NR 576 Week 8 Reflection, Assignments of Nursing

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Week 8 Reflection Chamberlain University NR 576 Differential Diagnosis in Adult-Gerontology Primary Care Dr. Cid Assignment Date

Week 8 Reflection Over the past eight weeks while in the Differential Diagnosis course, has strengthened my skills in many ways. To begin with, time management, I had to work hard to prepare for my week's classwork, clinical, my job, and my family. It instilled confidence in myself that as long as I was prepared and did not procrastinate I could achieve all of the tasks. One of the MSN Program Outcomes is to provide high-quality, safe, patient-centered care grounded in holistic health principles. With the support and guidance of my preceptor and instructor, I will be able to meet all of these needs. I have been using my skills as an active listener to discover and sometimes even read between the lines to find out the patients' concerns. My preceptor works in a rural practice, and there are times when it is busy, but most of her patients are scheduled for at least 30 minutes to provide ample time to meet their needs and provide a thorough history and physical. I noticed with several of the patients that worked with in the office that initially when they meet me as a “student” they were on guard, but once they realized that I was listening to them and focusing on their concerns their anxiety dissipated. The MSN Essential for quality improvement and safety was accomplished through the course work and then supported with the clinical. The iHumans modules were extremely difficult for me, but at the same time, they provided an excellent environment to learn the important factors to determine the differential diagnosis and then ultimately the diagnosis. They were also very helpful with continuing to learn how to accomplish the history, review of systems, physical exam, and supporting documentation. The VISE and SNAPPS were also very helpful for improving and fine-tuning my deductive reasoning and making me think about things from a different angle. The Nurse Practitioner Core Competency that I choose is using best available evidence to continuously improve quality of practice. During my clinical, my preceptor and I discussed on several occasions, what the best course of action was for the patient. One specific incident that I remember was regarding a patient with type 2 diabetes that was concerned about the out-of- pocket costs for the labs and if they were necessary, specifically hemoglobin A1C. She was routinely checking her blood sugars, twice daily, before breakfast and before dinner, and even brought in the logs for review. Ultimately, it was decided that due to her good record-keeping and reasonable results, it was okay to delay the lab work for the next three months. She was very appreciative and even reported that it made her want to work harder to eat right and keep good control in order to save money.