Nursing Practicum Journal Entries

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Week one: Practicum Journal

It is important for a nurse practitioner to be reflective that enables them to identify weaknesses and target the professional development that helps to address the identified weaknesses. The mandate increases the ability of the nurse practitioner in providing the best care to the patients and their families. Reflection by the nurse practitioner allows them to consider communication and the efforts towards creating a culture of mutual support with the colleagues. The essay provides preparation for the practicum experience and highlights the role of nurse practitioners in the clinical settings, the goals, and objectives of the practicum experience, and has a timeline for the practicum activities.

Nurse practitioners are the major group of the advanced practice nurses who deliver primary care in the United States. They have a significant role in contributing to the improvement of primary care and reducing the costly health resource use (Schiff, 2012). Advanced practice nurses fall into four major categories; the nurse anesthetists, nurse midwives, clinical nurse specialists, and the nurse practitioners. They work to deliver primary care and take the lead in clinical, management, and accountability roles in innovative primary care models (Buppert, 2015).

Nurse practitioners have a role in meeting the demand for primary care services that are strained in many states. The practitioners are trained to deliver the primary care services and also increase access to primary care. The nurse practitioners are the most common non-physician health care providers of primary care and provide the comprehensive services that include health promotion, disease prevention, and counseling. The nurses practice both independent and collaborative practice arrangements and take the lead in the clinical roles, management issues, and accountability roles in innovative primary care centers like health centers and the retail clinics (Naylor & Kurtzman, 2010).

The practicum experience for the course will entail several activities geared towards particular goals and objectives to enhance the nursing practice. The particular goals and objectives for the practicum experience include the need to address the diseases and health issues faced by adult’s patients aged 18 years and older. The practicum experience aims at enhancing the model of nursing practice by having hands-on experience in a health care setting as compared to the theoretical skills acquired throughout the course. The practicum experience has a goal of practicing the care management models to the adult patients acquired throughout the course by interacting with patients in their natural settings to understand their health-related needs. The practicum experience also aims at enhancing the skills of dealing with culturally diverse populations through addressing their health care needs. The practicum experience also aims at enhancing the skills of controlling the self-assessment checklist for the nurse practitioners, how to keep records through charting, and seeking to meet the nurse practitioner core competencies.

The practicum experience will take place in a local health care facility preferably a State funded hospital. The requirements of the practicum provide a basis for the proposed timeline for the practicum activities. The practicum will run for twelve weeks starting from the first week of practice and will have a schedule to guide the activities. For every week, I will have 40 hours of the practicum experience and utilize the remaining time for reflection and documentation of the practicum experiences. I will also have time for the search of appropriate resources to aid in enhancing my skills in the practice sessions. The practicum experience will have reviews every three weeks to assess the progress and also the areas that require changes. The schedule for the practicum experience will have sessions for dealing with adult patients aged 18 years and above, and the pediatric patients aged zero to 16 years.

Week Two Practicum Journal

In week two, I was assigned the role of taking care of an adult patient at the end of life stage. He was a male and suffered from aggressive prostate cancer for a long time. The patient presented to the health care facility few days before the onset of my practicum experience and was under the care of several registered nurses. He identified that I was new to the workplace, unlike the other workforce and expressed suicidal thoughts to me. He pleaded with me that I keep the issue secret for him and not share with the other colleagues. It was my first experience of an ethical dilemma since no care provider ought to share the confidential information of a patient to the others. However, it was against my practice ethics to keep the issue secret despite its consequences. I had to act responsibly and within the practice guidelines in making the decision about the issue. It was an ethical dilemma to me in the nursing practice similar to what other practitioners face in their day-to-day nursing activities.

The practicum experience was challenging to handle due to the consequences associated with the decisions made. Every nurse practitioner has a mandate of ensuring integrity and confidentiality of the information shared by the patient. However, I resolved to share the information for the benefit of both the patient and the health care facility and other providers. The experience taught the need to have self-assessment in decision making as well as networking with other health professionals when in practice. It is important to understand the expected mode of conduct when faced with an ethical dilemma. The decision made is likely to have far-reaching consequences to the nursing profession (Hamric, Hanson, Tracy & O’Grady, 2014).

Week Three: Practicum Journal

In week three, I worked under a registered nurse practitioner in the emergency department and handled different cases of an adult patient. The patients had multiple health problems, and I was required to meet their needs alongside other practitioners. The patients responded well to the therapies administered due to the quality of services offered at the heath care facility. My attention was focused on a female adult who suffered from osteoporosis. She was in her late fifties and was at high risk of the disease as evident to many women due to low levels of estrogen which helps to maintain bone mass. I assessed the risk of a fracture to help assist in identifying an appropriate therapy to slow down the further loss of bone and also increase the bone density. The experience with the patient was helpful in enhancing my skills in dealing with the diseases of the elderly. I observed that patients are satisfied when the care provider performs their duties as required in the core nursing competencies.

All the health care practitioners required being assessed for their performance throughout the week as a requirement for improving service delivery. We were assessed based on the patient outcomes and also the adherence to the nurse practitioner core competencies. The patients’ feedback, as well as the use of evidence-based practices, was instrumental in enhancing the level of competence (Hamric, Hanson, Tracy & O’Grady, 2014). The practicum experience for the week was crucial in enhancing my practitioner skills as well as understanding the use of evidence-based practice in clinical care. I learnt that the quality of services delivered by a practitioner nurse varies with the nature of the health care environment. Thus, it was important to have a good working environment in which both the providers and the patients are comfortable.

 Week Four: Practicum Journal

In the fourth week of my practicum experience, I was assigned the role of dealing with a male adult patient who suffered from diabetes. He had lived with the condition for several years though he visited different health care facilities to seek for a “good” provider. From his past medical and personal history, it was evident that he was never satisfied with the services offered to him in the attempts of managing the condition. I found him troublesome to deal with, but had to perform my clinical duties a required. He complained of negligence and malpractice by the former care providers he visited that led to the worsening of his condition. It was challenging to acquire information from him about the factors that led to the worsening of his condition due to his non-compliance. He did not allow any attempt to diagnose the present status of the disease or have the preliminary tests before treatment. He complained of non-competent care providers as well as delayed admission to the hospital. I had to refer the patient to my supervisor during the practicum experience since according to Stelmach (2015); it is against the ethical guidelines to dismiss a non-compliant patient.

The practicum experience for the week was hectic but also essential in enhancing my practice skills of dealing with non-compliant patient. Malpractices and negligence occur during care delivery, hence the need to enact measures to eliminate them as appropriate (Buppert, 2015). I observed that nurses have a mandate of working within the practice guidelines and also manage the risks that arise during care delivery. As such, the nursing profession is subject to undesirable occurrences that require to be addressed professionally. The experience of dealing with a non-compliant patient was essential in enhancing the practice skills and also meeting the goal of practicing the care management models to the adult patients. Most of the adult patients suffering from the chronic diseases do not seek for a clinical intervention at an early stage leading to worsening of their conditions. The practicum experience was successful in meeting most of the practicum goals and objectives.

References

Buppert, C. (2015). What is a nurse practitioner? In Nurse practitioner’s business practice and      legal guide (5th ed.) (1-16, 33). Burlington, MA: Jones & Bartlett.

Naylor, M. D., & Kurtzman, E. T. (2010) The role of nurse practitioners in reinventing primary     care: Health Affairs, 29(5), 893-899.

Retrieved from http://content.healthaffairs.org/content/29/5/893.full.pdf+html

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Ethical decision making:   In Advanced practice nursing: An integrative approach (5th ed.) (328 – 354). St. Louis, MO: Elsevier Saunders.

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Evidence-based practice:   In Advanced practice nursing: An integrative approach (5th ed.) (237-262). St. Louis,     MO: Elsevier Saunders.

Buppert, C. (2015).Negligence and malpractice. In Nurse practitioner’s business practice and        legal guide (5th ed.) (271-284). Burlington, MA: Jones & Bartlett.

Stelmach, E. I. (2015). Dismissal of the noncompliant patient: Is this what we have come to? The             Journal for Nurse Practitioners, 11(7), 723-725.

Schiff, M. (2012). The role of nurse practitioners in meeting increasing demand for primary          care,Retrieved from http://www.aacn.nche.edu/government-affairs/NGA-Nurse-    Practitioner-Paper.pdf



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