In-Patient Clinical Analysis

A clinical microsystem is a “small, interdependent group of people who work together regularly to provide care for specific groups of patients” (Institute for Healthcare Improvement, p.1). It is the goal of this paper to discuss the findings of the Johnson Clinical Microsystem Assessment Tool to the microsystem where I am employed on-call, the Multnomah County Health Department (MCHD), HIV Health Service Center (HSC), a primary medical home for patients with HIV/AIDS. Additionally, I will address each of the 5 P’s of the microsystem; purpose, patients, professionals, procedures and patterns that will then inform a practice change for the clinic.

1. This first clinic was a little intimidating. I mostly just shadowed some an older student today while he was interviewing patients. I felt like we have been well prepared to see patients though IPE and the standardized patients, however, knowing that these were real patients made it feel much different. Knowing that the patients had real problems and not knowing what to expect at first was the most anxious part.

In January 2015 a patient observation was conducted on an inner city psychiatric male admission ward commencing at 10.30 am and concluding at 11.30am. The observation was carried out by the ward manager and the patient advice liaison service (PALS) manager.

By learning the basics of the day-to-day tasks there will be more time to focus on the more difficult aspects of a rotation. The convenience of the Clinical Campus might seem simple, yet eliminating the effort required to relearn simple tasks can be very impactful. Learning such simple things such as, what services are available, where things are, how to use the EMR, where to park, where to eat, where the bathroom is, all require time and effort, time and effort that could be used to accomplish other tasks. To me the benefits and the reasons the Clinical Campus is the right choice for me is that I would gain some institutional knowledge that would enhance my learning experience. Instead of relearning everything about everything, every time I start a new rotation, I will be able to focus on learning the important things about that rotation because I already have some basic institutional

Emergency and critical care can be the most challenging parts of nursing and some of the most rewarding as it is carrying out intensive care for patients which may not always end well or may have the best result.

The first Med-Surg clinical round was quite interesting. Last semester I was in the rehab unit in the same hospital. So I found the Med-Surg unit to be different because most of the patients in this unit were either about to have a surgical procedure done or they had just come back from one. I really did enjoy this unit even though it was quite slow at times. However, one positive aspect of this clinical experience was how one of the nurses was extremely helpful. She offered to teach us different things from the around the unit. She walked us through a discharge and an admission. She also gave us the responsibility of performing a full head-to–toe assessment on a patient. Moreover, when she was passing medications she walked us through (EPIC)

I was able to be more confident and assertive with all of the tasks that I performed in clinical this week, which is a huge improvement for me.

To prepare for my clinical experience, I attended a brief orientation at my school a few days ahead about the clinic, what we can and cannot do at the site, as well as what to expect. In the morning of my rotation, not too many

The first assessment I performed for my patient, C.P., was during a day shift on February 23, 2016. Upon receiving her into my care at approximately 0730hrs, I noticed that she was extremely difficult to rouse awake as she was drowsy and could not seem to keep her eyes open. On top of this, she was exhibiting unusually slow respirations while laying supine on her bed, with many blankets around her. For the purpose of this paper, I will be focusing on my respiratory assessment. During this event, performing a thorough respiratory assessment was challenging because C.P. was unable to fully participate due to her current cognitive state.

Diagnostic/Patient Specimens - Specimens that are collected directly from humans or animals (including, but not limited to, excreta, secreta, blood and its components, tissue and tissue fluid swabs, and body parts) that are transported for research, diagnosis, investigations, disease treatment and prevention.

We are writing to request a waiver for the Inpatient Rehabilitation Facility (IRF)- Patient Assessment Indicator (PAI) penalty for that attached list of claims. The IRF unit for Medical City Dallas opened on 6/1/2016 and received the finalized tie-in notice on 6/16/17. PAI information was submitted once tie-in was finalized; however, the claims received a 25% PAI penalty. Our MAC is Novitas.

Throughout the second half of the semester, I have not made any significant changes to my pre-clinical routine. I still prepare and gather my supplies the evening beforehand, and I try to avoid during schoolwork in order to facilitate restful sleep. However, upon arriving to the unit, I have developed a familiarity with the staff and environment that has reduced my stress and anxiety levels, allowing me to focus more attention on my patient assignment for the day. Although we do not have assigned preceptors, I have developed a mentoring relationship with two of the nurses on the unit and will work with those staff members if available. As we have gotten to know and trust one another, we do not have to spend the first part of our shift familiarizing ourselves,

All of the patients on the unit have their own unique life stories and illnesses. Getting to communicate with and get to know the patients is enlightening. I decided to go onto the psychiatric side of the unit this week and immediately connected with the patients. By the end of the shift, I genuinely feel like I made connections with almost everyone on the unit. I was able to talk to the patients and look deeper into their problems. Compared to the week prior, where I was on the detoxification side,

You bring up very good points throughout your post. I hope you could provide some insight on how to discover a patients understanding. It is crucial, as you stated, that the patient is knowledgeable about a given situation so they can fully express their autonomy.

I thought you did a great job on this week’s discussion post. “A clinical microsystem is the place where patients, families, care teams, and information come together” (Nelson, Batalden, & Godfrey, 2007, p. 233). The rehabilitation unit at St. Joseph Medical Center that you described is a great example of this. It takes a variety of people and staff to run a microsystem properly. Everyone has to work together for the greater good of the unit. You talked about communication being an issue, but I believe communication is a matter that needs to be worked on in every microsystem. As nurses voicing our opinions and asking others for help is key to communication. We all can learn from one another and that is something I try to never forget.