NR 511 Week 8 Reflection|Week 8 Reflection NR511 Differential Diagnosis and Primary Care

After careful review of the clinical encounter summary, I was able to identify gaps in types of patients I have seen during my clinical rotation. In my clinical rotation for NR 511, I followed one preceptor in the family practice setting where I saw a total of 172 patients and completed 129 clinical hours. During this rotation, I had the opportunity to see a wide range of the adult population from age 18-95. The majority of the adult population fell in the age range of 66-75. Upon reviewing the clinical report from the MyEvaluations logging tool, about 86.63% of the patient population seen in this clinical rotation were African American, which is representative of the ethnic population in the Orange county of Orlando Florida. I also saw 8 Caucasian patients (4.65%), 12 Hispanic or Latino patients (6.98%), also 3 American Indian/ Alaskan Native descendant patients (1.74%). Lastly, only a few procedures were carried out during my rotation. I was able to perform one PAP smears, a breast exam, and mostly venipuncture. I was lucky enough to have a clinic that performed x-rays inhouse and I was also able to see and learn from a diagnostic testing stand point. In terms of client complexity, the majority of the visits (75.58%) were chronic condition associated with hypertension, hyperlipidemia, diabetes, and hypothyroidism. As I progressed towards the end of the clinical rotation, I was able to see more health maintenance visits and acute conditions. Nonetheless, I felt that this was a significant gap in the category of client complexity. Since the majority of the patients were chronic visitations, I was unable to perform many of the procedures listed in the competency list. I hope to close this gap with the next clinical rotation in general internal medicine. If I continue to see this particular gap in client complexity and procedures, I will obtain preceptorship in an urgent care facility that may provide plenty of opportunities to gain exposure to higher acuity patients and perform more procedures. 4 Reflection Urgent care facilities can certainly help fulfill procedures such as laceration repairs, foreign body removal, wound debridement, and nail avulsions. The other significant gap in this clinical rotation is the lack of pediatric exposure. Even though the practice is listed as family medicine, the youngest patient I was able to see was 17 years of age. Generally, the pediatric population is typically seen mostly by a pediatrician. In order to meet the pediatric requirements for this program, I will need to obtain a preceptorship at a specialized urgent care center or a pediatrician office. Luckily, I found a pediatric office for the November clinical rotation. Since the school required a 15% of total hours for woman women’s health, and I feel that in this session I was not expose enough to women's health category, hopefully by next session, I will have more opportunity to see more women issue, in order to meet the goal, or I will be looking for a preceptorship in a women's health clinic or health department to be able to have my skills. Clinical progression I felt that my progression through this clinical rotation was appropriate as a novice nurse practitioner student. When I first started this clinical rotation, my personal goal was to gain confidence in completing a full head-to-toe assessment in a primary care setting. While my assessment skills are proficient as a med-surgical nurse, my goal was easily achieved in this clinical rotation, and I gained more confidence in my assessment skills. I was also able to successfully fulfill my personal goal of presenting patients in SNAPPS format. For future practicum experiences, I hope to broaden my patient presentation skills to encompass more complex patients with multiple uncontrolled diseases.