Clinical Reflection Essay

For the beginning of clinical, we were asked to establish goals based on the clinical CCEI components; assessment, communication, clinical decision making, and safety. At the end of clinical, we were then asked to reflect on our goals established at the beginning of the year and if we were able to accomplish those goals. We then were asked to reflect on additional goals that we have moving forward and how we plan on accomplishing those goals.

Final Reflection

This semester, I had a wide range of different experiences on different MedSurg floors including, cardiac, gi, and oncology. I saw and experienced a variety of learning experiences that I will benefit me in my future career as a nurse, especially since I want to be a MedSurg nurse.

Reflecting on the goals that I set prior to the beginning of the semester, I have come a long way. I do still have personal goals for myself moving forward, but I am more prepared for them than I was at the beginning of the semester.
CCEI goals
For setting up goals for this semester, I reflected on the CCEI module that provided information on what we should be competent on. Based on the competencies, I developed goals that I wanted to work on and accomplish during my clinical experience. I then established different ways to accomplish these goals.
Assessment
My goal for assessment was to learn as well as improve my cardiac assessment including assessing for murmurs. I had a great deal of cardiac assessment on my cardiac MedSurg general floor. I was able to hear murmurs with some of my patients and worked closely with my nurse to make sure I was able to hear the murmur at the best spot. I also learned a great deal about the pathophysiology of cardiac disease and how that affects the body and how lifestyle factors can play can have a lifelong effect. An example of this is a majority of the patients on the cardiac floor had diabetes. I learned that diabetes can lead to hypertension which can then lead to cardiac failure. I also learned the importance of monitoring Is and Os on a cardiac floor, not only because it shows the function of the kidney, but also the heart. If the heart is not working effectively, they are not able to effectively perfuse to the kidneys. If the perfusion to the kidneys is not adequate, the body begins to hold on to fluids causing fluid retention in the lower extremities, lungs, and heart causing even more cardiac issues.
Moving forward, I want to continue practicing my EKG knowledge. I plan on accomplishing this goal by utilizing online resources that provide and quiz information on what to monitor and what different EKG looks like. I also want to continue to seek out opportunities to listen to different murmurs to gain additional knowledge on different murmur sounds.
Communication
My goal for communication was practicing communicating with the rest of the medical team, minus the nurse. I had a fair amount of practice this semester, an example is that I learned how to page. I also participated in rounds and informed the physicians, surgeons, and residence on healthcare information about the patient. During one of my clinicals, I paged a physician about information that needed to be changed in the chart. I also had an experience where I discussed with the physician about vital signs. I also had a lot of practice communicating my assessment, intervention, diagnosis, and concerns of my patients with my instructor which was very beneficial.
Moving forward, I want to continue becoming more comfortable relaying information to the rest of the healthcare team minus the nurses of my findings and potential concerns. I plan on accomplishing this by seeking out opportunities of practicing contacting physicians and surgeons about care on patients.
Clinical Decision Making
For clinical judgment, my goal was to practice EKG interpretation and analyzing labs.

I still require additional knowledge in EKG interpretation, but I was able to practice during my cardiac MedSurg rotation. I learned to measure the width of the waves and what some of the different lines mean and where to place to nodes on the patient. For analyzing labs, I feel more confident in my ability to analyzing labs and incorporating it into my patient care. An example of this, in my oncology rotation, I reflected on my patients’ lab values which showed they were neutropenic, based on this I was able to establish the nursing diagnosis of risk for infection, the risk for bleeding, risk for oxygenation, and altered cellular regulation. I have also had lots of practice with clinical decision making in clinical. I have practice assessing the lab values, medication, and diagnosis to establish interventions and potential complications specific to my patient.

Moving forward I want to continue connecting the pieces of my patients’ care and health history. I plan on accomplishing this by continuing analyzing the lab values, medications, and physiology of the diagnosis to establish diagnosis and interventions specific to my patients and finding the connections between the

diagnosis.
Safety
Finally, my goal for safety was I wanted to practice different procedures correctly and become more confident in my abilities to perform tasks independently. I have had lots of practice with different interventions that I now feel confident including medication administration, assessments, and removal of urinary catheters. I still need to practice having confidence while my instructor is watching. To accomplish this, I plan on reminding myself that I know the information and that I have done the assessments and interventions multiple times and that I know how to do them.
Conclusion
I have learned a lot this semester, I have learned how to do chest tube care, JT tube stripping, EKG monitoring, and how specialized and individualized chemotherapy is. Reflecting on my goals that I established during the beginning of the year, I have accomplished a fair amount of them. I do still have some goals that I wish to accomplish before I graduate. I have come a long way in my path to nursing and I look forward to seeking out opportunities to enhance my knowledge to become a more competent nurse.