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Journal Entry (450–500 words) – Check the Rubric Detail
Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you to identify opportunities for improvement in your clinical skills, while also recognizing your clinical strengths and successes.
This week, you will write a Journal Entry, reflecting on your clinical strengths and opportunities for improvement.
To prepare:
- Refer to the “Advanced Nursing Practice Competencies and Guidelines†found in Week 1’s Learning Resources and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.
- Refer to your “Clinical Skills and Procedures Self-Assessment Form†you submitted in Week 1 and consider your strengths and opportunities for improvement.
You will write a paper reviewing the three most challenging patients you had this practicum. Answer the following:
1. What made them challenging?
2. What did you learn in dealing with these patients?
3. What resources were you able to use?
4. What evidence-based practices did you use in treating these patients?
5. What new skills did you learn this practicum?
6. What would you have done differently during this practicum if you could go back and do it over?
7. How do you feel you’re doing in managing the amount of patients you’re seeing in the timeliness with which the patients are seen and dispatched?
- Also, reflect on how to improve on your skills and knowledge and how to communicate that back to your Preceptor.
- How are you doing? What is missing?
- What type of feedback are you receiving from your Preceptor?
It requires the same APA requirements: Title page, headings, three (3) credible references (not your textbook), and APA formatting.
Three most challenging patients:
Patient 1:
Visit information and notes: Patient P is 19 years old who lives with his parents and two younger siblings. P has been shown a significant change in behavior since he broke up with her long-time girlfriend that they had planned to marry. In the last few months, P has been quiet, binge drinking, and irritable when someone speaks to him. When James first saw the GP, he told the doctor that the breakup brings him bad memories where the GP ruled out depression. The behavior has hardly changed, which implies the patient is suffering from psychotic episodes of schizophrenia because, during the final examination, the patient showed signs of delusions.
Diagnosis: Psychotic episodes of schizophrenia
Procedure: Physical examination and psychosis test
Student treatment plan and notes: Chlorpromazine 25mg PO, taken three times daily, and cognitive-behavioral therapy to include three sessions per week for at least six weeks. The subsequent medical visit for the patient is within one week to assess the care outcomes and further care planning if required.
Patient 2:
Visit information and notes: Patient is a 70-year-old male who presents to the office with symptoms including general weariness, shortness of breath, and abdominal discomfort that have occurred for the past five days. His medical history incorporates hypertension and coronary artery disease. He had previously had a 90% LAD blockage and a 50% RCA occlusion, both of which had been treated with stents.
Diagnosis: Heart failure.
Procedure: An electrocardiogram test
Student treatment plan and notes – Metoprolol, 50mg PO once daily. The patient is recommended to engage in physical workouts, sustain a healthy weight and diet with low sodium.
Patient 3:
Visit information and notes: Patient is a 27-year-old female who arrives to the office two days after giving birth. She has significant abdominal discomfort and vaginal bleeding, according to her. However, she claims that her pregnancy was uneventful and that she had a regular vaginal delivery.
Diagnosis: Hypovolemic shock
Procedure: A blood test is done to assess for electrolyte imbalances and an electrocardiogram to examine heart rhythm.
Student treatment plan and notes: Care plan includes blood plasma transfusion and fluid replacement therapy.
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