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Blog #5

This has been my first semester in nursing school with clinical time. Although it has been cut short with in person clinicals, I am still participating in patient care online through virtual experiences. In the short time that I was in the hospital setting I have seen improvements in my communication skills.

Reflecting back on my first day on the unit I was so nervous. I remember feeling uncertain on how to talk to my patient and there was a lot of awkward silence. I do not think that in this case the silence was therapeutic. I was uncomfortable communicating with my patients early on this semester. I have seen through each patient I work with how my communication is increasing. I am less nervous and uncomfortable. I try to be friendly and positive; I want to talk to them and let them know my job is to provide care for them. I have seen through relationships with some of my patients that since I try my best to provide good care for them and actually talk with them while I am in there, that they enjoy when I come back to their room. Having a patient happy when I am in the room is a great feeling to have. I have seen my nonverbal communication skills develop during my clinical experience. I have been taught new skills in this class and other classes that I can actively apply to my clinical work. I try to make a point to make good eye contact, use a soothing tone of voice, and maintain an arm’s length distance. I make it a point to explain to the patients what I am doing so that when I perform an assessment or administer medications, they are not concerned why I am in their physical space. Verbalizing what I am doing or what I plan to do is also a way to keep the patients involve in their care. This offers them the time to decide what type of care they want if they want me to do something or not.

I want to keep improving in my skills. I want to have confidence with new tasks in my practice. That has been a challenge for me this year. I know I am capable of new tasks but each time I get an unfamiliar task I get a little nervous. Then after the task is completed, I look back and wonder what I was nervous about. I talked to my instructor about this and she told me that as a nurse I will never know everything, there is always going to be an unfamiliar task. The important thing is being calm and being able to think through it and perform. I want to grow in my confidence and not get frightened with unfamiliar tasks. I know that I can present myself in a confident manner to my patients, but I want to have that same confidence inside myself. Growing in my skills will allow me to have better nonverbal communication skills. I will sit up straighter and have a strong voice and be confident in the care I am giving.

I would like to grow in my professional vocabulary. I want to increase my knowledge and use of medical terms in appropriate settings. I feel that a strength of mine is being able to explain things to patients in simple terms. I want to work on my knowledge and familiarity with medical terms as I think this will help my reports, care plans, and charting. I have a good memory of remembering words I have heard before, but I cannot always recall their meaning. I think that being more comfortable with medical terms will also help me prepare for the NCLEX.

Blog #4

The show I chose to watch is Virgin River. I watched the first episode in the series. Virgin River is about a nurse practitioner and midwife named Mel Monroe. She moves to the small town of Virgin River to help the only doctor in the town with his practice. This is very different from the ER where Mel was previously working.

In this episode there is already an issue between Doc Mullins (the only doctor in Virgin River) and Mel. Mel was hired by the town’s mayor to help out Doc, since he is getting older. Doc feels betrayed and hurt that the mayor went behind his back to hire someone. Doc takes out his anger and distrust on Mel. He refuses to let her help. He does not even want Mel, who received very good training, to see patients, until she can prover herself to him. During a conversation between the two, Doc gets angry that Mel has the audacity to question him. He voices his opinion that a nurse is below him and should keep her mouth shut. This issue related to what we have learned in Therapeutic Communications about “the hierarchy”. Many people believe the nurse is below the doctor and must always follow him, however, this is not the case. Mel spoke up for the patient and although this angered the doctor this was the right thing to do. Good medicine is about teamwork and the issues between the doctor and nurse will not help provide good patient care.

In the episode Mel sees her first patient at Doc’s clinic while he is out. The patient that comes in is Polly Fishburn who is pregnant and due soon. When Polly comes in, she is looking for Doc. Mel greets her and is very friendly and polite. Mel has a smile on her face and is welcoming to her patient. This helps to create a safe atmosphere with the patient and facilitates patient-provider trust. When Mel and Polly are talking Mel makes sure to engage in eye contact. She lowers to eye level of her patient. This nonverbal cue promotes equality between the patient and the nurse. Another nonverbal characteristic that Mel uses is her soothing tone of voice. Polly is obviously in pain and concerned with her labor. Mel is able to use a calming voice to talk to Polly and help ease some of her anxiety. Another positive tactic Mel used is encouraging the patient to breathe. Mel can see that Polly is nervous and so she encourages Polly to take some slow deep breaths as a relaxation technique. Mel commits a boundary crossing when she comes in close contact with Polly to help her stand up, however this is done therapeutically and to ensure her patient’s safety, so she does not fall.

Mel then begins to perform an assessment on Polly to see if she is in labor. Doc walks in and sees Mel with a patient and is upset. However, Mel advocates for her patient and closes the door, telling Doc she is with a patient. This was Mel in her nursing role as advocate as she ensured privacy for her patient. Mel discovers Polly is in Braxton Hicks which is false labor pains. Mel uses this medical terminology but then also defines it for Polly in language that a nonhealthcare professional can understand. This is done so Polly can know what her diagnosis is and be informed with her care. Lastly, Mel offers to call Polly’s husband for her so that she does not have to go home alone. I think Mel should have asked if there was someone Polly would like called rather than assume, she has a husband.

Overall, I think Mel had a very good interaction with her patient. I was able to see Mel in many different nursing roles including advocate, educator, and care giver. I think this interaction was good for the patient as she seemed calmer at the end of the scene. Mel did a good job of easing Polly’s anxiety as well as ensuring her safety. I believe this interaction will form trust between Mel and Polly. I think this interaction will help Mel know that people in Virgin River need her help and are open to it, she only has to convince Doc that she is very competent at safely taking care of the patients in the community.

Blog #3

This has been my first semester in the clinical setting. I have had two, six-hour shifts on my Burn floor at University Hospital. My two days have been full of learning experiences. I know I am growing through this learning process, but it is showing me that becoming a nurse does not happen overnight! I have already seen great improvement between my first and second shift. I am gaining so many real-life skills that I have not been able to gain just through a lecture class or a textbook.

One of the biggest communication challenges I have faced in clinical is communicating electronically through documenting on IHIS. I have learned about IHIS and even got to practice on IHIS Learn last semester. However, now I am documenting on my patients in the hospital and I find it more of a challenge than I expected. Charting is of utmost importance in the hospital. I have lost track of the number of times I have been told “if you don’t chart it, you didn’t do it.” Documenting on IHIS is a way to let all the members of the care team see what I have done for the patient. Although documenting is not communicating verbally, it is still linguistic as it is communicated through written text in the chart. The technology of computer charting in the hospitals can save time and make patient care more efficient and safer. Through the electronic charting I am able to perform a skill or assessment on my patient and put it in their chart for all members of the care team to see. After it is in the chart, I only have to notify the nurse about abnormal findings or concerns. All other information can be seen through what I have communicated in the chart.

The reason charting in clinical is a communication challenge for me is that it feels unnatural. I am not used to having to report my work and document it. I think another issue I suffer from is stress with time management. I get very focused on making sure I take my vitals every four hours, and give my bath, and perform my head to toe. I get so focused on making sure I complete my assigned tasks that I forget to alert everyone that I did in fact complete the tasks. When I have remembered to document and communicate my findings via the electronic chart it has not been immediately after my assessments. Documenting accurately and in a timely manner is very important and that is definitely a communication challenge that I am working on improving.

I know that charting will come with practice. It is still a relatively new concept to me. Like any new skill it will take time. One of the best things I can do to overcome this challenge is practice. I can practice my documenting via IHIS Learn. I can practice in lab and keep practicing in the clinical setting each week. Another way to overcome this communication challenge is to make sure I am taking thorough notes during my assessments. Having in-depth notes on the patient will make my charting easier and faster. My instructor has given me pointers for my charting, and I am hopeful that as I get more comfortable with the system, I will improve in my ability to communicate the information about my patient clearly to everyone.

Blog #2

For my observation of others, I went to the Union Market on Tuesday, January 21. I was sitting in my corner table observing all those sitting and eating, as well as just passing through. I observed from 6:10 until 6:40 pm, so many of the people sitting at the tables were eating dinner. I speculated that the people eating food were eating dinner although I do not know this for sure. I also noticed some groups sitting together talking and not eating, as well as people sitting alone doing homework.

I noticed a variety of people engaging in verbal or linguistic communication. Groups of two or more people were talking directly to one another at their tables. One girl was talking on the phone while at a table with another girl, thus engaging in verbal communication just to someone not physically with her. I noticed a girl talking on speaker phone or facetiming as she walked through the union. Her head was down looking at her phone as she spoke, she was not holding it to her ear like a regular phone call. Another example of verbal communication I saw was an interaction between two girls and a worker. One of the girls left her backpack at the table and the worker made a joke to her in which she said something back and they both laughed. Overall, I noticed verbal communication between groups of people or through technology when people were sitting or walking alone.

During my observations, I noted a lot more nonverbal or paralinguistic communication types that I do not normally pick up on so actively. I noticed many different hand gestures such as one girl rubbing her temple with her hand. I deduced that this could mean she was stressed or perhaps deep in thought. I observed one boy who had his hands crossed over his chest, which we know can indicate unfriendliness or mean closed off. However, since he was at a table with another people, I perceived that it might just mean he found that hand positioning comfortable. Most groups of people interacting were making a lot of eye contact which is very normal for our culture here. Another nonverbal cue I picked up on was posture. I concluded that most of the people that were sitting had poor posture: slouched or hunched over. These postures seemed to indicate maybe relaxed or very casual state. A group of four girls stood out to me as having really good posture, which seemed almost rare at the dining hall setting. I saw the use of technology involved with nonverbal communication as well. I observed one girl with headphones on facing her computer and not talking to anyone which possibly indicated she was focused or busy. I also saw a boy show the girl he was sitting with something on his phone that caused her to smile.

This exercise had me noticing more types of communication than I normally pick up on in my day-to-day life. I found that there are so many more little cues people use in everyday life than just their words. This is important to study and pick up on now in order to better my communication skills for the future.

Blog #1

Hi my name is Emily Harbrecht and I am a second year here at The (emphasis on the The) Ohio State University. This is my second semester in the College of Nursing, which means I am very excited to have passed my first semester courses!

A little bit about me, I am from Columbus, Ohio, born and raised. Although, my family can be considered “transplants” as neither one of my parents are from Ohio. My mom (Mary) and dad (Jeff) moved here with my older brother in 1993 and have been here since. I am one of Mary and Jeff’s three amazing kids (some might say the youngest and possibly most amazing). My older brother, Matthew is completing his residency at Duke University in North Carolina while my older sister Amanda is currently working in Chicago at a marketing company. Family is very important to me. My brother and sister were my best friends growing up. The five year and eight-year age differences between us did not matter as we were and are still are so close. Lastly, in the introduction of my family, is my dog Rosey. Rosey is a mutt, part Yellow Lab and part Collie. Although, we are not really sure exactly, that is just what the information given to us by the farmer who had the litter. She is very soft and fluffy. She is now thirteen years old but still has her same puppy personality.

Some of my interests include watching sports, traveling, cooking, and volunteering at the animal shelter. I have loved going to Ohio State football games. My family and I are huge Duke basketball fans, as my dad was the manager of the team when he went there long ago for his undergrad. I still enjoy watching the Duke basketball games on TV or if I get the chance to see one in person, I love to do that as well. I also enjoy traveling. I have been so lucky to take many trips with my family to some really beautiful places like Hawaii, the Dominican Republic, and Jamaica. I love to go anywhere warm with a beach. I love cooking with my mom and that will be very beneficial as I move off campus next year and will have to cook my own meals. Every other Sunday, my mom and I volunteer at the CHA Animal Shelter. We started doing this together when I was in high school and have continued volunteering ever since. I love animals, especially dogs. I find walking them and playing with them very relaxing for me, and I know it is helping the dogs too.

I am very excited to continue learning more about the nursing career. I know a little bit about nursing from my mom who is a nurse. The desire to help others and be involved in healthcare runs in my family as my dad is a doctor, my brother is a doctor, and many of my uncles are doctors as well. So my desire to help others in some way has been a part of me for a long time, however, I came into the College of Nursing with an open mind. I do not have a predetermined goal of what floor I would like to work on. I am hoping that through my time in class and clinical I will experience a wide variety of patients and care settings. My end goal will be to find the profession in which I can best care for those in need.