Clinical Practice Journal
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Clinical Practice Journal
I met Dr. Francine Miller, my preceptor last week where we held a lengthy discussion regarding my objective, strengths and weaknesses. He encouraged me to be brave and face each challenge as an opportunity to learn and improve my clinical skills. The first clinical visit, I interacted with the patient who reported to the clinic with complains of pain in the RT lower back. She also complained of having difficulty to walk.
I performed physical exam and health assessment which indicated elevated blood pressure 180/100. Palpitation of the lower back RT caused severe pain. The patient was under clonidine 6.25 BID. The patient was given Lisinorpil to manage the elevate blood pressure. From my assumptions or differential diagnosis, the pain experienced could be the source of high blood pressure. The main question here is what is the source and course for the pain. To figure out the accurate diagnosis, a CT scan for the RT lower back was requested (Burns & Grove, 2011).
From this practice, I learnt that it is important to contain blood pressure, as the healthcare provider waits for other diagnostic tests. Additionally, I analysed and reflected on patient’s health history and medication. This exercise improved my confidence in clinical practices such as taking patient information, recording health issues and making clinical decisions about diagnosis (Hunter & Franken, 2012).
Clinical Practice Journal
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The theoretical framework that will be applied is the caring in action theory. This theory corresponds to nursing process, as the theory focuses on consistency, connection, commitment, community, and change. This will help me establish effective healthcare providers- patient relationship, which is imperative in effective delivery of care. Connection aspect of the theory explains the effectiveness of the NP’s that is based on relationship connectedness and relationship between family, patient and the community (Susan Hagedorn, 2004).
The aspect of consistency explains the importance of delivering care that is evidence based practice (EBP). Commitment describes the NP passion and responsibility to serve every patient to the best of their abilities. It also involves providing appropriate decisions especially when facing ethical dilemmas, maintain confidentiality, respect and compassion. Cultural competency must be in every NP’s skills.
Clinical Practice Journal
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Additionally, they should listen to the patient without prejudice and increased sensitivity towards the tradition and cultures that influence of the patient health and disease. This facilitates in the identification of the patient needs and simultaneously maintaining the confidentiality, respect and compassion (Susan Hagedorn, 2004).
My objectives for this exercise is that by the time I finish the 140 hrs of the 11 weeks, I would comfortably perform physical assessment, conduct and document patient medical history records, formulate differential diagnosis and make appropriate diagnoses as guided by the clinical manifestation of the disease and the laboratory findings/ reports such as the EKG and X-ray. Lastly, formulate of the action care plan to ensure that the issue is addressed using the therapeutic and non-therapeutic interventions. I feel confident and ready for the second meeting with my preceptor as I feel more knowledgeable and focused than the first time.
References
Burns, N., & Grove, S. (2011). Understanding Nursing Research (5th ed.). Elsevier. ISBN-13: 9781437707502
Hunter, J., & Franken, M. (2012). Health Literacy as a Complex Practice. Literacy And Numeracy Studies, 20(1). http://dx.doi.org/10.5130/lns.v20i1.2618
Susan Hagedorn, A. A. (2004). Theory-Based Nurse Practitioner Practice: Caring in Action. http://www.medscape.com/viewarticle/496718_3.
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