I showed the family that I was happy to assist them by treating them as I would my own family. (Taylor of homeostasis of fluid volume and electrolytes by a number of I will develop an information sheet for caring for patients with chest tubes within three months. others of their rights and being sure that they have sufficient He did deny thoughts of want to hurt himself or others. How did your intervention(s) affect patients, their families, your chapter members, or the community? Ted was started on thirty mg/hr and was receiving tremendous relief. I coordinated with the radiology nurses and the patient was able to go from the ED to radiology for his new PIC line and then home with the transportation the MSW had helped to arrange. We hear the news: the ED is holding three medical/surgical patients, one telemetry patient, two critical patients receiving mechanical ventilation, and five psychiatric patients. Of course most of Mr. Ps history is known to the ED staff but just in case, Mr. P keeps his cherished index cards, which documents his history, in his upper shirt pocket. respect, and shared decision making to achieve quality patient She has published and lectured throughout her career. University of Massachusetts, Boston. In planning for the admission of Her history included Parkinsons disease, CKD, COPD, and HTN and elevated K. She was now in a health center where she lived for 3 months prior to her hospitalization. This nurse combines flexibility with expertise to ensure that the team provides patients with consistent and safe care around the clock, even in the fact of work overload, acute staff shortage and the inexperience of new team members. I should be able to see beyond the immediate needs of my patient in the OR by being his advocate at the time he couldnt care for himself. The induction went smoothly. It takes an individual who possesses clinical nursing competencies, compassion, and empathy. Health care disparities are differences in health outcomes between The purpose of the exemplar is to communicate the chapters contributions and accomplishments that Name_________________________________________ Date_________________________ 2. the experience. I talked to the CCMD and my SBART. She agreed. I then called the hospice medical director on that day and requested she call the ED doctor and coordinate the needed doses to get this patient comfortable. Practice newfound skills in and out of work until they become second nature. Electronic and hand signatures are accepted; however, AACC requires hand signatures of RN managers on the evaluation. It was my job to ensure my patients safety at all times. In many units, the charge nurse monitors patient care, administers resources, schedules nursing staff, and assigns patients. I asked the ED MD if it wouldnt be better to trach this patient to protect the airway. I asked her if she could please give me 3-5 minutes and I would be back after talking with the CCMD. Returning to the patients bedside, I noticed his anxiety level increasing along with his respiratory rate. Work in the area of clinical specialty with the Employer for an average of 24 hrs/week over the last year. His family arrived at that time. The night ED team decided to admit him to the OBS unit instead of sending him home so late knowing that he lived alone. He is medically cleared and waiting for Psychiatric services to see him in the morning. These traits allow a successful charge nurse to coordinate work and resources, meet changing requirements, and help their unit produce positive patient outcomes. and declines. I took the time to elicit and understand her interpretation of her illness and that having a newborn to care for may cause her to minimize her symptoms. This nurse assists the patient, family and significant others in addressing their particular concerns. care settings, and this number is growing. D) The client has a right to informed consent. Once again, she returned to surgery, resulting in a colostomy. Oxygenation refers to the process of providing cells with oxygen I felt that a hospital admission was needed. It describes in detail a particular clinical situation that includes the nurses thoughts, feeling, intentions actions, critical thinking and Who was affected by the work that you achieved? They had checked his BP which he was slightly elevated and per protocol, he was sent to the station. I was able to support this family in their time of grief because I had support from my teammates. The next few week required much patience and flexibility on my part as his goals changed with each visit. 5. I was almost finished with the dressing when the nurse began to place the NGT in the right nare. 2. I notified HBS of there being no sign of bleeding and suggesting a vascular consult, made a referral to the Would Care RN for proper wound care orders and maybe some agents for debridement, and notified dietary of his need for proper nutritional supplements to aid in would healing. My preoperative assessment of the patient uncovered nothing remarkable except for his Right Renal Cancer. In my daily interactions with patients, I feel that I always function at a very high level. Provides safe environment. Blood loss brings about disturbance in fluid and electrolyte imbalance that could rapidly alter cardiovascular, neurologic and neuromuscular functions. Becoming an expert nurse. past experiences, and sociocultural influences and expectations. Understand When and How to Delegate Tasks. An exemplar is a story, not a case study or a report. I typed up the whole procedure in laymans terms with bullet points that were easy for them to follow, they were so appreciative. The following Benners Domains will be addressed: The Helping Role The Teaching-Coaching Function The Diagnostic and Monitoring Function Effective Management of Rapidly Changing Situations Monitoring and Ensuring the Quality of Health Care Practices Exemplar #4 I received a call last May via the GYN line from a 27 yr women named J.. She was requesting advice or a message be sent to her doctor. All applicants that meet minimum qualifications are interviewed unless the applicant withdraws their application Interview Date _____________ Application Form: All sections of application form are filled out completely and accurately. I asked her how severe her HA was last night and she said it was 9/10 but now it was 4-5/10. I questioned the surgical technician about the 2 missing sponges and I was told that the surgeon had one sponge in his hand and that the other one was resting on the drape. The night shift nurses reports that he has not moved much from that spot since the Ativan and has charted the medication treatment effective. He did have a negative work-up and, yes, he could have been sent home last night but he wasnt. I have continued to keep my trauma nursing core courses (TNCC). The evening charge nurse and I looked at each other and said, gotta be Mr. P. She thanked me and put the phone down. The Staff Nurse III is self-directed in ways consistent with the physicians scope of responsibility knowing whats required in order to best serve patients. He then went on to say that Mr. P had been evaluated by 2 other ED physicians and we only admitted him to OBS because of the time of night. His speech was no longer rapid but tangential, requiring several incidents of prompting to stay focused on the subject at hand. I knew I was taking a risk that I could have been wrong but it was well worth the risk when I had such a strong conviction we were missing something. IADLs include those complex skills needed for independent Knowing that my room was ready I went straight to the preoperative department to meet my patient and to receive a handoff. ( Anticipating problems: Future think. They have several years of experience as a nurse and are responsible for delegating duties to less-experienced nurses and staff members, including LPNs and CNAs, coordinating nursing schedules, monitoring medications and supplies, I asked her if she had support, and she told me her sister in law was coming over soon. WebVA Department of Veterans Affairs PROFICIENCY REPORT SECTION A - INDIVIDUAL REPORTED ON 1. That diagnosis did not prepare me for what would soon follow. I transferred Mrs. S. from the UV room to one of the dermatology treatment rooms, which is well equipped for skin diagnostics, but very limited for any other type of assessment. The education process began immediately on how to gown and glove to protect him, our staff and his family and friends. xb```f``. @18p_DRqK{I-{pR>|&x4a`z`"So2]JVi& bn@ I will join a hospital committee this year and bring information back to the staff within one week after each monthly meeting. Many patients cannot perform such Webnurse acts as an advocate by protecting the personal rights of clients and providing all necessary information so that clients are able to make informed decisions. I then called that physician to let her know my assessment and concerns. The patient had been attacked with a hammer and shot in the face. List of concepts and examples. I went to check and see who could be there. The urgency in her voice, the last night bad dream that gave her cold sweats and shortness of breath, an achy arm since morning, all could be very well signs of cardiac ischemia. (Karch, 2020). I assisted by holding the jaw line with both hands to help keep the lower jaw stable. 3. Checking labs confirmed where my thought process was going, her albumin was very low and that would really delay her wound healing. Mr. P underwent an ERCP with a sphincterotomy and a biliary stent was placed for a small intra-hepatic bile abscess. Laws and legislation define the scope of acceptable also advocates for others unable to make decisions for themselves, as As a recently post-op patient, I normally would have waited for surgery to remove the original dressing but I noticed her abdominal binder was saturated with serous fluid. The narrowing of an artery caused by building up of plague and its rupture leads to clot formation also. Chewing an ASA reduces the formation of blood clots thus maintaining the blood flow. Registered nurses must be knowledgeable and skillful in performing the charge nurse role. Mr. R. ended up with bilateral below the knee amputations. who is pregnant (12 th week). I asked her for how long she is having this pain today. The Facility Selection Committee shall review the appeal and either accept the application or deny the appeal, providing a written explanation of the reasons for the written denial. Include details so that reviewers can visualize the situation and become engrossed in the story. Performance evaluations are found on the MyHR website> KP & Me> Performance Management. specific needs to promote an effective exchange of information. Clotting Clotting is the process whereby platelets circulating in the What were your goals and did you achieve them? 8. The CMS-proposed rule is being met with resistance by professional organizations. The only outcome the family could come up with was to move the patient back to the hospital. When providing comfort measures, this nurse preserves the patients dignity in the face of pain and emotional or physical breakdown. She agreed. Change), You are commenting using your Twitter account. I then went to the hospice team and discussed the possibility relief with the PCA function. She wanted a quick solution but intuitively I knew she probably would need more emergent care. mechanisms that facilitate fluid and electrolyte movement within All letters must be dated within 12 months of the application deadline. Coagulation (DIC), Attention Deficit Hyperactivity When I inquired as to her disposition on that day, she advised me that she felt tired and out of sorts. Upon further questioning, I discovered that she had been experiencing intermittent dizziness since she awoke that morning along with feeling winded. Upon further investigation, she advised me that she had been having episodes of dizziness for several weeks, but on that day the symptoms were worse. I answered and Needham Fire came on line. I had been aware that prior to this incident, the new physicians had not been having positive interactions with the ED. Charge nurses must be able to multitask and stay calm under pressure. Interested in presenting at NTI? Upon entering her room and greeting her with what I say to each and every one of my patients each day at handoff, Hi, I am Denise, and I get the privilege of being your nurse today. She said she felt fine the next day but then woke up last night with another severe HA. F Reciprocal compensation occurs among See calculation below. At the bottom of the page, you will find a link to View your Performance or Development history this link will allow you to print out all of your completed performance evaluations. In this first link you will find an exemplar 9 Who will benefit from your achievements? It may be a clinical situation that went unusually well, an incident in which there was breakdown (i.e., things did not go as planned), a situation that is very typical, or a situation that you think captures the essence of nursing. I was not going to let this go. Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1, Holistic Health Assessment E'[i;T3^umhiBC CcM! It was the first time I ever saw Mr. R. standing up he was walking toward me between the parallel bars on his prosthetic leg with an incredibly brilliant smile on his face. Write the exemplar in your own words. Fortunately she arrived there safely. I could see that this nurse was nervous about placing an NGT tube but prepared for insertion by using a 16F NGT. The Diagnostic and Monitoring Function: I successfully triaged and assessed J. using my clinical judgment, past experience, and in this case patients who may be minimizing their symptoms. Up with bilateral below the knee amputations my own family the knee amputations what. 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