Log 4

Clinical Log      Clinical Log 4 s: Hours this week: Hours to Site: Preceptor: Personal Objective To achieve better understanding of clinical safety protocols in operation rooms through clinical practice and research so as to build knowledge and information to support practice aimed at improving outcomes for operation patients.
Course Objective
To acquire practical skills of developing the knowledge base and experience in enhancing patient safety
To demonstrate advanced skills and expertise in patient safety enhancement in healthcare and to develop problem solving capability via research
Observational Note
I reported to the unit on the first day so as to apply my observation tool. Prior to my arrival, Susan, the safety nurse had informed the staff in the unit about my arrival. As such, they were all aware of my arrival and supportive in all undertakings that I engaged in with them. I was expected to attend to cases scheduled for the operation room (OR). Upon my arrival, I met the nurse in charge, and she assigned me to a case involving the preparation of a patient for the operation room. The nurse in charge requested the Registered Nurse (RN) in charge of the Operation Room (OR) schedule to oversee my undertakings. Jerriann, the RN, was in charge of the most recent OR case that was scheduled for 11. 30 a. m. The first task entailed preparing a patient that was in the recovery room for the operation room. In order to begin working on the patient’s preparation we had to wait for the whole team to arrive. The anesthetist first talked to the patient before we could initiate the preparation. My role as a CNS in the preparation for OR entailed ensuring that the patient’s safety was upheld during the transfer process into the OR. The role of ensuring patient safety as a CNS is important in shaping the direction of managed care outcomes, therefore, I had to make sure that protocols of transfer to the OR and preparation were observed. As part of this task, I had to carry out double checks to ensure that the IV lines were appropriately positioned, the side rails were up and the indwelling catheters were secure and well knotted to avoid any dislodge.
After completion of the checks and observation of transfer protocols, the patient was safely transferred to the operation room. Once safely positioned in the operation room the nursing team began preparing the patient to receive spinal anesthesia. The process was quite challenging because the nursing team took almost one hour to properly insert the needle. The challenge was due to the fact that there was some resistance encountered during the insertion process. However, the process was finally successful on a second attempt. Everything was set to go after the completion of the anesthetist’s process, and the operation team started operating on the patient. Perhaps the first anomaly that I noted about the process is the fact that the team had failed to make a double check on patient’s name and details before the needle insertion process. This is an important step that should be observed in the OR according to set up protocols by the World Health Organization (WHO). However, the step was foregone because the team was sure that they were dealing with the right patient.
In the process of the case, I learned that the checklist was a very essential tool in determining the flow of the whole process. The checklist identifies different phases of an operation process, each corresponding to a specific period in the normal flow of work. According to the checklist protocol it is necessary to “ sign in” prior to the induction of anesthesia. Prior to the incision of the skin, it is also necessary to “ time out.” It is also necessary to “ sign out” before the patient leaves the operation room. In every step, a checklist coordinator is supposed to confirm that the team undertaking the surgery has successfully finished the listed undertakings before it continues with the operation process. These requirements were however, not fully integrated in the workflow, and each team seemed to work around its sphere. According to Gawande (2010), these doctors and nurses make errors in approximately one percent (1%) of their actions. However, this still amounts to an estimated two errors per day with every patient. According to my observation in the unit, only 5 items from the checklist were applied out of the total 40 items. However, the process was finally successful because the baby was delivered safely. In another unscheduled case for the OR, a 27-year-old woman failed to deliver safely and she had to be scheduled for an operation. Her case was no different because only two items from the checklist were observed. This implies that both scheduled and unscheduled cases were often treated in a similar manner.
On my second day, I was paired with another RN (Sam), who was assigned for a scheduled case. However, the case was later transferred to the general operation room (GOR). The case was due in three days, and the patient had had four previous processes. The patient was supposed to be transferred to the general operation room in the third floor of the facility because of the possibility to excessively bleed during hysterectomy. Like most other cases, this case also required the application of safe transfer protocols because the patient had to be transferred from the 8th floor to the 3rd floor. In ensuring safe and effective transfer, I had to compare the patient’s height to the OR table, because the patient was particularly tall and heavy-set. I made mention of some safety transfer tips in the process as a CNS, but I did not say much because my position as a student did not allow, and I did not want to cause any interference. Upon arrival in the OR, I noted that the staff and setting was well organized. The circulatory nurse (Robin) in the OR did not allow the patient in before clarifying the patient details. She first checked the patient’s name and ID to ensure that they were receiving the right case. The team was well organized and everyone played their role appropriately. However, I noted that they placed the patient on a small bed and a small room, which I deemed inappropriate for the case. The operation process was successfully completed in three hours. The staff members in this unit were less social and more quit, but I was able to work well with them.
On the third day was assigned to the GOR where I was paired with Balen, who was the circulatory nurse. I was able to go through my checklist and I compared it to what they had at the GOR. I noted some inconsistencies between my checklist and their operational process, and as such, I found my checklist inapplicable in their case because they were more organized.
Reflective Note
Communication and Collaboration
In my few assignments, I learned that a CNS plays a significant role in coordinating and collaborating with other practitioners in the implementation of processes such as the application of medical procedure protocols. Personally, I collaborated with the nurse in charge, Susan, and Carlotta-Puryear as well as other registered nurses within the unit so as to have a successful application of my observation tool. In order to have any successful engagement, a CNS has to maintain appropriate communication and collaboration with other team members. In order to synthesize and analyze acquired data, I also had to collaborate with the rest of the team within my engagement teams. Intra-operative communication is also necessary in ensuring that operation scheduling and activities such as transfer go on successfully (Cherian et al., 2007). Therefore, maintaining appropriate communication facilitates success in procedures, and this is in fact a recommendation by the WHO (Cherian et al., 2007, p. 66). I undertook the role of implementing collaboration in this work with clinical teams. In addition, I felt that it was necessary to combine straight nursing duties with the area of my expertise as recommended by Hamric, Spross and Hanson (2000, p. 284).
Researcher
The clinical experience showed that a CNS has a role to play as a researcher and contributor to the development of the body of knowledge, which supports medical practice. In my period at the unit, I had to collect data and read extensively on issues pertaining to patient safety in order to build my knowledge that could support my future role. The data collection procedures were supportive of the research role that practitioners have to play in acquiring knowledge that can further practice. Additionally, I learned that there is need to use documented research in supporting practice because I often had to refer from articles in the Cochrane database to determine effective organization and practice.
Educator
The educational role played by CNS’s emerged when I had to use my findings in showing the team of practitioners their weaknesses. The use of the checklist in the operation room was not up-to-date, and there was a need for change. I had to work using PowerPoint presentations to present my ideas about appropriate application of the checklist. The educating process gave me this indication of how CNSs who practice in hospitals perform as mentors to other nurses, and CNS in my personal reflection is like a mother who wants their kids to be perfect. As educators CNS’s typically contribute to the education in numerous settings, including patients, nursing staff, and the public. By writing materials or preparing PowerPoint I was able to provide the nurses with some information about this project (Hamric, Spross & Hanson, 2000, p. 272).
Self evaluation
After confronting various cases and challenges in three days, my eyes were wide open as my insight increased as well as my critical thinking skills. I began critically thinking about how CNS’s could work to improve patient safety in their areas of operation. My experience during this period showed me the essence of improving nurse awareness in issuing relating to patient safety. I felt that there is more that I could have done, and wished that I had the chance to work with the team from the beginning of the semester. The nurse in charge-Susan-taught me a lot and a greatly appreciate her help. However, she was never available at all times because she did not work on weekends. The fact that I have to work even on weekends and morning hours when she is not available is rather challenging because as a student, it is inappropriate for me to work without a preceptor. However, it is necessary for me to work on these hours and day because I have to cover my clinical hours in time. Working without a preceptor causes significant challenges, and it makes me feel lost at times. I particularly enjoyed working in the GOR, but they could not apply my checklist because after my discussion with Susan we noted that the team in the GOR had their own clear protocols and responsibilities, and there was no need to introduce any alterations.
Chapter Summary
Chapter 9: Quality of Life as an Outcome of Cancer Care
This chapter analyses the quality of life a prognostic indicator. It further analyses the use of quality of life in information in the care delivery within cancer units. The quality of life for cancer patients in defined and conceptual models on quality of life are developed within the chapter. The chapter also highlights the measurement of the quality of life through the use of questionnaires. The content and development of questionnaires used in assessing the quality of life is highlighted. Real-time data collection on quality of life and its essence in designing care for patients is clearly highlighted as well as rge significance. The chapter also highlights the challenges of assessing the quality of life by looking at various groups that present special challenges (Yarbro, Wujcik & Barbara, 2010). The chapter is important in developing care skills and knowledge for oncology care nurses.
Chapter 8: Diagnostic Evaluation, Classification and Staging
Chapter eight looks at factors and goals that affect diagnostic approaches applied for cancer cases as well as the various approaches applied. The basics highlighted include condition biological markers, analytical techniques, genetic testing, laboratory analysis as well as invasive and imaging diagnostic models. The chapter further classifies and develops a nomenclature system for the condition. The development of the condition is also highlighted as a form of sequential process with stages and grades. The stages of advanacement are highligghted and finally the nursing implications of this information and trends in relation to diagnostics are also highlighted (Yarbro, 2010). This chapter is essential in developing diagnostic skills and evaluation of patients.

References
Bero, L., Grilli, R., Grimshaw, J., Harvey, E., Oxman, A., & Thomson, M. (1998). For the Cochrane effective practice and organization of care review group. Closing the gap between research and practice: An overview of systematic reviews of interventions to promote the implementation of research findings. BMJ, 317 (7156), 465-468.
Cherian, M., Merry, A., & Wilson, I. (2007). The world health organization and anesthesia. Anesthesia, 62, 65-66.
Gawande, A. (2010). The checklist manifesto: How to get things right. Profile Books.
Hamric, A. B., Spross, J. A., & Hanson, C. M. (2000). Advanced nursing practice: An integrative approach. WB Saunders.
Yarbro, C., Wujcik, D., & Barbara, H. (2010). Cancer nursing: Principles and practice: Principles and practice Jones & Bartlett Learning.