Reflective journal

Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum courseIn your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences: New practice approaches Intra-professional collaboration Health care delivery and clinical systems Ethical considerations in health care Population health concerns The role of technology in improving health care outcomes Health policy Leadership and economic models Health disparities Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course. You are required to submit this assignment to Turnitin. This assignment uses a rubricWhile APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines. Please Spell/Grammar check your work before turning it in, there are points associated with Mechanics of Writing. Note: I will attach 2 examples. Please follow that Thanks


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Professional Capstone &Reflective Journal
Professional Capstone &Reflective Journal
Week 1: February 12-18
One of my first assignments for this week was familiarizing myself with the GCU
library and locating the scholarly database. By doing this it will help me easily find information
that I will need to do my evidence-base practice (EBP) project. We also studied about EBP and
how it benefits nursing practice. I realized that although EBP is essential in nursing it is not
being practice as often as it should. One of the main things that stood out for me this week was
that if EBP is properly implemented in our nursing care we can improve our patients outcomes.
Another important step I had to do this week was decide on who I would choose as my
mentor for this course. I choose my coworker Celso Hernandez, he has been a nurse for about 8
years and has a lot of nursing experience and patient care experience. We went over all the
requirements together so that he would have a better idea on how he could help me throughout
this course.
Week 2: February 19-25th
This week was a tough week. I had to finally decide on my topic for my capstone
project. What made it easier to choose a topic was my DQ question for this week, as it asked me
to analyze what clinical problem/issue my organization is facing. I knew that I wanted my
capstone project to be on how to increase patient satisfaction. I used all my resources I had
available to conduct my research on EBP articles/journals to guide me though the right direction.
I realized that patient satisfaction is a broad topic and unfortunately made it hard for me to focus
on one nursing intervention.
I met with my mentor to discuss the issue I was having and together we started to
brain storm. I came up with increasing patient satisfaction though the quality of care delivered to
the patient by the nurse.
Week 3: February 26th- March 4th
This week I met with my mentor and went over on how my capstone project was
coming along. My mentor read my PICOT statement and realized that I was all over the place.
He suggested changing my topic once again. Together we took another look on what we thought
needed a change on our floor. One of our major flaws that we have is not giving bed side report
during shift change. We did some research on bed side report and we learned that performing
bedside report has an effect in the patient satisfaction. We soon started working on a plan that I
could present to our floor manager for approval. We came up with three simple questions that
could be used to interview our patients who were fit to participate.
Week 4: March 5th-11th On Monday I met up with my manager with my proposed plan was for
approval. He asked me to present my plan on their next management meeting so that the clinical
supervisors could be aware and together with the manager would approve my study. Once, they talked it
over he approved it he sent out an e-mail to all the nursing staff to make them aware that this would be
taking place. The clinical supervisor announced it every time during huddle to remind nurses to conduct
bed side shift report. The change was soon implemented on our unit and noticed that not every nurse liked
this change. They asked me why I choose this intervention and I educated them on the importance of
bedside shift repot.
The patients whom the supervisor thought were suited for the study were asked if they wanted to
participate if they agreed their participation was going to be kept anonymous. Once the patient gave their
consent the clinical supervisor would perform these questioners on the day they got discharged.
Week 5: March 12-18th
This week I worked on finding several articles on bed side nursing and patient
satisfaction. My mentor made sure that these articles were appropriate to used in my project.
This was very time consuming and what made it even harder was that I had to read each article
which were at least 8 to 15 pages long. It was all worth it because these articles guide me on the
right direction on my research. This is the week when I started to notice that my colleagues were
doing better at giving bedside report.
Week 6: March19th-25th
This week was a busy week as I had a lot of work to do on my PICOT paper. At work
I’ve been seeing an increase in bedside shift report. One thing I noticed was a drop in ACT calls
and codes. There was also a drop in call lights going off at the beginning of shift. Bedside shift
report has made me realized that it also increases patient safety. I met with my mentor and he
went over the Hospital Consumer Assessment of Healthcare Providers and Systems Surveys
(HCAHPS) in more detail. We then conducted a research on our HCAHPS for our facility.
Hospitals send out patient surveys after the patient is discharged to get their opinion about their
hospital stay. Many of the questions that these surveys contain are based on nursing care and
actions. Some of the questions these surveys contain are: How was their communication with
doctors, nurses and the responsiveness of staff, how was their environment as far as cleanliness
and quietness, pain management and education about medication, and if they were included in
their plan of care, and finally patients overall hospital experience. These surveys have proven to
increase patients’ satisfaction.
Week 7: March 26th- April 1st
This week I worked on my DQ questions and familiarizing myself with internal and
external methods for the dissemination of my EBP project. Then I worked on trying to evaluate
my EBP project. I had not yet looked at the questionnaires but was able to notice a positive
change in my unit. The majority of nurses were conducting bedside report which told me that
they had adopted it as their routine. Like I mentioned earlier I have noticed a drop in ACT calls
and codes. This is due to incoming nurses assessing and evaluating their patients at an early stage
rather that catching it when it’s too late.
Week 8: April 2nd-8th
I finally got all the questionnaires and I will be reviewing them. Later on this week I
met up with my mentor to go over the questionnaires we input all the data on a spreadsheet.
Our Final results are the following:
The clinical supervisors collected 175 out of 242 completed questioners. The questions included:
1. Did your nurse perform bed side report in your room, if so, where you included in the discussion? 2.
Did your nurse answer all your questions accordingly? 3. Where you informed about your plan of care, if
so do you believe this impacted your satisfaction? We used the “Always,” “Sometimes,” “Never” for
patients to use to answer the questions. For the question, did your nurse perform bed side report in your
room, if so, where you included in the discussion? Only 113 patients responded Always, 20 responded
Sometimes, and 42 responded Never. For the question, did your nurse answer all your questions
accordingly? 65 patients responded Always, 72 responded Sometimes, and 38 responded Never. For the
last question which read, where you informed about your plan of care, if so do you believe this impacted
your satisfaction? 128 patients answered Always, 38 answered Sometimes, and 9 answered Never.
We presented the final results to my manager and he was impressed with the results. He thanked
me for doing this project and encouraged me to continue making a change for our patients.
Week 9: April 9th-15th
This was a major week as it was the week to complete our PICOT project. My mentor and I got
together to analyze my paper before submitting it. We also took the time to go through all the evaluation
papers and discussed our experience during this course.
Reflective Journal
Reflective Journal
Week 1, July 11-17
This week was spent familiarizing myself with evidence-based practice (EBP) and
how I will use it for my study. I have learned EBP is a resource not only for research, but
also to find new methods and technologies. Furthermore, EBP provides facts to support
changes in nursing, as well as teach other approaches that have not benefited the
profession. Ultimately this resource provides quality research and clinical guidelines to
improve the nursing practice.
This week I established Ashley Horn, my unit manager, as my mentor. We discussed
the goals of this course, my ideas for an evidence based change, and how we would
communicate throughout the class.
Week 2, July 18-24
This week I have chosen my evidence based (EB) change topic. I will be addressing
how lowered patient to nurse ratios improve patient outcomes, allow for higher patient
educational standards, and increase nursing satisfaction. I also utilized the Grand Canyon
University library to access peer-reviewed articles to support my EB change. After
gathering the information I organized the data and prepared a plan for the purposed EB
I meet with my mentor to discuss the EB change plan and how it would best be
implemented. She provided me with guidance on my strengths and weaknesses as a
leader and I provided personal goals to improve on them. We then collaborated with the
clinical coordinators to discuss the acuity model, how it would benefit the unit, when it
would start, and their role in the EB change. I also provided baseline nursing surveys to
the nursing staff. These surveys will indicate the nurses’ perceptions prior to the
implementation of the change.
Week 3, July 25-31
This week my manager and discussed the EB change with Carmela Kirk, our Director
of Medical Surgical Nursing. She expressed her approval for the EB change. The EB
change was implemented on the unit. The change was found to be accepted by several
nurses who have had exposure to EBP previously. However, a few nurses were not as
accepting of the change and further education was provided to the staff. Ultimately the
survey’s indicated a decrease in nurse satisfaction, time spent on patient education, and
time spent at bedside for the week.
During the meeting with my mentor we discussed the challenges of the study, my
short comings, and areas of improvement for the EB change. We determined further staff
education and a more standardized approach to establishing patient acuity was
necessary. We also discussed how to balance nursing assignments to ensure seasoned
nurses with better critical thinking skills received higher acuity patients to ensure positive
patient outcomes. I then produced a simple spreadsheet clarifying the different levels of
patient acuity to improve patient assignments. I also provided a nursing assignment chart
with a recommended balance of patient acuities to improve the nurses’ workload. The
clinical coordinators expressed these were helpful and the staff gained a greater
understanding of the EB change’s benefits.
Week 4, Aug 1-7
This week patient acuity and nursing assignments were accomplished utilizing the
spreadsheets provided. The nurses expressed a greater understanding of the acuity model,
the reason for the change, and were cooperative with the system. The surveys from this
week increased suggesting support and positive progression with the study.
This week my mentor and I discussed how Christian values benefit the nursing
profession. We also discussed how our individual values can be ethically challenging in
the workplace. We also researched the American Nurses Association views on being
more ethically sound. They recommend nurses know themselves first, being aware of
your own personal and professional values helps to make good choices when reacting to
an ethical situation. The ANA also recommends living by your values, listening to your
gut, checking with others when in doubt, and always being respectful (ANA, 2015).
Week 5, Aug 8-24
This week the study made a movement in a positive direction. The weekly surveys had
a significant jump in nurse satisfaction from 3.5 when we started to 6. While time spent at
bedside increased from 25 minutes the first week to 50 minutes. Nurses expressed how
they were experiencing improved workloads and were able to see extra time during their
workday. Education was provided on utilizing the increased time for patient education
and how it would improve the health of the community and lower re-admission rates for
the hospital.
During my mentor meeting we researched how the World Health Organization
(WHO) is combatting and monitoring global diseases, provided resources to third world
countries, and how they are reacting to the Zika virus. The WHO is reporting a 30-fold
rise in Zika worldwide in only the past 30 years, with the United States experiencing their
first outbreak this year (WHO, 2016). Our hospital is located in south Florida and the
infected Zika population in Miami is only two and half hours south of our hospital. We
discussed Zika awareness, how the public health system is combating the spread of the
disease threw spraying insecticides and recommending people stay away from the
affected area, and how our hospital is prepared for Zika should it come to our
Week 6, Aug 15-21
This week the unit experienced staffing shortages and multiple codes. However, even
with the increased stress the nurse surveys indicated an increase in nurse satisfaction with
only a small drop in time spent at bedside. Nurses reported an approximate ten minute
drop in overall direct patient care and education. While clinical coordinators report
notably fewer cases of negative patient feedback during supervisor rounding. This week
education was provided on how increased direct patient care by the nurse helps meet the
perceived expectations of the client; thus increasing patient satisfaction scores and
hospital reimbursement from Medicare/Medicaid.
This week my mentor and I discussed how health policy directly influences the
nursing profession. We discussed how EBP is being utilized to help lobbyist advocate for
our patients, nurses, and the success of the nursing profession. We considered how
nurses are the largest group in the healthcare field and we need to be engaged in health
policy. Nurses are a benefit to health policy, because of our one on one experience with
the population. We are more common sense based and less diagnosis based, we recognize
community needs and make resources available to improve the current situation. Nurses
are a vital part of healthcare system and with our professional growth we will have the
ability to lobby for better policies. We also discussed how holistic care must be sensitive
to others cultural needs. In south Florida we have a high population of people from the
Caribbean region. We discussed specific culture needs of the Cuban population. I also
learned that the Caribbean islands is one of the most heavily affected regions with the
Human Immunodeficiency Virus (HIV) and it is second in the world to Africa (Maharaj,
Week 7, Aug 22-28
This week the acuity model, nursing assignments, and overall cohesion of the unit was
on point. Nursing satisfaction scores maintained at 7 out of 10. While time spent at
bedside and patient education returned to previous levels following the heavy case load
of week 6. The acuity model, nursing assignments model, and patient education
expectations were discussed with two novice nurses orienting to the unit.
During the mentor meeting we discussed my transition into a more leadership based
role during the progression of this EB change. I was praised for my positive attitude,
person ability, and how engaged I have been during the progression of the change. It was
recommended to me to be more engaged with the night shift crew. To remember we are
one team and to ensure they receive the same level of guidance and education as their
dayshift counterparts. Overall I feel more confident in educating and promoting changes
in my work center. I believe this EB change has helped to guide me into a more
leadership based role.
Week 8, Aug 29-Sept 4
The EB change is coming to a close this week. This final week has shown a slight
jump in direct patient care and nursing satisfaction. While patient education plateaued
this week. With the final scores outlined in table 1.
Table 1: Evidence Based Change Results
Before EB change
After EB change
Nursing Satisfaction
Time Spent on Direct Patient Care
Time Spent on Patient Education
During the mentor meeting the clinical coordinator was available and we discussed
continuing the EB change after completion of my course. Both were happy with the
results thus far and expected to see positive results as we move into the busier winter
Week 9, Sept 5-11
This week all clinical observations were compiled for the EB change and reported on
the capstone thesis. During the mentor meeting we reviewed the practice immersion
clinical evaluation tool and discussed my future nursing goals.
American Nurses Association (ANA). (2015, February). 5 Considerations for Nurses
Ethical Challenges on the Job. Retrieved from
Maharaj, S. (2016). The needs, models of care, interventions and outcomes of palliative
care in
the Caribbean: a systematic review of the evidence. BCM Palliative Care,15(9), 12.
World Health Organization (WHO). (2016). Mosquito-borne diseases. Retrieved from

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