NR 601 Week 7 Reflection

Week 7 Reflection Chamberlain College of Nursing NR 601: Reflection DATE Week 7 Reflection I am glad to be completing this course and have enjoyed my clinical experience. My preceptor was very helpful enabling me to care for patients and was also open to questions. This course has prepared me for the future, through my clinical experience, I have achieved my MSN #5 program outcome which is advocating for a positive outcome by being compassionate, collaborating with other providers and using evidence based practice. According to Pfaff & Markaki, (2017), high quality care is achieved through compassionate and collaborative care which also leads to improvement and strengthening on care and control of cost. Also as nurses, we are expected to be patient advocates, because advocating for our patients is what makes us happy and fulfilled in our profession. There was an incident I had at work, we had a patient who came to her appointment with her 18 year old daughter, the daughter is also a patient of my preceptor but in this visit, she followed her mother who came to do her annual health screening. While I was discussing with mother and daughter, the daughter confined in me that for the past 3 months, she has had burning sensation in her vagina and some whitish cheese like discharge from her vagina which is itching at times but no odor. She has been afraid to share this with her mum because of fear of being seen as someone who has sexually transmitted disease. She said she has a boyfriend but they are not having sex together. I explained to her that what she may have is a yeast infection, and this type of infection can be contacted by people who are not sexually active. She asked me to explain things to her mum, so I discussed her issue with her mum and her mother was initially not happy that she did not share these symptoms with her but later calmed down and asked what could be done. I discussed it with my preceptor, he asked his secretary to get her registered to be seen the same day and ordered her some over the counter vaginal medication for yeast that she can use. She was asked to come back after 10 days if discharge continues or gets worse. I was happy when she left and felt fulfilled in my role as a nurse practitioner student and as a nurse. I also felt like I was able to show compassion to the young girl and collaborated with my preceptor. My second example was a patient that came in with COPD exacerbation. He was wheezing so we gave him aerosol treatment in the office and IV solumedrol 60 mg. The patient also has history of CHF and we were worried that if he is sent home, without proper treatment and evaluation at least for the first 24 hours, his COPD may get worse. Patient’s wife was worried about being at home alone. So she wanted the patient not to be admitted but instead be given all the directions of what to do at home. I discussed this case with my preceptor; we were both worried that the COPD may get worse at home. I went back to the room and asked his wife if she had children who live nearby that she can go to their house and spend some time with them, while her husband is admitted to the hospital for treatment. I explained to her that he will need some IV steroid and antibiotics and it is not very safe for him to go home because he may get respiratory distress at home and she may not be able to handle things the way she thought she could. The wife eventually agreed and the patient was then admitted to the hospital that afternoon. The other part of masters essential that I met is Essential Viii which has to do with prevention and population health. I met this essential by making sure that my care is patient centered and culturally applicable. We had a patient from Saudi Arabia who only spoke little English. It was very difficult for us to talk to him about diabetic diet, education and care of his foot. I had to go into the hospital to borrow their interpretive machine called “strata” With this machine, my preceptor and I was able to discuss healthy diabetic diet using names of food known to the patient and her husband and educating them on how to check her foot frequently. We also talked to them about hyper and hypoglycemia, follow up visit and when to call 911 for help. At the end of the day I was very happy to have used the help of this machine to really make sure that my patient understands her care. Providing culturally appropriate care enables the health care provider and their organization to show sensitivity to the differences in culture and use patient centered approach that meets the needs of the patient and patient families (Kamrul, Malin, & Ramsden, 2014). In this example, we were able to use a culturally patient centered approach to integrate clinical prevention of disease and health promotion in the elderly patient. Another example of culturally essential care in prevention and population health was during our rounding in the hospital, one of the Muslim patient complained to me that a male nurse came in to her room to help change her bed linen and she would prefer if she can only get a female care giver. She also requested that she would like nurses and doctors to knock on her door before coming into her room because of privacy reasons. I discussed this with the nurse taking care of the patient and the charge nurse as well and they immediately changed her nursing assistant to a female and I also suggested that they put a sign on her door that says “ please knock before you enter patient’s room”. The charge nurse reassured me that she will make sure that a sign is placed on the patient’s door. During my clinical experience, NONPF #8 clinical competencies became a priority. Ethical principles are important in health care because it enables the clinician or health care worker recognize ethical dilemmas and make judgement and decisions that will help in maintaining personal values and at the same time follow the laws (Haddad & Geiger, 2019). One of the issues I came across was a patient of ours who was recently released from the hospital two weeks ago; her son brought her into the clinic on a wheel chair with complaint of generalized weakness and continuous decline in health. The patient was treated for diabetes foot infection and CHF. Her son insisted that he was not going to take her back home because she is very weak, no longer able to care for herself and needs to be admitted to the hospital, so that she can be placed in a skilled care or rehabilitation center. He said, he was worried that if she is left alone to care for herself, she might end up falling at home and getting injured or sustaining a fracture. I discussed her case with my preceptor considering the fact that we do not have enough medical diagnosis to admit her as inpatient. But at the end, we agreed that it she can be admitted for generalized weakness and dehydration. She may qualify for inpatient admission which will enable her get physical therapy and eventually placement to a rehabilitation center. My preceptor said that at this time, the benefit of admission outweighs the risk of sending her home with potential risk for fall. Another ethical dilemma I came across was a patient of ours who has uncontrolled diabetes and has no insurance. This patient has been waiting for his disability insurance to kick in, he is already on metformin which he is not taking it regularly due lack of funds. We decided to give him samples of victoza (liraglutide) from the clinic which will last him up to 3 months and my preceptor told him that he could always come back to the clinic before his victoza runs out to get more samples until he gets his disability insurance. I also showed him and his wife how to use Good Rx to get cheap medications. The other staff members in the clinic were not very happy that we gave him almost all the samples of victoza we had for the month but we explained to them that saving one patient’s life was more important that keeping unused samples of medications in the sample storage room. References Haddad, L. M., & Geiger, R. A. (2019). Nursing ethical considerations. Retrieved from Kamrul, R., Malin, G., & Ramsden, V. R. (2014). Beauty of patient-centered care within a cultural context. Canadian Family Physician, 60(4), 313-315. Retrieved from Pfaff, K., & Markaki, A. (2017). Compassionate collaborative care: an integrative review of quality indicators in end-of-life care. BioMed Central, 16, 65.