Jan.

27

Today I learned a lot about the palliative and medical unit, D2 at PRHC. I shadowed a nurse, and
in the morning, she administered many medications for one of her patients. She was taking care of 5
patients for her half shift. At 0800h, one of her patients received about 7 different medications (All of
them being in tablet form). I would observe her checking the boxes on the EPIC system after ensuring
she gave them and the patient swallowed the pills.

In the late morning, I was able to perform an IV flush on the same patient. It looked
uncomfortable for them. I also broke an ampoule today and drew it into a syringe in preparation for a
subQ injection. My most challenging moments were times where I felt like I was a disturbance to
patients. I realized that many nursing actions are so invasive to people’s personal space. I also grew an
even greater appreciation for preserving the dignity of persons. As there were two occasions where I
assisted a nursing peer with a patient’s bowel movements. The first event was when I helped assist a
patient to sit on the commode and wiping her down with towels soaked in warm soap and water. The
second event was when me and, eventually the rest of my nursing buddies, helped a patient change his
brief to a clean one. However, during the change he started to defecate.

Overall, I learned so much, I also changed a bandage over a pressure ulcer. I am excited to learn
more, and to grow comfortable interacting with patients in a therapeutic way!

Jan. 28

Today my CI sent out emails to each of us which contained a mini evaluation of our clinical day
yesterday. I received feedback stating they would like to see more initiative from me. It’s something I am
still continuously working on, and I find it somewhat frustrating when others cannot see my progress.
But then again, I am the only one who has lived with myself the entire time and noticed the growth over
the years. I was a little stumped this morning because I didn’t know what else I could do to prove I was
wanting and trying to take initiative, but I certainly was not going to give up.

This morning I shadowed a nurse and had an emotional first few hours as the first patient we
saw had a pneumothorax and metastatic lung cancer. The nurse was giving him his IV Lasix and then an
IV flush. During the process, he coughed frequently and looked uncomfortable to breathe and talk. It
was difficult to understand his speech. As I watched her administer the IV meds, I started evaluating his
situation and empathizing with what he was going through. I did not expect to become so emotional just
from observing his condition. I nearly cried.

Shortly after, I saw another patient (This patient was assigned to me by my CI to conduct a head-
to-toe assessment and provide basic care for) and she was a pleasure to talk with. I fed her applesauce,
some sips of coffee, and a little bit of cheese. At one point I gave her some cereal that did not fully
absorb the milk and she choked on it, I felt so awful! But she was okay after. In the future I will be more
careful about dysphagia. I was able to converse with her and get to know a little bit about what her
lifestyle was like. When I read her profile and found out that she came in for a stroke and was found to
have skin cancer and brain mets. Nearing the end of my head-to-toe assessment a doctor came into the
room. The doctor spoke with her and asked how she was doing. They seemed very nice and careful
when telling her the news that she was not going to get better. That all they could do was provide her
with good care and have her feeling comfortable and safe here. They delivered the message with such
empathy and their body language, being near her, looked like it provided a sense of safety. I was still in
the room with them when this happened. I was stunned to hear how grim and honest, yet how caring
the message was. She responded back to them, “Thank you for being honest.” They left shortly after,
and I was left in the room with her. I asked how she was feeling after that and she said something along
the lines of, “Well, I was expecting some news … and they shot the ball right out of the park.” Then she
said, “Maybe I can trick them (By getting better)”.

In other parts of the day, I did an IV flush myself, completed a COVID swab for a patient,
provided a bed bath with one of my nursing peers, charted a little about my patient on the computers,
and then practiced giving a report about my patient to my CI.

Feb. 10

Today, I completed a lot of tasks! It was a different sort of determination that I felt at placement
this evening. I wanted to learn as much as I could. The patient assigned to me was very nice but also
very deaf and blind (Legally). She was the first patient I had who was not fully oriented and it taught me
how to carry out the head-to-toe assessment differently. Such as when she would repeat the same
comment about a frozen yogurt that she had, she was stating that 1 was enough and 2 cups were too
much. I did well on my head-to-toe today and learned how to ambulate her from the chair with wheels
to the bed safely. Then I documented my care, such as peri care and changing briefs, and repositioning
her to alleviate what looked like a stage 2 pressure ulcer. My nursing friend helped me change her at
that time.

After documenting care, another nursing peer and I assisted a nurse with 2 of her patients. We did this
by getting new briefs ready for them to change into. It took a long time to get the task done, because I
was answering a call bell and a different patient wanted a bedpan. So, my friend and I went to get a
bedpan ready and learned how to assemble it. We eventually got back to the task. When I was not busy,
I would catch up on my documentation. At about 1700h, I helped my patient set up for dinner. She
threw up from drinking milk and eating a grape. This made more sense after learning about her GERD. I
assisted her in eating 3 spoonfuls of mashed potato, gravy, and radish. She was pleasant to interact with
and told me I was very thorough. The documentation in her profile suggested that she seemed sad or
depressed, so I was glad to be a relief of boredom in during her stay in the hospital. Throughout our
conversations she would say unexpected statements such as when she replied to me after I told her I
was going to assess her stomach. She replied with, “You’re going to get a beer? Okay, have one for me
too.” Or “I would really like some scotch, that would be nice, do you think I could get that?” But I told
her that her doctor probably wouldn’t recommend that right now, and she laughed.

My CI showed me what a picc line looked like on another patient, which was interesting to see flushed
by one of my peers. On this day I also saw a SubQ injection done by another peer. Later in the shift, I
helped a nursing friend with her patient to provide peri care and oral care. Then I answered another call
bell to help a nurse with her patient in rotating, changing, and boosting him. I was very proud of my
progress today, relationally and in procedures.
Feb. 11

I had a really bad day towards the end of my shift as I was made aware by my CI that I was not
prioritizing my assessments for my patient. The reason my attention was not where it was supposed to
be because I agreed to help my nursing peers before completing my tasks. Looking back, I learned that I
need to be able to say no. Saying no for myself will save me from potential problems of taking on too
much responsibility from tasks or making false promises to patients. I was honestly tired that day, and I
barely had any time to check on my patient’s profile because of call bells, requests from peers, and
watching skills as a group. On top of this, it affected my preparedness for my medication administration
with my CI. This day taught me about time management and prioritization.

Aside from the sadder note it ended on, the skills I got to do this shift included: MRSA swab on a new
admission, responding to a call bell to assist a patient on oxygen (Nasal prongs) to the commode,
responding to a call bell to boost a patient, head-to-toe assessments on a new admission, practiced
relational skills when communicating with my patient and his wife during her visit, assisting in providing
post mortem care and moving patient to the morgue, administering medications (Tablets and capsules)
to my patient, and providing oral care for my patient.

Mar. 3

Today, I was on the medicine floor for the first time after the COVID outbreak on this floor was
cleared. It was exciting to see what this floor would be like, as I heard it was normally a busy floor. I was
introduced to my patient, and it was the first time I witnessed ascites, CHF, and pneumonia. I could
immediately tell something off about the distension of their abdomen and was careful to ask for any
feelings of pain while palpating their abdomen. Throughout the day I was able to watch a swallow test
through an x-ray to see my patient’s swallowing function. This was tested using various drinks and foods,
such as bread, thickened liquids, and water. We found that some water would go down the trachea.
Later in the day, I watched the insertion of an indwelling catheter into a female patient with my peers
and CI. It was more challenging than I thought it would be, which prompts me to review the sterility and
safety measures needed. For example, if you insert the catheter into the incorrect hole, you must leave
it there. It will serve as a landmark for the next attempt so that it is the correct insertion area next time.

Overall, I was able to prioritize my time better in terms of getting the documentation down promptly
after obtaining results of vitals and head-to-toe assessments. I was able to provide and document giving
a bed bath after our lunch break. Most importantly, I assigned enough uninterrupted time to review my
patient’s profile and MAR in preparation for my medication pass. At the end of my 0645-1430h shift, I
gave report to another nursing student. I felt prepared and that I gave pertinent information. I would
like to practice more in the future.

Mar. 4

On this day I had the same patient as yesterday, I got into the routine of taking vitals and head-
to-toe assessment then documenting it. I was able to see more skills with my peers such as draining a
chest tube, talking about chest tube drainage systems, and learning how to use a bladder scanner. The
most memorable thing about this day was giving my patient their medications for 0800h and 0900h. A
lot of checks go into this process, and I believe the amount of checks that occur in retrieving them from
the medication room, preparing them for intake, and finally being with the correct patient cannot be
stressed enough. They are there to promote correct administration. I referred to the 6 rights of
medication administration(Right medication, dose, time, patient, route, documentation) throughout the
process. I was more prepared and successful in this med pass. I did this by searching for information
about each medication and how they relate to his conditions. My CI emphasizes to us the importance of
knowing what the medication is, why we are giving it to our patient, and how we know it has worked.
When I was about to give his heart medication, which could lower is BP, we measured his BP again. It
was 81/52 on R arm and 89/52 on L arm, sitting up. This concerned us and we decided not to give the BP
lowering medication and the loop diuretic as this would promote fluid loss and lower BP. This could
drastically impact his heart and circulation. In this situation, I saw a critical nursing judgment in action,
and I learned a lot from it. We later had to make a nursing note on why the medication was missed. In
the process of writing it, my CI reviewed it and helped me edit the note to make it clearer and more
concise. In the future, I would like to be able to make critical judgments such as these and make direct
and accurate nursing notes!