NR 574 Week 8 End of Rotation Summary Example

End of Rotation Summary for a Medical Intermediate Care Placement: Final Verdicts on Five Aims, What the Unit Supplied and Did Not, and a Recommendation for the Next Student

Student Name

College of Nursing, Chamberlain University

NR 574: Acute Care Practicum I

Instructor Name

Month Day, Year

End of Rotation Summary for a Medical Intermediate Care Placement: Final Verdicts on Five Aims, What the Unit Supplied and Did Not, and a Recommendation for the Next Student

How This Summary Is Organized

The five aims from week 2 come first, each with a final verdict and the material behind it, compared with the verdict I gave at the midpoint in week 5. A section on what the unit supplied in volume sits beside one on what it did not. A passage on my own practice follows. The summary closes with a recommendation about this placement for whoever assigns the next student to it. My preceptor read this summary and initialed the verdicts.

The Aims, Second Time

Aim 1, presenting on rounds with my own plan first. Midpoint: partly met, three of seven forms. Final: met in full. Six of the eleven presentation forms from the term are marked "plan offered independently," all six from weeks 4 to 8. The change from the midpoint is accounted for by weeks 6 to 8, in which every presentation except one met the item.

Aim 2, noninvasive ventilation decisions for three patients. Midpoint: partly met, one weaning decision. Final: met in full, with a change. My week 6 request to spend two Thursdays with the rapid response nurse practitioner was approved. On the first of those days I made the initiation decision for a patient on a general ward, documented and cosigned. Two further weaning decisions on the unit brought the total to four decisions: one initiation and three weaning.

Aim 3, admission notes. Midpoint: met in full, nine notes. Final: met in full, eleven notes. No change in verdict.

Aim 4, ultrasound-guided peripheral lines. Midpoint: not reachable here, replaced with two arterial punctures under respiratory therapy supervision. Final for the replacement: met in full; two punctures in weeks 7 and 8, recorded with the respiratory therapist named by role. The original aim remains not reachable at this placement, for the policy reason recorded at the midpoint.

Aim 5, leading a family meeting. Midpoint: partly met, one observed. Final: met in full. I led one meeting in week 7 with my preceptor present; my preceptor's written comments note that I asked the family what they understood before giving information, and that I should have offered a pause before moving to options.

Where the Midpoint Was Wrong

One midpoint judgment did not hold. In week 5 I wrote that aim 2 would probably need to be revised, because the unit was unlikely to supply an initiation decision. That was correct about the unit and wrong about the term: the request in the week 6 memo changed the setting for two days and supplied what the unit could not. A second midpoint judgment held in a different way than I expected. I predicted that aim 1 would need one more presentation; it needed none in the end, because the habit of writing my plan before rounds had already formed by week 5 and the forms only caught up later.

What the Unit Supplied in Volume

The unit supplied a great deal of chronic lung and heart failure care, infusion management, step-down care after intensive care and daily multidisciplinary rounds. It also supplied an unusually good setting for learning to present, because the team challenges plans in the hallway and the challenge is fast and specific.

What It Did Not Supply

It did not supply the start of noninvasive ventilation, because those decisions happen before patients arrive. It did not supply procedures beyond those that respiratory therapy and the vascular access team control, and student access to those is limited by hospital policy. It did not supply night work or admissions from the emergency department seen from the first minute, since patients arrived after the emergency team's assessment.

My Own Practice

The midpoint showed that I was slower on aims that depended on speaking to the team. By the end of the term that had changed, and the forms show it. My midpoint draft had already shown how unreliable my own impression was against the written forms (Davis et al., 2006). What changed was not confidence in general but a specific habit: writing my plan on my sheet before rounds began, so that I had something to say before anyone else spoke. The week 4 journal entry about the venous gas also changed one reading habit that I have kept: pH, compensation and the previous gas before any plan. Mann et al. (2009), reviewing studies of reflection across the health professions, found it most useful when anchored to particular experiences and feedback, and the changes I can point to in my own practice came from single, specific events.

The one area I would still mark as weak is the moment in a family meeting when information has been given and the family needs time. My preceptor's comment on this was accurate, and I have not had a second meeting to practice it.

Recommendation About the Placement

For the next student assigned to this unit: the placement is strong for presentation skills, chronic respiratory and heart failure management and step-down care. It will not supply noninvasive ventilation starts or line placement unless arranged elsewhere. I recommend that the placement coordinator schedule one day a week with the rapid response nurse practitioner from week 2, rather than as a late request, since targeted exposure to a specific task is what builds skill in it (Ericsson, 2004), and that aims about procedures be checked against hospital policy on students before the term begins. Both recommendations are things the coordinator can do before the next term starts. I would also suggest that the next student meet the vascular access team lead in week 1, so that procedural aims are written knowing the policy. None of these recommendations requires the unit to change how it works; they change how the placement is set up around it, from the first week.

What This Summary Does Not Claim

It does not grade the placement as good or bad overall; it states what the placement supplied. It does not describe the term week by week; the journal entries do that. And it does not replace the evaluations completed by my preceptor and faculty, which are theirs to write and are not summarized or quoted here.

References

Davis, D. A., Mazmanian, P. E., Fordis, M., Van Harrison, R., Thorpe, K. E., & Perrier, L. (2006). Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. JAMA, 296(9), 1094-1102. https://doi.org/10.1001/jama.296.9.1094

Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79(10 Suppl.), S70-S81. https://doi.org/10.1097/00001888-200410001-00022

Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education, 14(4), 595-621. https://doi.org/10.1007/s10459-007-9090-2