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The Challenging Patient Encounters Assignment Paper

The Challenging Patient Encounters Assignment Paper

Journal Entry

The nursing career is a long-life learning experience because nurse practitioners need to improve their knowledge and expertise from time to time to keep up with the fast-paced technology in the healthcare field. This paper, therefore, seeks to provide a description of the three most challenging patient encounters that I had during my practicum including diverse lessons and experiences while delivering care services The Challenging Patient Encounters Assignment Paper

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Three Most Challenging Patient Encounters

First Scenario

During my practicum, one of the most challenging patient encounters was managing a 24-year-old mother who had experienced her third consecutive miscarriage. The most challenging part of this encounter was managing her stress and anxiety related to the loss. She complained of neglect by her spouse and peers. Evidence from scientific studies reveals that counseling and offering support interventions to clients and families effectively improve outcomes and enhance acceptance of loss (Galeotti et al., 2022). I advised the team that the mother could have cervical incompetence due to the nature of deliveries in the second trimester. In collaboration with the team, I advised the woman to present for a McDonald’s cerclage before she approaches 24 weeks gestation in her subsequent pregnancy to help prevent premature birth (Shennan et al., 2021)The Challenging Patient Encounters Assignment Paper. If I encounter a similar scenario, I will consider taking a detailed history, offering support, showing empathy, being compassionate, and recommending any medical or surgical interventions to prevent further mismanages.

Second Scenario

Another challenging case that I encountered during the practicum was handling a 38-year-old reserved woman of Islamic religion who had come in for a comprehensive assessment since was complaining of pelvic pain and abnormal vaginal discharge. The most challenging part of this encounter was convincing the patient to give consent for pelvic assessment. Upon examination, the patient was suspected to have cervical cancer that needed Papanicolaou test because her case was complicated. From this encounter, I learned that many patients are prevented by their lack of know-how and religion from getting well-informed about important health matters. Craig et al., (2018) suggest that patient education is important; especially for patients from underserved communities and those that hold their beliefs dearly despite the risks associated with practices they consider being taboo.

Third Scenario

The third most challenging patient encounter was when I dealt with a mother in the third trimester and was in a panic mood. She was having contractions and reported ruptured membranes three hours ago. I helped her calm down and get reviewed quickly. During the review, I noted that she was in the active phase of labor because of the characteristic signs of the show, dilated cervix at 6 cm, cervical effacement, good descent with a cephalic presentation, and strong uterine contractions (Hutchison & Mahdy, 2019)The Challenging Patient Encounters Assignment Paper. Her pelvis was adequate, but she declined vaginal delivery. The surgical team also talked to her to avoid unnecessary operations. Later she signed to proceed with vaginal delivery, but at 8cm dilatation and good labor progress, she revoked to continue with vaginal delivery and opted for surgical means. As the struggle with her unfolded, I requested my preceptor to handle the case, and eventually, the patient went into the theatre for a cesarean section. This was a challenging encounter because I had to respect the patient’s autonomy while practicing my profession and advising the client on what was appropriate for her and the fetus.

What did you learn from this experience?

I learned that women who experience miscarriage may undergo psychological complications and intense grief. I also learned that in cases where the patient is differing from a family member, it is important to listen to the patient and educate the parent on the importance of respecting the wishes of the patient.

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What resources did you have available?

With me was a supportive team of nurses and clinicians whom I collaborated with during the experience. I also had the consultation room, examination equipment, an examination couch, and charts of standard operating procedures to guide me in performing nursing procedures.

What evidence-based practice did you use for this patient?

I used evidence from scientific research to help guide the effectiveness of interventions that we adopted for every patient. The Challenging Patient Encounters Assignment Paper

What new skills are you learning?

I am learning to take comprehensive gynecology and obstetric history and physical examination.

What would you do differently?

I would spend more time getting details of the patient’s history and developing a clear insight into their problems. For example, at the second miscarriage of the patient in the second scenario, the care providers who handled her should have suspected cervical impotence and scheduled her for screening.

How are you managing patient flow and volume?

I manage patients’ flow and volume by controlling the time (a maximum of 20 to 25 minutes) that consultation could take. I also used EHRs to facilitate communication between departments and healthcare professionals handling patients.

How might I improve my skills and knowledge and communicate that back to my Preceptor?

I would improve by engaging my Preceptor more, learning more skills, and gaining insights into OBS/GYN practice. I would also learn from the physician and keep close communication with my Preceptor about my learning progress.

How am I doing? What is missing?

In my opinion, I am meeting all learning outcomes and have not missed anything so far.

What type of feedback am I receiving from my Preceptor? 

I am receiving positive feedback from my Preceptor, who affirms that I am doing well in applying the EBP into clinical practice and assimilating knowledge gained from class into real situations. I feel contented with the quality of guidance I am receiving from my Preceptor, and I feel privileged and encouraged to learn more and improve my experience, especially because of the positive feedback I am receiving from my preceptor. The Challenging Patient Encounters Assignment Paper

References

Craig, L. B., Buery-Joyner, S. D., Bliss, S., Everett, E. N., Forstein, D. A., Graziano, S. C., … & Undergraduate Medical Education Committee. (2018). To the point: gender differences in the obstetrics and gynecology clerkship. American Journal of Obstetrics and Gynecology, 219(5), 430-435. https://doi.org/10.1016/j.ajog.2018.05.020

Galeotti, M., Mitchell, G., Tomlinson, M., & Aventin, Á. (2022). Factors affecting the emotional wellbeing of women and men who experience miscarriage in hospital settings: a scoping review. BMC Pregnancy and Childbirth, 22(1), 1-24. https://doi.org/10.1186/s12884-022-04585-3

Hutchison, J., & Mahdy, H. (2019). Stages of labor. https://www.ncbi.nlm.nih.gov/books/NBK544290/

Shennan, A., Story, L., Jacobsson, B., Grobman, W. A., FIGO Working Group for Preterm Birth, Simpson, J. L., … & Mol, B. W. (2021). FIGO good practice recommendations on cervical cerclage for prevention of preterm birth. International Journal of Gynecology & Obstetrics, 155(1), 19-22. The Challenging Patient Encounters Assignment Paper

To prepare:

  • 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?The Challenging Patient Encounters Assignment Paper

Please keep in mind that this is OB/GYN Clinical rotation and it is outpatient  (in Physician office)

Please use heading for each major part of the assignment as follow

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  • Reflect on the 3 most challenging patient encounters and discuss what was most challenging for each (Please one of the patient should be an OB patient)
  • 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?
  • How might I improve on my skills and knowledge, and how to communicate that back to my Preceptor?
  • How am I doing? What is missing?
  • What type of feedback am I receiving from my Preceptor? The Challenging Patient Encounters Assignment Paper