Clinical Journaling: One Aspect of Nursing

Clinical

Journaling

MS BEA

Copyright © 2017 by Ms Bea. 752939

ISBN:   Softcover   978-1-5434-3050-9

   Hardcover   978-1-5434-3051-6

   EBook      978-1-5434-3052-3

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Rev. date: 06/26/2017

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TABLE CONTENTS

Acknowledgement

Introduction

Section I Maternity

Chapter I Labor And Delivery

Chapter II Post-Partum

Chapter III Nursery

Section II Critical Care Units

Chapter IV Intensive Care Unit-Icu

Chapter V Emergency Room

Chapter VI Dialysis

Chapter VII Progressive Care Unit-Pcu

Chapter VIII Medical Intensive Care Unit - Micu

Chapter IX Surgical Intensive Care Unit - Sicu

Chapter X Cardiac Cath Lab

Chapter XI Review

Acknowledgement

Before I even started this book I always told my students that someday I would write a book on Clinical Journaling and use their journals to emphasize the advancement shown while advancing their education to becoming a Registered Nurse. At this time I would like to thank all the students I had the privilege to teach during my tenure as their clinical professor. Without the input they gave me, the experience we went through, this book would not have been written. I was privileged to have had such great students that kept me young during my tenure while teaching them.

I would like to thank my husband Alwin, for his support and patience when I would sit down to write and forget lunch or dinner. My daughter Patricia who would come over whenever I needed help with my computer, printer or the internet. My friend Richard for reviewing my writings and his knowledge in helping me with the publishing of this book. My colleague Eloisa for all the editing and her awesome knowledge and reviewing of my book. My son David and his wife Malou reviews, corrections and the pictures she took of the areas we did our clinical in and needed. I am very grateful for all the encouragement that I received from all my family; Michael, Mary and all my friends whose encouragement helped me to complete this project. I would like to acknowledge Diana for her support when I mentioned my need to publish my book. Thank you to Ann who helped me find a way of self-publishing my book.

Introduction

Having been a nurse for over 43 years and a Woman’s Health Nurse Practitioner for ov32 years I have had the privilege of teaching my patients to learn and practice better health care as well as instruct their own families. At times I encounter some who say that their own daughter or son was now in college or already in nursing because of the education I had encouraged them to pursue due to my coaching.

I then entered Academia and transitioned as an Associate Degree Nursing instructor lecturing during their actual Clinical Rotations. But, how was I to evaluate the understanding of their clinical experience?

As educators we are forever researching new methods to use to enhance our students’ learning. With the constant and innovative changes occurring in nursing and medicine, we need to continue to find new methods especially when transitioning students from lecture and simulation to the actual nursing care of their hospital patients. The question then arises as to how to evaluate these students. A syllabus which provides grading: Satisfactory, Unsatisfactory, as well as Needs Improvement, Met or Did Not Meet the Essential and/or Non-Essential areas that are required.

At this time I enrolled in a course on Reflective Journaling. During this course I realized how this would be an area where I could evaluate and grade my students in their clinical rotations. I would be able to interpret and analyze the student, critically examine his or her professional practice and explore the social responsibility by promoting the value in journaling. The journals would not be a diary but with the changes of areas to be assigned there would be objective comments and subjective feelings and reactions recorded to serve as a communication tool between and among their student colleagues while documenting all his or her clinical hours. This will be a tool to help bridge theory and practice by strengthening critical thinking and allowing the students to analyze their clinical situations and examine their true feelings. The majority of the students in our program have been raised with English as their second language and some have difficulty verbalizing their true feelings. By writing their feelings each student is able to reflect by giving them more confidence in themselves in the clinical area. It also continues to develop each clinical experience as they continue to learn effective communication, to evaluate the efficacy, the benefit, and the success of a patient or group of patients under his or her care.

The students will be able to focus on their thoughts and feelings of everything they have experienced during each clinical experience. This will result in new insight allowing the student to reflect on thoughts and feelings as he or she evaluates outcomes and assists in a new approach, in the future, as to any modifications in similar cases.

Reflective journaling has now established a way to bridge theory and practice as it describes the experiences observed as applied to nursing skills. This will be done by identifying the use of critical thinking during the nursing process as they perform their nursing skills in their own words.

Usually a visit is made to the healthcare facility the evening before the clinical experience to review records, research medications and prepare a preliminary care plan. At this time and based on the unique needs of the patient, the student’s preparation may require a relative short amount of time or perhaps several hours. Students are prepared during their pre-conference meeting in which the daily course topic, clinical activities and course reading are presented and reviewed. Providing a hands-on experience for the nursing students continues to be met in their actual clinical setting where there is an opportunity to implement theory and practice while performing and perfecting their nursing skills.

Clinical practice allows the student to become professionally socialized improving their problem-solving, decision making and time management abilities. This also provides safe and meaningful learning experiences, connecting the students in the realities of nursing practice. The journal should show critical thinking, their personal learning, the ability to reflect on their clinical experience and become willing to examine their social responsibility as a professional. The journal is sent to the professor electronically on a weekly basis and includes clinical objectives, post assessment objectives, their perceptions of the clinical and develop an awareness of the clinical decision making with their time during each clinical visit as e-mail attachments.

I will share with you some of the journals my students turned in for review. The subjects I decided to follow are Responsibility, Grasping and Learning Procedures, Identifying, Continuance of Really Caring for Each and Every Patient, Striving to Really Help, To Always be Kind, Maintain a Kindly Face, and Poignant while caring for the patients assign to them during their clinical assignments. These will be journals from their Maternity Rotation including Labor and Delivery, New Born Nursery and Post-Partum areas and the Critical Care areas including Intensive Care Unit, Emergency Room, Dialysis, Progressive Care Unit, Medical Intensive Care Unit, Surgical Intensive Care Unit and Cardiac Cath Lab.

SECTION I

MATERNITY

LABOR AND DELIVERY

Chapter I

LABOR AND DELIVERY

The journals will be first while in the Maternity rotation. This clinical takes place on the last year of the student’s nursing program. The students are introduced to Maternity consisting of Labor and Delivery, Post -Partum and New Born Nursery. The first journals will be about Labor and Delivery.

I. SENTIMENT

Responsibility

Today I started my OB clinical today in Labor and Delivery. It was an interesting day to say the least. I am not familiar with OB and never really cared to learn about the subject but when faced with a challenge I gladly except it. It was interesting to meet women who just had a baby. I got to see what an incision from a C-section looked like and a vaginal delivery. I never realized how much blood a person could expel from their body. I got to do an assessment on a pregnant client to test for reflexes and I held my hand to the belly and felt the contraction. It felt like the stomach was tightening and then let loose, I like that. I got to help take out several IVs and even helped my classmate start one. The patient was a very hard stick and took several nurses to do but finally the patient could get her antibiotics. I was sad that I couldn’t get to see the C-section but I will get the chance and I am happy to wait. Next week I would like to start an IV and maybe learn more about what a woman is going through after birth. This experience has also made me think about having children and what will happen with me. I also wanted to note that I was very upset that the staff on the floor usually did not knock on the door before entering, to me this was not right and patients have the right to privacy.

In this journal I noticed the student first came to the clinical area not really expecting to enjoy or learn from this experience. As you read her journal she found herself wanting to learn more and actually pleased with her experience learning the delivery process and sad she had missed a C-section and unable to start an IV. But satisfied her patient finally received her antibiotics. She also noticed the need to always protect the patient’s privacy and knock before entering a patient’s room which was very important to her. She was now willing to wait for the next clinical to see a C-section.

Today I observed epidural procedures. I enjoyed this experience and learned more compared to last week. The CRNA I observed today did a good job of explaining the epidural procedure to me step by step. She even went over the anatomy of the spinal cord to further my understanding of the procedure. I learned that the patient should be injected in the lumbar portion of the spine because this is the area where there are no more nerves coming out of the spinal cord. I also learned that the injection shouldn’t be placed too low because it may hit the sacrum, which is a fusion of bones. Then, I assisted the nurse as she prepared the patient for a Foley catheter (I learned that a Foley is usually inserted after an epidural is administered).

I later observed a vaginal birth. This resulted in a minor midline laceration to the mother’s vagina, which the doctor stitched up. These are the same stitches I learned about in my OB lecture class. I know that these are the same stitches that do not need to be removed once the laceration heals because the stitches are capable of dissolving themselves.

I observed a dilatation and curettage for the first time. This patient was 14 weeks pregnant before she experience fetal demise. After the D&C, I got to see the fetus which I was told is going to be sent to pathology.

This student began her day making herself available to learn as much as she could and was able to be present with many procedures which left her different aspect of being in a labor and delivery area. She made sure she observed and participated in as many procedures as possible. She asked pertinent questions while she observed the procedures and making possible to refer to her lecture class while observing the delivery.

Grasping to Learning Procedures

Today’s clinical day at Labor and Delivery was full of excitement. We got busy as soon as we arrived. I was with a nurse since the charge nurse was training a new nurse. They were both very helpful and friendly. For instance, as my nurse was doing the assessment she was guiding me and telling me the reasons why those questions are asked. She did the assessment and taught me how to measure the fundus and to look for edema on the legs and always assess the reflexes. The first patient we had was slightly edematous. I have always read in the books but it leaves a lasting expression once we assess it and see it for ourselves. As the day went by I also placed the fetal monitor, the toco, pulse oximeter, blood pressure cuff, and learned how to replace the paper where fetal rate and the contractions are recorded, auscultated lung sounds, counted respirations and ask questions myself to a new admitting mom. Learning about accelerations and decelerations and how to count contractions was very helpful. On another birth, I saw the entire delivery process and then got to hold the little newborn. This was an amazing moment for me because I love babies. Seeing and holding the newly born baby girl and just looking how she would blink her little eyes, move her little fingers, open her little mouth definitely made my day. Although this baby’s mom was exhausted, I could see she was happy to have her little baby right next to her as she started breast-feeding her. Being present during this particular birth made my day.

This student began his clinical day meeting all the challenges willingly and eager to learn. He was grasping every opportunity to learn and practice all his nurse was exposing him to by applying his learning to his patients. But to him the most amazing thing was the experience with the newborn. To actually hold the baby and evaluating her was just awesome to him and a great experience of learning.

Today turned out to be very exciting, productive, and educational clinical. I got to observe the nurses role during a hysterectomy and a cesarean section. I saw the scrub nurse assist the doctor during the operation by helping him open the incision sites, providing the tools, and suturing the incision at the end. I observed and assisted the other nursing staff count and check the tools, log the operation times, and clean the room after the operation finished. I helped admit a patient that was to be taken in for an immediate C-section by providing the supplies for the charge nurse, prime the IV, apply the leg stockings, and observe the interview process. Finally I saw my first delivery and assisted in the role nurses play in deliveries by coaching the mother and helping the charge nurse take and document vitals.

I read several fetal monitors and was able to understand that they monitor the fetal heart rate, blood pressure, and the mother’s force of the contractions for abnormalities. I learned that the nurses collect incised fallopian tubes and send them to a lab for study in order to determine that they are fallopian tubes. I learned that an endoscopy is presented in the bladder after a hysterectomy in order to determine the ureters were not damaged by the procedure. Indigo dye is administered in the bloodstream and filtered by the kidneys. A normal reading shows indigo entering the bladder from the ureters, if not a catheter is inserted to act as a ureter until it is healed.

This student was very excited with this learning experience. He was able to participate during a C-section