The aim of this reflection paper is to give an overall picture of my accomplishments and experiences during my Master of Science in Nursing (MSN) program. It includes an integrated reflection of my achievements, MSN opportunities that have impacted immensely on my professional practice as a nurse leader and my practicum project experience in relation to the QSEN competency of quality. It will conclude with my suggestions for improving the MSN program and nursing student preparation.
Successes and Opportunities in the MSN Program
Working towards this MSN degree has provided me with opportunities to grow both at personal and professional levels. Obtaining the MSN degree has been my ultimate professional goal since completing my BSN. One of my greatest achievements is acquiring skills in research methods to conduct literature searches and synthesize the evidence to support practice improvements. Through the capstone experiences and assignments, I gained confidence in accessing and synthesizing the recent literature to inform evidence-based nursing interventions. This has impacted greatly on my reflective practice and clinical decision-making. Over the past semester, I have strived to apply what I have learnt in research in my area of practice to improve healthcare quality and patient safety.
My other professional accomplishment relates to the presentation and dissemination of research findings. My experience with PowerPoint presentation enabled me to organize my ideas and concepts related to quality improvement projects to interact and communicate effectively with my class audience. I can now incorporate photos and graphs into well-prepared slides to support my main ideas. The MSN program gave me an opportunity to prepare a teaching presentation on CAUTI prevention for staff nurses at my facility (KRMC). Further, through the assignments, I was able to evaluate my facility’s disaster preparedness and analyze the regulatory requirement and guidelines for RN’s role in conscious sedation.
Another achievement related to my MSN program is the use of technology in healthcare. Initially, I envisioned technology as a hindrance rather than a driver of quality health care. I have examined electronic health records and their use by providers. In one of my assignments, I wrote a memo to the medical staff seeking to realign the facility’s systems with the meaningful use requirements through EHR implementation (Harrison & Lyerla, 2012).
I have also used blogs as a communication platform for sharing my practicum project results. I was able to integrate the QSEN competency of safety into my blog post. Through my academic journey at the institution, I have achieved enhanced self-awareness and reflective practice in my work. According to Yanhua and Watson (2013), self-awareness is a continuous process that culminates in a positive therapeutic relationship. I have learnt to be conscious of my actions, the caring environment, and patient’s body language throughout my interactions.
Practicum Project and the Safety Competency
My practicum project was titled, ‘preventing respiratory complications in patients undergoing Interventional Radiology (IR) procedures under conscious sedation at Kendall Regional Medical Center’. The QSEN competency of safety was most relevant to this change project. The project achieved a significant reduction in conscious sedation-related respiratory complications after IR, indicating a positive safety outcome. Out of the 215 patients who underwent radiological procedures in this period (May-September 2016), only 2.7% of them developed respiratory complications. Higher patient safety outcomes were achieved through effective intra-procedure patient monitoring using capnography, nurse education/empowerment, institutionalized technology, and effective clinical communication and collaboration.
The QSEN competency of safety embodies a reduction of the risk of sentinel events in clinical settings. As a nurse, I take safety to mean the provision of care that is devoid of medical errors that lead to increased readmissions and LOS. Patient safety can be achieved through nursing process improvement to achieve quality and avoid communication lapses (Mansour, 2012). My practicum project sought to address systemic risk factors – human and nonhuman barriers – that compromise patient safety at KRMC.
They included lack of knowledge on conscious sedation management by nurses, change resistance, turnover, inefficient nursing communication, and insufficient monitoring technology. The project used a multifaceted approach to reduce adverse post-procedure respiratory prognosis. Adherence to the recommended guidelines in the pre- and post-procedure states and routine monitoring were emphasized in line with the KSAs defined under the QSEN competency of safety (Sherwood & Zomorodi, 2014).
Another area I addressed in this project was increasing patient safety levels through nursing skill improvement. The aim was to increase nurses’ skills in appropriate conscious sedation level, patient monitoring (capnography), and pain assessment and management. To prepare the IR nurses for the change, I developed an educational plan aimed at improving nursing competencies related to depth of conscious sedation. As Tella et al. (2014) state, over-sedation can compromise patient safety in patients undergoing IR procedures due to repressed responsiveness. Skills in airway assessment and management were also considered critical in preventing respiratory complications.
I was able to interact and network with staff nurses drawn from multiple specialties to realize the goals of my practicum project. It was a great opportunity for me to practice my team-building skills. The project brought together IR nurses, IR radiologists, nurse director, ED and ICU nurses, and intermediate care unit nurses. A culture of safety across all these practices was required to improve patient outcomes.
The nursing staff, as the agents of change at the facility, helped establish a culture of safety through patient monitoring and appropriate-level sedation. I was also able to apply theories of change – theory of human caring, transcultural nursing theory, and unitary human being theory – in practice to improve nursing perceptions and practices. Therefore, my project facilitated the achievement of the competency of safety through strategies that improved process and staff efficiencies.
Proposed Changes/Improvements
The MSN program curriculum is well integrated and responsive to the changing healthcare needs and technology changes. Its focus on research, capstone experiences, nursing theory, and practicum project gives students hands-on experiences and critical thinking skills to drive change in their respective clinical practices. In particular, I feel that the practicum experience improves a student’s capacity to develop and implement evidence-based interventions focused on health care quality and safety.
However, I would suggest improvements in the assessment criteria used. While direct assessment through practicum experiences can determine if learning has taken place, it only measures performance (Brown, Feller, & Benedict, 2012). I would suggest the use of indirect assessment methods such as graduate feedback/interviews would give a more holistic picture of the learning outcomes accomplished. Further, besides assessing integrated learning experiences, the program should evaluate acquired skills and abilities from competency-based practicum projects. The program should facilitate further development of the practicum project beyond a single facility. Utilization of the findings to inform practice improvement in other hospitals should be supported through liaison with regulatory agencies.
References
Brown, R., Feller, L., & Benedict, L. (2010). Reframing nursing education: The quality and safety education for nurses initiative. Teaching and Learning in Nursing, 3(5), 115-118. Web.
Harrison, R. & Lyerla, F. (2012). Using nursing clinical decision support systems to achieve meaningful use. Computer Informatics Nursing, 30(7), 380-385. Web.
Mansour, M. (2012). Current assessment of patient safety education. British Journal of Nursing, 21, 536–543. Web.
Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN competencies redefine nurses’ roles in practice. Nephrology Nursing Journal, 41(2), 15–22. Web.
Tella, S., Liukka, M., Jamookeeah, D., Smith, N., Partanen, P., & Turunen, H. (2014). What do nursing students learn about patient safety? An integrative literature review. Journal of Nursing Education, 53, 1–7. Web.
Yanhua, C. & Watson, R. (2011). A review of clinical competence assessment in nursing. Nurse Educator Today, 31(2), 832-836. Web.