Clinical Practice Essay

This paper explores the scenario of a client and looks at the presenting problem from an ecological and strengths perspective. It will also explore advanced clinical skills, intervention strategies and ethical dilemmas encountered. Methods for evaluating progress will be discussed within the social context of the case. Termination and follow-up approaches, and any ethical dilemmas will be included. Any problems with oppressed populations will also be discussed. Finally, the limits of the chosen model and limits of the practitioner, evolution of client and practitioner identities, any ethical or social justice issues for the agency, and an evaluation of the practitioner’s effectiveness will conclude the paper.

Being able to work along side some fantastic PAs and physicians has allowed me to benefit from their instruction and experience. My observations of procedures and treatment plans will help assimilate information from lectures and clinical

In addition, the course material and modules have allowed me to adjust the various aspects of my professional practice for the best outcomes. In fact, I have applied the course material to adjust my patient care plans with the result that I now appreciate the different treatment and prescriptive therapies, and the legal implications for more awareness and understanding. Besides that, my interest in the course has allowed me to prioritize with the intention of achieving a good grade. In essence, I have gained the ability to better balance what the patient needs with the legal

(Lowe, Plummer, O'Brien, & Boyd, 2012). They are re prepared with advanced didactic and clinical education.

Over the years of medical practice, I always enjoyed my role as an internist, in every level of my capacity. The broad scope of the field increased my interest and curiosity, and I feel myself more motivated and responsible for learning the art of diagnosis, evaluation and management of the patients in the most effective ways to make their lives better. This strong desire encourages me to choose the field of internal medicine as my career, with the vision to empower the ailing with knowledge and serve deprives in the community. The field of medicine demands devoted study life and endless practice to be a good clinician. The clinical evidences and guidelines are continuously changing for the betterment of patient care and to decrease the morbidity and mortality.

This program is geared to prepare students for an entry level position and limited patient contact. We offer practicum for certification exams (Smith).

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Primary care physicians do multiple tasks, from treating a patient to preventive services, and counselling. In the past they even used to do basic laboratory tests like urine complete examination, coulter blood count, EST etc. Medical knowledge and clinical training is critical, but not enough to serve a “Primary” role. To truly serve the purpose, PCPs should be trained in multiple aspects like economics, informatics, psychology, management and leadership skills. These are the essential basics for any PCP to enable them to understand not only the patients’ medical needs, but also their non-medical needs. It would enable them to make and maintain a stronger, long-term, and trustworthy relationship with their patients.

In this analysis of professional practice I shall examine the work I have undertaken in my current work setting and also evidence the progression in my practice. The names of the service users discussed has been changed in order to protect identity and to follow confidentiality policy (HCPC SOCPE: point 2). To conclude I shall identify and discuss my future learning needs.

My first encounter with a Certified Registered Nurse Anesthesia (CRNA) was during my undergraduate nursing OB/GYN rotation. I was impressed with the CRNA when she placed the epidural to the patient in labor. I remembered patient had difficulty staying still due to the contraction, but the CRNA took her time to explain the procedure while comforting the distressed patient. Once the epidural was in placed and the medication started working, I could tell the relief the patient experienced. I realized then that a CRNA goes beyond the delivery of anesthesia, pain management and monitoring of patients. Thus, obtaining this degree will prepare me to ease the patient’s mind through education, pain management, monitoring, experience and compassion.

This experience prepares the student for the realities of professional practice, acquiring the knowledge skills and attributes to become a safe, competent practitioner (Mcallister 2001, cited in Midgley 2006). Educational audits by the clinical lead universities monitor clinical learning environments for their appropriateness of learning provision, enabling the ward to facilitate change if necessary to ensure continuing suitability as a clinical placement (NMC 2008).

The purpose of this journal is to reflect on my experience and skills gained during my clinical placement at Ben Taub Hospital. On my first clinical day, I was excited and nervous at the same time. My first placement was in the PREOP/PACU area. I was assigned to help a patient who had been in the PACU area going on 2 days. Normally, once the patient comes from surgery they are only in the PACU area for a short period of time before they are discharged home or given a bed in another area of the hospital. This particular patient still had not received an assignment for a bed. The physicians would make their rounds to come check on him daily. The patient was a 28-year-old Hispanic male, non-English speaking, he had a hemicolectomy. He had a NG tube, urinary Foley catheter, and a wound vac. My preceptor had just clocked in and she needed to check on the patient’s vitals and notes from the previous nurse. Once she introduced me to the patient and explained while I was there, she then asked me to check his vitals. (Vital signs indicate the body’s ability to regulate body temperature, maintain blood flow, and oxygenate body tissues. Vital signs are important indicators of a client’s overall health status (Hogan, 2014). I froze for a quick second. I have practiced taking vitals numerous of times and I knew I could do it correctly. I started with the temperature first, when I was quickly corrected on a major mistake I had made by my preceptor. I HAD FORGOT TO WASH MY HANDS and PUT

2. After reading the reports by the Institute of Medicine, NLN “Excellence Initiatives”, and the IPEC “Core Competencies

Clinical practice guidelines (CPG) are designed to improve the quality of healthcare services, decrease unwanted, ineffective and harmful interventions for patients. CPG are used to facilitate treatments for each individual patient’s by maximizing the benefits, minimizing the risk of harm and obtain treatment with an acceptable cost. Researchers had proven that CPG is a bridge for change and improving health outcomes. The effectiveness of CPG is perceived to be helpful in clinical decision making. CPG are developed to assist healthcare providers such as doctors and nurses in decision making for specific clinical outcomes (Vlayen, et. al. 2005)

Clinical practicum has provided a valuable study opportunity to me.When I took care of a living person in wards,I could apply the skills which are learnt from indoor lessons in school and books.Also,I could achieve more knowledge outside textbooks.However,I find that there is a difference between the real situation and theory.In ward,nurses have to be multitasking and need to manage several patients,time is precious to them.Nurses have to make an effort to save time from different ways.To give an example,in the ward I worked in this clinical practicum,nurses connected the syringe to the end of tube and administered drug to a patient with nasogastric tube by giving pressure to pump drug solution down the tube.Thus ,the procedure finished in a few seconds.I learnt this method from them and applied it in my practice.However,I was stopped by the supervisor teacher during one of my practise.She told us that it was wrong to administer drug by using pressure.She then asked me for the right method.I was shocked in that time because I learnt this way from the