Final ePortfolio Reflection
Prompt: Reflect on what you learned from this project and how you will apply this in your future nursing practice. Think about your audience, which could be a potential employer in your first nursing position. What would you want them to know about your capacity to contribute to quality improvement and evidence-based practice initiatives as a new nurse resulting from this project? What did you discover about yourself as an inquisitive, reflective practitioner?
Response:
When I began working in memory care as a CNA at an assisted living facility, one of the first things I noticed was the positive impact of connection and purpose on patients. While transitioning to a new environment is never easy for an individual with dementia, I quickly realized that shifts were smoother when opportunities for activity and social stimulation were provided to residents throughout the day. When we were too short-staffed to run formal activities, even small gestures could make a difference, actions as simple as asking a resident about the pictures on their wall or putting on an oldies playlist in the common area. When connections were made and residents were more engaged throughout the day, I noticed that they seemed to display fewer challenging behaviors such as sundowning or refusing care. Moreover, it appeared that these activities brought out the best in residents. The same woman who barely spoke could suddenly recall all of the words to a Beatles song and sing along with a smile on her face. The man who yelled and swore at me when I helped him get ready for breakfast quickly became a good-natured, whip-smart historian when we played a trivia game about old movies. It was clear that cognitive stimulation did something positive for these individuals–but could the effects be beneficial in the long-term scope of their disease?
Around this same time, I began volunteering at a day center for adults with memory impairment who still lived at home. At this program, members remained engaged all day long, with opportunities for sing-a-longs, exercise groups, word games, art, and social hours. It became evident to me that these activities brought joy and connection to members, however, I couldn’t help but wonder if they (along with the activities provided at the assisted living home) had any impact on the progression of cognitive decline. Alzheimer’s disease and dementia are irreversible conditions–at least for now–but could something be done to slow the downturn? Ultimately, our group chose to study this topic for our research paper, and we found that the impact of day programs for those with dementia extends far beyond simply slowing the cognitive decline associated with the disease (though that would likely be reason enough to support them!) Instead, day programs provide a whole host of benefits, from improved physical independence, quality of life, and decreased caregiver burden.
Putting concrete evidence from multiple studies to what I was observing first hand in my work was powerful for me. For nearly two years, I had seen the impact of day programs (as well as regular activities and social stimulation) on patients with memory impairment, however, my hypothesis that these programs actually contributed to improved functioning came from only anecdotal evidence. Reading the results of research that had already been conducted was not surprising–after all, it makes sense that participation in these types of programs would be beneficial for those with memory impairments–but it left me with an important takeaway. Going forward, as a nurse, when I notice trends in patient care and outcomes, I hope to take the initiative to seek studies on these trends. In other words, are my observations backed up by research? If so, I can be confident that evidence-based practice is being implemented. And if not, well, maybe that’s even more exciting. After all, it presents the opportunity to introduce research that answers the question. While I don’t see myself working in research, I hope to remain engaged in current best practices and use my experiences to suggest trends or topics that could be explored further.
If I were to tell a future employer about this project, I would highlight how my real-world experiences led me to notice trends and become curious about them. This curiosity led to research, and, eventually, the confirmation of my original hypothesis. I think the ability to identify trends and a spirit of inquisitiveness are traits that serve a nurse well, no matter what their specialty. Nurses are in the best position to observe the factors that lead to improved–or decreased–patient outcomes and ask questions accordingly. These questions can lead to research and the development of new best practices (or the reinforcement of old ones), but nothing will change if the nurse doesn’t slow down and learn to notice. Perhaps new grads are among the best equipped to do this–after all, most are so nervous that they’re likely double and triple checking everything, and hyper-focused on all outcomes! Thus, when I graduate next year and begin working, I imagine that I will jump right into identifying potential topics for future research and evidence-based practice.
