Discussion w1 652

Q-1

In my last class and preceptorship, I was with the Intensive Care physician, Dr. Soto. He had created a structure for me that outlines the importance of evidence-based practice and why we do treatments and procedures, and the way we do them. I notice that the foundation that was built in the previous semester addresses course objective number two appropriately. During the last semester I was asked a variety of advanced questions daily about my patient's current illness and I would not know the answer and would have to report back thefollowing day with up to date resources and data that would support my interventions. I would like to continue to build this foundational skill with accurate, up to date, evidence-based knowledge that can help me take better care of my patients.

Course objective number three is another foundational skill that I was able to touch upon last semester. As an MSICU nurse, I have a lot of experience regarding diseases and how to treat them appropriately as a nurse, but I am finding it difficult when faced with choosing the appropriate treatment options as I do not know “why” we do them or why we put differentials in the order that they are. As I have begun nurturing this skill and course objectives, I realize the difference between nursing and being a healthcare provider, especially in the face of acute illnesses and rapidly changing conditions. My plan is to continue to cultivate this skill and improve on my previous performance during this semester, and change my thought process from a nursing one to a healthcare provider.

Course objective number four sounds to me like the final step for this semester once comfortability has been obtained with course objective numbers two and three. I have very little skill in terms of heathcare provider level but have mastery in the nursing level which carries over slightly. I would like to continue to grow this skill as I learn new things regarding two and three, then take that new knowledge with what I am seeing in a patient, and develop experience which will help me move forward in the development of number four.

I have some experience with objective one and five because I am already a MSICU nurse where patients deteriorate rapidly, lifesaving events happen, and sometimes patients expire unexpectedly. These situations have developed my skill regarding one and five, and how patients and families deal with acute illnesses or loss.

Overall, if I had to focus on three of the five skills, I would focus more so on skills two, three and four as they are the solid foundation of being a healthcare provider in my opinion, that can best help patients recover.

Q-2

After looking at the course objectives I am hoping to become more comfortable with transitioning from a nurse to a practitioner, become more confident in the skills, and make plans for patients based on evidenced-based practice. The preceptor will be able to help guide the learning process such as giving direct feedback on diagnosis and differential diagnoses, SOAP notes, history and physical notes, etc. to help me learn and become better at this. We have to be comfortable with being vulnerable as we are learning still.

The first objective is to use evidence-based practice to put it all together and look at a patient from admission to creating the diagnoses and differentials with adult patients with comorbidities. This will be a shift from just looking at fixing the problem as a nurse to looking at the whole picture of the patient and apply interventions as needed. It will be an adjustment to go back to novice after being a nurse for a while. Increasing self-confidence and autonomy will be huge to help with the transition and being prepared to be on my own once done with school (Twine, 2017). It is important to have a mentor/preceptor that is willing to help you learn and develop more critical thinking skills to be successful.

I am looking forward to this next career step for me and increasing my knowledge. The next objective is to analyze common problems and recommend appropriate treatments for those problems and restoring the patients’ health. This can include patients that have a chronic condition but have acute exacerbations and will require educating and making sure they are on the right medications. Studies have shown that new nurse practitioners were most prepared for health assessment, EBP, and health teaching, while they felt least prepared for billing, procedures, and interpreting tests (Hart & Bowen, 2016). This I feel is true as I try to focus on the interpreting and learning how to read x-rays and imaging better this time around as well

The third objective is acquiring the procedural skills that are needed such as chest tubes, central lines, arterial lines, interpreting X-rays and labs, etc. This will be a time to look at all that and learn them while being able to ask questions to the preceptor if something isn’t fully understood.

 

Twine, N. (2017). The first year as a nurse practitioner: An integrative literature review of the transition experience. Journal of Nursing Education and Practice, 8(5), 54. doi:10.5430/jnep.v8n5p54

 

Hart, A. M., & Bowen, A. (2016). New nurse practitioners’ perceptions of preparedness for and transition into practice. The journal for nurse practitioners, 12(8), 545-552. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1555415516301076

Q-3

My objectives with this course will be: -

1. Develop and improve my skill in Identifying and differentiating the critical, acute, complex, and chronic conditions and disorders in adults and gerontology patients.

2. Apply related research findings and improve my assessment skills based on history, presentation, and risk factors, ordering tests and analyze tests results.

3. Utilize evidence-based guidelines and develop care plans for treatment and discuss with patients which I still need to be fully aware. Discuss available assistive and life supportive devices in complex acute, critical, and chronically ill patients.

4. Discuss different prevention strategies including risk factors management and recommend appropriate environmental and nutritional interventions and alternative and complementary therapies when applicable, and palliative therapy in terminal conditions in adults and gerontology population

I hope to develop overall clinical skills and proficiency in all processes of management including assessment, ordering tests and procedures, documentation. Discuss the treatment plan with patients, counsel them considering their prognosis and assist in decisions among adults and gerontology patients in acute and chronic, and complex conditions in consultation with my preceptor. According to Khin-Htun, & Kushairi (2019), clinical reasoning is facilitated by placement in acute wards with trained teaching staff as supplemented with symptom-focused teaching, patient workshops, simulation sessions, virtual case banks, and clinical skill practice. I am hoping to learn best through this clinical experience and from my teacher.

Reference.

Khin-Htun, S., & Kushairi, A. (2019). Twelve tips for developing clinical reasoning skills in the pre-clinical and clinical stages of medical school. Medical teacher, 41(9), 1007-1011. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/0142159X.2018.1502418