Ambulatory Care Reflection

For clinical week 9, I was assigned to the UMC Wound Care Clinic to view a different field of nursing. As soon as I arrived at the clinic the nurse told me that I could bounce around from patient room to patient room to view as many wounds and burns as possible. The first patient room that I went into was a young Hispanic man who had an infection on his right lateral thigh area that spread from the popliteal area to the greater trochanter. When I asked the patient what had happened he told me he was injured at work and the injury got infected, which he never went to the doctor to have it evaluated. So, basically the infection was eating away at his skin and muscles. The patient has to come to the wound clinic every day to get dressing changes.

The purpose of this essay is to reflect on my personal role in the inter-professional team and the delivery of healthcare that I have encountered during my duty as a health care assistant in one of the hospitals here in England. In accordance with the NMC (2002) Code of professional conduct, confidentiality shall be maintained and all names have been changed to protect identity. The purpose of reflection as stated by John's (1995) is to promote desirable practice through the practitioner's understanding and learning about his/her lived experiences. I have decided to reflect upon an incident with the nurse in charge in one of my shifts and in order to structure my reflection I

One of the aims of the Patient Protection and Affordable Care Act (ACA) of 2010 is improved integration and coordination of services for primary patient care. The patient-centered medical home (PCMH) is one of the approaches by which improvements can be established. The patient-centered medical home model is particularly well-suited for people who have chronic illness. The design of the patient-centered medical home model departs substantively from traditional reimbursement policies, in that, the ACA provides for incentives and resources to enable care coordinators to be directly recognized and compensated for their care coordination work. Care coordinators are most often registered nurses who through their work that aligns with ACA engage in quality improvement work, cost-effectiveness measures, and patient advocacy. To bring the ACA model to a human scale, the authors present a case study of a care coordinator at a patient-centered medical home in rural Maine. The table provided below provides a basic textual analysis of the study as it is published in the professional nursing journal.

During the first three years I will work as a nurse practitioner in an urgent care/occupational health care setting serving individuals living in low socioeconomic areas. Providing urgent care treatment in an underserved community is important to me, as these communities are in dire need of healthcare providers who speak their language and understand their culture. I hope to make a difference in these communities by encouraging prevention. In order to be worthy of serving this population, I will need to partner with a practice that will take me under their wing and help me reach my highest professional development potential.

Throughout this course I have really learned a lot. Many of the things that were brought up in lecture and homework were key points to my success. First, an important take away that I have is that Medicare and Medicaid do not cover everything. Long term care is expensive. I learned that this is an on going issue, and something that Obamacare tried to help, but did not succeed with 100%. Also, I learned that there are several issues that come up within ethics. For instance, when dealing with the autonomy of a patient, when do you decide the patient cannot make decisions for themselves? And who decides? The loved ones who are emotionally attached? A takeaway from this is that there are certain rules and regulations that held to shape who gets to decide, but there are still grey areas. A final takeaway that I had was that even though the health care system is changing that brings both opportunities and set backs. Nothing will be right on the first try, and it will take time to figure out. For instance, long term care is not discussed enough. An opportunity was provided through Obamacare, but the setback is many baby boomers are unaware that the Affordable Care Act will not cover their long term care needs post retirement.

This semester, I hope to gain the confidence in my nursing skills necessary to help me work more independently with my patient care. Expanding on my assessment skills, communication skills, clinical judgment skills, and safety skills are important in gaining more independence in my care for my patients. I hope that this semester I can learn how to work with chest tubes, be more direct with what I need from my patient, be more confident with my knowledge in medications, improve my skills in delivering an SBAR, and learning the terminology used at Mayo Clinic and in nursing.

Such a structure revolves around clinical leadership dyads, or pairs of part-time physician-leaders teamed with full-time nurse administrators, based within geographic regions. The majority of the physicians involved in care delivery were independent, community-based practitioners motivated by shared professional values emphasizing high quality service and satisfying patients' needs. Their dyads regularly reviewed data on delivery costs and service outcomes, and they collaborated with one another throughout the IHC system to indentify improvement opportunities and share best practices. Equipped with sound evidence and empowered by management, the dyads formed shared baselines and drove initiatives that dramatically lowered healthcare costs by reducing the incidence of overused procedures, such as elective inductions and unplanned surgical deliveries.

I have always been drawn to outreach opportunities that allow me the possibility of improving the quality of individuals ' lives while working towards the betterment of my community. My experiences have given me a greater understanding of the social and economic barriers that affect patients in both urban and rural underserved areas.

The topic we focused in the class was about Inpatient Rehabilitation and Post Acute Care in the United States. The presentation was given by Susan Hartman and currently, she is working at HealthSouth Nittany Valley Rehabilitation Hospital, position of Chief Executive Officer . The lecture began with the topic of the continuum of care. I had experienced difficulty with this thought because I trusted that everybody should have to know all about acute care because it’s very vital to know in the HPA field. I didn't know whether I could regard it a privilege. I felt that access to health acute care status was significant, particularly because I also, from a place where health care is hard to find, as well as difficult to pay for services. During the lecture, I came to comprehend that without health acute care, few of us could legitimately appreciate the other fundamental rights. This presentation applies to me, when I was working at health clinic volunteer service in Bhutanese American Organization of Philadelphia.

The community where healthcare professional like me would like to work and live in is a multispecialty hospital set up in a rural area so that I can experience diversity among the patients and coworkers from all the departments. A multispecialty facility is a setup with wide varieties of physicians from a wide range of specialties who are hired by the same organization. The services given by the specialists, patients receive complete medical treatment that is systematic and organized. Systems and services are designed to assist physicians in the delivery of high-quality, coordinated, patient-centered care. Understanding and sticking to patient preferences influences satisfaction with health care delivery and also leads to the understanding of the higher quality of

My time in the medical assisting program has been some of the best and some of the worst times of my life, but one thing is for sure, I wouldn't take it back for anything. I have made some of the best friends and colleagues from the beginning of this program. I have learned what the definition of preservence and hard work meant from this program.

In the midst of attending a party with his friends, a random, ricocheted bullet pierced the right side of his head while he was trying to break up a fight. The bullet blew away part of his skull and lodged into his brain. When he arrived in the trauma bay, medically he was dead- no pulse, no spontaneous respirations. His family was forewarned that if he woke up there was a strong possibility that he would never speak or walk again. The patient- B.H., was a seventeen-year-old high school senior, who was class president, and captain of the football team when he was shot. During his month long stay in ICU, the hospital staff worked around the clock to ensure that his issues were properly managed. Despite all odds, B.H. is currently in his senior year of college, plays semi-professional football, and works two jobs. What was particularly fascinating, was the way the physicians were able to prioritize and execute their management in a dire situation. The intricate thought process of managing the patient as a whole,

The objective of this reflection is to explore and reflect upon a situation from a clinical placement on an orthopedic unit. The incident showed that I did not provide safe, timely and competent care for my patient when the oxygen saturation was low. Furthermore, this reflection will include a description of the incident, and I will conclude with explaining what I have learned from the experience and how it will change my future actions.

Over the past ten weeks, I have developed a greater understanding of quality improvement initiatives and interprofessional care. I liked that the course focused both quality and interprofessional care. The linkage between these two topics is important, since everyone on the interprofessional care team is responsible for providing evidence-based quality care. Two topics I found interesting, that will benefit me professionally in the future, were the discussions regarding Quality Improvement Care Models and Interprofessional Collaboration. I learned about many different care models for quality improvement. The Champion Model was of particular interest, since this model supports informal leaders who a advocates for, and support evidence-based

working outside of hospitals, so as care shifts into a community based setting, there is a strong