Weekly Clinical Guided Reflection/Analysis Paper

Weekly Clinical Guided Reflection/Analysis Paper

(Must show reflection and analysis in answers)

  1. (Safety) How did you incorporate a standard precaution and infection control guideline? (Choose the one you have not chosen before.)

I used personal protective equipment (hand gloves) and observed hand hygiene through proper handwashing. The handwashing was done using soap and running water.

Weekly Clinical Guided Reflection/Analysis Paper

Which National Patient Safety Goals did you use in your practice? (Choose the one you have not chosen before.)

I used the 2020 Hospital National Patient Safety Goals, NPSG.07.01.01, by the Joint Commission (The Joint Commission, 2020). These goals guide patient care safety regarding infection control, preventing surgical mistakes, medication safety, communication, and risk of injuries.

  1. (Concept Care Map) What is the highest priority problem for your patient? What is the rationale for this choice?

Impaired urinary elimination was the highest priority problem for my patient. This problem was related to the pain that she experiences when voiding her bowels, which makes her not entirely void. According to ABCs/MAAUAR methods of prioritizing patient problems, airway breathing and circulation are prioritized. The second level priority is given to issues of impaired urinary elimination, among other problems. Weekly Clinical Guided Reflection/Analysis Paper

  1. (Concept Care Map) What is the pathophysiology for the highest priority patient problem for each patient as it applies to the patient’s situation?

My patient had a medical diagnosis of urinary tract infection. Her highest priority problem was impaired elimination of urine. Colonization of the urinary tract by microbes, mostly bacteria, leads to infection and inflammation of the affected organ(s). Failure of immune defense mechanisms of the urinary tract enables bacterial colonization and growth in the tract. Inflammation of the urinary tract presents with pain and edema, causing a mechanical and functional obstruction that impairs urine voiding (Brusch et al., 2020). This causes urine retention that worsens, thereby providing a medium for continued bacterial growth.

  1. (Concept Care Map) Evaluate the patient goals for each of your patients (from your concept care map).

My patient goals were to improve urinary elimination and achieve a comfortable voiding without pain. The client would also understand various measures to employ to prevent future occurrence of urinary tract infections. The evaluation of the goals would be achieved through further clinical history, exam, and investigations.

  1. (Clinical Judgment) What did you learn about the concepts of the week from your patient(s) and experiences at clinical?

I learned that UTIs could affect women and men, but the presentation may differ slightly. The severity of symptoms and patient expectations may vary depending on the extent of the infection. Depending on the affected system, the presentations may vary depending on the urinary tract’s affected organ. Treatment intervention should therefore be individualized.

  1. (Clinical Judgment) Think of one clinical decision you made, which enhanced your patient’s care by addressing their cultural, developmental, and social characteristics.

I probed the cultural characteristics to assess their health-seeking behavior (Agarwal et al., 2016). This influenced my patient education on medication adherence.

  1. (Clinical Judgment) Share an “ah-ha” moment of insight you experienced or witnessed today in clinical.

I learned today that UTIs could present with psychological manifestations such as confusion and delirium. I believe that prompt management of UTIs may prevent developing infection-related delirium.

  1. (Clinical Judgment) Share one thing you plan to do differently next week in clinical?

I plan to care for a patient with UTI in the background of other comorbidities such as diabetes or hypertension. I will evaluate their social characteristics against their health-seeking behavior on sensitive illnesses such as UTI.

  1. (Patient Education) How did you assess the readiness of your patient and family member to learn?

I asked the patient about her understanding of urinary tract infections and what do in case they suspect they may have it. This enabled me to evaluate her learning needs and deficits in knowledge. I also questioned their willingness to discuss their conditions.

Identify any learning barriers; possible resolution to barriers.

The primary learning barriers were the discomfort and anxiety that hindered her willingness to learn. She was worried about her symptoms and possible complications that may emerge in future. She preferred them managed first before acquiring patient education. Weekly Clinical Guided Reflection/Analysis Paper

What content did you identify that you should teach your patient and/or family?

In the patient’s culture, I learned that illnesses that affect the urinary tract and reproductive systems are not a topic that most people can discuss openly with family members. The distinction between UTIs and STDs was not clear for the patient.

What teaching strategies did you use?

I first assessed the patient’s learning needs and literacy level, educated her using the most straightforward language that she could understand, and finally evaluated their feedback.

What teaching aides did you use?

I used a simple drawing to illustrate the structural difference between the two urinary and reproductive systems.

  1. (Patient Education) How did you verify their learning?

I verified their learning by asking questions and obtaining their feedback through oral answers.

Did they learn the content?  If not, why not?

The patient understood clearly my teachings and was satisfied.

  1. (Communication) Describe a therapeutic conversation you had with a patient or family member. Name the therapeutic communication technique you used? How did the person respond to your therapeutic communication technique? Upon reflection, what would you have said differently?

I questioned the patient on the impact of the illness so far on his social and interpersonal life. As she was responding, I used three therapeutic techniques to promote this conversation. I accepted by affirming to the patient that I was getting her. I actively listened to her explanation and finally sought clarification from her in cases where I did not quite get her responses. The patient appreciated my time listening to her reactions and feelings. No question that I can remember had a negative effect on the patients.

Describe one communication barrier you observed.  How did it interfere with the communication? 

The main communication barrier was translating the medical terms into more straightforward language. It took several attempts for the patient to understand. This took me more time for the conversation than expected.

  1. (Professionalism) Which standard of practice from the California Board of Nursing Rule did you implement? (Choose the one you have not chosen before.) How did you implement it?

The California Nursing Practice Act requires that a nurse “provide age-appropriate care in a culturally and ethnically sensitive manner.” I evaluated the patient’s culture and ethnic background and their impacts on health-seeking behavior. This allowed me to suggest care that is appropriate to her age and cultural views.

  1. (Leadership & Management) List interventions from your Concept-Care Map that you could only legally delegate to unlicensed personnel (UAP). How did you advocate for your assigned patient(s)?

I would delegate the interventions, such as providing patient education and monitoring of vital signs. These interventions would be recorded, and I would advocate for them by ensuring that the assigned personnel provides the appropriate intervention.

  1. (Quality Improvement or Evidence-Based Practice) Identify and explain a quality improvement project at your hospital – or – identify an evidence-based practice used in the care of your patients.

The standard treatment of UTIs is the use of antibiotics. However, not all cases of UTI would benefit from treatment by antibiotics. As such, clinical diction making should involve the patient, and the care provider has the responsibility of providing patient-centered care. Patient education ought to be individualized for better outcome (Lecky et al., 2020). Noteworthy is that patients may not benefit from medication alone. This necessitates the assessment of patient culture, lifestyle, personal characteristics, and behavior contributions to the disease, elements already proven useful in the successful management of UTI in patients.

  1. (Concept Care Map) List all of the interventions on your concept care map with cited scientific rationales.
  • Assess the patient’s voiding patterns – to serve as the foundation for all subsequent interventions.
  • Encourage patient voiding at least three times a day – to prevent urine retention that provides a conducive environment for bacterial growth.
  • Encourage adequate water intake, at least 4L per day, as tolerated by the patient – to maintain sufficient intravascular volume.
  • Encourage the patient to take the medications strictly as prescribed – promote drug adherence and reduce the risk of antibiotic resistance.
  • Patient education on behavior and avoidance of risk factors – to prevent recurrence (Agarwal et al., 2016).
  • Therapeutic conversation with the patient – to promote the emotional wellbeing of the patient
  • Monitoring vital signs at least thrice daily – to chart progress in the patient improvement and need for further patient monitoring.

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