Nursing students recognize the need to account for what they learn through clinical experience. The clinical years are necessary to acquire adequate experience that they can use in practice. They create the education portfolio for monitoring and recording their learning progress. During the clinical experience, they encounter various situations and issues that they should address as well as gain knowledge that they can apply in their clinical practice. During my clinical experience at a doctor’s office, I interacted with patients with diverse medical problems that required my attention to treat and overcome.
In my practice, I encountered patients, including males and females with different comorbidities, such as HTN, COPD, Asthma, GERD, Back Pain, gastritis, and pneumonia, among other conditions. I was responsible for supporting the care and management of diseases in patients seeking treatment at the doctor’s office. Although I was able to perform procedures, including assessment, drawing venous blood for diagnosis, administering drugs under the direction of a doctor, and advise patients about lifestyle changes or refer them to a specialist, I experienced challenges and experience gap based on the age of patients, the seriousness of medical conditions, limitation of procedures that I could perform at the hospital, and the level of complexity of disease conditions and their treatment.
I recognized the need for critical changes at the hospital to bridge the gap identified in the clinical experience. In terms of age, I would wish to have patients separated in the continuum of care based on their age, the type of disease, and severity, among other aspects. For example, since I focused on adult male and female patients in a wide range of ages, I would wish to care for pediatric patients under the age of 5 years. Therefore, instead of a primary care setting, I would practice in a separate pediatric site for a later practicum. I would also focus on various medical conditions such as HTN, COPD, Asthma, GERD, Back Pain, gastritis, and pneumonia, among other conditions to gain more clinical experience.
I gained considerable experience during the practicum and achieved some goals, although I am still working on others. For example, I gained knowledge on how to develop a treatment plan, administer medicines safely by understanding their side effects, and understood various clinical practice guidelines. However, I am working on other goals, such as developing knowledge on how to give a good differential diagnosis based on the symptoms presented by the patient in which I know that I can master that with reading, more patient encounter and by asking more questions to my preceptor.
I identified some areas of weakness that I should work on to improve my nursing experience. For instance, I need to improve my confidence with patients when implementing a teaching and assessment plan to manage their conditions. I am planning to work on developing my communication skills and working on more clinical hours at the site. I will also seek help from my preceptor to gain experience from them. I will also keep studying and learning how to develop effective therapeutic relationships with patients.
I realized the need for evidence-based practice to improve the safety and quality of care when working with different patients. As a result, I embrace the core competency, “to generate knowledge from clinical practice to improve care and patient outcomes” in nursing practice (Thomas et al., 2014, p. 5). It is important in nursing practice to integrate the evidence from research (external evidence) with the values and preferences of the patient, as well as the expertise of the clinician to improve quality (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014). I learned that the main focus to improve quality is to ensure that the provided treatment matches the needs of the patient. For example, when a patient came to the doctor’s office exhibiting COPD symptoms, I had to work with the physician to ensure the correct diagnosis and prescribe the right treatment based on the patient needs. I supported the use of medications and lifestyle changes to prevent the occurrences of diseases, such as the need to quit smoking.
I realized during the practicum that patient safety is critical and determines quality outcomes. In an Institute of Medicine (IOM) report released in 1999, patient safety moved to the forefront of healthcare in the country (Ulrich & Kear, 2014). The core competency that relates to quality is “Minimizes risk to patients and providers at the individual and systems level” (Thomas et al., 2014, p. 9). I achieved this competency, but I believe that other aspects of patient safety are evident, which I still need to learn, including how to avoid medical errors. When working with an adult patient with HTN, I realized that she was getting worse any time she took her medicine. I studied the possible cause of the problem and discovered that it could be due to the adverse effects of the drugs she was taking. My advice helped to discontinue the medicine and change her treatment to oxygen therapy, which led to considerable improvements in her health and was discharged within three days.
Clinical practice plays an important role in improving nursing practice. It is a chance to learn what a nurse can apply in practice, including the core competencies critical in achieving safety and quality outcomes. During my practicum, I achieved most of my educational goals and developed competence in various areas.