NU225CL Unit 10 Final Synthesis Paper Example

Two Met, One Met in Part, One That Measured the Software: A Final Synthesis Paper Judging Four Pediatric Rotation Objectives, Quoted Exactly From Week One, Against the Term's Own Written Work

[Student Name]

Purdue University Global

NU225CL: Pediatric Nursing Clinical

Unit 10 Final Synthesis Paper

[Instructor Name]

[Date]

The writer, rotation and documents are composite; verdicts rest on the term's written assignments only, not on clinical hours or any signed evaluation.

Introduction

In the first week of this rotation I wrote four objectives and named, in advance, the written evidence that could show each one met. This paper judges them against that evidence. It uses only the term's documents: the skills reflection, the family teaching record, the medication safety reflection, my preparation notes and my documentation review. It does not use clinical hours or anyone's signed evaluation, because those belong to the instructor's judgment, not mine.

Objective 1

Restated: get children ready for procedures with preparation and distraction chosen for their stage of development (wording in the Unit 1 reflection). Verdict: met. Evidence: the Unit 4 skills reflection describes an IV start for a five-year-old in which my distraction was passive and my words backfired, then records two specific changes. My later preparation notes show both changes used on two more procedures: asking the parent what the child fears most, and making distraction active. On the second, a seven-year-old's blood draw, the child counted bubbles with me and did not pull away. Distraction and other psychological approaches can reduce children's needle distress (Birnie et al., 2018), and the notes show me choosing them by age rather than by habit. Limit: three procedures is a small number, and all three children had a parent present. I have not yet prepared a child alone.

Objective 2

Restated: teach caregivers in plain words and confirm that they understood, by having them say it back or show it. Verdict: met. Evidence: the Unit 6 teaching record documents a grandmother's first inhaler demonstration with two errors, the correction and a second, correct demonstration. All three objectives in that record were met by the second session. Teaching until a person can demonstrate a skill correctly is more effective than a brief explanation alone (Press et al., 2012), and the record shows I did not stop at the first attempt. Limit: the record covers one family. My Unit 7 post shows I did not use teach-back in a four-minute urgent care visit, where it would have fit.

Objective 3

Restated: verify the weight, in kilograms, before any dose is prepared. Verdict: met in part. Evidence: the Unit 8 safety reflection shows the habit holding once in the way that mattered most: I questioned a weight that did not fit the child and a near miss was caught. But my preparation notes show the check done before preparation on [seven] of [nine] doses. On the other two, I checked the weight after I had begun drawing up the medicine.

The near miss shows the habit working once; the preparation notes show it is not yet a habit, because twice I checked after I had started.

Weight-based calculation is a known source of pediatric prescribing error (Conn et al., 2019), and an error in the weight spreads into every dose calculated from it, so a check that comes after preparation has started is weaker than one that comes first. Limit: the notes are my own, written after each dose, and may be generous.

Objective 4

Restated: chart each pediatric assessment in the electronic record no more than an hour after finishing it. Verdict: not judged, because the objective measured the software rather than me. Evidence: my documentation review showed timestamps between [20] and [140] minutes after assessments. On review with my instructor, the late entries were the ones that waited for my nurse to open a student documentation session and cosign. The timestamp recorded when the system allowed the entry, not when I was ready to make it. My paper notes, written at the bedside, were completed within [15] minutes every time. What I learned: an objective must measure something the student controls. I wrote this one without knowing how student documentation works on the unit. Limit: I cannot prove from the record when I would have charted. My paper notes are dated and timed, but they are my own notes, and an instructor reviewing them has only my word that each was written at the bedside. A fairer test next time would be an objective my instructor can observe directly, such as completing a bedside note before leaving the room, which she could see on any shift without relying on the software or on me.

What the Evidence Base Itself Shows

Looking across the documents, a second pattern appears. Every objective that was met has a document in which something went wrong first: the missed IV start, the grandmother's first demonstration with two errors, the weight I hesitated over. The documents that show learning are the ones that record a failure and what changed after it. If I had written only about procedures that went smoothly, I would have far weaker evidence. This is worth carrying into the next rotation: the most useful writing is about the moment that did not go as planned.

What I Would Write Differently in Week One

I would keep the first three objectives almost exactly as they were. Each named a behavior I control and a document that could show it. I would rewrite the fourth to measure my own bedside notes rather than the record's timestamps, and I would add a number to the third, such as checking the weight before every dose for two consecutive weeks, so that met in part and met could be told apart without argument. I would also add an objective about speaking up, since the most important thing I did all term was ask a question about a number, and nothing in my original four would have captured it.

Conclusion

Two objectives are met with evidence, one is met in part with a clear gap, and one was poorly designed. The pattern is useful: the objectives that named a behavior I controlled were the ones I could judge. Quality and safety competencies in nursing are meant to be shown in practice (Cronenwett et al., 2007), and the term's documents show where mine are developing.

Goals for the Next Rotation

1. Check every weight before touching the medication, and record the check in my notes before preparation begins, aiming for every dose in the first two weeks.

2. Use teach-back on one key point in every discharge or teaching moment, even when there are only four minutes (Perry et al., 2022).

References

Birnie, K. A., Noel, M., Chambers, C. T., Uman, L. S., & Parker, J. A. (2018). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, 2018(10), Article CD005179. https://doi.org/10.1002/14651858.CD005179.pub4

Conn, R. L., Kearney, O., Tully, M. P., Shields, M. D., & Dornan, T. (2019). What causes prescribing errors in children? Scoping review. BMJ Open, 9(8), Article e028680. https://doi.org/10.1136/bmjopen-2018-028680

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D. T., & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. https://doi.org/10.1016/j.outlook.2007.02.006

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.

Press, V. G., Arora, V. M., Shah, L. M., Lewis, S. L., Charbeneau, J., Naureckas, E. T., & Krishnan, J. A. (2012). Teaching the use of respiratory inhalers to hospitalized patients with asthma or COPD: A randomized trial. Journal of General Internal Medicine, 27(10), 1317-1325. https://doi.org/10.1007/s11606-012-2090-9