Clinical Reflection Essay

As a medical scribe in the Emergency Department at St. Agnes Hospital, I constantly work in a fast paced environment and learn something new everyday. Some days are good days. Some days go badly. My third day of training as a medical scribe was a bad day. Eight hours into my shift alongside my assigned physician, Dr. David Hale, we had already seen a myriad of symptoms and ailments from nearly twenty patients. Suddenly, an urgent overhead page called out, “Code Heart Emergency Department Room 5.” Dr. Hale sprinted to Room 5 with me rushing to keep up. The space was filled, shoulder-to-shoulder, with emergency medical services (EMS) and several nurses. I squeezed my way through the gathered crowd. A paltry three days of training left me simply awestruck amongst so much activity.

Working as a scribe in the San Bernardino Emergency Room has provided me with many different types of medical experiences, from seeing gunshot wounds and various lacerations to strokes and ST elevated myocardial infarctions to hypoglycemia and hyperkalemia. Observing the treatment process from triage to disposition has been an exciting experience, in which every patient encounter has only taught me more about the field of medicine and spiked my interests in learning more about the human body. It is truly an amazing experience watching people come in scared and worried, but in the matter of a few hours after various medications, diagnostic studies and procedures they are more comfortable than when they came in. Through this experience, I have

In today’s clinical, I was on the smaller less intensive unit. A lot the patients on this unit was more aware of the different situations. I found that talking to these patients was a little bit easier than I first thought it would be. I was really concerned on what I could talk to the patients about and what were appropriate questions to ask and what was not appropriate to ask to them. My biggest fear, was asking a question that may of offend them in way that might make them latch out at me. I also found that the clinical unit was a little depressing and did kind of remind me of jail. I thought that the idea of them not being allowed to have food in their room or shutting their room doors was like taking away some of their basic human rights.

This essay will discuss a clinical skill in which I have become competent in practicing as a student nurse.

During our return demonstration, we all felt like we needed to look to our instructor for guidance in what we should do. The reason for this was because we all lacked the confidence to feel like we knew what we were doing. If I could do it again, I would have liked to have been more knowledgeable about the scenario so that I could be more confident.

Today, Jessica, Laura, and I met with Holly to discuss concerns about clinical projects and hours. This meeting went well; we will be working on our projects, in clinical only. I also observed Holly teach 3- first grade classrooms, and 1- 2nd grade class room about nutrition. This was a great experience, and I learned a lot of great techniques for teaching. I was also able to interact with the kids, and they were a lot of fun. As well as, I had an hour- where I worked on my PSE project, and developed a plan for organizing a health fair that would occur sometime in March- I am very excited about this. Jessica and I also met with Katie- the foster teen program coordinator, that is overseeing our nutrition classes that we will be teaching 02/14

Through this experience, I have learned about "CPR, AED, cardiovascular emergencies, resuscitation team dynamics, post-cardiac-arrest, airway management, and Megacode and cardiac arrest algorithms."

I felt that I was not prepared for placement in October because the summer break away from University made me forget quite a lot of the theory work, I learned during semester one and two. I often doubted myself at times because I felt that I couldn’t remember how to carry out a musculoskeletal assessment; which is important for assessing any soft tissue injury and making clinical decisions. My experience is similar to student nurse’s first time experience on placement and how they felt incompetent to care for their patient assignments. And were scared about making patient care decisions because they would be liable if anything went wrong (Fink et al., 2008).

Today I had a great day at the clinic. For the morning section, I had Omar Lora as my patient. Last time when he came, I collected all my assessment data. Today I updated his medical history, dental history, vitals, and EIOE, then I completed filling out the gingival assessment, the treatment plan, and the SAOP. Finally, I was ready to have my assessment data checked. It went really well, and I learned ways to helped me be more efficient with my time management, for example, I did not know how to have my radiographs up in the other monitor while I was doing my assessments. It was a little time consuming having to open and minimized the window every time I needed to look at the radiographs. Also, I discovered that having a piece of paper out and taking

In my clinic this week I was taught how to assess the rooms for checked in patients and clients. I found out that before going into the room to talk to the client about the patient I should look at the patient's chart. When looking through the chart I will be able to find out why they are there and if they are due for anything. After assessing what I should ask for the history I go into the room and get as much information as possible. I was told when talking to the client I should ask open-ended questions due to the fact that this will allow the client to give me more detailed answers. While in the room I should also get some vitals unless the patient is aggressive. These vitals are temperature, heart rate, respiratory rate, mucus membrane,

In the last four weeks, I have been attending Oak Hill Hospital as my second clinical rotation. During this period, I noticed distinguished qualities in myself. Some skills I have strengthened over time are informing the patient what I am doing before, during, and after the exam, how to position using verbal commands, and giving the patient time and attention while in my care. These attributes may seem subtle, but they have improved my attitude in the working field and gave off a positive atmosphere around patients and co-workers alike. On the other hand, I have automatically sought out to improve on several obstacles I came to face at Oak Hill Hospital. One of the weaknesses is confidently operating the portable x-ray machines, especially knowing the correct tube angulation for the portable or wheelchair chest exams. Another struggle I faced at the beginning of this clinical rotation is transporting patients by stretcher and occasionally wheelchair. The body mechanics I have used are poor with transporting the patient, which risks the quality of the patient’s care (Bontrager, 2014). Lastly, marker placement for fluoroscopic overheads and timed studies have been an extreme struggle to battle against. With countless action plans from my clinical coordinator and instructor, I have found several action plans to change my weaknesses into additional strengths.

A twist on the "patient's perspective" approach is to describe a time when medicine failed to save or heal someone close to you. The purpose of this tactic would not of course be to rail against the medical profession, but rather to show how a disappointing loss inspired you to join the struggle against disease and sickness.

This week at clinical I got to witness and experience how appreciative the patients are to the therapists because of how they took care of them and treated them. One of our head and neck patient gave restaurant gift cards out to the therapists and also included me, and said thank you to. He said thank you to everyone. I saw how the therapist receive a lot of appreciations from their patients. This taught me a lot and motivated me as a student. Again this week, I saw a TBI patient who got threated on trilogy, it was just like the previous TBI patient I saw the last time. This was the same setup and almost the same dose however, I am not saying they have the same treatment plans.

D-The patient reports she is stable on her dose and haven't engaged in any illicit drugs. During the course of the session, the patient discussed the loss of a friend, who was know in the neighborhood as a drug dealer, but more so as a friend. The patient could not bare going to the funeral as it would be a trigger for her, but felt she should have went to the funeral to say her good-byes. This writer encourages the patient cherish the moments she shared with her friend. Furthermore, the patient then discussed the loss of two other people in her life that was close to her, at which this writer discussed further with the patient coping skills during the grieving process. This writer gained a sense of understanding by the patient comment, "

My client this semester was a 5-year-old boy who presented with a moderate expressive language disorder and a severe phonological disorder. Throughout the semester with my client, I found many aspects of clinical work both rewarding and challenging. The most rewarding aspects of clinical work was represented through my client’s overall progress. As a student clinician, it was rewarding when I learned how to facilitate my client’s performance for a specific skill. For example, learning that my client benefited most when I gave him tactile prompts for /s/ blends or that my client’s performance increased when implementing more motivating activities. Watching my client reach his objectives with the aid of my prompts and teaching was rewarding. However, seeing my client use these newly learned skills to achieve a more functional outcome was even more rewarding (e.g., using a consonant cluster when talking to his brother at the end of a session). Although, I experienced rewarding aspects of clinical work I also faced multiple challenges. Throughout the semester, I had difficulty with documentation. I was able to portray verbally what was happening in my session and what I was learning in all my courses, but had difficulty writing it all out on paper. Documentation is an important aspect of clinical work and I will need to continually focus on and practice this piece to become more proficient in my writing as a clinician.