NURS 4027 Preceptorship

What is it?The Reflective Journal is an evaluation method for

this preceptorship experience. For this course Reflective Journaling refers to a body of work that evidences the learning that has taken place in the Preceptorship Experience and perhaps throughout the academic career. The purpose of journaling is to encourage self-directed learning and reflective practice. Although there are some guidelines for its development, it will be your own project, developed in your own way. Your journals should capture and reflect on all three (3) dimensions of process, context, and perspectives.

Helpful HintsFor example, you should be able to reflect on an

issue/situation/event considering all of the various context concepts and discuss health perspectives. The Collaborative Bachelor of Science in Nursing Program Student Handbook should provide some further guidance (approx. page 32). Your journal is your personal way to illustrate the things in the course and experience that have been most important to you and to record them in a way that has meaning for you.

Each entry will include:

Evidence of engagement with the material related to the assigned topic.

Evidence of critical thinking.Reflection on personal meaning, making very

explicit links with content from courses taken throughout your academic career, and related literature.

Reference to scholarly nursing literature – journal articles as needed.

The journals must follow APA format (no first person writing).

Marking Criteria

Reflective thinking is the hallmark of Reflective Journaling. In turn, reflective journaling can begin the process toward reflective practice, an expectation for all Registered Nurses.

The Reflective Journal is to be submitted via email to the course professor, it should be approximately 3 pages in length. The Reflective Journal is also to be:Consistently handed in on time (see schedule below). Increasing in breadth and depth as the semester

progresses.Responding to formative feedback. Incorporating relevant literature as needed.

A Fake experience for Real Life

On September 27, I was able to experience one of the three parts of our fourth year clinical rotation, which is simulation. Simulation lab is where there is a scenario set up with a “doll” which is to replicate a real life patient and real life nursing situation. Students are to react as they would if they were a practicing Registered Nurse who had just walked into the situation. There is a team made up of a primary nurse, a secondary nurse, a recorder and a wife, which all add an extra element to the ‘real life’ experience.

In the first scenario given to students, the patient is in Congestive heart failure (CHF). Students make a preclinical based on the dx of CHF and the listed meds for that patient, what is unknown is the state in which the patient will be in when we arrive and what will happen as the scenario goes on. In our group there were eight students, and the scenario was repeated a few times as the roles were switched among the students.

As we all assumed our positions for the first run – through, our heart rates were raised, limbs were shaking and we were all a bit diaphoretic; I felt in worse shape than the patient. As we went through the first time it was a bit relieving to know that not all the students knew exactly what they were doing, and that I wasn’t the only one. It was so interesting to learn how everyone would have gone about that situation and there wasn’t just one straight answer, there were options to the right solution. In simulation lab room, there was a monitor hooked up to the patient displaying the vitals and heart rhythm of the patient, a very realistic possibility, it was interesting how one device can change the way the students handle the situation. For me personally I noticed how much my attention was drawn to the monitor instead of the patient in front of me. With almost all the students it was obvious that the monitor did not go unnoticed, in fact in many cases, determined the actions that were taken. When it was my turn to be the primary nurse the same scenario had run three times previous. The secondary nurse and I had been doing everything to a tee because we knew exactly what the others had done and not done, so we were doing everything that we had just seen that we didn’t even realize that our patient was in normal

sinus rhythm and we were still moving ahead as if he were in an emergency situation. All I was concerned with was if the heart rate was above 60, enough to administer Lasix, what I didn’t notice is that my patient was just put into V-FIB induced by us the nurses. I remember being so confused because the monitor said this patient had a pulse, however to feel the patient, there definitely was no palpable pulse. It was then I realized how easy it was to forget about the patient and to remain focused on the monitor.

From this experience, I learned so much. Although I was so nervous before hand, it was so valuable and applicable, which is definitely helpful as a fourth year student, soon entering the real world. The greatest value that came out of this experience, and that I’m sure will continue to come from future simulation scenarios, is that ability to think outside the box. It is a skill no text book can teach, that no one can learn through lecture, it is a skill learned only from experience. Especially as a student it is very easy to

get stuck in this frame of mind that the text books created or what we have been told to do, to actually use common sense and to think outside the textbook definitions is actually quite difficult. So, I am very excited to have this simulation lab available in our clinical rotation I am very excited for the next one, and can’t wait to learn more.

Caring

The word “caring” is often used in connection with the profession of nursing. Caring can be thought of in the physical sense, with a caregiver having the “responsibility for or attention to health, well-being, and safety” (U.S National Library of Medicine, 2003, p.1) But for others, there is the emotional dimension of caring in which a person feels or shows concern or compassion for other people (Farlex, 2009). Nurses are in the challenging position of dealing with both of these aspects of caring. After spending time in an educational setting completing nursing courses, working in clinical environments, and reading recent relevant literature, a nursing student is likely to come to the realization that the concept of caring is very complex indeed.

Many students enter nursing education programs with a vision of playing a caring role in their future profession. Whyte (2009) illustrates this point well. She interviewed five students who began a nursing course in Liverpool, England in September 2008. It is interesting to note that all of the students mentioned the fact that they wanted to enter the nursing profession because of a desire to help others and provide care and support for clients and their families. This particular training institution accepts only a small group of 45 to 50 students from the 660 to 700 applications that they receive. Acceptance is not just based on previous academic success. Each prospective student must submit personal statements. Individuals who have been touched by the work of nurses are the ones who are often chosen (Whyte, 2009). The admissions tutor defends this practice by saying, “you cannot nurse using clinical skills alone. You need to be able to empathise and understand the illness through each patient’s eyes” (Whyte, 2009, p. 19). It would be interesting to follow these students through their education careers and into their

professional lives and see how their views on caring evolve as they face the realities of working in a profession that provides many challenges.

As nursing students progress through their pre-graduate training and begin to work in the profession, it is likely that their opinions on the concept of caring will evolve. University courses provide information on the needs of different age periods, biological background knowledge necessary for nursing practice, and theoretical components related to the profession. Clinical experiences give student nurses an opportunity to practice and perfect the clinical skills and communication techniques so necessary when caring for clients. During the preceptorship program, it is time to work with an increased patient load and therefore a nurse’s ability to provide high quality care in the face of time restraints is tested. The nursing student may also have the opportunity to work with individual patients over a period of time and therefore take the emotional caring relationship to a higher level than is possible during the clinical experience. While

participating in the preceptorship environment, the student’s perception of the concept of caring may also by influenced by the views of other nurses as they express their successes and frustrations.

In contrast to that expressed by Whyte’s students, a different perspective on the concept of caring is discussed in an article by Twedell (date). Twedell takes an approach that at first seems quite cynical, as she describes a nurse’s “duty to care”. This is a contrast from the nursing students’ optimistic outlook on the role of nurses as caregivers. Twedell talks about the potential threat to the health of nurses and their families from a pandemic influenza outbreak. Nurses were placed in danger during the SARS outbreak and Twedell offers her opinion that personal risk and duty to care need to be clarified

through discussions in the nursing community (Twedell, 2009). Although worrying about a pandemic influenza outbreak may seem extreme, Twedell’s article raises some thought-provoking ideas on the topic of caring. Nurses daily place themselves at risk due to the demands of the job. Shortages in healthcare institutions at the present time make caring for others difficult and challenging. Dealing with the stress of working in difficult conditions means that nurses often put their own mental and physical health at risk in order to care for others.

During their lifetimes, many people are placed in the situation of caring for other individuals. Nursing is unique in that it is a profession in which caring is paramount. Although there are many challenges involved, there is also the reward of making a difference in the lives of their patients.