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Challenges Encountered During Outpatient Rotation Assignment

Challenges Encountered During Outpatient Rotation Assignment

• Reflect on the 3 most challenging patient encounters and discuss what was most challenging for each
The first most challenging patient encounter that I had during this outpatient rotation was with a 48 year-old woman presenting with a complaint of frequent hot flushes accompanied by sweating at night. Even after taking her history and performing a thorough physical examination, I could not find any obvious physical cause to her symptoms. It was only after consultations with my preceptor that it dawned on me this was the consequence of a fall in the estrogen levels around menopause (Stubbs et al., 2017)Challenges Encountered During Outpatient Rotation Assignment.

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What was most challenging for me was the intervention to use to reduce her symptoms, since they were so severe as to interfere with her daily activities. According to Stubbs et al. (2017)Challenges Encountered During Outpatient Rotation Assignment , selective serotonin reuptake inhibitors (SSRIs) are effective in lowering these symptoms. I ended up advising her to apply lifestyle changes such as exercise and weight reduction on top of prescribing paroxetine (Paxil) at a low dose as per the evidence.
The second challenging case was that of a woman who presented with a complaint of raised “bumps” on her genitalia that were painless. Arriving at the correct diagnosis for this patient was very challenging as many sexually transmitted infections (STIs) usually present with such lesions. I finally arrived at a diagnosis of molluscum contagiosum due to the very typical presentation (Meza-Romero et al., 2019) and after ruling out other possibilities such as syphilis and lymphogranuloma venereum.
The third and last most challenging patient encounter was that of a 39 year-old female patient who underwent a Pap smear and a human papilloma virus (HPV) test at the same time. The HPV test came back positive and the Pap smear result showed atypical squamous cells of undetermined significance or ASCUS (Rask et al., 2017). What turned out to be most challenging for me in this case was the correct next course of action. This I soon determined after consulting a senior experienced advanced practice nurse to be the performance of a colposcopy. I immediately ordered for the same.
• What did you learn from this experience?
What I learnt from this experience was that the application of the cognitive domain elements learnt in class theoretically in the practical area is not easy. It takes practice to be able to connect cognitive domain material (theory) to affective domain (attitude) and psychomotor domain (physical examination) elements in practice. Challenges Encountered During Outpatient Rotation Assignment
• What resources did you have available?
The resources I had available were the staff at the physician’s office, the physician herself, my preceptor, the computerized provider order entry (CPOE) in the electronic health record (EHR) system, and the “add-on” clinical decision support or CDS.
• What evidence-based practice did you use for this patient?
For the above patients, I used established scholarly evidence in practice based on the algorithms contained in the EHR system and guided by the CDS to order interventions.
• What new skills are you learning?
The new skills that I am learning are affective and psychomotor skills. I am becoming more aware and competent in multiculturalism (affective domain) and also better at physical examination (psychomotor domain).
• What would you do differently?
What I would do differently is that I would spend more time with each patient to gain a better insight into their problems. The current 18-25 minutes seems insufficient.
• How are you managing patient flow and volume?
I am managing patient flow and volume by making sure I do not spend more than 25 minutes with each patient.
• How might I improve on my skills and knowledge, and how to communicate that back to my Preceptor?
I might only improve on my skills and knowledge by tapping on the experience of the staff employed at the physician’s office. This includes the physician herself and my preceptor. I would communicate that back to my preceptor by agreeing on some 30 minutes at the end of each day to review the events of the day.
• How am I doing? What is missing?
In my opinion I am doing quite well. At the moment I do not feel like there is anything missing yet.
• What type of feedback am I receiving from my Preceptor?
I am receiving s far very positive feedback from my preceptor; and that is the reason why I feel I am doing well. Challenges Encountered During Outpatient Rotation Assignment

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References
Meza-Romero, R., Navarrete-Dechent, C., & Downey, C. (2019). Molluscum contagiosum: An update and review of new perspectives in etiology, diagnosis, and treatment. Clinical, Cosmetic, and Investigational Dermatology, 12(1), 373-381. http://dx.doi.org/10.2147/CCID.S187224
Rask, M., Swahnberg, K., Lindell, G., & Oscarsson, M. (2017). Women’s experiences of abnormal Pap smear results: A qualitative study. Sexual & Reproductive Healthcare, 12, 3–8. https://doi.org/10.1016/j.srhc.2017.01.002
Stubbs, C., Mattingly, L., Crawford, S.A., Wickersham, E.A., Brockhaus, J.L., & McCarthy, L.H. (2017). Do SSRIs and SNRIs reduce the frequency and/or severity of hot flashes in menopausal women? The Journal of the Oklahoma State Medical Association, 110(5), 272-274. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482277/ Challenges Encountered During Outpatient Rotation Assignment