During The Last Clinical Rotation Of My Adult-Gerontology

Evidence based practice is an integral part of nursing care. According to the Academy of Medical-Surgical Nurses, evidence based practice is defined as, “the conscientious use of current best evidence in making decisions about patient care.” (AMSN) The use of evidence based practice has drastically improved patient outcomes, increased quality and safety of healthcare, and reduced costs for facilities. (Melnyk, 2016) In this paper I will provide the history of evidence based practice, how it has already been incorporated and impacted healthcare, and why it is important to nursing and healthcare as a whole.

Over the past two decades, EBP has expanded on Florence's theories. EBP constitutes the combination of clinical expertise, patient values, and research evidence when making decisions about patient care. In the 1990's, it was determined that just increasing knowledge was not sufficient for improving patient outcomes. To obtain better patient outcomes "new knowledge must be transformed into clinically useful forms, effectively implemented across the entire care team within a systems context,

As a result of my versatile work experience, as well as my community and organizational involvement, I have learned the importance of being a team player in order to perform effectively and efficiency. Having exposure to multiple clinical rotations in variable institutional settings has enhanced my time management skills, multi-tasking ability, and effective communication to both diverse patient populations and fellow practitioners. These qualities, along with my genuine enthusiasm and empathetic passion to help others, will allow me to become an integral component to your residency team.

For my interview, I spoke with one of the Nurse Practitioners (NP) that I interact with while working my shift at the hospital. I will call her Terri Smith because although I asked to use her quotes in my paper, I did not think to ask for permission to use her actual name. Where I work, many of our internal medicine physicians are hospitalists. During the night, they are covered by the umbrella of Quest Care. There are several NPs that work under the afore mentioned physicians and are there, on-call, when needed for their clinical expertise. It is nice, because even though I can’t develop much of a relationship with the doctors whose patients I work so hard to take care of, I get to have the opportunity to grow strong bonds with the NPs that I see almost every shift.

Evidence-based practice is an approach used by health care professionals to continually use current best evidence-based research to make ethical and reliable decisions regarding patient care. “Research to promote evidence-based practice is becoming more and more a part of the regular work of health care leaders” (Grand Canyon University, 2015, p. 1). However, it is important to determine the difference between solid research and flawed research that provides unreliable inferences. Evidence-based research includes focusing on a clinical question; and includes the review and incorporation of several studies to strengthen the results of the new study (Grand Canyon University, 2015). Roddy et al. and Ganz et al. articles will be assessed to determine if the recommended changes were backed by solid research that warrants changes in a hospital.

Meanwhile, elsewhere in Habersham County, Tom was feeling slightly nervous as he exited the staff lounge and entered the hustle and bustle of County Hospital’s ER to begin his first shift as an RN. The first few hours of his shift passed slowly as Tom mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. He realized that the attending physician, Dr. Greene, who was rather “old school” in general about how he interacted with nursing staff, wanted to start him out slowly. Tom knew, though, that the paramedics could bring in a trauma patient at any time.

There have been several studies exploring the development, implementation and evaluation of preceptor programs for advanced practice nurses. Bahouth and Esposito-Herr (2009) described a formal, 12-week orientation program for newly graduated nurse practitioners that helped to integrate those providers into the clinical teams. One part of their program was the assignment of a NP preceptor for the new employee, which was found to be effective in reducing the new NPs feelings of isolation. In addition, Baumgartner and Williams (2014) developed and evaluated a mentoring pilot project, inclusive of a variety of advanced practice providers (APPs), which supported the program’s ability to improve inter- professional networks and system supports. Furthermore, Sorensen (2010) developed an orientation and mentoring program for APRNs and physician assistants.

Nursing can be a demanding career, but the benefits far much outweigh the challenges. Most importantly, it’s the rewards it offers by allowing an opportunity to make a difference in another person’s life through the provision of care when they need it. Just as Patricia Benner theorized in her book “Novice to Expert,” nursing encompasses both educational knowledge and extensive clinical experience acquired throughout one’s career. This far, I continue to acquire knowledge and clinical knowhow which will promote proper and efficient care to patients. Since I began practicing one year ago in a long-term healthcare facility, I have interacted with patients, families, physicians and other members of the healthcare team to coordinate patient’s care which has enabled me to gain confidence in myself. While I cannot deny that it was difficult to transition from a student to a licensed nurse, I learnt to overcome these challenges and focus on my strengths. Practicing as an LPN has provided a platform to learn and gain experience even though the duties and responsibilities are limited by the scope of practice.

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

As a practitioner or a population health coach, both APNs considered other nurses at any level, and physicians within the same discipline, as her peers. Over the course of their professional careers, increased confidence, trust, and knowledge were the commonalities with evolving roles. The confidence and trust originates with oneself, then, includes that of her co-workers and physicians, but mostly from her patients. Maturing from the novice RN to an expert APN, the confidence and knowledge base has developed, building an individual practice and supporting patients and communities towards optimal health. Each considered autonomy the greatest privilege guaranteed them as APN.

Professionalism in nursing has advanced greatly over the years. A cornerstone for change includes that of evidence based practice (EBP) as the drive of nursing intervention and patient care. According to the Quality and Safety Education for Nurses (QSEN), Evidence-based practice is described as the combination of the most recent evidence with clinical knowledge that includes the patient’s best interests in mind for greater patient outcomes (QSEN, 2017). The QSEN’s goal is to prepare nurses for improvement in quality and safety of patients (2017). Because of this goal, six competencies, including evidence-based practice, are listed for criteria of improvement in nursing practice (2017). I have been fortunate to have experience with implementing this practice and providing education in certain EBP protocols in my career. One EBP protocol in particular that our unit has been involved in since May of this year includes Enhanced Recovery After Surgery (ERAS) now referred to as Improving Surgical Care and Recovery (ISCR).

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.

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

During my time there, I shadowed a pediatric doctor. While I was asking him questions, he was called into an emergency surgery, and I was unfortunately not old enough to watch according to the hospital restrictions. So as I was waiting around, a PA swooped me up and let me shadow her instead. I was embarrassed to admit to her that I was not aware of a PA’s responsibilities to the hospital. Throughout the rest of the day, I followed the PA into patient rooms and recovery rooms. I was able to observe how the PA interacted with patients with such a reassuring and caring attitude that I had not seen with the previous physician I had met. I not only respected her compassionate personality, but I related to it.

When I first started college I wanted to be part of the science field. My first three semesters at school were under a science major which after a while I begin to feel worthless and I was not getting the joy that hope to feel. Further to my third semester at BMCC I started to notice that all the chemistry and math classes were not making me feel complete. I knew that I will have very limited to no interaction with others and that maybe when I finish with my associates I will not have anywhere to go referring to a working place, not even in an entry position. I started to look for different options referring to my career path until a came up with Gerontology. At first I did not know that it was and I started to do research. My fascination with