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Welcome to my ePortfolio. I am creating and maintaining this online site as a historical reference of my student learning and program leaning outcome achievements within the Kapiolani Community College Associate Degree Nursing Program.

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

The vSim with Julia and Lucy introduced me to a legitimate ethical scenario. In this case Julia was transitioning to hospice care, having unsuccessfully completed stage 4 cancer treatment. Counter to my natural instinct to preserve life, I felt an even stronger desire to ensure the client's wishes were observed to the utmost of my ability while providing the best care possible.

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Student Learning outcomes are ideals being pursued and the accompanying artifacts are evidenced of achieving those desired outcomes.

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My name is Brock Ratzlaff. I am a Nursing student in KCC's ADN program, having completed my second semester in December of 2020. I am married and I have two young teenage children.

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My personal philosophy is that every human being deserves to be treated kindly, with respect and dignity. I am driven professionally by my curiosity and commitment to life-long-learning to help those that are ailing, distressed, or suffering. I believe that care should be centered on the patient. As a Nurse I will, without fail, always serve as my patients' healthcare advocate. Witnessing the care of my ailing mother before she passed is what has helped shape this philosophy. Both the tremendous care from nurses as well as the shortcomings motivated me to pursue a career in nursing so that I can have a positive impact on the health outcomes of people in need of care.

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SHORT TERM GOALS (<2 years)

ADN

BSN

NEAR TERM GOALS (2-5 years)

Advanced Public Health Nursing (Masters Degree)

BA in Health Care Administration

LONG TERM GOALS (5-10 years)

Serve as a patient advocate ore care coordinator within the VA Healthcare System.

My educational path is specific to my end-state goal of becoming a case manager/care coordinator with the VA. I excel and enjoy planning, resourcing, networking, and problem solving. These skills will help me serve a specific population with complex needs in an even more complex system of healthcare through the Veterans Health Administration. As a Registered Nurse I will have the technical background to help clients navigate the VA healthcare system to best suit their short and long term healthcare goals. As a veteran, this underserved population is important to me and I hope to serve them well in the future.

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Aloha Care Long Term Care Facility (115 hours, Summer 2018)

Kuakini Health System (128 hours, Fall 2020)

Kapiolani Medical Center for Women and Children - Maternity, Labor & Delivery (81 hours, Spring 2021)

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American Red Cross BLS (Exp. July 2022)

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SNA Representative

Served as a cohort representative.

KCC Health Fair

Created a booth for community education on renal disease

West Oahu Veterans Center

Assist veterans in navigating the VA benefits and healthcare services.

VA Pacific Islands Health Care System

Staffed outreach booths that provided community education on VBA and VHA services.

Medical Reserve Corps - Covid Vaccination Clinic

Served as a vaccinator for an 8 hour covid vaccination POD.

Veterans Health Administration - Covid Vaccination Clinic

Served as flow control during an 8 hour covid vaccination POD.

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Business and Professional Writing - English 209 (Fall 2020)

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

Throughout our virtual clinical rotation I completed weekly reflections on care rendered to my client. This served as an opportunity for exponential growth through introspective thought as I weighted the pros/cons of my nursing actions against the clients responses. It allowed me to discover areas that require improvement as well as acknowledging areas where I excelled.

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

I learned through the vSim that subjective data is equally important as objective data. Although, it requires a much more keen awareness of your client. I found that curiosity is your best friend in Nursing practice, and to never stop asking questions because assuming something only means that you do not know with any level of certainty. An example of this is our client Lucy, who seemed to be prepared to cope with her partners death, which I found to be inaccurate in a follow on scenario in which she was still suffering from depression and subsequent related falls.

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Identify nursing care situations that require delegation and leadership decisions.

Our clinical rotation afforded me ample opportunities to sharpen my leadership skills within a healthcare team. I served as clinical team leader during two of the six week clinical. I do realize it will be drastically different on the floor, but the essential ideology of delegation remains the same. I was able to focus on the strengths and weaknesses of my team members in order to accomplish tasks and requirements in an effective and efficient manner. Additionally, I countered individual strengths with weakness so that we could improve our overall value as individual contributing members over time.

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

I was required to utilize interdisciplinary team collaboration every clinical week. Being cognizant of each member's role within the team was vital in order to provide the safest and highest level of care to the client. Having the most consistent contact with the client, I had to serve as the communication conduit between the client, family, PCP, Social worker, physical therapy, long-term care facilities, and funeral homes in various scenarios. While a Nurse does not necessarily "do" everything, they certainly serve as the backbone of the clients healthcare team in order to facilitate communication to all parties concerned.

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Describe the components of the health care delivery system.

Healthcare delivery is an orbital system that revolves around the patient and their needs, with each entity collaborating towards an improved health situation for the client. The delivery of these products and services is accomplished through various methods ranging from traditional brick and mortar hospitals, outpatient clinics, home care, community outreach, to the new and improving tele-health. Regardless of the modality of care, cost and quality are the driving forces of the health care economy. This newfound focus is requiring that providers accomplish better care with less with a client outcome focus.

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

The four primary elements of client-centered care are respect and dignity, information sharing, participation, and collaboration. Each component is equally important and strives to make the client the driving force of their own care. It does so my putting them in the drivers seat. People in our care deserve dignity and respect, which also build Nurse-client rapport. Sharing information allows the client to become educated on their own health situation, and empowers them with knowledge. By encouraging participation, you let the client know that they are the ultimate decision maker, which helps them become an equally vested partner in their care. Finally, collaboration is the ultimate concluding element. All healthcare team members working in harmony and unison to accomplish a better health situation, not for, but with the client leading the way.

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Practice effective oral and written communication.

Communication is the absolute bedrock of providing safe and effective healthcare to clients. I was able to hone my communication craft throughout the semester. I had to be able to articulate my inquiries during lectures and labs when I didn't understand important concepts. The semester required two research papers (Developmental and Community Client) where I was able to practice and improve upon expressing myself effectively with written communication. Although, the most profound educational experience in regards to communication was when our clinical shifted to an online instructional method. I feel this modality required the use of a wide swath of communication methods. Last, but not least, the DAR's and SBAR's from clinical were a tremendous opportunity to really whittle down my words into something that was both effective and concise.

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

Utilizing the Nursing process proved to be the most effective way to approach, basically, everything that I encountered this semester. This process proved extremely valuable throughout clinical. I worked through the Nursing process multiple times for each and every client that I cared for. It made the development of the plan of care a much more efficient process by directing focus and allowing for a more uncluttered thought process as I worked my way towards and through decision points in the clients time of care.

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Ethics

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

I consistently exercised ethical and legal standards of care by ensuring that I observed all HIPPA rules and regulations, especially in regards to patient and information privacy. Additionally, medications that were prescribed as IV piggyback were not administered because the facility administration practice failed to meet evidenced based practice standards.

Reflection

Use a structured plan to reflect on personal nursing practice.

I utilized weekly reflection practices throughout my clinical rotation. This practice allowed me to identify areas that were essential to sustain and those that required improvement. Reflecting on care provided to a diabetic patient revealed I had a significant knowledge deficit in this area. Based on this assessment, I was able to develop and implement a plan for improvement.  Continued reassessment through reflection of my nursing knowledge base and skills throughout this rotation, allowed me to gauge and refine my nursing practice based on the nursing process.

Evidenced Based Practice

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

I utilized evidenced based practice during catheter care to ensure that my client remained free of infection. I also frequently utilized evidenced based practices in care of patients on aspiration precautions.

Leadership

Recognize leadership attributes to the care of adult clients.

A patient had a 3 way foley that required irrigation. The following day the foley was removed. The client failed to void within the shift. Knowing this presented a problem, I made it a point to keep my clinical instructor abreast of the situation.  I inquired about a bladder scan. This was completed and the foley was reinserted after 8 hours of without voiding while presenting with abdominal distention and discomfort.

Collaboration

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

Collaboration is crucial in providing a level of care that helps meet the patients health care needs. It was imperative that I was clear on the roles and functions of each team member, including my own. This was especially important when I needed assistance, clarification, or help. I was able to have the UAP oversee catheter care, report the IO to the RN, and gain confirmation on my clinical observations from my clinical instructor. Additionally, the attending physician utilized the IO data that was observed by myself, documented by the UAP and nurse to make clinical judgements.

Health Care System

Identify factors that influence access and continuity of health care.

One of my patients was experiencing memory loss and confusion as a result of a wound that had turned into septicemia. The determining factor for their discharge was the ability for someone to be able to provide wound care. They were not fit to do so, and it was questionable if the spouse would be able to do so. The financial constraints strongly affected the patients ability to either stay in the hospital or seek long-term care. The patients ability to attend follow up appointments was also a constraint that would potentially affect continuity of care. The infectious disease doctor that communicated the scheduled follow-up seemed oblivious to the fact that the patient's current LOC was not conducive to scheduling follow up appointments and instructions of care as they were not in a state of mind capable of receiving teaching.

Client Centered Care

Deliver client-centered care.

Rendering care that is aimed at Improving and/or sustaining a patients health is a singular shared focus amongst a large team of professionals. A patient with a large wound that had become septic served as an example of the benefits of client centered care affecting positive health outcomes. The complications of the wound required additional team members expertise, yet even the smallest detail of care was communicated up and down the chain of concern to help improve the patients health through communication and care that focused on the client.

Communication

Utilize therapeutic communication skills with adult clients.

I learned that communication is the linchpin of collaboration.  I utilized both written and oral communication to provided patient updates to their healthcare team. The UAP, attending nurse, team leader, and clinical instructor were frequently and consistently informed of all patient data, status, care rendered, and any changes in the patients condition. I utilized therapeutic communication through actively listening to all my patients.

Clinical Judgement

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

I assessed my patient's case via medical records during pre-clinical. Utilizing sound clinical judgement I selected a diagnosis and intervention with the highest priority. I developed a nursing diagnosis based on the medical diagnosis provided by the physician. I implemented my nursing interventions (catheter care) and continually evaluated and reassess the outcome of those interventions throughout the care of the patient.

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Upon successful completion of NURS 320 the student will be able to meet the following learning outcomes:

Ethics

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

Utilizing patient centered care as part of the overarching healthcare team, I was committed to providing compassionate care that advocated for improving the healthcare outcomes of my patients. Building a patient provider rapport built on trust and respect was key to establishing a working relationship with my patients. This allowed me to successfully complete postpartum and neonatal assessments on 10 clients this clinical rotation, while providing care for the whole family while they were getting to know the new member of their family.

Reflection

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

I provided care for a young couple who just had their first child. Through therapeutic communication I was able to form an understanding that the mother and father were bonding well with baby, but they were somewhat apprehensive about being able to provide care for baby. I provided education for the father on how various hold that would help support baby's head, which helped build his confidence and interact more with baby. I provided education to the mother on sitz bath and peri-care, which she would have more time to accomplish now that the father was more comfortable handling baby. This promoted a better healthcare outcome for the whole family.

Evidenced-based Practice

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

Infection and DVT can be  complications in any postpartum patient. My knowledge of evidenced based care in these areas allowed me to implement proactive patient education measures into my plan of care. Proper use of the IS, SCD's, safe ambulation, peri-care, and sitz bath education were prominent topics with all of my patients.

Leadership

Apply leadership attributes to the care of clients and families.

While serving as team leader, I ensured that our student nurse team executed all necessary assessments and logged the patients vital signs while verifying that they were within the appropriate reference range.

Collaboration

Practice as a member of a multi-disciplinary healthcare team.

I assisted the attending nurse and lactation consultant by transporting the client back and forth between mother baby unit and the NICU. My patient had just had a tramadol order discontinued, but still required her respirations to be monitored on the hour. My consistent presence with the mother allowed me to monitor her respiratory rate hourly while communicating this information to the aide and attending nurse.

Healthcare System

Identify available community resources for clients and families.

The PMH assignment for domestic violence afforded me the opportunity to identify community resources available should I encounter a patient with that need.

Client Centered Care

Deliver family-centered care.

Each of my mother baby couplets had supportive partners. In that sense I liked to look at that family unit as my 3 patients. Taking this perspective allowed me to keep all parties involved in the care, especially in regards to education. I felt it important to involve the father in all aspects of care even if it was focused on the mother. This helped build a good relationship with the family unit and an open line of communication.

Therapeutic Communication

Utilize therapeutic communication skills in interactions with clients and families.

While conversing with a young couple who had just became first time parents, I sensed that they were both somewhat lacking in certain areas. Utilizing open ended questions allowed them to open up about what they thought may be shortcomings. This opened the door to teaching opportunities for both of them. I was able to explain the importance of peri-care to the mother while educating the partner on how he can assist with sitz bath preparation for his partner at home. This would help speed her recovery while providing pain relief and help prevent infection.

Clinical Judgement

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

I was able to most fully execute independent clinical judgement during the simulation lab. The scenario presented allowed my partner and I to rely on our knowledge base to make informed care decisions to promote positive health outcomes for our simulated patient. We successfully assisted our preterm mother by identifying proper measures to help slow her labor process, while minimizing negative health outcomes.

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KCC Associate Degree Nursing Program Learning Outcomes (PLOs)

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KCC Associate Degree Nursing Program Learning Outcomes (PLOs)

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Successful completion of the Associate in Nursing degree requirements will result in proficient abilities for the following:

1. Evaluate nursing care based on the legal and ethical framework of the state in which they practice and the American Nurses Association Standard of Practice and Code of Ethics.

2. Describe and analyze episodes of clinical practice and self-care; and identify areas of strength and those requiring development.

3. Implement evidence-based practice by locating and evaluating the best available evidence in making clinical decisions; and engage in on-going professional growth and self-directed learning in the practice of professional nursing.

4. Employ leadership skills in implementing and/or delegating the delivery of safe nursing care to clients and client systems.

5. Collaborate with the multidisciplinary team to advocate for clients, client systems, and groups in meeting their health care needs.

6. Contribute to the improvement of the health care system through involvement in interdisciplinary activities and choose from a variety of tools in accessing, interpreting, and providing cost-effective nursing care.

7. Develop therapeutic relationships based on mutuality, respect, cultural sensitivity, caring, and the beliefs and value systems with the client, client systems and community.

8. Communicate professionally, clearly and therapeutically in all interactions.

9. Demonstrate clinical judgment in the delivery of safe, cost-effective, quality care, using information and patient care technologies to diverse clients across a wide-range of settings. AND Utilize health promotion, disease prevention, and restorative nursing in assisting clients and client systems to maintain independence.

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Lecture and Continuing Education Credits

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Lecture and Continuing Education Credits

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Nursing During Pandemics - Hawaii State Center for Nursing

Nursing During Pandemics - COVID-19 module completed (Spring 2021)

American Nurses' Association COVID-19 Webinar (Spring 2021)