NURS 6551 Week 5 Assignment 2: Journal Entry #1

Assignment 2: Journal Entry #1

On any given day, a nurse can play a pivotal role in someone’s life. Experienced nurses often share stories of previous experiences and draw upon these experiences when circumstances warrant.

Hence, reflection can be a valuable tool. It serves as a tool for not only recalling experiences but also for applying lessons learned from those experiences. Keeping a nursing journal provides these benefits and more.

To prepare for NURS 6551 Week 5 Assignment 2: Journal Entry #1:

  • Refer to the current Clinical Guidelines found in this week’s Learning Resources and consider how these guidelines inform your clinical experience.
  • Refer to your FNP or AGPCNP Clinical Skills and Procedures Self-Assessment Form you submitted in Week 1, and consider how your self-assessment might inform your Assignment.
  • Refer to your Patient Log in Meditrek and reflect on Weeks 1–5 of your clinical experience. Consider your observations and experiences with patients during this time.

Journal Entry #1 (450–500 words):

In your journal entry, answer the following questions:

Learning from Experiences

Reflect on the 3 most challenging patient encounters and discuss what was most challenging for each.

  • What did you learn from this experience?
  • What resources did you have available?
  • What evidence-based practice did you use for this patient?
  • What new skills are you learning?
  • What would you do differently?
  • How are you managing patient flow and volume?
  • Communicating and Feedback

Respond to the following reflective questions:

  • How might I improve on my skills and knowledge, and how to communicate that back to my Preceptor?
  • How am I doing? What is missing?
  • What type of feedback am I receiving from my Preceptor?

NURS 6551 Week 5 Assignment 2: Journal Entry #1 Instructions

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized NURS 6551 Week 5 Assignment 2: Journal Entry #1.

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page NURS 6551 Week 5 Assignment 2: Journal Entry #1. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

Journal Entry #2: Most Challenging Patient Encounter

Case 1: A Rape Victim

The most challenging patient encounter in my experience was a thirteen-year old rape victim. The resources I used for handling this case were Rape, Abuse & Incest National Network (RAINN), National Sexual Violence Resource Center (NSVRC), Sexual Assault Awareness (SAA) and SafeBAE (Before Anyone Else). The physical, emotional and psychological implications of rape on the victim cannot be overlooked. Gynecological complications related to rape include vaginal infection and bleeding, fibroids, genital irritation, diminished sexual desire, urinary tract infections and chronic pelvic pain (Bates, 2017). Moreover, victims of physical and sexual abuse suffer more adverse effects compared to victims of sexual violence alone.

Regarding evidence-based practice, I applied emerging approaches in trauma therapy. First, cognitive processing therapy is a principal component of the practice, owing to the mental and emotional trauma the victims experience. The skills am acquiring currently are establishing trust and rapport, providing strict patient confidentiality, approaching the client in non-judgmental perspectives, encouraging verbalization and explaining the signs or symptoms the victim may experience in the short-term and long-term (Strunk, 2017).

Several areas exist that I would do differently. In approaching the client from non-judgmental perspectives, I would avoid expression of emotions such as horror, disbelief or disgust that could create a mental-emotional barrier. Also, I would apply words such as reported instead of alleged, declined instead of refused and penetration instead of intercourse.

The management of patient flow and volume was possible via incorporation of a multidisciplinary team. On documentation, the nurse took the vital signs for each client, after which the client proceeded to the clinician’s office for consultation. During consultation, the clinician conducted a physical examination on the client and performed a high-vaginal swab that was sent to the laboratory for microscopic, biochemical and genetic analysis. While one client was being checked for vital signs, another was doing consultation at the clinician’s office while yet another was having her samples being analyzed at the laboratory.

The significance of communication and feedback cannot be overemphasized. During an encounter with the victim, I applied both verbal and non-verbal cues of communication, including maintenance of proper eye contact, observing the client’s postures, gestures and facial expressions, noting the intonation and using the therapeutic conversation (Vrees, 2017). Also, I ensured patient education took place effectively by asking a few questions after the talk to confirm comprehension.

Several options are available for improving on my skills and knowledge. First, attending seminars and workshops of sexual and domestic violence would boost my expertise in handling the victims. Also, practicing under supervision of sexual assault specialists would be resourceful. This information could be communicated to my Preceptor via an email detailing the requirements.

A relevant PowerPoint presentation could be attached to the email. The current feedback from my Preceptor is encouraging; that my progress is commendable. Nonetheless, I need improvement in communicating with rape victims, particularly how to get emotionally involved in the conversation and how to more effectively apply the cognitive processing therapy. I also need exposure to a client with rape trauma syndrome to be competent in managing the syndrome.

References

Case 2: Diabetic Foot Care

The lessons learnt from foot care of persons with diabetes include identification of the at-risk foot, regular inspection and examination of the at-risk foot, education of the patient, family and healthcare providers, routine wearing of appropriate footwear and treatment of pre-ulcerative signs. The afore-mentioned were the preventive measures for foot problems in diabetics (Armstrong, Boulton & Bus, 2017). The resources for this case were the New England Journal of Medicine, the Annals of New York Academy of the Sciences, and the Association of South East Nations Management of Diabetic Foot Wounds. The evidence-based practice studies consisted of Cochrane reviews pertaining to diabetic foot ulcers, some of which directed the international guidelines. The reviews analyzed several reports on foot care in persons with diabetes and compared to the International Working Group on the Diabetic Foot to provide guidance in scenarios devoid of expert advice.

New skills learnt in the diabetic foot case are as follows: relieving the pressure while protecting the ulcer, restoring the skin perfusion, treating any underlying infection and improving the metabolic control while treating existent co-morbidities. Also, local wound care approaches, educating the patient and relatives; and measures to prevent recurrence were learned (Everett & Mathioudakis, 2018). In my opinion, I would do several things differently. First, in relieving the pressure, I would recommend the non-removable casts as recent evidence proves them to be more effective than dressings alone or removable casts. Also, in treating infections, I would begin with a broad-spectrum antibiotic before the definitive cause of the infection is identified by laboratory culturing, microscopic and biochemical analysis. Once the results are available, I would start the patient on medication which is specific for the identified organism, to provide optimum treatment and more efficacious effects.

The management of patient flow and volume was also challenging. Nonetheless, I achieved by integrating a mutli-disciplinary team that attended to different aspects of patient needs at particular times. For instance, while one patient was undergoing the consultation process with the clinician, I took the vitals: blood pressure, temperature and pulse rate for another patient. At the same time, another patient was having his random blood glucose being tested while yet another patient with a diabetic foot ulcer was having a sample of the ulcer taken for microscopy, culture and biochemical analysis.

The importance of appropriate communication and feedback cannot be overlooked. I practiced communication skills by maintaining appropriate eye contact with the patient, assessing the non-verbal cues of communication such as facial expression, posture and gestures and engaged in therapeutic conversation. Also, I educated the patient and family on the measures of preventing diabetic foot ulceration.

Improving my skills and knowledge would be possible via attending seminars and workshops relating to diabetes and diabetic foot ulcer. Also, working closely with diabetic foot ulcer specialists would prove to be resourceful, besides reviewing emerging studies pertaining to the presentation, complications and care of diabetic wounds (Nather et al., 2015). These perspectives could be communicated to my Preceptor through a formal email with an attached presentation of the subject.  At the moment, I am actively analyzing recent trends and international guidelines on management of diabetic wounds. My Preceptor is providing trustworthy feedback that my learning process is commendable. However, the feedback also points out other areas that I need to improve on such as patient motivation and what details to include or exclude in patient education.

References
  • Armstrong, D. G., Boulton, A. J., & Bus, S. A. (2017). Diabetic foot ulcers and their recurrence. New England Journal of Medicine, 376(24), 2367-2375. https://doi.org/10.1056/nejmra1615439
  • Everett, E., & Mathioudakis, N. (2018). Update on management of diabetic foot ulcers. Annals of the New York Academy of Sciences, 1411(1), 153. https://doi.org/10.1111/nyas.13569
  • Nather, P.A., Soegondo, D.S., Adam, D.J.M.F., Nair, D.H.K.R., Zulkilfly, D.A.H., Villa, D.M.A.A., Tongson, D.L.S., Yeng, D.B.C.S., Wijeyaratne, P.M., Somasundaram, D.N., Mutirangura, D.P. & Chuangsuwanich, D.A. (2015). Best practice guidelines for ASEANPlus: Management of diabetic foot wounds. Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 5(1), 1–37. DOI: http://doi.org/10.4038/sjdem.v5i1.7277