Assignment: Journal Entry #2

• Refer to the current Clinical Guidelines found in this week’s Learning Resources and consider how these guidelines inform your clinical experience.
• Refer to your FNP or AGPCNP Clinical Skills and Procedures Self-Assessment Form you submitted in Week 1, and consider how your self-assessment might inform your Assignment.
• Refer to your Patient Log in Meditrek and reflect on Weeks 6–10 of your clinical experience, and reflect on your observations and experiences with patients during this time.

Journal Entry #2 (450–500 words):

In your journal entry, answer the following questions:

Learning and Experiences

Reflect on the 3 most challenging patient encounters and discuss what was most challenging for each.

• What did you learn from this experience?
• What resources did you have available?
• What evidence-based practice did you use for this patient?
• What new skills are you learning?
• What would you do differently?
• How are you managing patient flow and volume?

Communicating and Feedback

Ask yourself the following self-reflective questions:

• How might I improve on my skills and knowledge, and how do I communicate that back to my Preceptor?
• How am I doing? What is missing?
• What type of feedback am I receiving from my Preceptor?

Nursing Journal Entry Sample

Introduction

As a Family Nursing Practitioner (FNP) I have often encountered different patient situations, some of which I was able to handle but some were a bit challenging and required that I use various nursing intervention strategies. Among the three most challenging patient encounters included first a resistant patient while working in the surgery ward. This patient was often angry, defensive, and frightened every time I was required to dress his wounds or administer mediation through the IV, in most cases the patient did not like to have nurse around her and preferred having to be attended to by a family member (Gremigni et al., 2016). The second patient was one with the habit of somatizing. This patient was 68 year old and was admitted into the palliative care program for cancer. While attending to the patient he would frequently present us with vague complaints, exaggerate symptoms. In some case he would even fake his falls and displayed signs of personality disorder and depression. The third patient encounter was of a patient who would like to keep to herself (Sassen, 2017). This patient was a single mother and had been admitted to the clinic since her blood pressure was abnormally high while pregnant. It would be a challenge to get information from the patient or check her blood pressure level since most of the time she would deny the nurse to check on her based on schedules. 

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Looking at the three difficult situations, it was important for me to use various resource to ensure that treatment was done as required. Such resourced included referring the difficult patient to another nurse and the use of active listening and empathizing with the patients (Gremigni et al., 2016). While doing this I would also assure the patient of my full support with their decision while also explaining to them why certain procedures had to be taken. The type of evidence based practice that I applied with the difficult patient was self-care and management, where the patient did not allow medication to be administered by the nurse, I would teach them to check on their IV, and how to use the alarm response in case they needed to see the nurse. For the difficult patient I would also teach them on how to read their vitals and the importance of providing true information to the nurse (Ross et al., 2013). Based on my experience what I would do differently is not to refer the patient to a new nurse but to work with the patient and ensure that we are able to create a level ground. In regard to management of patient flow and volume, as an FNP I have often ensured that we work as a team in the assigned ward, where we organize shifts based on the number of patients admitted in the wards. 

Communicating Feedback

There are so many ways that I can improve my skills and knowledge as a FNP; among the most important is to ensure that enroll in refresher courses where I learn more about the trends in nursing practices, I will also join community public health drives which gives me more opportunities to practice. In communicating with my preceptor, I will make use of written reports on my experiences and ensure that success and challenges are highlighted. Currently I can say that I have been do well in regard to patient care and encounters (Ross et al., 2013). This is because I have been receiving encouraging feedback from my preceptor and patient comments are also positive. 

References

Gremigni, P., Casu, G., & Sommaruga, M. (2016). Dealing with patients in healthcare: A self-assessment tool. Patient Education and Counseling, 99(6), 1046-1053. https://doi.org/10.1016/j.pec.2016.01.015

Ross, E. L., Goldberg, I., Scanlan, E., Edwards, R. R., & Jamison, R. N. (2013). Dealing with difficult patients: Do customer service initiatives improve patient satisfaction at an interdisciplinary pain center? Journal of Applied Biobehavioral Research, 18(3), 123-133. https://doi.org/10.1111/jabr.12010

Sassen, B. (2017). Patient education and improving patients’ self-management. Nursing: Health Education and Improving Patient Self-Management, 141-234. https://doi.org/10.1007/978-3-319-51769-8_5