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All Clinical Log

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Week 1

Supportive Data/Narrative [report activities, what was done, activities, interactions, interventions, research project(s), etc. Note, objective met, not met, in progress, or revised]

Today is the first day of my clinical practice. I arrived earlier, and my preceptor showed me around the clinic, so as to get me familiar with the environment and get me used to it. I was extremely excited, yet, at the same time, very anxious. I have goals and objectives for each of my clinical, and I discussed them with my preceptor, and, of course, it is going to be a long way to reach each goal, but it is a decent start.

My goal for today is to define my role as an APN, followed with my objectives (O’Grady, 2004). I am trying to get an overall understanding of the various roles required to treat patients successfully and understand the full extent of care required (Donaldson & Crowley, 1978). In order to accomplish this, I intend to interact widely with my advanced practice nurse (APN). On the other hand, I can learn from her certain emerging issues that are extremely relevant to the practice of clinical nursing in treating and solving various problems, beginning from the minute, the patient enters the clinic and seeks care.

I will follow APN today to each patient examination room and just observe her role. She reviews every patient’s chart and looks at the previous lab work, and if there are any new labs drawn. We check the patient’s BP, which has been done by medical assistance before we enter the patient’s room, and also check heart rate and respiration. APN showed to me the way, how to look for the reason, why the patient is seeking care, and how to be preparing before seeing the patient (Benner, Tanner & Chelsea, 2009). APN tells me that it is necessary to be confident when seeing a patient. It is also convincing to tell the patient that you will do the best to help him to get the right medical care, if you do not know the answer. The key principle is: never make an assumption and be an active listener (Donaldson, S., & Crowley, D., 1978). She explained to me that in most of the cases, if you listen to patients carefully, they will tell signs and symptoms, and thus, it would be possible to come up with right diagnosis. She also encourages me to involve the patient’s family in his care, if he has a family, or involve patient support system.

Assessment/Application of knowledge experiences gained from clinical activities as reported in supportive data.

The first day of my clinical

I was trying to follow my APN and observe how I need to do an assessment, as well as to find out my role as an APN. I was observing her and followed her to each patient’s examination room. I needed to find out, how to interact with patients and also make patients confident, so they can trust my care and judgments. I was very nervous and tired, after following her to almost 14 patients in the morning and 16 patients in the evening. I tried to define my new role as APN.

APN has years of experience as a nurse, and she is involved in patients’ care every day. Every day I learn something new, which is a part of nursing care. It is a continuous learning process, and I am sure it is the same as being APN, except it is at a higher level and with more advance knowledge (Zaccagnini, & White, 2011). My APN told me how important the education is while working with patients in her clinic. She tried, most of time, to explain the diagnosis to patients. However, if they still needed more information about their medication, APN would print out most of information that she could provide for them, such as safety use of their medications. When I look at lab results for each diagnosis, I am also learning what I need to look for and how to relate the abnormal lab to the diagnosis. My APN is kind, and she tries very pertinently to explain my concerns; when I tell her that I feel lost, she tries to give me courage and tells me that I will gain knowledge every day, and it requires time. I try to listen carefully to know what questions I need to ask the patients so they can lead me to the right diagnosis (O’Grady, 2004). I think that it is an excellent opportunity for me to see patients of different ages and with various illnesses in the clinic.

As I have mentioned above, one of the main goal is to learn to listen patients carefully before commenting or making suggestions. And I am doing my best to grasp it. I have to proceed my active learning so it helps me in the future. “Taking over” this knowledge is an on-going process.

I was not in direct patient care as it was my first day. I was just in observation. Hamric says that the CNS is particularly skilled at surveillance and can identify problems quickly so as to prevent further complications (Hamric, Sprouse & Hanson, 2009).

At the end of the day, I had a meeting with my preceptor, and I asked her about my concern and how I felt, and she gave me some advices.

Week 2

Supportive Data/Narrative [report activities, what was done, activities, interactions, interventions, research project(s), etc. Note, objective met, not met, in progress, or revised]

Today is the second day of my clinical practicum. I am still trying to focus on my goal from the last clinical practice, which is to understand my role as APN. I am following my preceptor and observing her at the same time. I will follow her to the patient examination room. And today, I will take one step further and do an assessment of a patient’s state of health; however, I need to have my preceptor observing me. My focus on today’s assessment is a few patients with heart disease and HTN.

I have to examine one of patients supposed to be seen today by 09:30. I had read her past medical history and verified the reasons, why she needs to be seen by APN. I looked at her current medication, her allergy and her family history, as well as her social history. I have prepared myself for her visit. I printed out educational materials for her and questions, about what I need to be more well-informed. I discussed my concern and plan that I came up for the patient with my preceptor, and she gave feedback of her concern.

When a patient arrived, her BP on this visit was 172/88 and her heart rate was at 90. She was currently taking Lisinopril 10mg once a day and also Norvasc 5mg daily. Other medications, which she was taking, are thyroxin 120mcg once a day for hypothyroidism, and Prozac 20 mg for depressing. We went to the examination room with my preceptor together. I did physical assessment. My preceptor allowed me to take the lead and talk to the patient about our concerns. I told her about our finding, and that we were concerned about her BP. The patient’s reaction was very tearful and open, and she started crying. We listened to her and had sympathy about her emotional problem. My APN had to leave the room as she was getting behind to see her other patients. I was able to stay and listen to the patient. We had a good talk, and after that, she told me that she had small children at home and that she was going through a lot of emotion at this time. I told her that she needs to stay strong and healthy to be able taking care of her children. I came up with a plan to refer the patient for some therapy and consulted an internal medicine doctor to follow up her uncontrolled BP. I discussed the plan with my APN, and she agreed. I also printed out some educational material for her, such as about the importance of controlling the BP, and how it will affect her other organism systems, if she continues having high blood pressure.

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The rest of the day we saw more patients, and I focused on physical assessment and plans for patients during my clinical. Today, I reviewed three patients’ charts, of their health history and previous visits. My goal for today is to spend more time with these three patients, in order to deepen my education and collaboration. I also coordinated with my preceptor the education part I will discuss with the patient.

Interdisciplinary meeting with the preceptor and other Professions representatives included EKG technician, phlenobotmist and medical assistant. We discussed how is it important to work as a team and be able to provide for the patient proper care with the best outcome.

Assessment/Application of knowledge experiences gained from clinical activities as reported in supportive data.

I felt more confident in my second day by following my preceptor to understand my role as APN. After she had introduced me to the patient, I took the next step and asked him questions to take the lead for the assessment. My preceptor was asking questions and collecting data from the patient of what had brought him to the clinic for a visit. I also participated in active listening, so to be able to start asking questions, when I can lead the diagnosis of the patient. I was able to use the knowledge gained in the assessment and pathophysiology classes to provide an in-depth cardiac assessment (Benner, Tanner & Chelsea, 2009).

I was also learning to know what should I do in order to come up with an educational plan for the three patients with HTN and cardiovascular disease (Zaccagnini & White, 2011). After reviewing one patient’s chart, I examined her and asked why her blood pressure even with three blood pressure medications was still not under the control. I spent one hour with this patient and did an education how she can manage her blood pressure by eating healthy food, taking medication on time and exercising regularly (Brown, 2005).

I learnt to listen actively to the patient before commenting or making suggestions. I am able to allow active learning take place, rather than “taking over”, but it is still an on-going process (Hamric, Sprouse & Hanson 2009).

Today I was able to use the CNS competencies of how to do an assessment and understand the reason why the questioning patient is seeking care. I was also involved with making plans.

The meeting with my preceptor was productive, since she taught me how to do electronic charting for the part I did. I was unusually slow, but looking forward to every day practice to learn something new.

Week 3

Supportive Data/Narrative [report activities, what was done, activities, interactions, interventions, research project(s), etc. Note, objective met, not met, in progress, or revised]

Goal 1

Exhibit an advisory role to patients through fostering of communication, leading to recommendation of appropriate remedial action to patient with various diseases, specifically focusing on cardiac patient. Act as a teacher, who can provide accurate and relevant information and proper education. As a professional provider, APN needs to enable patients understand the requirements needed to mitigate the effects of the disease (O’Grady, 2004). This would include dietary, rehabilitation and exercise options, which could boost health, hence, prevent stroke and heart failure.

I will also observe our lab technician today in order to learn how to run the lab equipment, in case that the lab technician is at private practice or is not able to show the test during the day of duty. My consulting APN has to show me how to run some tests in order to get familiar with the equipment and procedures. My APN told me that, in a private clinic, we need to learn most of the basic stuff, so we can run the clinic, in case, we are short handed or something needs to be done immediately. It is always interesting to learn new skills and be able to do best we can in an emergency situation.

Goal 2

Practice extensive consultation with cardiologists for the purpose of cardiac rehabilitation. Inquire from the preceptor how the in-service attendance regarding a cardiac patient can be accomplished. Increase knowledge in different aspect of cardiac complications based on age of patients. Moreover, understand different electrocardiograms of different age groups.

Assessment/Application of knowledge experiences gained from clinical activities as reported in supportive data

During my third day of clinical practicum, I followed my APN examining each patient in an examination room. I asked my preceptor if there were patients with cardiac problem so I could focus on their problem. She informed me that we had four patients with HTN and cardiac complication. I felt confident in taking the lead to educate patient and refer them to cardiologist if needed, so to help them prevent further complications. I reviewed their charts and looked for information in order to be more helpful. I also verified if their BP is under control and provided diet instruction and medication teaching. I used the knowledge that I gained from my nursing practice and as a cardiac nurse, provided better education in a cardiac assessment.

I was still learning to listen to patients, but this time, for the purpose to find out the cause why they are not able to control their cardiac problem (Brown, 2005). In this clinic, most of the patients are arising because of tier hard finance situation and low income, and they are not able to get a healthy nutrition. I was trying to come up with an acceptable plan how we can help these patients.

Care of this type by the CNS provides a patient with complex, comprehensive care, and allows the CNS to recognize problems with the system that may arise. Hamric says that the CNS is particularly skilled at surveillance and can identify problems quickly to prevent further complications (Hamric, Sprouse & Hanson, 2009). I felt that my meeting with each patient was truly comprehensive, and I was able to see how patients were willing to take right steps to help themselves. My preceptor suggested that I should do some research for cardiac patients. The research should be related to the right nutrition and exercise method for these patients, since they have lower income. I will also provide additional research studies through the Heart Association of America.

My meeting with my preceptor was remarkably productive, and she gave me shot recommendations, as to how I would be to able to provide better information for these patients. However, I felt much more competent as every day went by.

Week 4

Supportive Data/Narrative [report activities, what was done, activities, interactions, interventions, research project(s), etc. Note, objective met, not met, in progress, or revise]

Today is Thursday, and my CNS informed me that they have both women and children to exam in the clinic. We are going to have a different scudded, except somebody walk in for an urgent problem. I have to review a few patients’ charts before their arrival and learn what signs and symptoms I have to look for. Also, following my CNS’s instructions, I have to learn how to do these examinations. My goals are to prepare myself to learn new skills in examining and right communication tools. I also shall focus on patient’s education and on how I can be helpful to teach them be preventive. I shall do this by observing my CNS, who will demonstrate right skills to perform theses examinations. Moreover, I shall need to be aware of what lab work needs to be done and look for any warning signs or risk factors that patients might face in the future. I need to learn the right examination method and sensitivity of the examination and be familiar with patient cultural background. I have to learn what planning and recommendations for the patient are at risk from the viewpoint of any further complication as well.

Assessment/Application of knowledge experiences gained from clinical activities as reported in supportive data ion needs to be done.

I was unfamiliar with theses examinations, because I had never worked in OB or pediatric unit, so most of these exams are new for me, except I did have knowledge about some signs and symptoms, as well as knew about the need to look and be aware of abnormal lab results (Benner, Tanner & Chelsea, 2009).

I asked my CNS to help me, since this was my first time for this testing. I just observed and learnt what questions need to be asked and how to educate patient in future planning. I was also learning how my preceptor uses appropriate communication tools and eye contact with a patient. She explained every step she had taken during the examination. It was an ongoing process for me today before I am able to perform this in the future.

In rounds up for today, I was able to use the CNS competencies of direct patient examination care, collaboration, and consultation. The direct care was provided to both woman and a child, and their examination went well. It was an example of a regular care described by Hamric (Hamric, Sprouse & Hanson, 2009). Care of this type by the CNS provides a complex patient care, such as patient with abnormal Pap smear. Hamric says that the CNS is particularly skilled at surveillance, and she can identify problems quickly, to prevent further complications. In any abnormal finding of any examination, there is a risk of many complications, moreover, difficulties, such as how to inform the patients and also their family, so they are supportive (Hamric, Sprouse & Hanson, 2009).

Week 5

Supportive Data/Narrative [report activities, what was done, activities, interactions, interventions, research project(s), etc. Note, objective met, not met, in progress, or revised]

I have discussed with my CNS that I will focus today on referral, in other words, consultation for a patient, who needs additional clinical evaluation by a specialist. I arrived an hour earlier, and she was able to share information with me, which patients she has decided to send for referral today. She also explained to me that, for each of these patients, she will explain and reason why she thinks they need to be seen by a specialist. When my CNS started seeing first patient at 08:00am, I stayed in her office and reviewed a patient chart, which had the appointment around 09:30am. She had been seeing this patient almost for a year for a new onset of hypertension. Patient has been prescribed blood pressure medication, but she is not following her medication prescriptions, as she is supposed. Also, she has gained weight and is not following a healthy diet and exercises. The patient had given her complaints, such as getting up a lot at night and voiding more than she used to; also, during the day she was shaky and felt not good. My APN recommended her to fasten today’s visit to do some extra lab work. Moreover, since her BP had not been under control, it might make harm to her kidney, and she might be suffering of type two diabetic, so one of the lab test today was to see what her blood sugar is on fasting period. When the patient arrived, we went to the examination room, and my APN explained to the patient why she wanted to do an extra lab test. Her BP on arrival was 170/80, which she was concerned about, and APN asked the patient, if she was taking her medication.

My CNS explained to the patient the reason, why she had to do an additional blood test, and then the medical assistant draw the blood. While we were waiting for the test results, we had two other patients, who needed to be examined. As soon as the results were ready, my APN shared them with me in her office. As was suspected that the patient had been developing type two diabetics, and her hbgac1 level confirmed it as it was 8. Now we were ready to go and tell the patient this bad news, which, I am sure, she will not be happy to hear. We went in, and APN showed the patient the results and explained to her what needed to be done before it is not too late. She recommended a referral to an endocrinologist so she can be treated the right way and emphasized how vital it was to be done as soon as possible. APN further explained to her, why it was necessary to see a diabetic specialist. She was extremely angry and tried to blame everything on us, and we tried to calm her down. At the time, my CNS recommended some counseling and suggested seeking more help at a therapist to be able to deal with the situation and get help. We gave her a plan about how she could start with controlling her nutrition. We also recommended that she exercises and takes her BP medication until her next appointment. The office was able to make an appointment for her to see an Endocrinologist within the next three days.

Assessment/Application of knowledge experiences gained from clinical activities as reported in supportive data.

I’m feeling confident now in taking the lead when going to the examination room and doing assessment and asking question related to patient condition.

I am also learning to listen to the patient before commenting or making suggestions. I am able to allow active learning to take place, rather than “taking over”, but it is an on-going process.

It was remarkably different experience for me today, and I am learning every day of clinical something new, which was an examination of both a woman and a child. In some cases, today, we did consultation and referral the patient for further investigation (Brown, 2005). Also, education was a crucial part of the day. Every patient has a different way of learning, so we had to be prepare for how to educate the patient in the best way in order to have the best outcome for patient’s well being (Benner, Tanner & Chelsea, 2009). Communication while examination of a woman, played a vital role. It was essential to have an eye contact with patients and explain every step during the examination, so patients are aware what we are going to do and why (Hamric, Sprouse & Hanson 2009).

At the end of the day, my meeting with preceptor went extremely well, and I asked questions of what I have for the next session, such as when I am going to do a similar examination and for what I need to be prepared.

Week 6

Supportive Data/Narrative [report activities, what was done, activities, interactions, interventions, research project(s), etc. Note, objective met, not met, in progress, or revised]

Today it was a different clinical day for me. I found out that it will be an educational session with some cardiologist. The session should be hold in the university hospital. I had discussed it with my APN and she told me that it will be useful for me to attend this meeting. She also asked me to bring as much information as I can get and take note for the next clinical practicum so to share this information with her (Hamric, Sprouse & Hanson 2009). This seminar had been held for three days. It was tremendously exciting to attend one of these seminars, since I could learn much for my future in the care of cardiac patients. Each session had covered a lot of information. At the first session, I learned about advanced skills to define the stage of hypertensive and which drugs can be used in an emergency situation. At the second session, discussion continued about the cardiac care and the use of Anticoagulation Antiarrhythmics.

Each of the sessions was hugely informative, and most of information was provided in the mornings, what, I think, was a good part of the whole seminar. It is necessary to know the risk factors and how to prevent and treat them; this information impressed me the most.

In the afternoon, the seminars were focused on the vascular disease, as well as information on how to identify PAD during the physical examination of the patient (Benner, Tanner & Chelsea, 2009). The most important part of this session for me was how to measure the ankle-brachial index. In my opinion, if we were able to do right examination, we could start with preventive measures. The last session was about how we can help patients with hypertension and cardiac problems, including education and council of these groups of patients for prevention of hypertensive conditions. I felt the seminar was extremely beneficial for my future job, and I was also very excited to share all the information and knowledge, which I retained, with my preceptor.

Week 7

Supportive Data/Narrative [report activities, what was done, activities, interactions, interventions, research project(s), etc. Note, objective met, not met, in progress, or revised]

This day was a usual day, and we started to examine patients at around 08:00am. I was more confident to go to the examination room and see patients, do a physical examination and talk to patients. My APN went with me and introduced me to a patient. She asked a patient if it is okay that I start physical examination, while she will be away shortly. After I was done with physical, I asked the patient some questions, related to his visit, and if he had any concerns. I let the patient know that I was going to talk to APN and that I will be back to let him know about the plan of treatment. I went to my APN and discussed my finding and plans for the patient. After we had discussed the plan, she let me know what I needed to add to the plan and where she disagreed with my suggestions. We went back, and APN let me tell the patient what the plan was, which medications we were going to prescribe, and if the patient needed any further education or had questions to be answered. I demonstrated my knowledge, which I had gained during my clinical to be able to help the patient for the best outcome. Around 10:30 my CNS told me about a patient, which we were going to see, who was 46 years old. The patient comes twice a month for her back pain mostly, and once a month for medication for her anxiety. The patient had been in the clinic that week, and we just found out that, besides her back complaints, she was suffering from the chest pain. My APN informed me that the patient might be here for seeking some extra pain medication. I already learned to listen to the patient and never make my judgmental, before I can hear the patient’s concerns. So, we went to the examination room and the patient started complaining about her bad chest pain. Patient’s BP was checked by MA, and it was 178/91, and her heart rate was at 110 bpm.

Examination

We went to the examination room together. APN introduced me, and we started to do a physical examination. Patient seemed to be much stressed and also gasping for air. I asked her, if she took her BP medication this morning and her response was that she did. I also asked her to explain, what character of the pain she had and if she had experience of such pain before. I asked my APN, if we could run EKG for this patient and also draw blood for cardiac enzyme. She agreed with the plan, and we explained to patient the reason why we were going to do EKG and blood drawn.

My goal on this case was to specify, if there was the underlying cause of the patient’s chest pain. While we were waiting for EKG, I looked up the patient’s history and also her family history. I found out that her maternal side family had extended cardiac problem. I also found out that the patient did not comply with her medication and exercises and healthy eating. Her lab from the last month showed her lipid profile; her LDL was low and her HDL was high. She was also prescribed Zocor. So, lab numbers were not ideal or even close to demonstrate any changes, since she was taking this medication. I started to provide nutritional education including some additional educational brochure for the patient and started to guide her into the advantages of taking control over her blood pressure, before more damage has been done to her heart. Later on, when her EKG was done, I and my APN looked at the results, and I was able to see a clear abnormality, after being a cardiac nurse for a quiet time. We discussed her EKG outside the examination room and came up with a plan. Both of us, APN and I, suggested that the patient needs to go to ER and be examined by a cardiologist. We were concerned in this case, and explained to the patient the reason, why we thought she needed to be seen by a specialist. We showed the patient her EKG and explained it. We also talked to her husband and recommended to him to take the patient to ER for further investigation. We also spoke with her husband about the disease progress and provided information about the family support group.

I had attended interdisciplinary meeting with my preceptor, before we talked to the patient. We used the knowledge regarding the signs and symptoms that the patient had this morning, and being not judgmental about her current complains. She usually comes to the clinic for pain medication, for most of her visits. The plan for ordering EKG and drawing first set of cardiac enzyme was due to an aspect of being concerned about some other problems going on with her; we were also advocating the patient for this visit and the problem she was facing. We drew a plan for further investigations along with additional tests, as well as a plan for additional support from her family, who would be able to help her in this situation.

Assessment/Application of knowledge experiences gained from clinical activities as reported in supportive data

Results of 7th week

I’m feeling confident in taking the lead, when visiting a patient by myself and making a plan for them. I tried to be prepared in the best way I can for answering patients’ questions, including situations, when I feel lack of knowledge to provide them with relevant information. I write down their questions and make sure I discuss them with my preceptor and get information the best way I can to respond to their needs, as well as provide information that they need (Benner, Tanner & Chelsea, 2009). In this case, with the 46 years old female, I was able to use the knowledge gained in the assessment and path physiology classes to provide an in-depth cardiac assessment.

I am also learning to listen actively to a patient before commenting or making any suggestions. I am able allow active learning to take place, rather than “taking over”, but it is an on-going process. In today’s case, I was able use the APN competencies of direct patient care, collaboration, and consultation. The direct care, provided for 46 years old patient, is an example of a regular care, as described by Hamric (Hamric, Sprouse & Hanson, 2009). CNS provided a complex patient care, such as comprehensive care, which allowed us identify problems with the system, including those that may arise. Hamric says that the CNS is particularly skilled at surveillance and can identify problems quickly, in order to prevent further complications, as been seen by a specialist (Hamric, Sprouse & Hanson, 2009). In the patient’s case of today, she was at risk of further complications related to her abnormal EKG. We also informed her family about the support she needed, when taking her to the ER specialist. I also asked her husband to update us, when the ER physician comes up with the plan after his findings.

All in all, we avoided making judgments, given the fact that the patient was using different medications. Thus, we opted to treat the patient just like a drug seeker. Having a vast experience working in the cardiac department, we quickly noticed that the patient’s EKG test results were abnormal. Further to this, we gave recommendations for the patient to go to ER physician. We were confident and objective in our interaction with the patient, moreover, we were determined to provide the best health and nursing care with a view of helping the patient’s life come back to normal (Brown, 2005). Later on we had a call from her husband, who informed us that the patient was admitted to hospital and was seeing a cardiologist for further investigation.

MY meeting with my preceptor at the end of the day was particularly informative. The talk concentrated on today’s case mostly, and we were pleased with our decision to send the patient to the ER specialist, since this proved to be the right thing. I also brought all notes that I took during the last visit, when I attended an educational session last week, and I shared this information with my preceptor.

Week 8

Supportive Data/Narrative [report activities, what was done, activities, interactions, interventions, research project(s), etc. Note, objective met, not met, in progress, or revised

Today is the eights day of my practicum. I am more independent and confident to see patient by myself and come up with a plan for patient. I usually read the patient’s medical history and clarify the reason, why he/she is in the clinic for a visit. I also look up the patient’s current medication and his allergies plan, as well as prepare myself to do an assessment and answer the patient’s questions. I let the patient know that I will discuss my findings with my preceptor. I let my preceptor what I know and what plan I have for the patient. Then we go together, and APN lets me talk about the plan and what needs to be done. I am learning every day, and I am surprised that learning goes by in such a short time. My preceptor has been tremendously helpful for me to develop and utilize the patient’s plan and understand my role. I am also developing in my collaboration with other healthcare professionals aimed to foster the advancement in specialty of the nursing practice, as well as to ensure that the best practice is implemented with understanding the best outcome for a patient (O’Grady, 2004).

I reviewed the chart from the last visit and checked the current lab work availability, in case that something had to be done, and I also payed close attention to any changes. We verified if the patient’s disease progress was what we were expecting, or if there was anything else that needed to be done to be helpful. I followed three patients during these 8 weeks, who had been seen every two weeks or, sometimes, more often, because of their complicated diagnosis or various problems that they had. Example of the patient that we had seen more often was a cardiac patient, and she also was newly diagnosed with diabetes type two. I had been following this patient, since I started my clinical, and I developed a bond with her and spent additional time to educate her aiming to show how she can help herself to live a healthier life. I also tried to teach her how to check her blood sugar before each meal with a nutritional review. I spoke with the patient’s family to involve them in helping her and provided information about the family support group.

I attended interdisciplinary meeting with my preceptor. I also tried to serve as an advocate to the patient and find out what other resources are available to patient outside the clinic. I involved patients in their own care and life style explaining how influential is for them to take steps toward a healthier life. It is always beneficial to listen what patients want to say. Most of the time, patients are able to give us right information, and we will be able to diagnosis their diseases and get them as much help as we can. In some cases, we might need also to refer a patient to a psychologist for further evaluation. Collaboration with other healthcare professionals is crucial in the nursing practice in order to foster the advancement of the specialty and to ensure that the best practice is implemented and understood by the patient in his care.

Assessment/Application of knowledge experiences gained from clinical activities as reported in supportive data.

Identifying problems of clients and providing a comprehensive care

I’m using my knowledge of nursing that I gained through years to develop my new skills and advanced them to take better care of patients and provide them with better treatment. Thus, I develop advanced knowledge and clinical expertise in caring for patients with various problems. I am also more confident to see patients on my own and develop the right plan for them.

I am also learning to listen what patients can say about their health problems, before commenting or making suggestions. I am able to allow active listening take place, rather than “taking over”, but it is an on-going process. I am able to connect my knowledge to competencies of direct patient care, collaboration, and consultation regarding patient. The example during this clinical was the patient with an onset of diabetes type two, due to none control hypertension along with a bad habit of nutrition and non active life style. The direct care provided to this patient is an example of regular care as described by Hamric (Hamric, Sprouse & Hanson, 2009). However, such care of the patient may not comply with the variety of complications that may arise. Hamric says that the CNS is particularly skilled at surveillance and can identify problems quickly in order to prevent further complications. Complications may impose risks in the future for the patient (Brown, 2005). I was involved to teach the patient how valuable taking her blood pressure is, as well as medication intake and check up of her BP before taking her medication. I also instructed her to keep a record as a log and bring it for the next visit. We also tried to teach her check her blood sugar and change her diet and be more active on the daily basis. Knowing some of her underlying socio-economic background, we provide this patient with blood pressure cuff and glucometer, so she could use it at home. Some patients are unable to provide for their needs. In the clinical setting, such patients seek care from the beginning, and they are an excellent example why a comprehensive care is needed. 

Today I felt highly productive, since I had taken real substantial steps towards being an advocate to this case and giving the patient a hope and educating and inspiring her in order she could help herself. She will be able to stop further system damage. I felt that the interdisciplinary meeting was particularly beneficial. I was able to present her case in a comprehensive fashion.

Educating of patients reduces the risk factors for various heart diseases; therefore, it is crucial to monitor their histories and communicate with patients during their visits. Moreover, there is a further need in educating patients on preventative and ameliorative measures. These measures are related to diet, exercise, and nutrition; therefore, there is a need to teach the patients some of at-home self-help techniques, such as how to monitor their own blood pressures (Zaccagnini & White, 2011). Design and implementation of programs and educational forums for patients are the best strategies.

Week 9

Supportive Data/Narrative [report activities, what was done, activities, interactions, interventions, research project(s), etc. Note, objective met, not met, in progress, or revised]

Today is the last day of my clinical practice. I am trying to evaluate myself with the help of my preceptor in order to have a firm grasp on my role. I know I have a long way to go. I am comparing my first day of my clinical with today. I have learned a lot; however, I need to continue this process to be able to develop myself further. I am able to go to patients’ examination room and review the patient’s chart before starting an examination. I also have learned how to conduct an effective communication with patients during their visit. I feel increasingly comfortable talking to patients. My communication skills have improved since the first day of my clinical practice.

I have set firm objectives of my further goals, such as utilizing collaborative strategies in interacting with Advanced Practice Nurses in order to understand my role in caring for patients comprehensively. Moreover, I need to consult with physicians and medical staff regularly, and stay up to date on the latest research in order to implement the best evidence-based practice in the care of patients (Fawsett, 2005). I have to collaborate with physicians and medical staff to develop an advanced understanding of the various functions of the CNS, including the duties to act as expert clinician, educator, consultant, case manager and researcher in treating the patient (Hamric, Sprouse & Hanson, 2009). Finally, I realized the need to develop compassionate and professional relationships with patients by employing thorough and clear communication strategies.

Assessment/Application of knowledge experiences gained from clinical activities as reported in supportive data.

Today is the last day of my clinical for this session. I had revised all my goals and also my clinical log records. My preceptor had looked through my entire log records and had spent almost two hours discussing them with me. She gave me her suggestion about which areas need to be improved and how I can be more prepared for my next clinical session. She was extremely pleased about my dedication. She also mentioned that I had worked really hard to achieve my goals and objectives. She talked about her own clinical experience, and her advice to me was that every day I have to learn something new and never stop to find out new things as life goes by.

Other most significant conclusions that I drew during my last day and the clinical session, as a whole, include the following crucial points.

There is a need to collaborate with other healthcare professionals in order to foster the advancement of specialty, and to ensure that the best practice is implemented and understood. It is essential to provide clinical consultation and direct patient care to help patients with their condition. These skills may be further improved through medical researches and literature review.

Education of patients helps in reducing the risk factors for various diseases; therefore, it is vital to monitor patients’ histories thoroughly, as well as communicate with patients during their visits. This includes providing of education and guidance to patients of practical medical information pertaining to their conditions (Brown, 2005).

It is vital to ensure the administration of proper quantities and qualities of drugs prescribed to manage patients’ condition, as well as it helps instruct patients of proper drug use. (Benner, Tanner & Chelsea, 2009).

In order to ensure a comprehensive approach, it is necessary to educate patients on preventative and ameliorative measures, such as diet, exercises, rehabilitation, nutrition, as well as teach them at-home self-help techniques, such as how to monitor their own blood pressures (Zaccagnini & White, 2011). This includes education of patients to increase their knowledge base concerning the function of their system and how medications affect on their system.

MY preceptor introduced me to different web-sites, so I can get more information and knowledge to increase my nursing competency. It has been a 9-weeks blessing for me, and I am immensely thankful to my preceptor that she took her time on the day-to-day basis and was always there to answer my questions and concerns.

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