Critical Care Wrap Up.

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This past term I was placed in the Critical Care Unit (ICU) at a smaller local hospital. This has been an incredibly rewarding, but at times anxiety inducting experience. I started off as a very hesitant and timid individual to a nursing student who has demonstrated a willingness to learn and better my nursing skills. Over the term, I have found a new sense of confidence in my ability to perform my physical assessments and communicate with my patients and their families. Most important, this experience in the critical care unit has provided me with the opportunity to manage my emotions and critical thinking during crisis situations. Initially, I dreaded this placement, feeling immense anxiety over my lack of skills that I had developed over the past couple of years, feeling as though I wouldn’t be good enough and worried i’d be judge for being such a novice by more experience professionals. Throughout the term, I have developed strong relationships with the nurses on the floor and have felt a strong sense of support in guiding me through my nursing practice. As a critical care nursing student, I cannot emphasize how important this support has been in allowing me to flourish and find my footing, particularly when both my patients I was tasked with helping the bedside nurse coded and hence have a new-found appreciation for the importance of maintaining and facilitating a strong team dynamic. 

Commonly through my prior critical reflections, I have found common themes of learning to embrace being outside of my comfort zone and the importance of building and maintaining both inter-professional and intra-professional relationships throughout my practice as a future healthcare professional. These two themes are incredibly important, particularly in a setting where a patients’ status can change relatively quickly and without much notice. The significance of these themes is critical in not only facilitating a positive work environment but are also important aspects in providing optimal patient care and supporting my own well-being as I transition into professional practice. 

Following the questions outlined in the manual, I have selected the 3 which have resonated with me most. I will first discuss the experience when I felt most disconnected and disillusioned with being a student nurse. The second question I will address will be my greatest contribution to nursing and to my clients. Lastly, I will address my thoughts and feelings as to what I think about when I realize I am graduating at the end of next term. 

            I believe one area where I have experienced disillusionment this term is living vicariously through the experiences of the other bedside nurses. In nursing school, I have found new grad nurses have been greatly unprepared to handle the realities of the nursing profession. Some of this can be related to personal characteristics, but a lot of the issues that arise seem to stem from organizational and management decisions that have often increased stress and workload placed on the nurses, particularly those in the acute care setting. This finding has been supported in the literature in which it has been found that the central cause of nursing disillusionment is related to the pressure nurses face in betraying their own personal values when caring for a client (Oberle & Davies, 1993). On my floor, this has been evidenced by an elderly patient, suffering from end stage COPD, whose family has often made it incredibly difficult for nurses to feel comfortable caring for the client due to fears of bullying tactics, providing care the is futile and of no benefit to the patient, and fear of litigation. In turn, many of the nurses I have spoken to have brought up feelings of post-traumatic stress disorder because of the lack of support management has offered them in being able to ethically navigate the situation, often siding with the families wishes over the opinions of medical professionals who have worked tirelessly at the bedside. While the nurses have expressed great concern in providing the most optimal care in maintaining the little quality of life the patient has, it has impacted them quite deeply and many have become jaded and morally distressed about the care they are able to provide (Burston & Tuckett, 2012). 

            In addressing the contributions, I have made to the nursing profession, I believe I have strived to see my patients as more than just an individual that has been admitted to the unit. Throughout my nursing practice, I have aimed to practice compassionate care and adopt more empathetic approaches in caring for my patients. I have learned that caring is simply not enough and that as healthcare professionals we need to strive to ensure my patients feel listened to and cared for. I have sought to adopt a more structured approach to empathetic care and have found that adopting empathetic care has not only been shown to improve patient outcomes, but also improve personal wellbeing (CPSA, 2018). I have found taking a few minutes each shift to interact with my patients has decreased my anxiety and has improved my comfort in caring for my patients and feeling more confident in my abilities. This finding has also been supported in the literature (CPSA, 2018).  On a more systematic level, this year and for most the fall term, I have taken the initiative to become a student leader, sitting as a board member on the Canadian Association of Nursing Students. Through this experience, I have been able to build links and represent students at the Ontario Nurses’ Association and Canadian Mental Health Association. I have been able to create initiatives to break down health literacy barriers and have been able to give students a platform to share their research and expose other students to both academic and research opportunities. Through these experiences, I have been able to develop relationships that will hopefully allow me to make systematic changes as I gain more experience being at the bedside and working with patients, their families, and other healthcare professionals. 

            When I think of graduating next term (something I didn’t think was possible 3 years ago), I feel a sense of both excitement and a sense of feeling overwhelmed. I have been incredibly fortunate to have been given a critical care placement, I recognize some of the feelings I am facing now, will continue to exist once I transition into independent practice. My feelings of anxiety are common amongst those transitioning from student to new graduate. When having examined the literature focusing on perceptions of nursing students transitioning into independent professional practice a number of areas are brought up. Issues that nursing students have brought up include feeling unprepared to deal with the increased responsibilities of being a new graduate nurse, patient workload and assignments, and development of time management skills (Simmons, 2011). I believe in addressing these feelings, it is a common phenomenon and I am in a position where I can take steps to ease my transition as to not feel as overwhelmed and anxious. I believe part of addressing their fear is to embrace the concept of growth and being able to step outside of my comfort zone and reflect.

Through my placement in the critical care unit this term, I have recognized and embraced the fact that I cannot stay in the comfort of being a nursing student forever and as such it will be exciting but also intimidating to enter a new critical care environment at SickKids in January. As someone who holds incredibly high standards for myself I know this opportunity will continue to challenge and excite me. Everything I have worked towards in the past 3 years has come together and cumulated in my goal of working towards being a paediatric nurse and I am incredibly grateful for those that have supported my journey along the way.

Works Cited:

Boissy, A., Windover, K., Bokar, D., Karafa, M., K. Neuendorf, Frankel, R.M., J.Merlino, F.J. & Rothberg, M.B. (2016). Communication skills training for     physicians improves patient satisfaction. Journal of General Internal    Medicine, 31(7).  Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26921153

Burston, A. & Tuckett, A.G. (2012). Moral distress in nursing: contributing factors, outcomes and interventions. Nursing Ethics, 20(3). Retrieved fromhttps://www.researchgate.net/profile/Anthony_Tuckett/publication/234012097_Moral_d            stress_in_nursing/links/00b4951857ed0c6712000000.pdf

College of Physicians and Surgeons of Alberta (CPSA). (2018). Caring is not enough: how to develop an approach to empathetic communication. Retrieved from http://www.cpsa.ca/caring-is-not-enough-how-to-develop-a-structured-approach-to          empathetic-communication/

Oberle, K. & Davies, B. (1993). An exploration of nursing disillusionment. The CanadianJournal of Nursing Research, 25(1). Retrieved from            https://cjnr.archive.mcgill.ca/article/viewFile/1181/1181

Simmons, J. (2011). Undergraduate nursing students’ perceptions of preparedness as they  graduate [thesis]. St. John Fisher College. Retrieved from            http://fisherpub.sjfc.edu/cgi/viewcontent.cgi?article=1016&context=nursing_etd_masters

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