Beth Mancini, RN, Ph.D.
Introduction
The cooperative nursing work experience is designed to give BSN students practical experience and a chance to relate nursing practice to the theoretical knowledge acquired in class. Besides integrating class knowledge to nursing practice, the course gives BSN students a chance to develop skills in leadership and professional conduct, technology management and appreciate lifelong learning. I did my cooperative nursing work experience in a psychiatric hospital with various units for children, adults and chemical dependency. My goals in the program were to develop skills in evidence based practice, professional conduct in line with APNA guidelines, and performance in a team by rising above team dynamics.
Evidence based care requires nurses to base nursing decisions on credible evidence. This was evident in my cooperative nursing work experience when I was required to determine whether patients in the chemical dependency unit required the medicines they were asking or whether they wanted them just to substitute their addictions. Professional conduct skills were developed by implementing patient centric care. I spent more time with my patients especially in the chemical dependence unit where the workload was lower. This enabled me to educate the patients and enabled them to make informed decisions on the type of care they wished to have. An incident of a broken pipe flooded some units and the supervisor was busy moving the patients form the flooded unit. I took the opportunity to develop my team work skills and communication skills by working with other unit leaders to determine the location of needed drugs rather than wait for the supervisor who used to direct me on drug location but was unavailable. In this reflective essay, I discuss the skills developed during the cooperative nursing work experience in relation to the BSN program courses and how these skills helped me to realize my goals for the program.
Goal 1: Evidence Based Practice
My goal under the skill of evidence based care was to develop treatment plans that are clinically relevant and can be followed by patients and nurses for three of my most acute patients. This would enable the patients to be active participants in their health and reduce the rate of relapse for patients in the chemical dependency unit. To achieve this goal, the first step was identifying the hospital regulations regarding treatment plans. Then I identified the acute patients and doing a search for treatment options that are safe, effective and could be implemented with the existing resources.
A significant experience that contributed to achieving this goal was the case of a 16 year old girl who was admitted after an attempted suicide. I helped this patient identify personal goals such as reducing anxiety and improving self confidence. The patient responded positively to the treatment plan and including the parent in care delivery enhanced the quality of care. Kuhlthau et al., assert that involving the family in care delivery helps to promote positive patient outcomes in children with special health care needs such as those undergoing psychiatric care (2011). This is evidence supporting my approach to the case.
Goal 2: Professionalism
My goal under professionalism was to make change in at least two areas to enhance the quality of care offered or to better comply with APNA guidelines. To achieve this goal, I identified situations which jeopardized patient care and looked for ways to mitigate the situation in a timely and professional manner. In one incident, I was assigned to the children unit which had 17 patients, 7 of whom had been classified as acute. The hospital policy requires 2 nurses in the children unit when there are over 15 patients or a high ratio of acute patients. I notified my supervisor of this situation which was unsafe and could reduce the quality of care. Unfortunately, I could not get another nurse assigned to the unit and I worked alone. Afterwards I filed an incident report as required by APNA guidelines and knowledge acquired in school.
This intervention helped as the hospital reemphasized on the appropriate staffing level in different settings and it ensured there was a standby nurse in the children unit when the situation called for more than one nurse. An appropriate staffing level not only complies to APNA guidelines but also improves the quality of care offered leading to better patient outcomes (Polacek, 2012). The goal of professionalism was also exhibited when developing treatment plans in which I acted in the patients best interests. Professionalism changed my attitude of a nurse as just a care provider to a patient, to the view that nurses are partners in the patient health and should preempt situations which would jeopardize patient health. To further develop professionalism, my future endeavor in the field will involve using hospital and APNA policies as tool to improve patient care.
Goal 3: Team Dynamics
My goal under team dynamics was to identify and solve a team problem in the hospital. One of the problems I identified is breakdown in communication during shift handover leading to discontinuation of work started by the previous shift. To address this problem, I ensured proper documentation to ensure that the incoming nurses had all the required information to continue care delivery. This was critical since this hospital had no computer systems to handle patient’s records and handover. According to Govier & Medcalf (2012), digital health records helps to improve patient handover and introduction of a patient computer database was part of my recommendation to the hospital management.
Another experience that helped me realize the goal of enhanced team dynamics was the frequent allocation to the adult unit. Although this reduced the time spent in the children unit, working with the adult unit team enhanced cohesiveness since we were able to implement a treatment mall in which a multidisciplinary team is used to provide holistic care. This was important since some patient had problems which could be solved by other disciplines. For instance, there was a suicidal patient who at 16 years felt was obese and ugly. Involving a nutritionist helped the patient to develop better eating habits for weight control. The treatment mall provided one-stop care and is a recommended approach to treating acute mental illness in a hospital setting (McLoughlin et al., 2010). The treatment mall approach enhanced communication and helped address the problem of communication breakdown during patient handover. Going forward, I will endeavor to promote team work in patient care through peer education of the importance of team work and invoking interdisciplinary health care teams to provide holistic care to the patients.
Conclusion and Impact on Practice
The cooperative nursing work experience provided an opportunity for me to develop skills such as applying evidence based care, team work and professional conduct. These skills are the basis of the BSN program and developing these skills leads to positive contribution to nursing practice (Spetz & Bates, 2013). The experience helped me to apply skills such as formulating goals, research for evidence and best practices, and doing reflective journaling which I had learned in school to solve actual nursing practice problems and influence patient outcomes positively. This is well aligned with my philosophy of nursing that addresses society, environment, and patients. The society is a group with common interests such as a nursing team interested in offering quality health care services. The environment refers to the platform on which the society thrives. Quality healthcare services results form positive interaction between the society and the environment with the patients need as the guiding principle. Solving team dynamics problems such as witnessed in this course makes the society cohesive and the environment suitable for health care delivery. Looking forward, I will endeavor to live my nursing philosophy every day by promoting patient care through evidence based care, policy changes and continual education to acquire new skills and enhance the old skills.
References
Delaney, K. R., & Johnson, M. E. (2012). Safety and Inpatient Psychiatric Treatment
Moving the Science Forward. Journal of the American Psychiatric Nurses Association, 18(2), 79-80.
Govier, M., & Medcalf, P. (2012). Living for the weekend: electronic documentation improves patient handover. Clinical Medicine, 12(2), 124-127.
Kuhlthau, K. A., Bloom, S., Van Cleave, J., Knapp, A. A., Romm, D., Klatka, K., &
Perrin, J. M. (2011). Evidence for family-centered care for children with special health care needs: a systematic review. Academic pediatrics, 11(2), 136-143.
McLoughlin, K. A., Webb, T., Myers, M., Skinner, K., & Adams, C. H. (2010).
Developing a psychosocial rehabilitation treatment mall: An implementation model for mental health nurses. Archives of psychiatric nursing, 24(5), 330-338.
Polacek, M. (2012). Staffing inpatient psychiatric units. Journal of the American
Psychiatric Nurses Association, 18(3), 144.
Spetz, J., & Bates, T. (2013). Is a Baccalaureate in Nursing Worth It? The Return to
Education, 2000–2008. Health services research, 48(6pt1), 1859-1878.
