Nicole Perretta - Course of Study

NURS20010  Interpersonal Communication

• Competencies:  Speech, presenting,  becoming comfortable with speaking in front of a group of peers
• Patient Teaching:  N/A
• EBP:Generational Diversity Paper (View)
  
• Personal Reflection:  I believe this class encouraged me to step outside my comfort zone when it came to talking in a big group of peers.  This class was very helpful in being able to get what I wanted to say across firmily and without confusion.
  

NURS20020  Foundations of Assessment and Communication

• Competencies: Acquired neccessary skills in check offs weekly; hand washing, vital signs, skin hair and nail, HEENT, neurological, musculoskeletal, respiratory, cardiovascular and abdominal assessments;  all which came together for a final head to toe assessment
• Patient Teaching:  N/A
• EBP: IPR Assignment (View)
  
• Personal Reflection:  This class helped me understand the basics of the nursing program and the nursing process.  The skills I was checked off on in this class would allow me to complete assessments on patients effectively.  The skills I learned will be used on a daily basis and with me for the rest of my nursing career

• Competencies:  Introduction to the clinical setting, implemented the nursing process to care for clients with differing need, used acquired interpersonal skills, medication calculations and administration, used physiological principles to promote health, practiced the professional nurses role, acquired nursing skills such as wound care through lab and clinical experience.
• Patient Teaching: During clinical I had direct contact with patients after their surgeries.  Depending on their type of surgery, I engaged in patient teaching when needed.  I showed patients how to use their PCA pump, ROM activities, discussed the importance of ambulation after surgery, and answered their questions referring to why they were taking certain medications.  I also discussed the importance of coughing and taking deep breaths after surgery for patients who’s O2 sat were below 92 at times and promoted use of incentive spirometers. I also encouraged patients to eat their breakfast (protein) when they were unsure if they were hungry and promoted good self care.
• EBP: IPR (View), weekly concept care maps (View), diagnostic sheets (View), and medication sheets (View), OR rotation (View), wound care rotation (View)
• Personal Reflection:  I enjoyed this clinical rotation because I was finally able to put to use what I had learned in lab the semester before to demonstrate my knowledge and skills. As my first clinical rotation I was nervous the first day but throughout the semester I was able to gain the confidence that I am going to need for the rest of my nursing career.  I feel that this clinical was a great start for me and that I learned an ample amount of information that was critical to becoming a nurse.
  

NURS30050 Nursing Informatics

• Competencies:   Developed an understanding of the basic concepts of nursing informatics, understanding of the legal, ethical and economic issues related to safeguarding clinical information, use of information technology and terminology related to nursing informatics, utilization of these technologies in the nursing environment, use of nursing informatics to promote quality patient care
• Patient Teaching: H1N1 nursing proposal
• EBP:Patient education brochure (View), concept care map on breast cancer (View), weekly discussions and readings
• Personal Reflection:  I was unsure about this class because it was an online class only and I didn't have the one on one personal attention that other classes did.  I did learn a lot about nursing informatics and all that accompanied it.  It taught me about the technology that is in the nursing field and how it benefits not only the nurses that are using the technology but also the patients that come in contact with the technology being used.

NURS30030 Nursing of Adults

• Competencies: Head to toe assessment of the adult patient in the acute care setting, IV flushes, SUB Q injections, electronic charting, taking care of two patients, caring for adults with acute and chronic health problems
• Special  Experience: Hyperbaric oxygen therapy, cardiac diagnostics, cath lab, respiratory therapy and critical thinking cxercise, student team leader
• Patient Teaching:  turning every 2 hours, using a trapeze to shift in bed with a hip replacement, explained to patient how to manage their pain effectively and how to use an incentive spirometer.
  
• EBP: Adults process paper (View), functional health patterns & concept care map (View), clinical prep (View), medication sheet (View), cath lap prep (View)
• Personal Reflection: I thoroughly enjoyed this clinical rotation and I looked forward to Friday clinical.  I felt very confident in this rotation being able to handle more than my first clinical rotation.  The challenge of taking care of two patients and making sure both had what they needed at all times taught me very good time management skills.  Also on one occasion the floor was without a nurse’s aide and while my patient was out of his room for testing I offered my services to my nurse to help with her other patients.  I took vital signs on 5 patients including mine, changed sheets, gave bed bathes, toileting when needed, and settled a new patient that was transferred from another floor.  My nurse said she appreciated my help and that she wanted to keep me till three o'clock when her shift was over.
  

NURS30040 Gerontology/ Rehab of Adults

• Competencies: Head to toe assessment of the aging adult with focus on orientation, taking care of two patients and their medications, administering multiple medications, blood glucose checks, bowel and bladder training, weekly journals, dressing changes, electronic charting, lab simulation experience, tube feeding, coccyx dressing changes, catheter insertion
• Special Experience: Oak MS clinic, physical therapy
• Patient Teaching:  turn every 2 hours and signs and symptoms of infection
  
• EBP: Gerontology process paper, functional health patterns & concept care map (View), weekly journal (View), clinical prep with medication sheet (View)
• Personal Reflection:  I did enjoy this clinical rotation.  It was much more challenging but I learned a lot through this rotation.  It was a nice experience because I got to know the resident on a more personal level because I got to see them multiple weeks in a row, where as in the hospital I rarely saw the same patient two weeks in a row.
  

NURS30010 Maternal and Newborn Nursing

• Competencies: Postpartum and Newborn Assessment (BUBBLE-HEB), assessing the newborn's reflexes, IM injections of both mother and baby for vaccinations, electronic charting on a different system, organization of care for both mother and baby, assessing the newborns location, skin, diaper changes, and feedings and the mother's pain level on rounding, infections and STI's, stages of labor, postpartum and newborn adaptation, pregnancy and delivery at risk, & newborn at risk.
• Special Experience: watched two inductions take place
• Patient teaching: Explaining to the mother the importance of a feeding schedule and stimulating the baby to wake up for feedings,  educating the mother on the importance of the Tdap vaccine and also the Hepatitis B vaccine for the baby,  educating my patient on the stages of lochia and how it will decrease over time,  assisting the lactation nurse in different feeding positions for a breastfeeding newborn,  explaining the use of a sitz and peri bottle for perineal comfort, also the use of a "donut" for perineal comfort.
• EBP: Case Study Power Point Presentation  (View)
• Personal Reflection:  I was really looking forward to this clinical rotation because one route I was looking to pursue in nursing was an OB nurse.  I was very nervous however because I was nervous on how the new parents would react to a student assisting with the care of their newborn.  Most of the patients I had were gravida 1 para 1 which just means that this was their first child.  I expected that they would want the baby in their room as much as possible and that they would be holding the newborn a lot.  I was so excited to come to clinical every Wednesday and to get to see new life being brought into this world and how happy all the mothers were.  This would definitely be my first or second choice in choosing which type of registered nurse I would like to be.  The mother's would look to me if they had any questions because I was in and out of their room so much.  They were very receptive of my help and were willing to accept help or suggestions.  Overall it was a very insightful clinical rotation and I just wish it would have been longer to experience the wide varieties of pregnancy and the outcomes of those pregnancies.  
  

NURS30020 Healthcare of Children

• Competencies: Assessment of the pediatric patient, admission history and physical, discharge instructions and teaching, computer charting, safe medication dosage calculations by weight in kg, caring for children age ranges from infants to adolescent, respiratory pathway care, post treatment assessment for the child’s pathway care, IV push medication and flushes of IV, effective communication with parents and children of all different cultural groups, working effectively with other members of the healthcare team
• Special Experiences: Pediatric ER, NICU, community health teaching
• EBP: Process Paper  (View)
• Patient Teaching:  Teaching the parent/child about how to decreased the spread of infection. Teaching the importance of using the incentive spirometer in preventing lung complications after surgery.  Teaching about incision site care and when to notify the doctor if problems occur.  Educating about proper nasal suctioning and the importance of it to maintain the baby's airway.  
• Personal Reflection: This semester was a new challenge for me because instead of dealing with just the patient and maybe some family members, I had to deal with the child themselves but also with the parent.  I had to take care of children in all different age ranges and to apply the developmental theories.  I thoroughly enjoyed this rotation as I got to better myself as a nursing student by being able to show my abilities and to treat each child in their correct age group.  I also got to see what working on a pediatric floor would be like and if I would like to consider working on a pediatric floor after graduation. 

NURS40005 PROFESSIONAL NURSING DEVELOPMENT - WRITING INTENSIVE

• Competencies:  resume and cover letter writing, peer reviewing, seminar creation and facilitation of discussion, attending a professional organization meeting, writing of a scholarly paper on a selected topic, discussion of topics that are important to the profession of nursing, assistance with development of professionalism
  
• EBP: Scholarly paper on the topic of whistle blowing (View)
  
• Personal Goals:  My goal for 1 year after graduation from the BSN nursing program is to have passed the NCLEX and also have placement at a job in either an obstetrics or critical care setting.  My goal for 5 years after graduation from the BSN nursing program is to start my Masters program of a certified nurse anesthetist or certified nurse midwife or planning to complete my Masters degree.  Nurse continue to learn well after they graduate from any degree program.  I have always had an interest on furthering my career and my degree level.
  
• Personal Reflection: After taking this class I feel that I have developed further into the nursing professional I would like to become.  I was able to focus on the business aspect of nursing such as my professional appearance, creating a proper resume and cover letter and also learning the skills I will need to develop from a nursing student into a nurse.·         

NURS40030 PSYCHIATRIC NURSING AND MENTAL HEALTH NURSING CARE

• Competencies: Biopsychosocial assessment, self-awareness journals, big book discussion (AA), understanding of different mental illnesses and their symptoms, therapeutic communication with patients with mental illness
• Special Experience: Crisis Center, Foundations and Recovery, adult psychiatric unit in a hospital setting, Akron Children’s psychiatric unit
• EBP: IPR therapeutic communication techniques to help patient where used to identify skills the patient was capable of and ways to deal with anxiety and depression.  Biopsychosocial Assessment Paper identified priority nursing diagnoses for a specific patient, that I had a therapeutic relationship with and a verbal contract for 7 weeks, that have patient centered goals and interventions that are supported using scholarly journals. Completed four self-awareness journals and psychoeducation outline (View)
  
• Patient Teaching: Held a Psychoeducation class on ways to decrease anxiety, taught patients at the clinical site how to cope with anxiety, explained the importance of taking prescribed medication and being compliant, explained how long it takes SSRIs to start to work (4-6 weeks).
• Personal Reflection: This clinical was different for me.  I’ve never really experienced being around a large group of people who were schizophrenic, bipolar or depressed. I was apprehensive the first day I went to clinical however every day after that I became more comfortable being there.  I feel that I have grown in my self-awareness of mental illnesses and that I will be able to be a better nurse even if I do not end of going into psychiatric nursing.  I felt like I learned a lot in this clinical rotation and was able to make my therapeutic techniques more enhanced for future interactions. I enjoyed learning about the different mental illnesses and the symptoms that accompany each illness.

NURS40045 INTEGRATION OF LEADERSHIP AND MANAGEMENT IN NURSING

• Competencies:  Working 120 hours on a Telemetry unit, assumed total patient care for 6-7 patients during a shift, electronic charting, patient education, discharge information, learning the  most common medications of the unit, antibiotic therapies, comfort care of a dying patient, post mortum care, therapeutic communication with patient and families, working as a part of the healthcare team, intensive medication administration PO/IV/SUBQ, learned unit and hospital protocols, time management, proper patient prioritization and delegation of tasks, admission assessment and history, PICC line care/dressing changes, IV starts/maintenance/assessment, evidence based care practices, foley insertion and d/c, placed telemetry monitor electrode
• EBP: 40 Hour Journal (View), 80 Hour Journal (View), 120 Hour Journal (View)
• Patient Teaching: Explained when I administered any medication the reasons for use and side effects of medications that were unknown to the patient, explained importance of an incentive spirometer, completed discharge information
• Personal Reflection: I thoroughly enjoyed this part of the nursing program because I felt like I was more than just a nursing student.  I felt like I was integrated as a part of the nursing team on 7 Main.  I was able to properly complete total care of 6-7 patients and I was even given my team’s phone so the patient was able to directly get ahold of me.  Even though it was not in my field of choice I looked forward to going to the hospital on the days I was scheduled. I looked at this experience as an internship and I made sure I was on time to start the day, looked professional, and made sure I was professional and followed HIPAA guidelines. I was sadden on my last day with my preceptor because I was going to miss the happiness I got from helping my team of patients.  This helped me realize I was more than just a nursing student and that I was one step closer to becoming a nurse.  I will take a lot of experiences away from the 120 hour I completed.  I had one elderly man who started to tear up when he was being discharge and when I asked him, “You seem sad almost as if you do not want to leave, is there a reason you are tearing up?” and the elderly man looked into my eyes and said, “You were the nicest nurse I’ve had during my stay here in the hospital.  You didn’t just come into the room ask me a bunch of questions and give me my medications you came in and held a conversation with me and treated me like I was human. You made my stay much more enjoyable and I am happy I was able to come across someone like you.”
  

NURS40010 NURSING OF THE CRITICALLY ILL

• Competencies: EKG interpretation, hemodynamic monitoring, providing care for a critical ill patient, patients on ventilators, mouth care for patients on ventilators, art line monitoring, administering medications through an OG tube, maintaining IV drips for one patient and suctioning a vented patient.
• EBP: Nursing Process Paper One (view) and ECG (view), Process Paper Two (view) and ECG (view)
  
• Patient Teaching: educating a patient on the importance of wearing his BiPAP mask and maintaining his O2 levels.
  
• Personal Reflection: I personally loved this rotation. I felt confident going into clinical and felt I was capable taking care of a patient that was critically ill.  I was able to finally pull together all the pieces and parts that I have learned throughout my nursing school career and apply them to patients.  There was a wide variety of patient's that had acute and chronic illnesses that until this clinical I was never exposed to.  Being a student I can read the book, listen to the powerpoints and lectures and listen to experiences of my nursing professors but with this semester I was able to deal with those illnesses I had only read about.  This was also a very sad clinical for me because until now we had taken care of live patients that may be coming in for a knee or hip surgery, but with this clinical I was exposed to patients that outcomes weren't always happy.  I've experienced 3 individuals who coded or were brought into the hospital and ended up not being resuscitated and passed away.  Until nursing school I had never seen an individual pass in front of me.   It wasn't until I saw the family members being brought in to identify their brother or husband that made it real to me that not every patient that I will take care of will have the same happy ending. But seeing their pain and hearing things such as, "Let go Dad. It's okay" made my reason for getting into nursing that much stronger. The hardest thing that I had to come to terms with was that there are some instances where as health care professionals we want to do everything we can for someone but by law we are not allowed to and nursing to me is the exact opposite. As a student nurse I wanted to do everything I could for my patient right so that they could go home.  This clinical was emotional but the knowledge and experiences that I underwent will continue to drive my passion for taking care of others. 
  

NURS40020 COMMUNITY HEALTH NURSING

• Competencies: Clinical experiences: Home care, Stat Care, nursing care of a individual in jail, cancer center, local health department, population teaching for 3rd graders on the importance of oral care, conference on eliminating health disparities. Completing a community assessment, applying the nursing process to that community,
   learning what the nurse's role is in the community
  
• EBP:  Community Assessment Tool (view), Community Nursing Paper (view), Conference Powerpoint (view) and Outline (view)
  
• Patient Teaching: Population teaching to 3rd graders on the importance of oral care.  Visual aids, demonstrations and games were used to facilitate learning.  Packets were also sent home with information for the parents but also more activities for the children to complete.  Toothbrushes, toothpaste and floss were also give to each child.
  
• Personal Reflection: This clinical was interesting to me due to the fact that I knew nurses where in the community I just had never realized how many nurses were actually out there.  Before I started nursing school I knew nurses were in hospitals, schools and doctors offices.  Now that graduation is approaching I have began looking into jobs that are not in those areas.  There are many different settings I can choose from other than a hospital.  The most interesting experience of the semester was the going to our local jail. Just because an individual is arrested and taken to jail doesn't mean that the individual doesn't receive any care they may need. Like with hypertension or diabetes,  the individual would still receive medications. I enjoyed seeing the wide range of people that are helped everyday in the community and enjoyed all of my special experiences and the people that I came in contact with.  Some of the experiences even changed the way I viewed getting a job following graduation.