Week 8 Reflection
NR511 Differential Diagnosis and Primary Care
July session, 2019
Dr. P
Clinical Experience and Gap Review
3
Reflection
After careful review of the clinical encounter summary, I was able
...
Week 8 Reflection
NR511 Differential Diagnosis and Primary Care
July session, 2019
Dr. P
Clinical Experience and Gap Review
3
Reflection
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.
Areas of Weakness
5
Reflection
Even though I am improving on my assessment skills in this clinical rotation, I feel that
my area of weakness is developing differentials for acute concerns. Developing differentials for
“common cold” symptoms have become easier as I gain more exposure to cases of upper
respiratory infections and bronchitis. However, I still have trouble with other acute concerns such
as orthopedic injuries and abdominal pain. My other area of weakness involves choosing the
appropriate antibiotic regimen. With a wide range of antibiotic choices, I am not as confident in
choosing a specific medication. To address these deficiencies, I plan to create a document during
spring break with the most common complaints seen in the primary care setting, along with
symptoms, differentials, and possible treatment plans. I will also study the different classes of
antibiotics for specific illnesses ranging from respiratory to dermatology disorders.
FNP NONPF CORE Competencies
I plan to work towards meeting two of the practice inquiry competencies in the
family/across the lifespan section of the core competencies. As a novice FNP student I believe
that I am constantly working to generate knowledge from clinical practice to improve practice
and patient outcomes (Thomas et al., 2013). In order to generate knowledge, I need to apply
evidence-based research that is patient centered and use an evidence-based approach to manage,
evaluate and apply research finding to improve the patient’s outcome. I have identified this as an
area of weakness found during my clinical rotation. I need to become more proficient in
determine appropriate, and cost-effective testing, and drug management, in order to do so I will
be using the evidence-based research and clinical practice guidelines
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