Professional Capstone and Practicum Reflective Journal
Understanding clinical approaches to addressing healthcare problems in a practical manner are critical in supporting one’s understanding of nursing practices as a science. In practice, combining theory and practice is critical for advancing nurses’ understanding of healthcare issues and shedding light on evidence-based professional nursing practice. A professional capstone and practicum course, according to Martin et al. (2011), gives students the opportunity to engage in real-world nursing practice and gain knowledge through experience. Nurses working in the medical unit are frequently faced with patients who have undergone surgery. Understanding the risks that predispose patients to hospital-acquired infections (HAIs) and implementing an evidence-based practice to aid in the prevention and management of HAIs. The reflective journal for the capstone and practicum provides a description of the new practice approach, the role of interprofessional collaboration, clinical and healthcare delivery systems, ethical considerations, population health concerns, the role of technology, health policy, health disparities, leadership, and economic models.
Approach to New Practice
Addressing healthcare issues entails implementing effective HAI prevention and management strategies. The capstone and practicum courses have given me the opportunity to learn about the various approaches to preventing and managing HAIs. The most effective evidence-based practice learned during the course, however, was the use of hygiene practices such as hand hygiene, equipment sterilization, and room sanitization in the prevention and management of HAIs in patients who had surgeries and are currently hospitalized for recovery. This is consistent with the findings of studies by Gifford et al. (2011) and Gould (2012), which acknowledge that the development of HAIs among surgical patients is significant as a result of unsanitary practices by patients and healthcare providers, which results in wound contamination. The adoption of hygiene practices influences how surgical patients are cared for, and it also serves as a guide for nursing students on clinical practices in the profession. According to Gould (2012), the adoption of hygiene practices necessitates that healthcare providers understand the risk factors, causes, and current evidence-based practices in the provision of quality and safe care.
Collaboration Among Professionals
Unlike in other professions, the capstone and practicum course revealed that nurses, like all healthcare professionals, must always collaborate to improve their clients’ health. They must collaborate because effective care delivery is dependent on the input of various healthcare professionals within an organization (Braum et al., 2015). A registered nurse, for example, may perform a diagnosis while a physician prescribes medications; in order to avoid errors, these two must collaborate. The practicum project revealed that achieving positive healthcare outcomes is difficult unless healthcare professionals collaborate, as there will always be cases of medical errors.
Given the variety of healthcare professionals involved in the care of surgical patients, including pharmacists, clinical officers, bedside nurses, and surgeons, ensuring patient wellness necessitates interprofessional collaboration (Braum et al., 2015). According to the practicum project, communication is an important aspect of care that is essential in supporting collaboration in the care of patients. A well-established communication channel is critical for improving communication among healthcare professionals caring for patients. Aside from communication, it was clear that professionalism, which fosters mutual respect, is essential in fostering collaboration. Healthcare providers must use professionalism to influence change when implementing hygiene practices, and this was a clear aspect of the entire project.
Systems for Clinical and Healthcare Delivery
Healthcare delivery is dependent not only on healthcare providers but also on healthcare and clinical systems that aid in the coordination of care services. According to Erwin and Krishnan (2016), in order to influence change, healthcare delivery and clinical systems must be redesigned to meet the needs of both healthcare professionals and patients. To increase the adoption of the new practice aimed at preventing and managing HAIs, the healthcare facility had to redesign both the healthcare facility system and the clinical system. Through the incorporation of hygiene practices, the clinical system and practices were redesigned to improve the health of surgical patients at risk of developing HAIs and to meet the patient’s health needs. Aside from redesigning the systems to allow for the implementation of primary care strategies, the healthcare system underwent systematic changes aimed at improving the quality, effectiveness, and efficiency of healthcare services delivered to patients. Patient-centered care, for example, was used collectively or individually to reorganize healthcare service delivery in order to improve the health outcomes of surgical patients. The system changes included improving surgical patients’ self-management, empowering healthcare professionals to make change suggestions and implement change practices, and enhancing the development of leadership skills.
Considerations for Ethical Behavior
It is critical to consider the ethical issues associated with the implementation and maintenance of the changing practice in order to improve the health and well-being of surgical patients at risk of developing HAIs. In fact, it is always recommended that healthcare providers consider ethical issues that may arise as a result of a given procedure or practice in all clinical practices. According to Anderson et al. (2014), healthcare providers are responsible for improving their patients’ health, preventing harm to their patients, and applying their experience in patient care.
While the implementation of hygiene practices is critical in improving patients’ health and well-being, an ethical issue may arise if healthcare professionals fail to follow organizational hygiene practice guidelines. This ethical issue, according to Mortell et al. (2013), falls under the theory-practice ethics gap. Staff may fail to meet hygiene practice targets on a regular basis due to a lack of time, a lack of leadership, a lack of prioritization, and antibiotic intolerance. Failure to adhere to healthcare delivery guidelines may result in ethical issues, according to the practicum, and healthcare providers always consider adherence to practice guidelines. The practicum revealed that the baseline of ethical consideration is that sensitive issues such as patient privacy must be preserved, and patients are well-served by the use of evidence-based practices.
Concerns about Population Health
The capstone and practicum courses revealed that patient populations always have health concerns that vary from patient population to patient population. The capstone project demonstrated that the surgical patient population differs from other patient populations in that they are more likely to develop HAIs due to the presence of a wound. According to Borelli et al. (2016), HAIs are a major health concern for surgical patients because they are associated with decreased quality of life and increased mortality rates. The economic impact of HAIs is another health concern.
According to Pinto et al. (2016), accessing and utilizing quality healthcare services for surgical patients who have developed HAIs is an expensive endeavor due to the infections’ associated medical costs. As a result, the population is constantly fighting to reduce the cost of care, which may result in less utilization of healthcare services for critical issues, leading to poor health outcomes. In overcoming such challenges, the capstone and practicum courses demonstrated how healthcare professionals and surgical patients could collaborate to address such concerns. The capstone and practicum course demonstrated a step toward addressing these issues by encouraging patient-provider collaboration in the adoption and maintenance of hygiene practices.
Technology’s Role
Technology became an important part of the healthcare system in the twentieth century, with most processes involving one or more technological implementations. Electronic record-keeping, which improves information sharing from one healthcare provider to another, is one such technology that is effective in the implementation of changing practices. Many healthcare professionals, including surgeons, bedside nurses, and physicians, are involved in the care of patients who have had surgeries (Braum et al., 2015). The implementation of the technology has the potential to promote the provision of high-quality, evidence-based care to patients. Furthermore, the technology enables healthcare providers to take precautions to prevent the development of HAIs in specific patient populations, such as those with diabetes, a condition linked to the immediate development of HAIs Botarelli et al. (2016). Aside from this technology, predictive analytic technology has been discovered to be important in changing practice. According to Baum (2014), predictive analytic technology is useful for processing bacterial data from patients, determining antibiotic information, and performing PCR tests to determine the exact cause of an infection. Because some patients are resistant to certain antibiotics, it is possible to use technology to determine the best approach for managing HAIs.
Health Care Policy
Health policies are the guiding plans for achieving or completing specific goals. According to WHO (2013), health policies are the actions, plans, and decisions that an entity takes to achieve certain goals. The policy can be effectively implemented through a clear definition of a project’s or organization’s vision, as the vision establishes the project targets as well as the reference points. The capstone and practicum courses revealed that in order for any change practice to be successful, policies must be established to guide the target agencies in their implementation. Rather than using hygiene practices as an intervention, the capstone project adapted them as a health policy aimed at influencing care provision in order to improve patients’ health. According to WHO (2013), the policy establishes priorities and fosters consensus within the organization. The change in practice was implemented as a primary prevention strategy for HAIs in the project. Furthermore, the organization’s vision to provide care before inquiries on payment plans is an organizational practice policy with the goal of advancing patient care.
Economic Models and Leadership
Change can be a difficult task at times. The capstone and practicum courses, on the other hand, revealed that adopting effective leadership models is critical in supporting change. The transformational leadership theory has proven to be the most effective leadership model in the prevention and management of HAIs. According to Tomajan (2012), the transformational leadership model requires leaders and their followers to work together to solve a problem while influencing change. The theory’s application not only aids in the smooth transition from antibiotic reliance to the use of hygiene practices in the prevention and management of HAIs, but it also aids in the transfer of leadership skills from a leader to the followers. Because the implementation of the change practice imposes no economic burden on the organization, the applicability of any economic model was not obvious.
Disparities in Health
Health disparities are a common issue in multicultural societies. According to the CDC (2013), disparities can occur as a result of existing factors such as age, geographic location, sexual orientation, ethnicity, socioeconomic factors, and disabilities. According to DHHS (2000), the existence of health disparities is critical in preventing the achievement of Healthy People 2020 goals. An individual may become disabled following surgery. However, the healthcare facility was effective in implementing practices and building infrastructures to support the disabled population. Concerning socioeconomic factors, the organization has advocated for the implementation of Obama Care and the Affordable Care Act to improve service accessibility and utilization.
Conclusion
Nurse students always need both theoretical and practical instruction. The professional capstone and practicum course was one of the most challenging yet interesting because it allowed students to interact with real-life situations. The course has given me a critical understanding of nursing processes and how healthcare practices affect patients’ health and well-being. The course was effective in bridging the gap between theory and practice, enhancing one’s ability to produce in the profession from the start.
References
Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S66-S88.
Baum, S. (2014). Can predictive analytics help reduce hospital-acquired infections? MedCity News. Retrieved from http://medcitynews.com/2014/06/can-point-care-diagnostic-help- physicians-reduce-hospital-acquired-infections/?rf=1
Botarelli, F. R., Queiroz, Q. J. R., de Lima Fernandes, A. P. N., de Medeiros Araújo, J. N., Júnior, A. F., & Vitor, A. F. (2016). Nursing diagnosis Risk of infection in patients in the postoperative period: a cross-sectional study. Online Brazilian Journal of Nursing, 15(2), 245-253.
Braun, H. J., O’Sullivan, P. S., Dusch, M. N., Antrum, S., & Ascher, N. L. (2015). Improving interprofessional collaboration: Evaluation of implicit attitudes in the surgeon–nurse relationship. International Journal of Surgery, pp. 13, 175–179.
CDC (2013). Center for Disease Control and Prevention health disparity and inequality report – the United States, 2013. Health equity – minority health. Retrieved from https://www.cdc.gov/minorityhealth/chdireport.html
DHHS, (2000). Healthy people 2010. Washington, DC: US Dept of Health and Human Services, p. 13.
Erwin, K., & Krishnan, J. A. (2016). Redesigning healthcare to fit people.
Gifford, C., Christelis, N., & Cheng, A. (2011). Preventing postoperative infection: the anesthetist’s role. Continuing Education in Anaesthesia, Critical Care & Pain, mkr028.
Gould, D. (2012). Causes, prevention, and management of surgical site infection. Nursing Standard, 26(47), 47–56.
Martin, D. L., Brewer, M. K., & Barr, N. (2011). Gradually guiding nursing students through their capstone course: registered nurse preceptors share their experiences. Nursing research and practice, 2011.
Mortell, Manfred, Hanan H. Balkhy, Elias B. Tannous, and Mei Thiee Jong. “Physician ‘defiance towards hand hygiene compliance: Is there a theory–practice–ethics gap?.” Journal of the Saudi Heart Association 25, no. 3 (2013): 203–208.
Pinto, A., Faiz, O., Davis, R., Almoudaris, A., & Vincent, C. (2016). Surgical complications and their impact on patients’ psychosocial well-being: a systematic review and meta-analysis. BMJ Open, 6(2), e007224.
Tomajan, K. (2012). Advocating for Nurses and Nursing. The Online Journal of Issues in Nursing, 17(1).
WHO (2013). Health policy. The World Health Organization. Retrieved from http://www.who.int/topics/health_policy/en/
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Question 
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 course.
Professional Capstone and Practicum Reflective Journal
In 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
- Interprofessional Collaboration
- Health Care Delivery and Clinical Systems
- Ethical Considerations in Health Care
- Practices of Culturally Sensitive Care and Ensuring the Integrity of Human Dignity in the Care of all Patients
- Population Health Concerns and Health Disparities
- The Role of Technology in Improving Health Care Outcomes
- Health Policy
- Leadership and Economic Models
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.
While APA style is not required for the body of this, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide located in the Student Success Center.
This uses a rubric. Please review the rubric prior to beginning to become familiar with the expectations for successful completion.
You are required to submit this to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.3: Understand and value the processes of critical thinking, ethical reasoning, and decision-making.
2.6: Promote interprofessional collaborative communication with healthcare teams to provide safe and effective care.
3.2: Utilize patient care technology and information management systems.
4.2: Preserve integrity and human dignity in the care of all patients.
5.5: Provide culturally sensitive care.