NUR 460 Capstone
Practicum Log week 1 - week 6
Name: Nwaego Happiness Ukanwa
Practicum Agency: Post-Acute Medical (PAM) Rehabilitation Hospital
Department, Units, or Division Location: Dover Delaware
Preceptor: Susan Litchford
Date and Objective Met (CCPOs and
Times or PGCs)
9/12/2022 CCPOs # 3- Apply leadership
0830-1630 principles to communicate,
collaborate and delegate
within interprofessional teams.
and PGCs # 2 Demonstrate
leadership skills to promote
patient safety and the delivery
of high-quality health care,
and PGCs 6 – Direct patient-
centered care through
advocacy, interprofessional
communication, collaboration,
and delegation
9/19/2022 CCPOs #2 Analyze healthcare
0830 -1630 issues impacting healthcare
Detailed Description of Experience Hours
I attended the PAM leadership morning meeting with my Preceptor. The 8
members at the meeting were the CEO and other heads of the department. They
briefly discussed patient care, staffing, and ongoing problems and mapped out
strategies to mitigate them. In that meeting, I observed how the CEO applied
his leadership principles and skill through communication by asking for
people's ideas and giving his idea on how they could deal with staffing
problems, mainly during the weekend, to ensure safe care to the patient.
I observed that at PAM, nursing leadership is not just delegating to the nurses
but is all about being committed, being there for your team, showing your
support, and helping when needed. This writer observed that my Preceptor
collaborated with the nursing team to ensure adequate staffing per shift; she
delegate patient care to the Charge nurse, and then the charge nurse reports
back to her. I observe my preceptor review patient care with another team
regarding a fall to ensure adequate intervention. I also obverse my Preceptor
advocated for a patient that wanted to leave Against medical advice (AMA).
My Preceptor called the Doctor for appropriate patient discharge to avoid
keeping the patient against the patient's will; after completing the discharge
order, she also went to the patient to make a transportation plan.
I obverse my Preceptor, the Wound Care Manager, on how she uses 8
information technology to review new admission lists, checking for those that
systems and professional
nursing practice and PGCs # 3,
#7 – Apply inquiry, analysis,
and information literacy skills
to support evidenced-based
professional nursing practice
and PGC 4- Integrate
information management
technology to improve patient
outcome.
have wound, what type of wound, stage, and what treatment is in place. At
PAM, they have a wound care Nurse Practitioner (NP) who comes on Mondays
and Thursdays. The NP reviews the wound and gives orders for treatment
which are entered into the computer system by the wound care manager for the
nurse to apply. I also observed the wound care manager do some dressing
changes and, at the same time, train and educate the patient and the family
member on the dressing change or how to care for the wound after discharge; I
saw some return demonstrations from the families. I saw how the wound care
manager incorporates health promotion and disease prevention by teaching the
patient, family, and nursing staff appropriate infection control to maintain
during dressing changes.
I observe that PAM uses evidence-based wound care supplies for dressing
change and wound treatment.
I also attended an Interdisciplinary meeting where the Doctor reviewed the care
of every patient. Every team member gave a progress report on the patient in
this meeting. The MD set a discharge date if the patient met the set goal. If not,
they changed the intervention in place to ensure that the patient goals are met,
I observe my Preceptor review patient charts to see those that have wound,
foley, look at the nurse's picture of the wound on admission, check for pressure
injuries, an incontinent patient, and set up a plan for wound care and adequate
intervention to avoid hospital Acquires injury. I learned that she reports all
pressure injuries monthly, reports wounds that healed within 6-7 days, which is
a good indicator of wound care, check patients with a Braden scale of less than
13 score, poor mobility, and patients that qualify for Air mattress. This was a
piece of new information to me because, at a nursing home, poor mobility does
not allow you for an Air mattress.
She also plans for dialysis patients to get Air mattresses to prevent skin
breakdown during dialysis.
She also set up an intervention for Deep Tissue Injuries, such as getting them an
air mattress, Roo Cushion, Dietician consults, and a Turn schedule.
From a leadership perspective, the wound care nurse follows up with the patient’s

9/26/2022 CCPOs # 4- Demonstrate
0830 -1630 professional and ethical
behaviors as a member of the
healthcare team and PGCs #5 -
Advocate for patients and the
nursing profession with regard
to healthcare policy at the
local, state, national, and
global levels, and PGCs #6,
#7, #8, #1, #2
wound three times a week, asking the patient about their concerns. I did wound
rounds with my Preceptor and learned that using Medi honey to debride a wound is
evidence-based, and the facilities are getting good results with such a product.
I review the patient chart with the Director of case management. It was a good 8
experience because I understood that the case manager’s role was centered on
patient discharge planning. They assess the patient to know if the patient needs
home health care, an Aide, if they need nurse or PT, OT if they need
equipment; the case manager gets the orders from the Doctor and sets up the
plan. They also schedule a follow-up appointment for the patient depending on
the patient’s diagnosis. If it is a stroke patient, they will schedule a follow-up
appointment with the Cardiologist., They do their assessment as soon as the
patient is admitted, review the patient's family support system and insurance,
and send updates to the patient.
At approximately 0900, I attended the Flash leadership meeting chaired by the
CEO and department heads. In the forum, the CEO run statistics of the
Facility’s activities and achievement daily; such as staffing and how many
patients in the Hospital, whether they were able to meet set goals, what
percentage were their patient satisfaction rate, admission, discharges, did any
patient leave AMA, any compliant, how is their revenue, are they making gain
since the company is a profit-oriented organization, are there maintenance to be
done, were they able to meet or improve on set goal?.
I also observe that the leaders in the meeting announce when they may be
absent, either for conferences or personal activities.
I observed how the Case manager director, in a leadership role, demonstrate her
professional and ethical behavior by ensuring that she and her team were doing
what was suitable for the patient by respecting the patient’s rights, providing
the patient with their autonomy, and respecting the patient wishes. If patients
decline to participate in their therapy or care, the case manager may make a
referral to skilled nursing or a long-term facility. They do this with statistics
based on patient satisfaction audits and patient response to treatments.
I observe how the Case Manager review progress of the patient with the Case
Missed index (CMI). This was new learning for me because I learned that, with
the CM, I could be able to know the severity of the patient care. For PAM, a
profit-oriented facility, a higher CMI is better and more pay and extended
patent stay. For instance, a patient with Pneumonia is on a lower index, while a
patient with stroke is on a higher index.

I observe how the case manager advocate for the patient by ensuring that the
patient gets the equipment they need before they go home. If the patient or
family complains that they think the patient is not safe to come home at a set
date for discharge, the Case manager (CM) advocates for the patient by
discussing with the Interdisciplinary team (IDT) to see if there are other
available interventions they can do for the patient.

I observed the CM integrate health promotion and disease prevention by

educating the patient about being discharged. The Case manager maintains the
record and reports their patient two days discharge follow-up and 30 days
follow-up and readmission. They educate the patient to ensure they complete
their therapy and also set up some services if they need one. They follow up
with the IDT meeting, which is held twice a week, Mondays and Wednesdays.
This meeting is chaired by the medical director, who reviews patient progress
from the therapy services, nursing, respiratory if needed, and Case managers
and schedules a date for discharge.

From a leadership perspective, I learned that a case manager's main goal was to
meet the patient's goal and be discharged home within Medicare allowed
window, get the patient safe without readmission if readmitted with a different
diagnosis. This she does by ensuring that therapy gets the patient back to their
level of independence and medically stable, which is completed by the nursing
department, educating the patient on maintaining their chronic disease and
health and managing their health upon discharge.

The director of case manager as a leader technologically reviews the census,


10/3/2022 CCPOs # 3- Apply leadership
0830 -1630 principles to communicate,
collaborate and delegate
within interprofessional teams.
PGCs # 7, #2, # 3, #6
PGCs # 6, #2,
PGCs #6, #3
PGCs #8
and email, represent the other CM team in the Flash leadership meeting, check
on the team, delegate task, review work up study that PT or Respiratory
therapist can do, review patient insur,ance ensuring they are up to date, check
what is due and help out the team on task not completed.
The PAM Quality Management and risk management manager took this writer 8
around the unit to show me how she does her monthly unit audit. This rounding was
a very good experiment for me because at PAM, they have red tape they put in area
that is prone to fire hazard, that red tape is 18 inches from the ceiling. During the
rounding, anything that is placed above the red line was removed by my Preceptor.
My Preceptor taught me that if there is fire, anything above the red line continues to
burn with fire because the water from the sprinkler does not get to it.
I learned that the Quality management and risk Management director covers every
department: plan operation, safety, kitchen, nursing, pharmacy, and Environmental
services (EVS). She keeps tracts of the quality control of the facility. She reviews
incident report and determines if it is state reportable, she reviews if an incident
resulted due to neglect or is it a sentinel event, she investigates to find the root cause
of the incident.
I attended the Flash leadership meeting. I observe that quality management on a
leadership level involves ensuring that the quality of every department meets the
joint commission standard.
I had a tour of the facility ( each department), and I had an opportunity to see how
the quality management director audits each department checking for expired item,
checking and ensuring that the fridged logs are UpToDate, there is no expired food,
binder and log are up to date. For instance, we checked the ED room, lab, and fridge
in the lab, checking if temp were within range, the dialysis machine have a tag marked
“cleaned and ready to use” sign on them, EVS triage room where chemicals are kept,
ensuring nothing is above the red line. This was an experience for me because I did
not know that the fire hazards up in the ceiling was also water sprinkler.
I observe my Preceptor check the kitchen to ensure the area is clean, has no bugs,
and is free from infection. In the kitchen, they expect everybody to wear a hair net.
During the tour, I observed my Preceptor take pictures of things that she has a
concern about and relate that to the unit affected to fix.

She ensures that equipment is clean, negative Air Pressure room checks to ensure it is
following state regulating room, check the nurse cart to Ensure no HIPPA violation,
check the therapy room and report thing that is not right.

My Preceptor showed me how the hospital reviewed falls, and their goal for falls is
less than 7, Monthly death, wound mostly Hospital-acquired pressure injuries, pain
management control, and its effectiveness are reviewed by the nurses, overall patient
satisfaction, employee recognition, infection control (hand hygiene, review of a
medication error, an overview of the incident report, was there any rapid call or code
call, any HIPPA violation, new policies have to be approved by the quality or two
other committees.

She also keeps the Survey readiness binder for joint commission
I observe her apply her skills while analyzing the PAM injuries and analysis by using a
joint commission set standard. I observed how she used the Joint Commission set
standards to prepare the company survey readiness using information technology to
support evidence-based professional nursing practice, such as quality monthly
meetings done every month, and FMEA completed yearly.
They incorporate health promotion and disease prevention by ensuring that they
complete their infection audit.

Random Audit on a patient about their food, the facility's goal is to be greater than
90%, which is how they check patient satisfaction. This writer learned how the quality
manager help to promote patient safety and delivery of high-quality care, advocates
for the patient by ensuring that the patient gets the right food, and provides
adequate interprofessional communication of food given to the patient if it does not
meet the required standard. Also, she monitors the safety of the food by ensuring
that food is not expired and food near the expiration date is used or discarded. 
                                                                   
This writer learns how to practice professional nursing within an ethical framework by

10/10 /2022 CCPOs #1 integrating genera
0830 -1630 education knowledge, skill,
and aptitudes acquired in the
RN-BSN program, and PGCs
# 1,2,3,
PGCS # 6,7,9
CCPOs # 5 Formulation a
lifelong learning plan that
empowered personal and
professional growth and
PGC #9
ensuring all new policies must be approved by quality or two other communities in
the facility.
I had opportunity today to observe the PAM nurse Manager on how she utilizes her 8
critical thinking skilled that she received from her BSN- education, and general
education to grow as a professional nurse from being charge nurse to nurse manager
which is a professional and leadership position. I observe how she uses her skills to
assist nurse on the floor when they need assistance with their patient care. As a
leader I observe her demonstrate her skill to promoted patient safety and delivery of
high-quality care by investigating on a fall incident on the unit using information
technology in finding root causes of the fall, educating the staff and putting in place
an adequate intervention to prevent such fall and to promote patient safety.
This writer attended Leadership flash meeting with the CEO and all the departmental
head, and they have a rundown of the activities that happened over the weekend or
the past day, review falls, complaints, grievances, staffing, census, discharges,
potential admission, revenue, review their statistics to see if they met their goal, if
not another intervention is put in place.
I attended interdisciplinary meetings with my Preceptor, this writer observes and
learned how patient centered care is collaborated and communicated, at this
meeting, the Doctor reviewed care and progress with OT, PT, Speech pathologist,
Dietician, nursing, Case manager perspective, report patient progress and the Doctor,
based on the progress report set a discharge date, and the patient is communicated.
In this meeting any unit that thinks patient is not ready for discharge may advocate
for patient to be given more time or for the Doctor to write an order for patient to
continue with outpatient therapy or home therapy. If it is nursing, the Doctor will
make a change in the patient medication.
I observed how the Nurse manager demonstrated lifelong learning from her BSN
education to educate other nurses, complete in-service training, educate nurses on
the nurse huddle and nursing departmental meetings, teach new technological
methods of documentation and reporting monthly Audits, Infection control, monthly
PowerPoint presentation on infection rate, education on a new policy. From my
interview, this writer found out that the Nurse Manager receives training as a floor
 nurse and a charge nurse together with her BSN education; this empowered her and
lead to her growth in a leadership role.

This writer observed my Preceptor as she practiced nursing within an ethical

PGC # 5 and #8, #2, framework when I observed her interview a patient on the facility Survey, how she
respected the patient’s right and choice of word and answer, provided the patient
with her dignity, giving patient her autonomy and the right to make decision. From
my observation, and question to my Preceptor, I learnt that patient survey speaks
volume about the hospital admission. Positive evaluation shows the facility is meeting
the required expectations, which could create goodwill for the organization,
especially PAM, which is profit-oriented.

I also Observe my preceptor advocate for the patient and the nurses when a nurse
brings a concern that they think the Doctors are not addressing properly, The Nurse
manager take it up with the Doctor or another doctor utilizing a clear and effective
communication skill as a leader while addressing those concerns.

I observe my preceptor advocate for patient and the nursing profession with health
care policy on monitoring and reporting of an outbreak, using a state reporting
system, she follows local, state, and national infection control policy, monthly
infection reporting, health screening for the staff, PPD and Immunization compliance,
Random hand hygiene and PPE check, C. diff, Vaccines, CUATI, HAI, quality infection
control rounding with the Environmental services, dietary and Pharmacy. Ensuring
that expired food and drugs are removed for patient safety.

I learned that the Nurse manager performs some Administrative job such as
scheduling, auditing staff documentation, completing staff education, monitors bowel
audit, foley to prevent CAUTIs, C.diff. She is in-charge of employee health, annual flu
clinic, interviewing potential employees, staffing, evaluating employees 90 and yearly
evaluations, payroll and approving before staff is paid, and infection control reporting
( 2times a month infection control rounding).

I observed my Preceptor utilize the electronic gadget (Called Tiger) used in the
hospital to communicate patient electronic information with other team members
 about patients’ care.

I learned that each leader is assigned to follow up with a patient during their stay,
ensuring that they follow the facility’s ethics and that their complaints or needs are
met.

10/18/2022 CCPOs #1 and 2 This writer had an overviewed of the leadership role with the Director of Nursing. I 5
0830-1330 And PGCs #1, 2, 5, understood that the General education I studied, and my nursing skill would
empower me as a leader to excel in any leadership position I find myself in, either
nursing or the administrative field.

I observe my Preceptor as she advocates for employee health; I watch her educate
and administer the employee’s annual flu Vaccine.

I learned that leadership is about supporting your fellow nurses and staff or those you
lead. I learned as a professional leader that Giving your team support will help them
ensure that you have a successful administration.

I learned that if you take care of your staff, your staff will, in turn, take care of the
patient, and this will result in good patient-staff relationships and a higher percentage
of patient evaluation.

45