Exam (elaborations) NR 511 WEEK 8 REFLECTION WITH UPDATED & CORRECTED CITATION

Exam (elaborations) NR 511 WEEK 8 REFLECTION WITH UPDATED & CORRECTED CITATION In this NR 511 clinical rotation I was in a primary care office where I saw a total of 129 patients and completed 130 hours. I saw a well-rounded adult-age population comprising of every age group from 18 to 85+ with most of them being in the age range 36 to 55. I saw two pediatric patients age 1-4, one patient age 5-11, and five patients age 12-17. This totaled 6.21% of my patients seen this session who were in the pediatric range; this is short of the required 15% for the family nurse practitioner program (FNP). As one of my weaknesses was confidence and ability to connect with pediatric patients I will bring my stethoscope to practice on my nieces and nephews. I will also ensure I have good clinical experiences with pediatrics in the future. Per the MyEvaluation reports, I saw four patients from the pacific islander population (3.10%) and thirty-two from the Hispanic population (24.81%) which is fairly representative of the Utah population. According to the US Census Bureau, in Salt Lake County Utah, the pacific islander population here is 1.7% and the Hispanic population is 18% (United States Census Bureau, 2017). Per the MyEvaluation logging tool, I also saw one African American patient (0.78%) and two Asian patients (1.55%) which is slightly lower than the population of these groups in Salt Lake County, Utah at 2% and 4.2% respectively (United States Census Bureau, 2017). However, I did label 4 patients, or 3.10%, of my patients seen as “other”. The following areas are considered Asian by the US Census Bureau: Far East, Southeast Asia, or the Indian subcontinent (United States Census Bureau, 2017). I should have labeled these “other” ethnicities as Asian because they were primarily middle eastern. If I had done this, I would have the appropriate percentage of Asians seen per the US Census Bureau of my area. Therefore, for this gap I will correctly label the ethnicity of my Asian patients for my future clinical sites. This study source was downloaded by from CourseH on 08-31-2021 14:07:06 GMT -05:00 This study resource was shared via CourseH DIFFERENTIAL DIAGNOSIS REFLECTION 3 I did a lot of well woman exams, breast exams, and 10 pap smears. I also removed an intrauterine device (IUD). I did 18.6% of my hours in women’s health, so I exceeded the required 15%. I do know that I have an Internal Med rotation next where I may not see as many patients in women’s health so I am looking for a partial-rotation with an OB/GYN as a back-up. I also want to do an OB/GYN rotation since I am still weak at doing paps on obese elderly women. At first, every pap was difficult, but I quickly mastered the technique in young healthy women. The excess tissue from age-related sagging and the obesity made it harder to find the cervix and not pinch vaginal tissue with the speculum; therefore, I would like to work on that skill more. I was able to do a lot of adult acute and chronic care and the complexity was well balanced. I did many well-exams, sick-exams, hospital follow-ups, and exams of patients with many controlled and uncontrolled illnesses; I even sent several patients to the emergency room. I do not feel that any gaps are represented in this category, but I still have personal goal for improvement here. I noticed that I was better and more knowledgeable about the chronic illness and well physical exams. I was weakest, as is expected, in coming up with differentials for acute concerns. Despite improving in all these areas over my clinical experience, I plan over the twoweek spring break is to make one document with the common complaints and differentials I should consider for each. This will ensure even greater growth for me in the future. These three common complaints compromise the three weakness I plan to address as part of this reflection assignment: upper respiratory infections (URIs), abdominal complaints, knee pain etc… The primary gap in this clinical experience was clearly pediatric in nature. 15% of my hours in this session were not in pediatrics as required, only 6.21% were. Additionally, my next session is in internal medicine so I will likely not get the required pediatrics there. Therefore, I This study source was downloaded by from CourseH on 08-31-2021 14:07:06 GMT -05:00 This study resource was shared via CourseH DIFFERENTIAL DIAGNOSIS REFLECTION 4 have sent out requests to several pediatric providers and to my employer’s organization’s education department to distribute to all their pediatric providers. I plan to aggressively search for pediatric rotations over the two-week spring break that follows this NR 511 class to meet the pediatric requirement. Part 2 - NONPF Competencies Review The National Organization of Nurse Practitioner Faculties (NONPF) has designed several core competencies that each nurse practitioner student should meet (Thomas et Al., 2014). I will discuss several of them and describe how I met them or how I plan to meet them in the future; I had great growth in several of the NONPF competencies this session. I will provide specific examples from my clinical rotation as support for this growth and for future desired growth. I feel that I met the competency section “Quality Competencies” number 1 through 4. It discusses applying the best quality evidence to improve clinical practice (Thomas et Al., 2014). I partially applied this as part of the NR 511 course with my clinical practice guideline (CPG) review of non-alcoholic fatty liver disease (NAFLD) and peer review of the CPG on gastroesophageal reflux disease (GERD). I was able to bring the best and most current guidelines into my clinical practice. The biggest thing that was not being done already was adding vitamin E for NAFLD. The peer part also applies to number 4 in this section. I will continue to broaden my ability to apply this competency. As I have a greater knowledge of all the best practices, I can better apply them in clinic. Another section I applied to my clinical experience was in the section on technology. Specifically, number 1 states to integrate technology to improve health care (Thomas et Al., 2014). I learned how to use quite a few features within the electronic medical record (EMR) in This study source was downloaded by from CourseH on 08-31-2021 14:07:06 GMT -05:00 This study resource was shared via CourseH DIFFERENTIAL DIAGNOSIS REFLECTION 5 my clinic. The name of the EMR I used is iCentra. I was able to make student notes into the EMR and send to my preceptor for her approval and signature. I was also to make little templates called “hot texts” that I could use to ensure I did not forget important pieces within each type of office visit note. I will continue to work on this competency as technology used is different among clinic sites and is continually changing with updates. This study source was downloaded by from CourseH on 08-31-2021 14:07:06 GMT -05:00 This study resource was shared via CourseH DIFFERENTIAL DIAGNOSIS REFLECTION 6 References Thomas, A., Crabtree, M.K., Delaney, K., Dumas, M., Kleinpell, R., Marfell, J…Wolf, A. (2014). Nurse practitioner core competencies content a delineation of suggested content specific to the NP core competencies 2014. NP Core Competencies Content Work Group. Retrieved from