Narrative Reflective.

Narrative Reflective.

OVERVIEW

Students will reflect on an episode of patient care that exemplifies their approach to professional nursing practice. We will use the criteria from the clinical domain of the UWHC Nursing Clinical Advancement Program (NCAP) to guide this reflection. Components of the clinical domain include the following: primary nursing, therapeutic relationships, diversity and cultural congruency, ethical decision making, assessment, diagnosis, outcome identification, implementation, evaluation.

PROCESS (adapted from the UWHC Nursing Clinical Advancement Program)

1. Begin by identifying a patient care story that exemplifies your nursing practice.
2. Spend time reflecting on that story – break down what occurred:
   1. What were your roles/responsibilities?
   2. What were your thoughts in the moment?
   3. What actions did you take and why?
   4. How did you reflect upon the experience afterwards?).
   5. The Tanner Clinical Reflection Example may be a helpful in getting started.
3. Consider the Clinical Domain Components of the UWHC NCAP Model as you continue to reflect on this story. Identify the criteria that can be addressed with this story–you may be surprised by how many criteria can be addressed with a single story.
4. Write the narrative describing the story while addressing 1-2 items from at least seven components of the clinical domain. You may explicitly identify up to two Clinical Components that were not part of the patient care story, along with a description as to why they were not applicable to your role in this specific patient care story.
5. Make sure you have paid careful attention to HIPAA privacy concerns.

SUBMISSION

• The submission should be a cohesive narrative. You do not have to divide it into separate clinical domains with headers for each domain; rather, please use superscripts^{1, 3, 4} to tag each domain covered. Use the numbering below for your superscripts:
  1. Nursing Care Delivery System: Primary Nursing
  2. Therapeutic Relationships
  3. Diversity and Cultural Congruency
  4. Ethical Decision Making
  5. Assessment
  6. Diagnosis
  7. Outcome Identification/ Plan of Care
  8. Implementation
  9. Evaluation
• Please submit a Word (or similar) document of no more than three single-spaced pages, by the due date. The font should be 12 point, Times New Roman (or similar); margins should be 1″ on all sides.
• Put your name, the course number, and the assignment title (Narrative Reflection) at the top of the first page. Do not include a cover page. 
• HIPAA is not being explicitly graded; however, points will be deducted for including protected patient identifiers in your submission (up to a loss of all points for including the patient’s full name or similar explicit identifiers).
• Turnitin is on for this assignment and should give you immediate feedback. Please consider using that feedback to modify/improve your assignment prior to the due date (we will only grade the last document submitted).

Rubric

Some Rubric

THE Tanner clinical reflection example

Table adapted from Box 36–1. Guided Reflection in Trakalo, K., Horowitz, L., & McCulloch, A., (Eds.)

(2015). Nursing: A concept‐based approach to learning (2^nd ed.). Volume 1 & 2. Boston, MA: Pearson Education, Inc.

This activity illustrates how one new nurse reflects on a situation he encountered during a clinical day that caused him to think about what happened and how he responded. Organizing thinking about client care and professional nursing practice is a learned skill. Reflecting on thinking processes supports recognizing the “lessons learned” for personal improvement in clinical judgment.

10. What was your “take‐away” from the 10. “Keep an eye on the clock and give priority to

experience?       things I need to do that have specific times to be

done—work the other interventions around the

timed ones.”

Source: Based on Tanner, C. (2006). Thinking like a nurse: A research‐based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204–210.

CLINICAL DOMAIN COMPONENTS OF THE UWHC.

Adapted from: UW Health Nursing Clinical Advancement Program (©2014)

1. Nursing Care Delivery System: Primary Nursing
   1. As a primary nurse utilizes UWHC primary nursing model with assistance from preceptor/mentor
   2. Understands and functions as a team nurse and follows/ modifies the plan of care established by the primary care nurse with assistance from preceptor/mentor
   3. Strives to model exemplary care delivery

2. Therapeutic Relationships
   1. Initiates and maintains therapeutic relationship with patient/family, as evidenced by the following:
      1. Recognizes and respects patient/family and their unique situations
      2. Solicits patient/family input and involves patient/family in care decisions (e.g. care conferences, rounds) to fulfill basic needs

• Understands limits and boundaries of therapeutic relationships

1. Incorporates focused time with patient/family (e.g. five minutes at the bedside, procedure area or in the exam room)
2. Incorporates key aspects of therapeutic policy and procedure and/or online educational offerings into daily practice

1. Acts as patient/family advocate by communicating with patient/ family and team about routine clinical practice issues

3. Diversity and Cultural Congruency
   1. Self-awareness of one’s own culture, biases and stereotypes; accepts and respects diversity and all cultural backgrounds of patient/family
   2. Has an understanding of frequently served cultures and adapts care to meet patient/family needs
   3. Identifies potential cultural concerns; seeks out assistance and utilizes resources with assistance from preceptor/mentor

4. Ethical Decision Making
   1. Identifies potential ethical concerns, seeks assistance, and utilizes resources with assistance from preceptor/ mentor

5. Assessment
   1. Performs focused patient/family assessment including physical, psychosocial, cultural, etc.
   2. Recognizes normal and abnormal findings and/or changes from baseline; seeks help when appropriate
   3. Recognizes patients’ typical response to familiar treatments or interventions
   4. Utilizes screening tools to assess and guide practice (Pain Braden Scale, Heindrich Fall Risk, etc.)

6. Diagnosis
   1. Identifies and individualizes relevant nursing diagnoses with assistance from preceptor/ mentor

7. Outcome Identification/ Plan of Care
   1. Understands and supports the interdisciplinary model of care and identifies patient/family outcomes with assistance from preceptor/ mentor (Plan for the Day/Plan for the Stay)
   2. Initiates the interdisciplinary plan of care with assistance from preceptor/ mentor
   3. Incorporates patient/family input into the development of an interdisciplinary plan of care

8. Implementation
   1. Provides basic explanations and interventions in support of the plan of care
   2. Safely manages basic emergent situations by initiating appropriate response and following directions
   3. Organizes and prioritizes work load based on patient/family needs with assistance from preceptor/mentor
   4. Identifies and implements routine safety measures (e.g. two patient identifiers, medication administration, specimen labeling, hand washing, PSN, hand-off communication)
   5. Identifies patient/family learning needs and collaborates with the interdisciplinary team to effectively provide education with assistance of preceptor/ mentor
   6. Effectively utilizes appropriate information management technologies for clinical practice (e.g. e-mail, Intranet, Quadramed, Health Link, pump technologies, telemetry, medication administration devices)
   7. Displays a positive attitude toward technology integration in nursing practice

9. Evaluation
   1. Monitors ongoing progress and evaluates effectiveness of interventions in collaboration with the patient/family and the interdisciplinary team