Karen Davis
Content
Karen Davis GNUR 460 Reflection Paper July 22, 2012 Critical Incident Analysis: I have learned a lot over my five years of nursing, much of my gained knowledge has come from difficult situations. I cherish these moments when I can admit that I am wrong, or do not know the answer because I can only learn from the outcome. One of my most difficult times a nurse happened about a year ago. I work on a hematology/oncology unit, as well as an inpatient hospice unit, so death and dying is not a new part of my job. While I am around death and dying on a daily basis, I will never get used to it and when I do I know it is time to move on. This particular incident really struck home with me and will forever be a part of who I am. My patient was a female in her early 40’s who had 3 teenage children. She was originally admitted to the hospital for pain management and ascites related to her cancer. However, as the days progressed it became clear that she was nearing end of life. She was becoming confused and her pain was almost impossible to manage. Her family was upset because of the change in her condition, but also because no matter what we did we could not get her comfortable. To add to the pain management problems, we were having problems with a physician on her case. The patient was related to her PCP. When the patient was first admitted the PCP was not on consult, just her oncologist and other physicians consulted to help manage her care. However, after the PCP found out that the patient was dying he consulted himself on the case. Once the PCP started getting involved in the patient care, things became increasingly difficult for the staff. The PCP was unwilling to accept that she was dying and wished for comfort care. Each morning her would round on her and order new
tests and blood work and even discontinue her scheduled and PRN pain medication. When the staff would question the necessity for his orders and discontinuing of her medications he would simply state “because I said so”. After he would leave we would call her oncologist and the covering resident and discontinue his orders and reorder her pain medication. Each evening the PCP would return and do the same thing. After several days of this it was becoming quite an issue. We were unable to provide the best care to the patient because we were having to spend more time chasing around doctors to cancel orders and get new medication orders. By the fifth day I had been taking care of her, I called the ethics team at our hospital. I was looking for advice on how to handle the situation. I have always believed that a major part of a nurse’s job is to be an advocate for their patient. I felt that my patient was not getting the best possible care we could give her. After listening to my concerns and reading through the chart the ethics team felt that the PCP and oncologist needed to have a meeting together to formulate what the goals of care were. By this time the patient’s family had accepted her change in condition and wanted nothing but for her to be comfortable. After much argument we were able to get a meeting with the PCP and oncologist and family. Along with the ethics team I sat in on the meeting. We all voiced our concerns about what was happening on a daily basis with the orders and cancelation of medications. After the meeting concluded we were able to formulate a plan of care that worked for everyone involved, most importantly the patient. We were able to transition the patient to hospice where she was able to return home and died within a couple of weeks. The whole experience really helped me learn who I was as a nurse. I learned that I will always put my patients first, be their advocate when they do not have a voice. I also learned that I can step in and question a physician on what they are
doing and why. Before this incident I had always been hesitant about question what a doctor was ordering, I always felt that they knew what they were doing. Now I know that I can question anything a physician orders because it may be more harmful than good to my patient. I have always held this incident close to my heart and probably always will.
Evidence in Portfolio that Indicates Your Growth There is evidence in my portfolio that indicates growth, but I know that as I continue in my nursing career and master’s program it will only grow. I have been a nurse for four years now. In that time I have worked in three different areas of nursing; ortho/trauma, hospice and heme/onc. I started on an ortho/trauma unit right out of nursing school. I thoroughly enjoyed the fast past of the unit because it truly taught me time management. However, I did not feel like I could grow as a nurse on that particular unit. After a year and a half of working on the unit I felt that I was stuck in a rut, seeing the same patients on a daily basis. I have always loved to learn and challenge myself, and I felt that in my current position I was not able to do either of those. I have floated to the heme/onc unit quite a bit and really enjoyed it. Lucky for me there was an opening. Since I have worked on the heme/onc floor I have found my niche as a nurse. While I was in nursing school I had always toyed with going back to school and getting my Adult NP and moving on to finally get my DNP, however I did not have the motivation to do it. After starting on the heme/onc floor I found my motivation. I wanted to go back to school for my ANP/Oncology CNS. I started researching masters programs in the Chicago area and found that Loyola’s was the only one that offered an Oncology specialty. While I was doing my research I decided to take the OCN
exam. I was incredibly nervous, but passed it with a 98%. After receiving my OCN and knowing the score I got, it only affirmed that I was in the right field for me. Since starting the ANP/Onc CNS program I have been able to grow more as a nurse. After taking nursing theory and doing my final paper and presentation on Palliative Care I have determined that is where I want to focus my career upon graduation. While taking research I was able to focus on two areas of nursing that have always been close to my heart; VTE prevention and alternative treatments. Taking the cancer genomics class opened my eyes to a whole new part of nursing, research, which I may focus on when getting my DNP. I have only been a nurse for a few years, but I feel that I have accomplished quite a bit in those years. I have become a certified nurse, I have returned to graduate school and I am starting to conduct pilot studies at the hospital I work at. As I grow as a nurse, and especially once I become an ANP my portfolio will only grow. There will continue to be evidence of my growth and development. I absolutely love the nursing field because there are so many options and ways to continue to learn and grow.
Fondest Memory of Graduate School I have only been in the graduate program for a little over a year. So far I have taken numerous interesting classes and have done enjoyable work for each one. My favorite memory of graduate school thus far has been research. I really enjoyed being able to pick my own topics and running with them. While I believe in medication and chemotherapy, I have always believed that there are alternative treatments that can help manage a disease as well. One of my greatest passions in life is yoga, I have used it to help ease pains and decrease stress. I have always wanted to know if research has been done on using yoga to help reduce symptoms that cancer patients
have. I would choose my research paper on Yoga for Symptom Management as the part of my portfolio that describes my favorite memory of graduate school. I really enjoyed getting into all the research papers that had been conducted on the topic. I even discovered a physician at my hospital who was trying to start a pilot program using yoga to help breast cancer patients. It is hard to pick my fondest memory of graduate school so far since I have truly enjoyed each class. I am sure that I will only continue to have fond memories of graduate school and be able to complete more projects that mean a lot to me and my nursing career. Future Plans My biggest short term future plan is to finish graduate school and start practicing as an ANP. My dream job would to work on a palliative care team in a hospital. After I have become settled in my new role, I would like to go back to school for my DNP. I would like to focus my DNP on cancer research. In ten years I would like to have my own palliative care team, but also to have started a clinic/center for alternative treatments for cancer symptom management. I believe that not all symptoms need to be managed by medications. Studies have shown that using meditation, yoga, acupuncture etc can help to reduce symptoms that cancer patient experience. Currently not many people are aware of the uses for these alternative treatments and I would like to make more people aware. I feel that the best was for more people to be aware of the alternative treatments is to open a center where they are offered. Eventually I would love to have a holistic clinic available for cancer patients. Not only would they be able to receive their treatments for their cancer, but there
would also be other services available to them for example; spa treatments, massages, yoga practice, meditation, tai chi, acupuncture etc.
tests and blood work and even discontinue her scheduled and PRN pain medication. When the staff would question the necessity for his orders and discontinuing of her medications he would simply state “because I said so”. After he would leave we would call her oncologist and the covering resident and discontinue his orders and reorder her pain medication. Each evening the PCP would return and do the same thing. After several days of this it was becoming quite an issue. We were unable to provide the best care to the patient because we were having to spend more time chasing around doctors to cancel orders and get new medication orders. By the fifth day I had been taking care of her, I called the ethics team at our hospital. I was looking for advice on how to handle the situation. I have always believed that a major part of a nurse’s job is to be an advocate for their patient. I felt that my patient was not getting the best possible care we could give her. After listening to my concerns and reading through the chart the ethics team felt that the PCP and oncologist needed to have a meeting together to formulate what the goals of care were. By this time the patient’s family had accepted her change in condition and wanted nothing but for her to be comfortable. After much argument we were able to get a meeting with the PCP and oncologist and family. Along with the ethics team I sat in on the meeting. We all voiced our concerns about what was happening on a daily basis with the orders and cancelation of medications. After the meeting concluded we were able to formulate a plan of care that worked for everyone involved, most importantly the patient. We were able to transition the patient to hospice where she was able to return home and died within a couple of weeks. The whole experience really helped me learn who I was as a nurse. I learned that I will always put my patients first, be their advocate when they do not have a voice. I also learned that I can step in and question a physician on what they are
doing and why. Before this incident I had always been hesitant about question what a doctor was ordering, I always felt that they knew what they were doing. Now I know that I can question anything a physician orders because it may be more harmful than good to my patient. I have always held this incident close to my heart and probably always will.
Evidence in Portfolio that Indicates Your Growth There is evidence in my portfolio that indicates growth, but I know that as I continue in my nursing career and master’s program it will only grow. I have been a nurse for four years now. In that time I have worked in three different areas of nursing; ortho/trauma, hospice and heme/onc. I started on an ortho/trauma unit right out of nursing school. I thoroughly enjoyed the fast past of the unit because it truly taught me time management. However, I did not feel like I could grow as a nurse on that particular unit. After a year and a half of working on the unit I felt that I was stuck in a rut, seeing the same patients on a daily basis. I have always loved to learn and challenge myself, and I felt that in my current position I was not able to do either of those. I have floated to the heme/onc unit quite a bit and really enjoyed it. Lucky for me there was an opening. Since I have worked on the heme/onc floor I have found my niche as a nurse. While I was in nursing school I had always toyed with going back to school and getting my Adult NP and moving on to finally get my DNP, however I did not have the motivation to do it. After starting on the heme/onc floor I found my motivation. I wanted to go back to school for my ANP/Oncology CNS. I started researching masters programs in the Chicago area and found that Loyola’s was the only one that offered an Oncology specialty. While I was doing my research I decided to take the OCN
exam. I was incredibly nervous, but passed it with a 98%. After receiving my OCN and knowing the score I got, it only affirmed that I was in the right field for me. Since starting the ANP/Onc CNS program I have been able to grow more as a nurse. After taking nursing theory and doing my final paper and presentation on Palliative Care I have determined that is where I want to focus my career upon graduation. While taking research I was able to focus on two areas of nursing that have always been close to my heart; VTE prevention and alternative treatments. Taking the cancer genomics class opened my eyes to a whole new part of nursing, research, which I may focus on when getting my DNP. I have only been a nurse for a few years, but I feel that I have accomplished quite a bit in those years. I have become a certified nurse, I have returned to graduate school and I am starting to conduct pilot studies at the hospital I work at. As I grow as a nurse, and especially once I become an ANP my portfolio will only grow. There will continue to be evidence of my growth and development. I absolutely love the nursing field because there are so many options and ways to continue to learn and grow.
Fondest Memory of Graduate School I have only been in the graduate program for a little over a year. So far I have taken numerous interesting classes and have done enjoyable work for each one. My favorite memory of graduate school thus far has been research. I really enjoyed being able to pick my own topics and running with them. While I believe in medication and chemotherapy, I have always believed that there are alternative treatments that can help manage a disease as well. One of my greatest passions in life is yoga, I have used it to help ease pains and decrease stress. I have always wanted to know if research has been done on using yoga to help reduce symptoms that cancer patients
have. I would choose my research paper on Yoga for Symptom Management as the part of my portfolio that describes my favorite memory of graduate school. I really enjoyed getting into all the research papers that had been conducted on the topic. I even discovered a physician at my hospital who was trying to start a pilot program using yoga to help breast cancer patients. It is hard to pick my fondest memory of graduate school so far since I have truly enjoyed each class. I am sure that I will only continue to have fond memories of graduate school and be able to complete more projects that mean a lot to me and my nursing career. Future Plans My biggest short term future plan is to finish graduate school and start practicing as an ANP. My dream job would to work on a palliative care team in a hospital. After I have become settled in my new role, I would like to go back to school for my DNP. I would like to focus my DNP on cancer research. In ten years I would like to have my own palliative care team, but also to have started a clinic/center for alternative treatments for cancer symptom management. I believe that not all symptoms need to be managed by medications. Studies have shown that using meditation, yoga, acupuncture etc can help to reduce symptoms that cancer patient experience. Currently not many people are aware of the uses for these alternative treatments and I would like to make more people aware. I feel that the best was for more people to be aware of the alternative treatments is to open a center where they are offered. Eventually I would love to have a holistic clinic available for cancer patients. Not only would they be able to receive their treatments for their cancer, but there
would also be other services available to them for example; spa treatments, massages, yoga practice, meditation, tai chi, acupuncture etc.
