Professional Capstone and Practicum Reflective Journal-Week 10

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University of Nairobi *

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Nursing

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Nov 24, 2024

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1 Professional Capstone and Practicum Reflective Journal Student's Name Institutional Affiliation Course Code Professor's Name Due Date

2 Professional Capstone and Practicum Reflective Journal Population Health Concerns My first week of practice has been the most eventful as it involved getting to know the facility, staff and being introduced to the general working tradition. It was to note that when patients came to seek care, they were guided each step by the nurses it made navigating through the facility easier. During the week, it became clear that the implementation of evidence-based practice is a venture that needs serious data collection and analysis. This is because I saw charts on walls that displayed targets on tackling conditions and comparisons with previous months. This reminds nurses and other caregivers about the importance of applying necessary interventions to improve population health outcomes. On the other hand, I was able to analyze the population health concerns in the facility to inform the development of the capstone change project topic. In the analyses, which consisted of consulting my preceptor and colleagues, it was pointed out that obesity among children caused by poor eating habits is a serious health concern as it can lead to the development of other health comorbidities. Other population health concerns that were identified are the reduction of diabetes prevalence among adults and hypertension management. According to Neuhouser (2019), chronic diseases need effective interventions to ensure population health concerns are addressed. Thereby, if not well addressed, the issues identified can have severe health implications on the patients and lead to poor health outcomes. Interprofessional Collaboration This week, I had a nice experience interacting with patients and working alongside other caregivers to do rounds. It was a good experience to know what other patients felt about their progress and what they think might help them get better. In this healthcare environment, it was

3 easy to note that majority of the patients like having conversations when seeking care and not just question and answer questions. According to my colleagues in the facility, patients are not satisfied when a caregiver asks questions and makes a clinical decision. This has led the facility to encourage a conversational approach to understand a patient and provide the necessary care. One aspect of care that I learned this week is interprofessional collaboration in providing care. Even with staff shortages, this practice is highly emphasized in this facility as it helps improve health outcomes. In one case that I witnessed, it was caring for the high blood pressure patients whereby the information from diagnosis will be sent to a physician and a nutritionist, and they will plan the best treatment for the patients. According to Reeves et al. (2017), interprofessional collaboration in a healthy facility improves professional practice and healthcare outcomes of the populations. This means that when a condition is complex or touches other practices, it is better to involve the concerned specialists and get in-depth information on tackling the condition. Lastly, this week, I completed the topic selection and approval assignment where I chose Hypertension management and prevention among adults aged 30 years and above using physical exercise and lifestyle change. The condition can cause other severe chronic illnesses if it is not managed well and appropriate actions are taken. New practice approaches Care delivery in every facility continues to improve to meet various medical demands of the patients. In my practicum facility this week, I had the opportunity to do assessments for patients. My preceptor pointed out that one needs to combine clinical knowledge and available evidence to provide care when evaluating patients. This means that even if a process is

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4 recommended and the available evidence suggests it is ineffective, one needs to use the alternative method within their means. Hence, the facility dwells more on conducting assessments to have enough information to enable a caregiver to make a better clinical decision. This week, I learned about new approaches to care that are meant to improve health outcomes and health knowledge. One practice approach that I witnessed is the use of a self- monitoring approach to reduce blood pressure levels. In the past, the patients were more concerned about taking medications only and waiting for clinic visits. This was not yielding good results, and caregivers have intensified education efforts to improve self-management knowledge. The approach is meant to make the patients more independent and reduce the number of appointments while improving health outcomes. With knowledge about staying healthy, the patients can help improve pressure reduction as they observe increased self-care activities. According to Kitt et al. (2019), this approach reduces costs of seeking care and transportation as one can comfortably attend only one clinic per month or when their dosage ends. In this week also, I was able to define the objectives of the capstone change project. Each objective that was listed was achievable, and it can impact the health of hypertension patients. I also researched various resources that might support the project and the information each will provide. Practices of Culturally Sensitive Care This week has been a fascinating experience as I had the chance to assess patients with the help of a nurse who the preceptor assigned me. During the week, I learned that assessing and taking patient history is vital to making critical healthcare decisions. This is because during the

5 encounter, the nurse has and the patient exchange a lot of important information that helps point out the root cause of a problem or a heal condition. This means that one must be very attentive to ensure that they have captured all the details and recorded them for reference later. It was easier to note that not every patient could easily point out the exact signs of their illnesses but giving out pointers from their explanations helps point out the exact problem that a patient has. This way, one can easily make reference to the patients’ electronic health records and make comparisons to any previous visits to the facility and the condition treated for. In this encounter, the nurse pointed out that nurses have to uphold and provide culturally competent care. According to Nalayeh (2018), culturally sensitive care considers the patient's religious, cultural, and spiritual aspects when providing care. This means that if a patient comes to a health facility, it is good for the nurses to a cultural assessment to establish the patient's background and how they can provide care. Through a cultural assessment, the nurses can identify the patient's ethnicity, language capability, common cultural practices and view certain aspects of care. This will enable caregivers to consider these aspects to provide care that conforms to the practices of the patient. A good example my preceptor gave is dealing with clients such as Muslim men women; their practices dictate that a female nurse cannot handle a male Muslim and vice versa. This means that an appropriate caregiver has to be assigned to such clients and protect their practices. Hence, it is advised that caregivers have to embrace various cultures and be culturally conscious to provide high-quality care to all patients. Ethical considerations in health care This week I had several interactive sessions with my colleagues as they allowed me to provide patient education and help the patients understand what is expected of them once they leave the facility. This meant that I collaborated with other caregivers to understand the discharge

6 plans and how best to deliver patient education for better outcomes. When dealing with elderly patients, I learned that one has to use a different language approach that will help them understand and speak slowly, as some have hearing problems. Handling the patients throughout the week taught me that one must have the composure and confidence to answer all the questions patients have in each case. This will improve the implementation of the instructions provided as they understand the need for adherence. It should be noted that in providing care in a health facility, adhering to the needs of the patients will help improve health outcomes but forgetting the ethical considerations means that the process might be flawed and reduce outcomes. According to Bratz and Sandoval-Ramirez (2018), ethical principles in care are vital as they ensure that the welfare of the patients and care delivery is not compromised. This included protecting the privacy and confidentiality of the patients in all scenarios, as each violation might lead to poor outcomes and dissatisfaction. The nurses are also supposed to uphold the four ethical principles of care (beneficence, non- maleficence, autonomy, and justice) as they ensure that every individual has access to care and their opinions are considered. In cases where a patient is admitted, if they provide instructions, caregivers are supposed to consider them, and if they contradict care delivery, one needs to refer to the ethical principles to resolve any dilemma that may arise from the situation. This will help ensure nurses provide high-quality care and protect the safety of the patients in all instances. Hence my capstone project will strive to adhere to various ethical considerations to ensure that hypertension patients receive the best knowledge for improved self-management. Ensuring the integrity of human dignity in the care of all patients The practicum experience for this week has been challenging as I had to learn new practices in caring about patients, and it motivated me to ask for more patient interactions to

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7 improve my skills. My preceptor taught me about caring for patients with chronic conditions, and it was a humbling moment interacting with the patients. The majority of the patients had developed a positive attitude towards managing their conditions, and it was easier handling them as they were informed what was needed on their part. I remember one of the patients narrating the challenges she undergoes back at home, like lack of a helping as her children were all living far away. The preceptor arranged for a social worker to visit her assess her place to decide what is best for her to stay healthy and longer. I also consulted with my preceptor about the resources I needed to implement the capstone project I am developing and how to acquire each. During the week, the preceptor pointed out several times that patients come from various backgrounds, and treating them with dignity will improve the interaction and treatment. This means that when every patient comes to the health facility, they are all equal, and no one deserves special treatment than the other. Thereby, treating all the patients with respect and understanding will help patients be comfortable about sharing their health conditions. If patients realize that others are being given preferential treatment, it most likely will affect care delivery. According to Haahr et al. (2020), nursing practice is a professional that should be rooted in holistic care that is meant to respect and preserve the integrity of all patients. Thereby, caregivers need to ensure that the wishes, beliefs, and opinions are respected at all times and support the patients in observing them unless when they affect the wellbeing of the patient that is when one can override them and provide effective care. The Role of Technology in Improving Health Care Outcomes My week has been eventful, and I have learned a lot from my colleagues as we have held several discussions as they helped me provide care to the patients. In one instance, there was this child who was not ready to take medications, and forcing them was is that appropriate. My

8 preceptor advised me that it is appropriate if you take time to play with the kid while hinting why it’s good to take medications. The trick worked after a few games on my phone and as the child was able to soften and took the medications happily. This taught me that one needs to approach each patient differently and find better solutions to ensure adherence to the treatment plans when handling patients. It was also vital to note that when a caregiver connected well with the patients, it led to improved knowledge of conditions and constant consultations to ensure better health for the patient. During the week, I interrogated the use of technology to provide care in the health facility, and it was overwhelming to note that each department had adopted substantive technology use. The majority of the department heads reported that their work had been made easier with technology, and they can now provide care efficiently. The most used in the facility are the vital electronic machines that help capture the patients' vitals such as temperature, heart rate, and other vital components directly into the electronic health records system. According to Sharma et al. (2018), technology has reduced waiting time for results and enhanced evidence- based practices as it provides real-time information to make better clinical decisions. It should be noted that the EHR technology has been vital in providing telehealth and improving health outcomes as caregivers can provide care even to remote patients. This encouraged me to learn more about technology use in hypertension management and how each can improve self- management and communication with the caregivers. Leadership and economic models I had an amazing experience this week as I was able to help several patients in the wards plan for their discharge and educate them on how they can improve their health outcomes while at home. One case that stood out is that of the patient who had elevated blood pressure levels and

9 was admitted to stabilize his condition. When he was admitted, he had a blood pressure of 172/85 mmHg, and within the first three days with medication, it reduced to 147/83. A colleague of mine assigned me the case as it aligns with my capstone change project, and educating him would provide a deeper insight on the management of high blood pressure. During the education session before discharge, the patient noted that he was using medications only and could only manage one hour of physical exercise per week, which explained his unhealthy weight. I recommended various measures that the patient needed to implement to help him stay healthy and reduce any health risks. This week I analyzed the leadership of my practicum facility and the economic models that they use to make financial decisions. According to Korlén et al. (2018), leadership plays a vital role in healthcare provision as it provides guidance about the organization's vision and steers the performance of the caregivers. My preceptor pointed out that the facility uses the transformational leadership style, which has helped them scale up the quality of care and organizational performance. It should be noted that through proper leadership, a facility creates reasonable economic models that guide spending, billing of patients, and implementation of projects. Without implementing better economic models, a facility can experience poor performance, misuse of resources, and poor prioritization of projects. Hence, the facility usually liaises with the finance department to regularly review spending and earnings before adjusting to charges. Health Policy This week, I was assigned ward rounds with other caregivers where I could help prepare and administer medications. During the rounds, it was evident that some patients preferred injections over taking tablets and vice versa, and the other nurses had to find ways to ensure that

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10 such cases were addressed properly or alternative medication was administered. This made majority of the patients happy as their wishes were met accordingly, and they were eager to communicate about their progress. It was easy to note that the process of medication preparation and administration is very rigorous, and one has to follow the stipulated guidelines to avoid committing any medication error. Hence, I prepared a checklist reminder of details that I had to confirm each time I attended to a patient. It was easier to identify a patient, compare their records for any changes, and then administer their medication with the checklist. I also made sure that the process was conducted conversationally to make the patient at ease. In attending to patients, it is vital to note that there are several health policies that caregivers have to adhere to to protect the patients and improve the quality of care. Health policies that various health agencies develop are vital in ensuring that patients receive the care they deserve. According to Annesley (2019), health policies have a significant impact on the practice of nurses and facilities, and thus complying with them prevents a facility or caregivers from any consequences. Health policies such as the ACA, HRRP, HIPAA, and others all advocate for quality and affordable care that protects the privacy of the patients and their privacy. The expansion of the ACA, on the other hand, has enabled several patients to access care, more so those with high blood pressure, as it was considered an underlying issue and was not covered by many insurance providers. Health Care Delivery and Clinical Systems The week has been good, and I learned a lot from my colleagues about how the facility works and coordinates its staff. It was pointed out to me that the department heads manage the facility shifts, and they develop them weekly as some caregivers negotiate for new shifts. The preceptor communicated that as much as the facility allows professional collaboration, one

11 should always stick to the patients they have been assigned during the shift to avoid mixing up medications or carrying out wrong procedures. Thereby, if one seeks an opinion about an issue, it is recommended that other caregivers offer guidance, and if the problem persists, the supervisor is notified before any steps are taken. This means that the welfare of the patients is taken into account and provided with the necessary support all the time. It was also vital to learn about the health care delivery and clinical systems that make the facilities provide care seamlessly. According to Veet et al. (2020), when healthcare delivery systems are well linked, patient needs are met, and resources are allocated equally. The healthcare delivery system is made of healthcare providers, insurance providers, governmental and regulatory agencies, and drug suppliers. This means that these systems have to work hand in hand to ensure that a patient is admitted fully, insurance providers pay for their hospitalizations costs, and other agencies ensure that the patient receives quality and safe care. On the other hand, clinical systems include those used in diagnosis, drug discharge, admission, and monitoring, and they are meant to ensure that the patients are well taken care of, and their condition is healed. References Annesley, S. H. (2019). The implications of health policy for nursing. British Journal of Nursing (Mark Allen Publishing), 28(8), 496–502. https://doi.org/10.12968/bjon.2019.28.8.496 Bratz, J., & Sandoval-Ramirez, M. (2018). Ethical competencies for the development of nursing care. Revista Brasileira de Enfermagem, 77(suppl 4), 1810–1814. https://doi.org/10.1590/0034-7167-2017-0539

12 Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2020). Nurses’ experiences of ethical dilemmas: A review. Nursing Ethics, 27(1), 258–272. https://doi.org/10.1177/0969733019832941 Kitt, J., Fox, R., Tucker, K. L., & McManus, R. J. (2019). New approaches in hypertension management: A review of current and developing technologies and their potential impact on hypertension care. Current Hypertension Reports, 21(6), 44. https://doi.org/10.1007/s11906-019-0949-4 Korlén, S., Essén, A., Lindgren, P., Amer-Wåhlin, I., & von Thiele Schwarz, U. (2018). Leaders as intermediates between economic incentive models and professional motivation. Lakartidningen, 115, E399. https://lakartidningen.se/klinik-och-vetenskap-1/artiklar- 1/originalstudie/2018/05/ledaren-viktig-lank-mellan-styrmodell-och-medarbetare/ Nalayeh, H. (2018). Addressing the cultural, spiritual, and religious perspectives of palliative care. Annals of Palliative Medicine, 7(Suppl 1), AB016. https://doi.org/10.21037/apm.2018.s016 Neuhouser, M. L. (2019). The importance of healthy dietary patterns in chronic disease prevention. Nutrition Research (New York, N.Y.), 70, 3–6. https://doi.org/10.1016/j.nutres.2018.06.002 Reeves, S. P. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. The Cochrane Database of Systematic Reviews, 6(6), CD000072. https://doi.org/10.1002/14651858.CD000072.pub3

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13 Sharma, A., Harrington, R. A., McClellan, M. B., Turakhia, M. P., Eapen, Z. J., Steinhubl, S., Mault, J. R., Majmudar, M. D., Roessig, L., Chandross, K. J., Green, E. M., Patel, B., Hamer, A., Olgin, J., Rumsfeld, J. S., Roe, M. T., & Peterson, E. D. (2018). Using digital health technology to better generate evidence and deliver evidence-based care. Journal of the American College of Cardiology, 71(23), 2680–2690. https://doi.org/10.1016/j.jacc.2018.03.523 Veet, C. A., Radomski, T. R., D'Avella, C., Hernandez, I., Wessel, C., Swart, E., Shrank, W. H., & Parekh, N. (2020). impact of healthcare delivery system type on clinical, utilization, and cost outcomes of patient-centered medical homes: A systematic review. Journal of General Internal Medicine, 35(4), 1276–1284. https://doi.org/10.1007/s11606-019- 05594-3

Professional Capstone and Practicum Reflective Journal-Week 10

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