Clinical Reflection

Being able to reflect back on my clinical experiences this semester kind of makes me wish that we were still able to have clinical at the hospital in person, but with the current situation I am happy that the College of Nursing is adapting our learning so we are not being put into this stressful situation. Even being online through virtual simulation, I have seen many improvements in myself and my communication between the knowledge that I have learned and the confidence that I have gained.

For the improvements with myself, I have noticed how much more knowledgeable I am about procedures, patient diagnoses, and especially medications. I am now able to look at a patient’s summary of stay and see their diagnosis and know why they have certain medications that they are taking and what they are indicated for. It is amazing how much content we are able to retain in such a short amount of time, but being able to learn it in the classroom then apply your knowledge in a real-life setting really helps to engrain the material into your practice. Another improvement I have seen in myself is my ability to remember critical values such as lab value ranges that are critical to know when evaluating how your patient is responding to the treatment regiment that they are on and how you will use those values moving forward in their care. Being able to know what certain lab values ranges are supposed to be makes me feel more confident in how I am retaining the material and how I am enhancing my education.

My improvement with communication has also gained significantly, somewhat due to feeling more comfortable in the clinical setting but also from my gain in confidence in what I am doing. I am able to give a more thorough handoff-report that includes all necessary information that my nurse would need to know, and I also know the key elements that I have to listen for and specifically ask for when receiving a hand-off report as sometimes not everything that is vital is stated. I am able to ask my nurse or clinical instructor what certain medications are being used for when I don’t understand why they are being described and actually understand the other uses that medications can have. I have been able to communicate with the other PCAs and nursing students to coordinate care with my patient and even help my peers understand certain topics that I feel confident about.

The growth that I would like to see in my future practice is being more confident and willing to perform the skills that we get checked off in the clinical setting. I feel like sometimes when I have to perform a skill in clinical that I had to get checked off on, I get more nervous to do it for the sole fact that we had to get checked off on it so it seems a lot more serious to me. I would also like to get more concrete with the content that I know because I feel like there were multiple times in clinical when me and the other students would be asked a question and I felt like I knew the answer but didn’t want to say it but then I would end up being right I would say about 75% of the time. Just being able to solidify that knowledge and being confident applying it is something that I need to work on and get better with, which I hope working at the hospital over the summer will allow me to do. Being able to get the extra practice with my skills and knowledge in the hospital being independent will definitely help solidify everything that I have learned so far and maybe even get me ahead in the content for next year.

TV Drama relationships

The TV drama that I selected to watch was an episode of Grey’s Anatomy. In this particular episode, there was a lot of patient-provider conflict in terms of whether the provider should be allowed to be the patient’s doctor. In this episode, one of the doctors that works at the hospital had a sister that had been lost for 10 years from serving in the army. She was the wife of another doctor working at the hospital, since she went missing, they never technically got a divorce or split up, and that doctor started another doctor at the hospital named Meredith. Well Meredith became the patient’s surgeon for multiple upcoming procedures that the patient agreed to doing that were a little more risky than usual.

In the beginning, Meredith didn’t want to tell the patient about her relationship with the patient’s husband and neither did the husband. But other health care providers intervened and explained to both of them how this patient-provider relationship was not professional and how there is a conflict of interest between the relations of all of the parties. While Meredith never showed any type of positive or negative actions or words because of her association with the patient, it was apparent and known that the relationship that she indirectly had with her patient was a compromise of her health care. However, Meredith sat down with the patient and explained everything to her, and the patient still continued to have Meredith as her surgeon and continue on with the following procedures. While this may not be allowed in a real-world hospital setting, I think it was a good example of displaying integrity and building trust with a patient when you tell them everything that you know about any given situation.

Another provider-patient relationship that was occurring during the show was a young female came into the emergency room that wanted pain killers for “chronic back pain” that she had been experiencing for months. The doctor that was assigned to her was an attractive person, and she tried to use her youthful appearance and “sweet” side of her to get what she wanted when she was telling her story about why she came to the emergency room. She even initiated physical contact with the doctor which was a major over-step of boundaries. This is a great example of how a provider is solely responsible for how their relationship progresses in a professional manner and how the patient can make things awkward or difficult moving forward but the provider is responsible for communication moving forward in a professional manner that solely serves the purpose of making the patient’s health conditions better. A positive interaction that came out of this was that the provider was able to sit down with the patient and explain that he is not able to do what the patient wants solely off of a conversation, but based off of her need for treatment and health status, which allowed the patient to reflect on her actions and how they were portrayed. I think this show has a lot of situations that would usually never be okay in the real medical setting, however it is a good tool to utilize when identifying communication errors in relationships between coworkers and patients when being analyzed.

Clinical Experience Reflection

My clinical experiences this semester have been very exciting and educational. I have only had clinical on the floor twice so far, but each time I exceled at whatever our tasks have been and I was able to show a few other students how to do whatever it was. It felt nice to be able to see what you practice in lab, come to life in the real-world scenario. I was able to watch a couple of blood draws from the PCA’s on the floor and one was actually a friend from my freshman year so she let me follow her around for a little bit to see some of the routine stuff that she does. I was able to draw two blood sugars and they both went well and had no complications. I learned a lot about the medications my patient was taking and about some other procedures that he had done in him from his past medical history.

I haven’t really had a big communication challenge yet, as I have not had a full day with a patient yet, as the first clinical with patients my patient got discharged in the first hour I was there so I was just floating around assisting with other patients. However, from the exchange of my hand-off report I can tell there is a challenge for me to be able to decipher all of the diagnoses and treatments that the nurse is saying when they are speaking in medical terminology. I just need to learn all slang/abbreviations in medical terms for a good exchange of communication. I have not had a problem communicating what I have needed to say so far.

I feel like something about me that contributes to the challenge is that I have no past medical experience with my environments or my family/peers. Nobody from my family works in the medical field and I do not have a job as a PCA yet, so I feel like other people are getting that exposure to specific terminology before it is brought up in clinical that I don’t have the opportunity to learn. Two of my good friends have moms that are nurses and when we are talking about procedures from clinical or situations from class, they will say how their moms told them about times they did those things or their experiences with that and my friends have an outlet to remember it early on. Not that I feel this is a big disadvantage for me, but it would definitely be easier to know the material when you have been exposed to it earlier on.

To overcome this challenge, I should ask my clinical instructor as much as I can when I have questions about procedures or medications because they will be able to explain right then about it and I would be able to remember more easily when there is a situation associated with it. In my free time, I could also look up the diseases or drugs on Ucentral and see all of the implications for them and how they impacted my patient. I always think it is more useful to expand upon something new that you learned so that you can know the in-depth aspects of it before you build on that basic foundation and get more confused if you are unsure on what it actually occurring with a procedure or medication. I am sure as I continue the next few weeks with clinical that instances will arise where I have some type of communication challenge that I will have to learn to overcome more in-depth, but as of now everything has been pretty smooth and I am feeling confident with my knowledge on the floor.

Public Observation

I decided to spend my 30 minutes of observation in the café of the The Ohio State University Wexner Medical Center during peak lunch time from 12:30-1 pm. I saw many different types of communication from both verbal and nonverbal perspectives, while also seeing the use of technology in various forms.

One of the first few observations that I made is that people sitting alone were more than likely to be looking at their phone (sometimes laptop) in such a busy setting. Every single person that I was sitting around that was alone was staring into their device, wouldn’t talk to anyone or really look around at their surroundings, then when they would finish eating their meal, they would put their phone away, pack up their meal and head out of the cafeteria. They had zero verbal/nonverbal communication during this time as they did not try to interact with anything besides their devices.

Another aspect that I noticed during my 30 minutes was that when people were wearing the same uniform (green scrubs, grey scrubs, surgical attire) they were more actively engaged in the conversation with the others compared to people who were conversating with others in different fields than them. Those that were setting among the same type of people would not be on their phones, were making direct eye contact with the person speaking, and would make facial expressions or reactions that would show their interest in the conversation. Facial expressions and eye contact are both great indicators of nonverbal communication, showing that you are really listening to the person speaking and that you are interested in what they have to say. Another form of nonverbal communication that I saw from the person that was speaking would be the use of hand motions. Hand motions are a great way to really emphasize the point that you are trying to make or a story that you are trying to share as I feel that it engages the people that are listening more actively.

Another aspect of communication that I noticed is that when people were sitting with people around their age, they would actively participate in the group conversation more often. Verbal communication includes anything that you say to another person. When people were sitting with similar looking peers they would all actively participate in the group conversations and every person would talk about their thoughts on the group conversation compared to groups that were differing in age. The older people in the differing age groups would do most of the verbal communication while the younger members of the group would do most of the nonverbal communication such as eye contact and head-nodding. Both of these types of communication are important when being engaged in a conversation, but I thought it was interesting to see the differences in communication when it came to different demographics of the participating individuals.

One last observation that I noticed is the differences of the use of technology with different occupations. Those that were in scrubs or medical attire seemed to be more actively engaged in their conversations with their peers and did not seem to pay much attention to their devices. Those that were in suits or in business professional attire seemed to be on their laptops or phones while sitting with their peers at a table that was either having a conversation or was not. Those that were in business professional attire would barely look at the other people while they were talking or listening and it was noticeable how uninvolved they were with the conversation or with their surroundings in general. I am glad that I chose the hospital to do my observational study because it allowed me to see the differences between professions, age, group size, and technology use when it came to verbal and nonverbal communication in a relaxed setting.

Interests & Background

Hi! My name is Madi Shoemaker and I grew up in Heath, OH which is right by the OSU-N campus so I was able to take a few OSU classes in high school before coming to campus my freshman year. I come from a household of a single mom who raised me and my three younger siblings (two brothers and a sister). I am a first-generation college student in my family so coming to campus and enrolling in a hard major on top of not really knowing how to go about college life was difficult at first, but I have loved every minute of my experience so far.

Coming from a single-income household I have to pay for everything on my own now, so I currently work about 30 hrs/week between two serving jobs at Hangover Easy and Condado Tacos. I am also involved in my sorority, Alpha Xi Delta, where I held a director position this past year. Finding a good time-management schedule between work and school has been my hardest challenge this year, as I am usually working on the days that I do not have class. However, I have been trying to be proactive about my organization skills and pre-planning my time management for the week so I do not get behind in any of my classes. So far it has worked well, but I just hope I can continue the trend with the workload this semester requires.

I am currently a junior enrolled in the nursing program with a minor in social psychology and personality. I have always wanted to go into the nursing profession, but I have also always had a love and interest in the psychology field! I am grateful I am able to study both of these subjects and possibly use both of them in my profession someday. My friends and family have always thought it was unique why I decided to go into nursing, as nobody in my family works in the healthcare field at all. However, I have always had nursing as my career choice since I was a freshman in high school. I loved learning about the human body and how everything works and being able to care for patients and really make a difference in the community that you lived in has always been an important aspect in my life. I was also attracted to the profession for the various different jobs you can have within the field of nursing and how you are able to go literally anywhere in the world and be able to do your job. I have always been a person that loves to travel and hated the thought of having to be in the same place for a long amount of time so having this flexibility within the nursing field was a huge bonus.

My interests moving forward with nursing would be to get my degree from Ohio State, stay in Columbus and work for a year or two, then travel nurse for two years preferably in California or on the east coast somewhere so I can experience the “beach life.” I then want to get my master’s degree to become a Critical Care Nurse Practitioner. I love the energy and momentum an ER would bring and I have never been one to want to do the same thing day in and day out, so I still believe this would be the best placement for me. I have thought about doing OB, but I haven’t had any exposure to that field yet and obviously will need to go through the rest of this program before I can find out what I really love.

My interests in life are currently living a healthier lifestyle more holistically (9 dimensions) and to do something for myself every day that will help further my future self. I have also been reading a lot of motivational and “life-coaching” books when I have the free time. I have found that I like to save my money to go to concerts and music festivals more than going out to eat everyday or going shopping a lot, so I now attend some type of concert every 1-2 months as a self-care gift for myself to enjoy the artists that I love with my best friends. I love to take as many vacations as I can to a new part of the world with various people, and I am planning on one day in the next few years to take a little weekend trip by myself to really get in touch with my thoughts and my goals for the future.