came out from bilateral nose. With this experience, I was able to demonstrate autonomy, by assessing the patient (nasal flaring, grunting, turning red), diagnosis (ineffective airway clearance), plan (notify the nurse, provide nasal suctioning), implement, and evaluate. After nasal suctioning, the baby was able to breathe better without any distress, but still turned red when coughing due to effort to cough.

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An interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improve new ones as deemed appropriate by patient's response (Yoost & Crawford, 2020).

The patient was 5 months old infant, born on 11/05/2021 (54w6d PMA), born premature 31 weeks. The patient was admitted to the hospital on 04/20/22 due to fever (100.5F), bilious emesis since last evening, and poor feeding. From abdominal x-ray, multiple moderate dilated gas filled bowel loops with gas filled liquid was noted. For further investigation, abdominal ultrasound (limited) was done, and small bowel obstruction was diagnosed from secondary of persistent omphalomesenteric duct with cystic abscess. When I was introduced to the primary nurse, she gave me couple things to focus on the patient. To take vital signs every 4 hours, measure abdominal girth (at umbilicus level), check NG-tube, weigh diaper, strict I/O’s, and to assess IV site. I went into the patient’s room and assessed the patient and took vital signs. The patient was very irritable and fussy, which increased the vital signs including pulse, RR, and BP. Since the patient was consolable, I was able to practice clinical judgement in delivery of care to take the vital signs when the patient is more relaxed and quieter. As an advocate of the patient, I notified the primary nurse, and she was able to come into the room and help taking vital signs. The nurse tried not to stimulate the baby as possible to get accurate vital signs, and we were able to get normal range vital signs: T= 37.6 C, P= 133, BP= 114/67 (78), RR= 35, O2= 100%.

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Student Learning Outcomes: Upon successful completion of NURS 360 the student should be able to:

1.      Analyze ethical and legal concerns that are experienced by clients.

2.      Analyze episodes of clinical practice and be able to identify areas of strength and those requiring development.

3.      Analyze evidence-based interventions in providing care to clients with altered states of wellness.

4.      Apply leadership skills in implementing and/or delegating the delivery of safe nursing care.

5.      Collaborate with members of the health care team to develop an individualized plan of care for clients.

6.      Assist clients to identify available health resources within the community.

7.      Advocate for the delivery of client-centered care.

8.      Communicate professionally and therapeutically.

9.      Demonstrate clinical judgment in the delivery of nursing care.