Clinical Experiences Journal
For ten minutes, I just held her hand while her eyes slowly opened and closed. The first patient I worked with was a woman in her seventies. She had had a whole host of physical problems. Her back went out; she had a hip replacement. Now it seemed she might have dementia or Alzheimer's Disease. The medication the head nurse gave her was strong and made the woman fall in and out of consciousness. I kept asking the head nurse what I could do, and all she would say was, "Just stay with her for now. I don't want her to get too confused." In addition to performing some of the basic duties like helping the woman get to the washroom, reach for the television remote control, eat, and take her medicine, the only thing really left for me to do was to hold her hand. I was…...

Clinical Experience
Sunrise Clinical System Version 6.1

The Emergency Room: Hybrid System

Meetings and Collaborative Care Councils

orkflow of the EMR

The KBC ( Knowledge Bas Charting) 3.4 Upgrade 6

The Role of the Nurse Informaticist

Comprehensive Analysis of my Clinical Experience

After completing 100 hours of practicum in informatics, the following will show the time at the site with my preceptor. The practicum took place at Franklin Hospital - North Shore Long Island. North Shore-LIJ which is an award-winning health system that consist of world-class tertiary hospitals, a nationally well-known children's hospital, a notorious mental facility and an assortment of community hospitals, in addition to a range of wellness and health programs. North Shore-LIJ Health System consist of 16 award-winning hospitals and approximately 400 physician practice locations all through New York, as well as Long Island, Manhattan, Queens and Staten Island. North Shore-LIJ Proudly serving an area of seven million people, North Shore-LIJ delivers world-class services…...

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Works Cited

North Shore-LIJ Health System. (2014, April 29). Retrieved from North Shore LLJ:  http://www.northshorelij.com/hospitals/services-and-programs/bariatric-surgery 

Russell, C.L. (2010). A clinical nurse specialist -- led intervention to enhance medication adherence using the plan-do-check-act cycle for continuous self-improvement. Clinical Nurse Specialist, 24(2), 69-75. doi:10.1097/NUR.0b013e3181cf554d

Seidl, K. L. And Newhouse, R.P. (2012). The Intersection of evidence-based practice with 5 quality improvement methodologies. JONA, 42(6), 299-304. doi: 10.1097/NNA.0b013e31824ccdc9

Smith, K., Tremblay, M.L., Richer, M.C., and Lanctot, S. (2010). Exploring nurses perceptions of organizational factors of collaborative relationships. The Health Care Manager, 29(3), 271-278. Doi:10.1097/HCM.0b013e3181e9351a

traumatic experience with a patient a few years ago that still left me with a bad feeling. It was a hit-and-miss instance, and the fact that it was so, more closely being miss than hit, has stayed with me ever since. It was the first time that I ever came so breathtakingly close to being implicated in causing another to die. I hope it will be the last. As to the lessons that it can teach me -- there are several.
The story was the following: It was one fine, not especially busy aturday morning when this patient was wheeled in for a percutaneous transfemoral aortic valve implantation. While the cardiology team was inserting the femoral guide wires and sheath for valve placement the ventricle was perforated. Usually we have more time and can proceed more placidly, but in this particular case, we had to rapidly respond and open the…...

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Source

Brennan, TA et a l (1991). Incidence of Adverse Events and Negligence in Hospitalized Patients -- Results of the Harvard Medical Practice Study I. N Engl J. Med 1991; 324:370-376

Greenlaw, J. (1981). Understaffing: Living with the Reality, 9 L. Med. & Health Care 23- 41

Clinical ReviewRelationship with Preceptor and Fulfillment of Clinical GoalsMy experience in the Comprehensive Psychiatric Emergency Program (CPEP) has been significantly enriched by my relationship with my preceptor, who has been great in guiding and gradually increasing my responsibilities. In terms of fulfilling my clinical goals, I have made progress, particularly in understanding psychiatric conditions and patient care, but I recognize the need for further improvement in writing concise psychiatric notes and managing my time effectively.Evaluation of the Agency/Clinical SiteThe CPEP is a first point of contact for patients with acute psychiatric conditions, providing a high-energy and challenging environment. The interdisciplinary team works cohesively and quickly. As a psychiatric NP student, I observe that NPs help with managing patient care by balancing clinical assessments with therapeutic interventions. The site is conducive to learning although fast-paced.Factors Influencing the NP RoleThe main barrier to my role as an NP student has been the…...

Clinical Education
The objective of this study is to conduct a critical analysis of issues in clinical education. Toward this end, this study will conduct a review of literature in this area of inquiry.

The work of Strohschein, Hagler and May (2002) entitled 'Assessing the Need for Changes in Clinical Education Practice' reports a study that identifies areas of need within clinical education and well as describing "…various models and tools that are proposed and utilized in clinical education, as well as the exploration of the extent to which these models and tools might meet the identified needs of the clinical education process in physical therapy." (p.1) Physical therapists are reported as working in a health care climate "of increasing complexity and rapid change, of fiscal restraint and demands for accountability, of scrutiny from both internal and external sources. In such a climate, the ability to respond appropriately to these pressures…...

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Bibliography

Cross V. (1997) The professional development diary: a case study of one cohort of physiotherapy students. Physiotherapy.1997; 83:375 -- 383.

Hagler P, McFarlane L. (1991) Achieving maximum student potential: the supervisor as coach. Canadian Journal of Rehabilitation.1991; 5:5 -- 16.

Hayes KW, Huber G, Rogers J, Sanders B. (1999) Behaviors that cause clinical instructors to question the clinical competence of physical therapist students. Phys Ther.1999; 79:653 -- 667.

Higgs J, Glendinning M, Dunsford F, Panter J. Goals and components of clinical education in the allied health professions. In: Proceedings of the 11th International Congress of the World Confederation for Physical Therapy, London.1991: 305 -- 307.

Clinical supervision provides a mechanism of data collection and the information reclamation in support to the recent projects and the programmatic developments.
Management of the high number of complex mental health caseloads

These implementations occur under the influence of the Workplace Implementation Committees (WIC) that were established to the oversee agreement by the CMS at the local levels. The CMS is supposed to accompany the implementation of the policies that clearly outline the expectations and responsibilities based on periods and review methods (Cogan 1972). The implementations are expected to be transparent in the process of the WIC members and the staff groups. This includes the clear articulate mechanism for regular workload assessment, management and review.

I. egularly collect the workload from all the executives to make the caseload management process easier.

II. Use the caseload information to make the staff allocation of the resources while measuring their performances.

The workforce plan and individual plans…...

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References

Cogan, M.L. (1972). Clinical supervision. Boston: Houghton Mifflin.

ERIC Clearinghouse on Educational Management., & National Institute of Education (U.S.). (1984). Clinical supervision. Eugene, or: ERIC Clearinghouse on Educational Management, College of Education, University of Oregon.

Powell, D.J. (1980). Clinical supervision: [1]. New York: Human Science Pr.

Bernard, J.M., & Goodyear, R.K. (1998). Fundamentals of clinical supervision. Boston: Allyn and Bacon.

In certain countries, an effective supervisor possesses basic teaching skills, facilitation skills, negotiation and assertiveness skills, counseling and appraisal skills, mentoring skills, and knowledge of learning resources and certification requirements (Kilminster).
The most important aspect of the role of an effective supervisor is giving supervisee responsibility and the opportunity to practice it (Kilminster, 2000). Supervisees come to view the supervisor as a colleague and this leads them to become self-directed. Some supervisees consider teaching skills and techniques, interpersonal style and professional competence the most important characteristics of an effective supervisor. An effective supervisor shows empathy, is supportive, and exhibits flexibility, instruction, knowledge, interest in supervision and good tracking of supervisees. He is interpretative, respectful, focused ad practical. In contrast, an ineffective supervisor is rigid, shows little empathy and provides low support. He fails to consistently track supervisee concerns, teach or instruct. He is indirect and intolerant. He is close-minded. He…...

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BIBLIOGRAPHY

Borders, L.D. (1994). The good supervisor. ERIC Digests: ERIC Clearinghouse on Counseling and Student Services. Retrieved on October 28, 2011 from  http://www.ericdigest.org/1995-1/good.htm 

Joslin, v. (2008). Ten traits of a good supervisor. Associated Content: Yahoo. Inc. Shine.

Retrieved on October 28, 2011 from  http://www.associatedcontent.com/article/969660/ten_traits_of_a_good_supervisor.html 

Kilminster, S.M. (2000). Effective supervision in clinical practice settings. Vol 34

Concisely, Comfort results when an individual keeps of negative or unhealthy living and sticks to positive and healthy living. Comfort has been associated with positive institutional outcomes that include patient satisfaction. The outcome of Comfort is therefore one of the most important indicator of measuring success in nursing practice particularly for patients and families going through some tough or stressful healthcare conditions.

Benefits of the Comfort theory to the Clinical Nurses of the 21st Century

Comfort theory is an important theory that is applicable to the 21st Century clinical practice because of its many inherent benefits or advantages. This theory defines the working environment for healthcare practitioners while at the same time it charts the direction for improving the services offered by the clinical nurses. The universality of the language and concepts used in presenting the theory also promotes its wide acceptance. The simplicity of the tenets of the Comfort theory ensures…...

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References

Kolcaba, K. (2003) Comfort Theory and Practice: A Vision for Holistic Health Care and Kolcaba, K.Y. (1994). A theory of holistic Comfort for nursing. Journal of Advanced Nursing, 19(6), 1178-1184.

Kolcaba, K., & DiMarco, M.A. (2005). Comfort Theory and its application to pediatric nursing. Pediatric Nursing. New York, NY: Springer Publishing Company, Inc.

Magyrary, D. (2002) Positive mental health: a turn of the century perspective. Issues of Mental Health Nursing, 23, 331-349

Malinowski, a., & Stamler, L.L. (2002). Comfort: exploration of the concept in nursing. Journal of Advanced Nursing, 39(6), 599-606.

Clinical Supervision and its Strengths and eaknesses

Annie Pettifer and colleague Lynn Clouder explain in the peer-reviewed journal Learning in Health and Social Care that clinical supervision is commonly used in professional contexts as a way to "guide reflection with the purpose of advancing practice" (Pettifer, 2008, 169). Clinical supervision "…enables critical practice and development of personal knowledge, professional expertise and competence" (Pettifer, 169).

Pettifer mentions that there is no hard and fast rule as to how the clinical supervision model should be presented. There are many interpretations, the author explains, and there is "conceptual ambiguity" as well; but the ambiguity can be explained because there can be no single model that meets all the professional needs of principals. But that said, there is a basic definition of clinical supervision that is presented by the authors:

"…[clinical supervision] is a formal process of support and learning which enables individual practitioners to develop knowledge…...

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Works Cited

Gibble, J.L., and Lawrence, J.D. (1987). Peer Coaching for Principals. Educational Leadership.

Huston, T., and Weaver, C.L. (2008). Peer Coaching: Professional Development for Experienced Faculty. Innovations in Higher Education, Vol. 33, 5-20.

Pettifer, A., and Clouder, L. (2008). Clinical supervision: a means of promoting reciprocity between practitioners and academics. Learning in Health and Social Care, 7(3), 168-177.

Pfeifer, D. (2011). Transforming Staff through Clinical Supervision. Reclaiming Journal,

A level of 126 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.
An oral glucose tolerance test measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. This test can be used to diagnose diabetes or pre-diabetes. OGTT is more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. The OGTT requires you to fast for at least 8 hours before the test. Your plasma glucose is measured immediately before and 2 hours after you drink a liquid containing 75 grams of glucose dissolved in water.

If your blood glucose level is between 140 and 199 mg/dL 2 hours after drinking the liquid, you have a form of pre-diabetes called impaired glucose tolerance or IGT, meaning that you are more likely to develop type…...

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Works Cited

Braunald, Eugene., Fauci, Anthony S., Kasper, Dennis L., Hauser, Stephen L., Longo, Dan L., Jameson, J. Larry. 2001. Harrison's Principle of Internal Medicine, 15th ed. New York: McGraw-Hill Medical Publishing Division.

The Merck Manual (16th ed.). (1995). Portland, Oregon: Merck & Co., Inc.

According to the AACN's report, "Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric, and Women's Health" (2002), "Competencies are the domain or body of knowledge and skills that essentially define a profession or discipline. This domain of competencies guides training programs, provides expectations for employers, and drives the nature of assessment instruments and performance standards for credentialing institutions, certifying agencies, and accrediting organizations" (p. 14).
The core competencies for nurse practitioner graduates are intended to help candidates used what they have already learned and require a graduate-level education in order to attain certification as an APN and the AACN has developed this graduate curriculum as the basis for advanced practice nursing. As described by AACN, advanced practice nursing preparation includes ". . . graduate nursing core content (e.g., research, health policy, ethics, and more) and advanced nursing practice content (e.g., advanced health assessment, advanced physiology and…...

Since modern medicine can sustain patients with proper medical follow-up for years, it becomes incumbent on the profession to follow the patients and provide them with the knowledge and tracking to insure that they are observing the procedures and medications which prolong their quality of life. Given hospitals' short-term orientation with the patients, there is a need to bridge patient care before, during and after acute-care visits.

While there are some nursing specialties which can be regarded as solely hospital- or community-based, many of the specialties call for a more holistic notion of patient care. y combining the CNS and NP specialties, this profession has a better chance of assuring better patient outcomes, and a better quality of life for the patient.

ibliography

ennett, .J. (1998). Psychiatric mental health nursing: thriving in a changing environment through outcomes-based measurements. Semin. Nurse Manage., 144-148.

erger, a.M.-F. (1996). Advanced practice roles for nurses in tomorrow's healthcare systems.…...

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Bibliography

Bennett, B.J. (1998). Psychiatric mental health nursing: thriving in a changing environment through outcomes-based measurements. Semin. Nurse Manage., 144-148.

Berger, a.M.-F. (1996). Advanced practice roles for nurses in tomorrow's healthcare systems. Clinical Nurse Specialist, 250-255.

Chaska, N.L. (2001). The Nursing Profession Tomorrow and Beyond. Thousand Oaks: Sage.

Cukr, P.L. (1997). The psychiatric clinical nurse specialist/nurse practitioner: an example of a combined role. Arch Psychiatr Nurs, 2-12.

Clinical Learning Outcomes
Interaction of Variables.

Evaluating clinical learning outcomes

Describe the skill and the learner you intend to teach and evaluate

Because of cutbacks in the number of days new patients are allotted to spend in the hospital, patients and their families are increasingly responsible for more of the patient's care, even immediately following a diagnosis of a serious illness such as type I, or juvenile, insulin-dependent diabetes. Teaching patients to correctly monitor their blood sugar and self-administer insulin is essential, but it requires a high level of patient compliance and willingness to learn. It is essential that young patients and their parents have a thorough understanding of the process.

Briefly describe how you would design the learning experience

Learning is a step-by-step process. It is important not to bombard patients with knowledge right away, when they are still frightened and confused. Also, although there are real risks with insulin injection, these risks should not…...

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References

Hahn, K.K. (1990). Teaching patients to administer insulin. Nursing, 20(4), 70-70.

Retrieved:  http://search.proquest.com/docview/79701645?accountid=10901 

Silvestrone, J.M. (2004). Performance-based assessment: Improving the value of laboratory and skills examinations. New Directions for Teaching & Learning, 100, 65 -- 71.

Clinical isk Management
Hospitals are one of the top listed high-risk places of work. Just like any high-risk workplaces, Clinical isk Management (CM) procedures are formulated to enable hospitals in identifying, containing, as well as manage work related risks such as injuries, which are bound within the facilities. Implementation of element contained in risk management procedures in any hospital setting should be effected in order to ensure for the safety of both patients and workers accommodated in the facility.

isk Management

isk management is highly prioritized in most high-risk organizations. Technological advances have been realized in modern medicine progressively resulting to more complex care and treatment processes. Despite the positive result of leveraging care opportunities, such advancements may result in adversities that might in turn affect patients and staff working in hospital environments. Since it is far from possible to eradicate such risks completely, clinical risk management procedures are there to enhance the…...

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References

Elizabeth, A. H and Betty, J.H. (1976). The American Journal of Nursing, Vol. 76, No. 6, pp. 924 -- 927: Lippincott Williams and Wilkins Publishers.

Stanbury, M. S and Anderson, H.A. (2000). Guidelines; Minimum and Comprehensive State-Based Activities in Occupational Safety and Health: DHHS (NIOSH) publication No. 95 -- 107.

Stanbury, M.J. And Goldoft, M. Use of OSHA Inspection Data for Fatal Occupational Injury Surveillance in New Jersey. Am J. Public Health 1990; 80: 200-202.

Tepper, A. (2000). Surveillance of Occupational Illnesses, Injuries, and Hazards in New Jersey. NJDOH.

In clinical situations, for example, problem-solving techniques are often required to ensure best practice. According to Lyth, some authors argue that a balance between roles should be maintained in order to optimize both clinical practice and theoretical knowledge.
Generally, it appears to be agreed among theorists that the focus of clinical supervision should be professional development and self-actualization. In addition, an inter-disciplinary approach to supervisory practice will also provide a platform for emerging best practice among the various professions, and ultimately benefit the practice in nursing. Although it appears that the theory on clinical supervision is often arbitrary and little researched, it is also true that the phenomenon has been in effect of many years, decades, and even centuries. For midwives, for example, supervision has been part of their profession since 1902, being a statutory requirement.

One problem with clinical supervision, according to Lyth (2000, p. 276), is the fact that…...

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References

Lyth, Gordon M. (2000). Clinical supervision: a concept analysis. Jounral of Advanced Nursing, Vol 31, No. 3.

Macdonald, Joanna. (2002, Feb). Clinical Supervision: a review of underlying concepts and developments. Australian and New Aealand Journal of Psychiatry, Vol. 35, Iss 1. Retrieved from  http://www.informaworld.com/smpp/content~db=all~content=a772090191 

McLean, Duncan (1996). Clinical Supervision. Psychiatric Bulletin, Vol. 20. Retrieved from  http://pb.rcpsych.org/cgi/reprint/20/1/1.pdf 

Todd, C. & O'Connor, J. (2005). Clinical Supervision. In N. Skinner, a.M. Roche, J. O'Connor, Y. Pollard, & C. Todd (Eds.), Workforce Development TIPS (Theory Into Practice Strategies): A Resource Kit for the Alcohol and Other Drugs Field. National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide, Australia. Retrieved from  http://www.unodc.org/ddt-training/treatment/VOLUME%20D/Topic%202/8.Workforce%20Development%20TIPS.pdf

I. Introduction
A. Definition of physical therapy
B. Role of the physical therapist
C. Types of physical therapy

II. History of Physical Therapy
A. Ancient origins
B. Development in the 19th and 20th centuries
C. Modern advances

III. Education and Training
A. Educational requirements
B. Clinical experiences
C. Continuing education

IV. Physical Examination
A. Subjective examination
B. Objective examination
C. Special tests

V. Treatment Planning
A. Goals of treatment
B. Development of a treatment plan
C. Collaboration with other healthcare professionals

VI. Treatment Techniques
A. Exercise therapy
B. Manual therapy
C. Electrophysical agents
D. Assistive devices

VII. Patient Education
A. Importance of patient involvement
B. Home....

Key Features of Evidence-Based Practice

Evidence-based practice (EBP) is a systematic approach to healthcare that integrates the best available scientific evidence with clinical expertise and patient values to make informed decisions about patient care. EBP has become increasingly important in modern healthcare due to the exponential growth of medical knowledge and the need to ensure that patients are receiving the most effective and appropriate care.

The key features of EBP include:

1. Integration of Research and Clinical Expertise:

EBP is based on the idea that the best decisions about patient care are made when clinicians consider both the latest scientific evidence and their own....

1. The Impact of Clinical Rotations on Medical Students Perception of Human Rights

    This title explores how medical students view human rights within the context of their clinical experiences.

2. Understanding the Role of Human Rights in Medical Education Perspectives from Clinical Rotations

    This title delves into the importance of integrating human rights principles into medical training during clinical rotations.

3. Human Rights Awareness Amongst Medical Students Insights from Clinical Training

    This title discusses how exposure to real patient cases during clinical rotations may shape medical students understanding of human rights.

4. Bridging the Gap Human Rights Education and Clinical Practice in Medical Training

    This title examines....

1. Icing an injury can help reduce inflammation, which in turn can aid in the healing process.

2. Studies have shown that applying ice to an injury can help decrease pain levels and improve overall comfort for the individual.

3. The use of ice therapy has been a common practice among athletes and healthcare professionals for decades, indicating its effectiveness in aiding in the healing of injuries.

4. Ice can help constrict blood vessels in the injured area, which can prevent excessive swelling and promote quicker recovery.

5. Cold therapy, such as icing, has been shown to be effective in....