Chloe Arredondo University of Utah Hospital Fall
2024
INSTRUCTIONS:
1. Use the journal template below to write a reflection after every clinical. Continue adding to your journal each
week and submit all journal entries up to that point.
2. Journal entries must be emailed to the capstone clinical instructor within 2 days of the clinical shift or there may
be late penalties applied.
3. Do not forget to put the date and hours of your clinical shift.
4. Journal entries need to be more than just a list of “tasks” you accomplished for the shift. Provide a reflection of
your experiences, i.e. how you felt about what you observed or did during your shift. How will you do things
differently or the same?
5. Please include your observations of how the interdisciplinary specialties (Rad tech, OT, PT, Physician, nurse, etc.)
collaborated with each other (either good or bad) and reflect upon your observations.
Journal Date/ Learning Experiences
Entry # Time
Today I got to use a PAPR for the first time which was a new and interesting experience. The
Shift 1 interdisciplinary teams communicate really well with each other on this unit, and call or talk to
you in person about any changes, tests, or patient movement. My nurse delegated to the Health
10/25/2024 Care Assistants a lot today because we had several complicated patients that took a lot of time, so
0700-1930 I was able to observe her delegating in a positive and appreciative manner. It was a very busy
day, and because the request for me to have access to Epic was not submitted by administrative
staff, I was unable to help with charting. I am hoping that by my next shift I am able to help with
charting and therefore able to be a bit more independent than I was today.
Today I had Epic access, so I was able to chart for the patients that my preceptor and I were
Shift 2 assigned. I got to work with a great health care aide who worked with me to change soiled sheets
10/26/2024 for a patient, place a bed pan for them, and reposition the patient effectively despite the patient’s
0700-1930 large stature. I was able to be more independent in administering medications and reminding my
preceptor when certain patients were due for critical medications. I got experience working with
patients that are moderately unwilling to take part in their care and tried my best to educate
about the plan of care and expected outcomes which was challenging and interesting. Next time I
would like to communicate more with other team members including providers.
I got to watch a paracentesis being performed on a patient with liver failure from alcohol abuse. I
Shift 3 didn’t realize how much fluid could be in the peritoneal cavity. He was also the first patient I’ve
11/1/2024 ever seen with jaundice. I also assisted with wound care for a bedridden patient. Honestly, it was
0700-1930 pretty gross. However, it was an interesting experience, and I got some experience moving a
morbidly obese patient to be able to perform routine care. Today was the first day that I saw
some communication difficulty between my preceptor and both the HCA and the pharmacy.
There were multiple meds in the Omnicell that had run out, and it took several attempts to hear
back from the pharmacy and get the Omnicell restocked. I also saw that because the University
uses phones to communicate, and allows you to send text messages, sometimes the intent of those
text messages is somewhat lost. I definitely was able to see the value of both face-to-face
communication and texts, and the short-comings of each.
I had a patient with Down’s Syndrome today and it was a really unique and rewarding
Shift 4 experience. The prior nurse had stated that the patient was unable to express her needs and was
11/2/2024 pretty much non-verbal. However, I spent about ten minutes with her and just took the time to
0700-1930 wait for her answers and found out her favorite color, favorite animal, if she had any pain, and
what she liked to do. I also took care of two patients that were extremely difficult due to multiple
inordinate requests. My preceptor let me take charge of the order we saw the patients in and that
made me feel really good and capable. It was the highest number of patients that I have had so far
too, so I was proud of myself when my preceptor said that I handled it extremely well. Tomorrow
I’m going to try to use the Volte phone for communication with other team members to practice
delegating more.
This shift was sort of difficult. The day was normal for the most part. I placed an IV on my first
Shift 5 11/2/2024 try and I was really proud of myself even though it wasn’t the first time I’ve placed one
0700-1930 successfully. I also removed an IV and helped with patient discharge. At the end of the day, my
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preceptor and I went in to see one of our patients who is always so kind and cheerful. There were
three phlebotomy techs taking sepsis cultures from him, and I could immediately tell that
something wasn’t right. He was quiet and seemed really angry. When the techs left, I asked him
what was wrong, and he told me that the techs had talked in front of him about making the blood
draw a game to see who could draw blood from the patient the fastest as a race on the left versus
the right hand. They were rushing, forgot supplies, and ended up being unable to draw any blood
from his left side. He asked the techs if they treated all patients this way, and they said it was
because they had to get blood from the left and right at the exact same time. I was really angry
and left while my preceptor was talking to him to call the lab and tell them what happened. I told
the phlebotomy team lead what happened and told them that I did not want to see those same
technicians in that patient’s room, and they needed to be talked to about the behavior. I was
really upset that my patient had that experience and was treated in such a cruel way, and I really
wanted to go to bat for him and advocate for him. I was glad that I could stand up for him and
advocate for better care as the whole situation really bothered me, too.
I had some unique patients today. I worked with a tetraplegic patient who had a post-pyloric
Shift 6 feeding tube. I administered crushed meds via his feeding tube, which I haven’t done outside of
11/15/2024 NG tube labs at school. I also helped to reposition him, give him eye drops, and administer IV
0700-1930 push medications via his intra-jugular line. All of these things were new and unique to me, so I
was glad to be able to participate in his care. There was a patient in our unit who passed away
and was a veteran, so I also participated in the flag ceremony that the hospital staff did for him
which I thought was really thoughtful and lovely. I worked on paying more attention to small
details in the chart that are basically helpful hints on what you need to do next and how to chart
the activity so that the alert no longer shows up in workflow. I think the hardest part for me at
this point is the charting, because we really don’t get much practice with it at school. I was also
really excited because I was able to remove an internal jugular IV. My preceptor helped me look
up the SOP, and supervised while I took it out. It was nerve wracking for sure, but I’m so glad I
got the opportunity to do it.
My preceptor and I had to trade a patient today because he refused to work with us. It was
Shift 7 difficult because he had had so many things go wrong in the process of his care before we even got
11/16/2024 assigned to him, and he clearly needed someone to be angry with despite us having no part in the
0700-1930 issues that he had. He had a limb amputated yesterday and the wound vac stopped working
overnight. The night nurse paged the provider five times before anyone came to look at the
wound vac, and it was so clogged they couldn’t use it anymore. That same team then rewrapped
his wound in a wet to dry dressing but didn’t wet the bandages enough as the night nurse
discovered when she went to change the dressing, and the bandages were fused to the wound. He
was also supposed to have revision surgery today and needed to be NPO after 3 AM. The
provider never informed the night nurse that he needed to be NPO, and the patient ate at 6 AM
pushing his surgery to tomorrow. When we came in to tell him this at the very beginning of our
shift, he was extremely angry. He wouldn’t let us do any assessments, give any meds, nothing. He
just told us to leave every time we walked in. It was difficult to transfer him to another nurse
because there was no guarantee that he wouldn’t repeat the behavior, but we had to try as he was
refusing his daptomycin. After his transfer, a couple other nurses and aides apologized to me for
his behavior, but I really wasn’t upset. I think he had every right to be angry, as things had not
been going well up to this point. He also had mental illness that may have been a contributing
factor. It isn’t personal, and even if it were, I’m just trying to do my job and take care of a
person. If they won’t accept that care, I have to find someone that they will accept it from.
My final capstone shift was definitely interesting. I had one patient who was really just a psych
Shift 8 11/22/24 patient that had no place else to go. He had a TBI, so most psych hospitals won’t take him. He
0700-1930 also had issues with anger and aggression, so he had been kicked out of most long-term care
facilities in the area. It’s definitely a difficult situation to address because his behavior made it
difficult to take care of the other patients we were assigned to, and he can’t go anywhere else until
they find a facility that’s willing to take him. He fell during our shift, which we all had to respond
to. Luckily, he was uninjured, but he fell with an aide right next to him because he had put
himself in a position where the aide couldn’t catch him. Meanwhile, I had three other patients
that were waiting for care any time we were responding to this other patient leaving his room,
trying to enter other people’s rooms, and just generally putting himself in unsafe situations. I
hadn’t really thought about the fact that some patients end up stuck in a medical facility because
their psych facilities can’t take them back. It makes me really sad, and makes me wonder where
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he will end up.
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