Posted: January 8th, 2023

nr511 clinical practicum reflection

In the NR511 clinical, I was in a family medicine office. During my practicum, I practiced in a small-town rural area of Byron, IL, about 96 miles from Chicago, IL, where I saw vast age groups of patients from newborns to up to 98 years. I see 8-12 patients a day. It was a very interesting clinical as I practiced in a rural area where most of the patients are established. Most of the patients I saw were Caucasian, some Hispanic, and Asian ethnicity. I provided care from managing acute episodic care, chronic illness management visits, annual physical check-ups, sports clearance participation, school physical, pediatric, and newborn wellness visits, STD visits, law review, women wellness exams, and telephone visits as telemedicine, which according to Dlamini et al., (2020), are  some of the roles of a family nurse practitioner.

One of the gaps I noticed during my experience in my practice is the vast majority of people, about 60- 70% population still not vaccinated for the COVID vaccine. Education and informed decision are provided, but the community at Byron, IL is still reluctant to be fully vaccinated for COVID-19 compared to the population of patients in Chicago, IL, because it is not mandated to get fully vaccinated yet. This clinical finding is similar to that of Fridman, Gershon & Gneezy (2021) who established that despite having adequate about COVID 19 vaccine; individuals are still hesitant to get immunized due to demographic ad ideological factors.

As I reviewed my clinical competencies checklist, one of the gaps in my patient care are not being able to perform an I&D and insert an IUD, we had a patient that needed an I&D and IUD insertion. Still, we had to refer the patient to another provider. My preceptor said we could do something, but she needed a checklist off from the collaborating physician before performing the procedure. In my next clinical rotation, I will also do family medicine to experience another well-rounded learning experience. I will make sure to talk to my future preceptor before the start of clinical to see what skills she usually performs to check off some checklist goals I have.

One professional goal I achieved and felt accomplished was being comfortable assessing acute patients we saw in clinical and coming up with a diagnosis and plan. The primary goal I achieved was to comfortably use an otoscope and Ophthalmoscope, perform a musculoskeletal examination, and use a speculum for a women’s wellness visit. One of the areas of weakness for me is using the Epic computer system and hoping to be as fast as my preceptor when documenting and collecting history and physical in the computer while at the exam room. I was hesitant to do it as I didn’t want to delay patient care. I hope to chart before the end of my clinical rotation for my last two clinical classes. One of the solutions to be comfortable for the computer charting system is to start doing it more often so that I’ll be more comfortable doing it.

One competency I met from the NNOPF was Technology and Information literacy competency. During clinical, my preceptor and I utilized evidence-based web resources to distinguish proper antibiotic dosage for our patients. For example, prescribing antibiotics for the pediatric population that came in with Otitis media, we were able to distinguish the proper dosing using evidence-based technology and information from the web. Another NNOPF competency met was the Ethics competency. As stated by Hemberg & Hemberg (2020), ethics competency integrates making an ethical decision in making a clinical decision. I met this competency when I was evaluating one of my patients with Type II diabetes on Januvia for hunger control and diabetes. My preceptor and i discussed the risk and benefits of Januvia. They made sure the patient understood the risk and benefits, including evidence-based research found to cause pancreatic cancer for high-risk patients.

Overall, my NR511 clinical experience was well- a rounded learning opportunity, and I will continue to consider family practice for my next clinical rotation

References

Dlamini, C. P., Khumalo, T., Nkwanyana, N., Mathunjwa-Dlamini, T. R., Macera, L., Nsibandze, B. S., Kaplan, L., & Stuart-Shor, E. M. (2020). Developing and Implementing the Family Nurse Practitioner Role in Eswatini: Implications for Education, Practice, and Policy. Annals of global health, 86(1), 50. https://doi.org/10.5334/aogh.2813

Fridman, A., Gershon, R., & Gneezy, A. (2021). COVID-19 and vaccine hesitancy: A longitudinal study. PloS one, 16(4), e0250123. https://doi.org/10.1371/journal.pone.0250123

Hemberg, J., & Hemberg, H. (2020). Ethical competence in a profession: Healthcare professionals’ views. Nursing open, 7(4), 1249–1259. https://doi.org/10.1002/nop2.501