As a first semester nursing student, there are limited things that you can do in the hospital. In the first 4 weeks, I struggled to figure out how to help patients. I had put in two straight catheters in patients, but they were not my patients. Those seemed more like in and out tasks, instead of truly helping them out. It was not until the fifth week of my clinical rotation where I felt like I had made a difference with the patient’s care. This last week was the first time I sat down with the patient and got to know their history and why they were in the hospital. I was lucky enough to have the patient’s spouse in the room to help initiate talking about their back story. They had spoken about how immersed in their community they were, and how it had been difficult not being able to be around to help their neighbors. I felt important just as someone to have therapeutic conversation with them. It was easy to see that they had missed interacting with their community and I was glad to be there for them in rough times. They had spoken about how the patient had restless leg syndrome. This was a diagnosis I was familiar with, but did not have first-hand experience with. When the patient started to have symptoms of the condition, the spouse became worried. Although there was nothing that I could do while the pain medication kicked in, I knew I had to be there for them. It was starting to get to the time where the spouse had to leave, but they did not want to leave their partner in that much pain. This was the first instance where I had to reassure someone that the health care team will do their best to take care of the patient when they are gone. In this moment, I saw the amount of appreciation in the spouse’s eyes. This was the first time I truly felt that I was important in this couple’s well-being, even though I could not do much regarding the physical state of the patient. Emotional well-being can be just as impactful, and I learned that on this day.
Self-Care Exemplar
My first wellness goal of this semester was to improve my life balance and satisfaction. To obtain this goal, I created some strategies to try throughout the rest of the year. The first strategy I set was to go to bed at a reasonable time each night. I believe I have been good at sticking with this goal. Getting enough sleep is so important to me, especially during the school year. I know my brain works best with eight and a half hours of sleep, and I usually reach that number every night. During the week, I practically never go to bed later than 10:30pm. The only time I break this habit is on the weekends, but this is partly to achieve another strategy of making time for myself. I tend to get stressed about school and put all of my focus on homework and studying. This semester, I wanted a change in that mindset to allow time for self-care. I have been trying to follow a weekly schedule of homework of Sunday through Thursday, and taking Friday and Saturday to myself, hanging out with friends, or seeing family. I have been able to keep this schedule through most weeks, but sometimes it had to be broken for studying purposes on the weekends. Self-care is important to me because it will be necessary in the future, especially being a nurse. It is best to learn the most favorable ways now as a student, so I can apply them later in my adult life.
The second wellness goal I set for myself this semester was to improve my physical health. My first strategy was to meal prep for the week and plan meals in advance. I did a great job doing this at the beginning of the semester, but as I became busier, it was much more difficult. Although I love to cook, it is hard to make time to prepare fresh meals when my school schedule each week is different. This has led to much more snacking than I had planned to do. One of my strategies was to not snack as much during the day. Although I did great with this at the beginning of the semester, I found myself buying more snack foods at the grocery store and eating snacks instead of meals. I did a great job with my other strategy of going on walks. The past few weeks have been less often because of the cold weather, but I try to go when it is not as cold. That is the extent of my exercise for the week. So, I can say I did not achieve my last strategy of doing exercise or cardio at least twice a week. What seems to get in the way of working out most is my motivation. It is hard for me to get started, especially when I have a busy day and all I want to do is relax. Once I get myself going, it is easier from there.
When it came to improving my life balance and satisfaction, I was willing to change. I believe my willingness to change was my driving force to achieving my goal. I knew that these changes were necessary for me to be successful in school and in my personal life. I believe I am now in the maintenance stage of change for this goal. My second wellness goal however, I do not believe I was truly ready to start the process of changing. I have contemplated for a long time about changing my physical health, and I have prepared to take the next step to change. It seems that I cannot get past the preparation stage and into the action stage. I think in the future, I should designate specific days to exercise that align with my schedule. This way, I cannot make excuses as to why I cannot do something. I still truthfully think that I am not completely ready for this change. This is a topic I will need to revisit within the next few weeks and decide my plan from there. This can also be applied to patient care because sometimes, you do not have a specific plan or have all the information you need. In this situation, it is okay to take time to revisit and change plans. In nursing, things are constantly changing, and it is important to learn how to adapt. One last thing that is a reminder to myself is that it is okay to ask people for help. This can be applied to my life now, and especially in the future as a nurse.
Empathy and Compassion
Being a great nurse requires a multitude of skill sets. Along with practical and hands on skills, a nurse must have both empathy and compassion. Although compassion and empathy are closely related, they differ in meaning. Empathy is the ability to see one’s pain and suffering and understand what they are going through (“Compassion Definition” 2020). By viewing the situation from the patient’s perspective, a nurse should be able to take on and feel the same emotions. When a nurse experiences empathy, generally what comes next is compassion. Compassion is the desire to help relieve the patient’s suffering after empathizing with what they have been going through (“Compassion Definition” 2020). These two concepts played a large role in Jean Watson’s development of the 10 carative factors that are critical to providing patients with caring interactions, which I can apply to my future clinical practice.
When it comes to Jean Watson’s theory, caring and compassion are essential to nursing practice. She believed that compassion can change simple medical care into health promotion, which is a focus of nursing. By taking a holistic approach to practice, it promotes healing and a feeling of being accepted, instead of a patient feeling judged. This shows that a patient is truly valued and cared for, which can create a more open environment to healing. These concepts are what influenced Watson’s development of the 10 carative factors for nursing practice. The purpose of her developing these factors was to create ideals to be addressed by nurses when caring for patients. By integrating these 10 factors, a nurse can change their job of just practicing their profession into a caring role. Through caring practice, a patient feels valued, is more likely to heal quicker, has less pain, and expresses less anxiety. Patients are also more likely to follow care plans if they feel supported and are able to contact providers easily if they need help (Steele, 2017). Not only does the patient feel better, practicing compassion can make the nurse
feel better, slow their heart rate, and decrease their risk of getting heart disease (“Compassion Definition” 2020). When the nurse is feeling good, they are able to provide the best care.
During my first 4 weeks of my clinical rotation, I had struggled making a connection with my patients. It was not until my last week that I truly got to know my patient and their family enough to provide compassionate care. I was lucky enough to have both the patient and spouse in the room with me to talk about how the patient had ended up in the hospital. By being able to hear the story from two points of view, I was able to really understand what the couple had gone through. They had spoken about how immersed in their community they were, and how they would always do their best to help their neighbors. Feeling isolated from their community from a long stay and a long commute to the hospital was difficult for them. Being able to be there for them, just as someone to talk to and share interests with, felt important. Not only was I important to the couple through providing therapeutic conversation, they also felt important to me by giving me purpose and meaning as a student who can only perform minimal tasks in the hospital. Through being able to empathize with this couple’s story, I felt compassion. I wanted to do anything I could to try and ease this family’s suffering. I was able to establish a supportive environment and promote an expression of feelings with this couple, demonstrating the use of some of Watson’s 10 carative factors.
Later in the evening, the patient began to have intense spasms with pain. The nurse had administered medication, but it had not kicked in yet. In this situation, there was not much I could do for the couple. The role I played in this situation was as a messenger between the family and the nurse. The nurse had told me that the medication was supposed to work within the next 20 minutes. I was able to convey this to the patient and their spouse to assure them that the pain would not last much longer. This was around the time when the spouse was scheduled to leave. They expressed concern about leaving the patient alone, especially in his condition. I was able to put her mind at ease by letting her know that the staff at the hospital will do their best to make sure the patient is okay. By speaking to the spouse, not only was I able make her feel hope that her spouse would be in good hands, I was able to establish trust between her and the healthcare team. This is another example of using some of Watson’s 10 carative factors.
In the future, I think it is important to establish a trusting relationship with your patient from the beginning. By establishing trust and compassion at admission, it allows the patient to be more comfortable and more open to receiving care. I wish I was able to spend more time with the patient and develop that trust sooner. This is something that I want to work towards and apply to the rest of my clinical rotations and my future nursing career. I believe trust is one of the best ways to incorporate caring behavior in clinical practice. By establishing a caring nurse-patient relationship through trust, the goals become more easily achievable. Not only is it important to have the patient trust you, you must also have faith in your patients.
I know that I wanted to become a nurse because I have always liked helping people and would like to incorporate that into my future career. Some of the best ways to care for people are through empathy and compassion. Without these two concepts, nursing would just be another profession, instead of caring for the ill, restoring, and promoting health. Through empathy, compassion, and Watson’s 10 carative factors, I will be able to improve patient outcomes and satisfaction. The best ways to incorporate these concepts are through establishing trust, providing therapeutic conversation, and incorporating emotions and feelings with problem solving. Caring behaviors are essential to nursing practice and the well-being of our patients, and I plan to incorporate them into the rest of my years as a student, and in my future nursing career.
Medication Reconciliation
Client Name JK Date of Review 11/1/2020
Allergies: none
Storage of Medication: drawer
Keeps medications in original container? Yes, unless traveling: will take what is needed for trip and put into one bottle
Access issues? none
How many providers does this client use? 1
| Drug (generic) | Trade Name | Dose | Where client obtains meds from? | Frequency | Intended Use | Patient Use (if different) | Demonstrates UnderstandingYes or No |
| Rosuvastatin Calcium | Crestor | 20mg | CVS | 1x before bed with full glass of water | hyperlipidemia | High cholesterol | Yes |
| lisinopril | Zestril, Prinivil | 30mg | CVS | 1x in morning | hypertension | High blood pressure | yes |
| Albuterol sulfate | Airomir | 90mcg per actuation | CVS | About 5x a year | Bronchodilator | Allergy season rescue inhaler | yes |
| indomethacin | Indocin | 75 mg | CVS | During gout attack (about 1-2x a year)Takes 1-2 a day PRN (ranging from 2 days-2 weeks) | Anti-inflammatory | Gout | yes |
Based on your review of the above individual’s medications, what do you feel are actual or potential safety concerns surrounding medication administration and why?
Rosuvastatin Calcium is a medication given to reduce total and LDL cholesterol. The patient expressed known possible drug-drug interactions between this medication and lisinopril. To reduce risk of interactions, rosuvastatin is taken at night and lisinopril is taken in the morning. Another possible interaction with rosuvastatin is with antacids. It is important to remember to take an antacid at least 2 hours after taking rosuvastatin so it does not decrease the effects of the medication. Indomethacin can interact with lisinopril, reducing the hypotensive effects of the medication. Since indomethacin is not taken on a regular basis, it is important to closely monitor blood pressure when taking this medication. If the effects of lisinopril are reduced, the patient should call the provider and see if an adjustment of the dosage is necessary. When taking indomethacin, it is important to take with food to avoid GI upset. Indomethacin can also increase the risk of heart related issues, especially in patients with preexisting conditions. The patient expresses understanding to take this medication for the shortest duration necessary. It is most important with these three medications that aspirin and alcohol uses should be avoided. Safety regarding albuterol sulfate involves proper administration of the medication through the inhaler. The patient demonstrated correct understanding on how to properly use the inhaler and when the inhaler is necessary.
Considering concepts of safe medication administration and delivery, how would you approach a teaching plan with this individual to improve the safety of their medication delivery?
When it comes to a patient who has high cholesterol and high blood pressure, education is extremely important. Even though this patient was genetically predisposed to these conditions and is not overweight, diet and exercise can still contribute to decreasing these levels. Cardiovascular exercise is a way to strengthen the heart muscle and decrease the mass of the left ventricle (Bacon et al., 2004). By having a stronger heart, blood can be pumped more effectively. When blood is pumped more effectively and efficiently, blood pressure will decrease. Exercise is also a great way to reduce stress, which can lead to a decrease in blood pressure. For patients with high cholesterol, it is important to avoid a diet high in fats. The best way to do this is by avoiding fried foods and saturated fats. Another great way to affect lipid levels is by adding more fruits and vegetables. For the best results, medication therapy for these conditions should be given in conjunction with diet and exercise
Medication Reconciliation Reflection
When doing the medication reconciliation assignment, I had noticed some safety concerns. The first safety concern I noticed was that indomethacin can interact with lisinopril. Indomethacin reduces the hypotensive effects of lisinopril, so it is important that blood pressure is closely monitored when taking these two medications together. It is also important to avoid alcohol and aspirin due to its interactions with rosuvastatin, indomethacin and lisinopril, and wait 2 hours before taking an antacid after taking rosuvastatin. The patient showed significant knowledge of each medication and why they were taking it. They also showed appropriate understanding of how and when to use their albuterol inhaler. The only interaction that was unknown to the patient was between indomethacin and lisinopril. By doing this assignment, I was able to learn more about these drugs which allows me to apply this knowledge during my clinical rotations.
