NURS 767 Week 6 Practicum Log 2 Example

Practicum Log 2: Debriefing a Quiet Hemorrhage, Writing Exam Items and Watching a Curriculum Decision Get Made

Entry 1: Second Simulation and Debriefing (Week 5, 6 hours)

What happened: I facilitated eight runs of the second postpartum hemorrhage scenario, the version where the bleed announces itself only through a climbing pulse and a mother who feels vaguely unwell. My preceptor operated the manikin and debriefed alternate groups. Five of eight groups took vital signs within the first three minutes; three did not until the scripted cue. In my first debriefing I asked too many closed questions, and the students answered in single words.

Analysis: This entry relates to the NLN competency of facilitating learning, which includes creating opportunities for learners to develop critical thinking and reflecting on one's own teaching (Halstead, 2019). Decker et al. (2021) describe debriefing as a structured conversation that promotes reflection and transfer, led by a facilitator who asks open questions and lets learners do most of the talking. My first debriefing was closer to a quiz. My preceptor suggested a simple change: start each analysis question with "what" or "how" and wait at least five seconds before speaking again. By the fourth debriefing, students were explaining their own reasoning, and one group worked out on its own that they had treated "I feel a little off" as anxiety rather than a cue.

Change: I will write my debriefing questions on a card and keep count of how long I talk. The three groups that missed early vital signs will be the focus of my questions on the clinical unit.

Entry 2: A Student Who Froze (Week 5, clinical day, 8 hours)

What happened: A student was helping her assigned mother to the bathroom when a large clot and a gush of blood followed. The student stood still. The staff nurse took over, massaged the fundus and called for help; the bleeding was controlled. Later, in tears in the staff lounge, the student told me she had known every step in the lab and still could not make herself move.

Analysis: This entry involves the competency of facilitating learner development and socialization, which includes helping learners develop as professionals and attending to their needs and emotions (Halstead, 2019). Oermann et al. (2018) describe the emotional demands of clinical learning and the teacher's role in helping students process difficult experiences without turning them into failures. The student's reaction is common in a first emergency: knowing what to do and doing it under stress are different abilities. I resisted my clinical instinct to review the steps and instead asked her what she noticed first, what she felt and what she would say to herself next time. She said she would say "fundus first" aloud. We agreed that she would tell the staff nurse she wanted to perform the next fundal check with supervision, which she did an hour later.

Change: I will ask simulation groups, during debriefing, what they would say to themselves to start moving if they froze, since rehearsing that first step may make it easier under real stress. This also gives the clinical conference a topic: freezing as a normal response that nurses learn to work through.

Entry 3: Writing and Reviewing Exam Items (Week 6, 4 hours)

What happened: As part of Goal 2, I drafted ten items for the postpartum unit exam: six single-answer, two multiple-response and a short case with two items. My preceptor reviewed them with me. She rejected two: one had a distractor that was also correct in some hospitals' protocols, and one tested a fact students would look up in practice rather than a judgment.

Analysis: Here the relevant competency is the educator's use of assessment and evaluation, which covers constructing valid assessments aligned with learning outcomes (Halstead, 2019). My preceptor's first objection taught me that items in clinical content must have one answer that is correct everywhere, not only on my old unit; I had written from my own unit's protocol. Her second objection was about level. Fiedler et al. (2015) describe a PhD course that prepares students for teaching by covering the teacher, the learner, curriculum and evaluation, with a practicum to apply them; I had studied item writing in theory, but writing items about content I know well made me prone to testing what I care about rather than what the objective asks. I revised both items and wrote a rationale for every option.

Change: I will check every clinical item against the national definition of postpartum hemorrhage (American College of Obstetricians and Gynecologists, 2017) and the course textbook rather than my own experience, and I will ask a second faculty member to answer my items without the key before they are used.

Entry 4: Curriculum Committee Meeting (Week 6, 2 hours)

What happened: I attended the undergraduate curriculum committee, which discussed whether to replace four hours of maternal-newborn clinical time with a simulation day, because the partner hospital has reduced the number of students it can host on the postpartum unit. After discussion, the committee approved the change for one term, with an evaluation plan, and sent it to the full faculty for a vote.

Analysis: This entry relates to two competencies: taking part in designing the curriculum and judging program outcomes, and functioning within the educational environment (Halstead, 2019). I saw how a decision moves through governance: the course coordinator brought data on lost clinical placements, the committee chair asked how the change would affect the course objectives and the simulation coordinator described capacity. The committee did not decide on the basis of preference but on whether the objectives could still be met, and it attached an evaluation plan before approving. Tufano and Summers (2025) found that new faculty learn the academic environment mostly through informal mentoring, and my preceptor's explanation afterward, on why the chair asked for a one-term trial rather than a permanent change, taught me more than the meeting itself.

Change: I will ask to see the evaluation plan for the simulation day and suggest using the quiet-hemorrhage scenario, with its timeline data, as one measure.

Progress on Goals

The entries in this log that taught me most were the ones in which I did something wrong or wanted to. The second half of the practicum will focus on evaluation and on the academic environment, where my self-assessment showed the largest gaps. My preceptor and I have scheduled the midterm evaluations for Week 7, and I will draft both before our meeting so that she can compare her ratings with mine.

References

American College of Obstetricians and Gynecologists. (2017). Practice bulletin no. 183: Postpartum hemorrhage. Obstetrics & Gynecology, 130(4), e168-e186. https://doi.org/10.1097/AOG.0000000000002351

Decker, S., Alinier, G., Crawford, S. B., Gordon, R. M., Jenkins, D., & Wilson, C. (2021). Healthcare Simulation Standards of Best Practice: The debriefing process. Clinical Simulation in Nursing, 58, 27-32. https://doi.org/10.1016/j.ecns.2021.08.011

Fiedler, R., Degenhardt, M., & Engstrom, J. L. (2015). Systematic preparation for teaching in a nursing doctor of philosophy program. Journal of Professional Nursing, 31(4), 305-310. https://doi.org/10.1016/j.profnurs.2015.02.009

Halstead, J. A. (Ed.). (2019). NLN core competencies for nurse educators: A decade of influence. National League for Nursing.

Oermann, M. H., De Gagne, J. C., & Phillips, B. C. (Eds.). (2018). Teaching in nursing and role of the educator: The complete guide to best practice in teaching, evaluation, and curriculum development (2nd ed.). Springer Publishing Company.

Tufano, V. C., & Summers, E. J. (2025). The nurse educator mentoring dilemma: Novice nurse faculty needs and outcomes. Journal of Nursing Education, 64(3), 177-184. https://doi.org/10.3928/01484834-20241120-03