JOURNAL FOR CLINICAL EXPERIENCE 2

Name: Chandace Regano

Date of clinical experience 11/18

Clinical location/setting/agency St. Elizabeth (Mercy/Boardman)

Beginning time: 0700 End time: 0100

Agency contact/nurse (if community site):

Nursing competencies and skills that were observed for the day were maintaining a clean
and safe environment for the laboring mother, maintaining cleanliness or sterility for certain
procedures such as inserting and IV or a foley catheter, and ensuring there is a baby nurse to
attend to the newborn’s assessment. An L&D nurse is responsible for assessing, monitoring the
mothers vitals, monitoring the FHR, contractions, etc. In comparison to the mom-baby floor, the
nurse job is a great deal more one on one and require closer and continuous monitoring
especially if the mother more dilated and closer to giving birth. Ultimately, the nurse’s primary
concern is making the right judgements and observations to ensure a safe delivery and immediate
postpartum period for mom and baby.
Two nursing diagnosis that were utilized were anxiety r/t perceived pain in the case of a
mother who recalled a high amount of discomfort with having a foley inserted, and risk for
bleeding r/t surgical incision and postpartum complications which is evident in a mother
undergoing a c-section.
I think the most significant event that I had was inserting in a foley catheter, it being the
first time that I had put one in, which was an opportunity I was grateful to receive. I think I
overall did sufficiently, however, I think I could have been better at giving the mother more
guidance prior to inserting it.
In the case of labor and delivery, these nurses are primarily responsible for the safe
delivery of baby and the care thereafter for mother and child. A nurse here works carefully with
both the OB doctor and other nurses, but has a great healthcare team but also the patient in
regards to the surgical process with each step and instructions accordingly, including spinal
anesthesia administration and when the mother’s support person would be allowed in the room
before the procedure and where they would be located (sitting near the mom’s head in a
wheelchair). Important aspects of the process where the nurses skills were needed was
assessment of the infant right after being derived from the uterus (heart rate, respirations,
appearance, activity, and reflex irritability) performed 1 min and 5 min after with the baby being
continuously monitored while in recovery with the parents. Prior to being admitted to the OR,
mom must have a foley inserted and have her vitals monitored. It seemed like moms did better
once any procedure was explained to them, giving them a better sense of control. A good
example of the sensitivity and respect was demonstrated to diversity was when one mom asked
to pray prior to her c section to which the health care team acknowledged and abided by her
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wishes. One thing that stood out to me was the leadership role that an L&D nurse must assume
not only regards to her patient prior to the OR (such as with monitoring heart rate and variability
and contractions) but also in the OR because unless it is a high risk situation, that one nurse is
responsible for the assessment of the infant post delivery. In one case also, we had an
opportunity to insert an IV an a patient but had to use judgment in recognizing her veins were too
scarred and damaged to put one in normally and an IV team would be necessary.
Overall, I definitely appreciated the opportunity to see another C-Section, and especially,
putting in a foley catheter. I highly enjoy my time on L&D because there’s always the possibility
of seeing or doing something new.