Respond to the 2 following discussion posts separately with separate reference lists.
1.. FNP 592 DQ2: Discuss your plan for completing your clinical hours. What specific skills or goals would you like to accomplish during this clinical rotation? How do you plan to use evidence to support your clinical decisions?
I have been in communication with my preceptor frequently about my schedule and my clinical hours requirements. She is in private practice and has three clinic locations in the Piedmont Triad Area where I live; she also does many sessions online. I will have to work around her schedule and my RN work schedule (currently two 12-hr night shifts per week) to complete the hours required. I will attend sessions at the clinics as well as participate in online sessions to meet my requirements. Since this is my first clinical rotation, I would like to focus on improving my clinical skills of differential diagnosis as well as physical examination and developing treatment plans.
According to Decker et al., (2019), evidenced-based practice (EBP) is using the most reliable research studies to provide evidence to make optimal health care decisions in combination with the NP’s own clinical knowledge and expertise from her practice, as well as the patient’s preferences. According to the same reference (Decker et al., 2019) an effective point-of-care strategy based on EBP includes: 1) asking a clinical question, 2) having evidence resources available (see below), 3) completing the search using these resources, 4) examining the results of the search, and 5) applying the findings to the individual patient. Several sources for EBP and clinical practice guidelines are listed, including the National Guideline Clearinghouse (www.guideline.gov), Cochrane Collaboration (www.cochrane.org), Essential Evidence Plus (www.essentialevidenceplus.com), UpToDate (www.uptodate.com/home/index.html), DynaMed (dynamed.ebscohost.com), and the smartphone apps Skyscape (www.skyscape.com) and Pepid Primary Care (www.pepid.com ) (Decker et al., 2019).
During my past two years in the program, every single class has focused on EBP. In terms of applying research to clinical practice, I have learned a few additional effective principles. First, the research must be current, and the program’s guideline has always been to use sources that are no more than five years old. Another principle I have learned is to consult more than one source, and when possible, more than one type of source. The primary sources I have learned to use are online research journals (accessed both in and outside of USU’s online library), textbooks focusing on clinical practice, online associations and organizations providing clinical practice guidelines, online applications such as Medscape (available for free to the public) and UpToDate (available via my employer), and consultations with professional colleagues (mostly in the USU NP program) and mentors from the program (professors) as well as in practica (my clinical preceptors).
The main clinical textbooks I will use to continue to guide my clinical practice include: Dunby, et al.’s (2019) Primary care: The art and science of advanced practice nursing – an interprofessional approach, Cash et al’s (2021) Family practice guidelines, Stern et al.’s (2020) Symptom to diagnosis: An evidenced based guide, Burns’ (2020) Pediatric primary care, Wolff et al.’s (2017) Fitzpatrick’s color atlas and synopsis of clinical dermatology, and to a secondary extent, Rosenthal & Burchum’s (2021) Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants, Dlugasch & Story’s (2021) Applied pathophysiology for the advanced practice nurse, Bickley et al.’s (2021) Bates’ guide to physical examination and history taking, Hamilton’s (2020) Tarascon pocket pharmacopoeia, Esherick’s (2016) Tarascon primary care pocketbook and the American Academy of Pediatric’s (2017) Bright futures: guidelines for health supervision of infants, children, and adolescents.
References
Decker, I., Dunn, D. J., Doshier, S. & Thomas, D. J. (2019). Evidence-based practice. In L. M. Dunphy, J. E. Winland-Brown, B. O. Porter & D. J. Thomas (Eds.), Primary care: The art and science of advanced practice nursing – an interprofessional approach (5th ed., pp. 59-72).
2. I am excited to delve into the world of family practice with the start of my clinical rotation. It is a new area of practice for me and will reintroduce me to the world of standard medicine as I have been in aesthetics my entire nursing career. Family practice is the ideal area of practice, as it combines “biological, clinical, and behavioral sciences…[encompassing] all ages, genders, each organ system, and every disease entity” (AAFP, 2019, para 1).
I strongly believe that any personal goal should be SMART – specific, measurable, attainable, realistic, and timely. I want to make sure I log my shift and journal hours the same day they occur. I will create a template or outline for myself to make journal hours quick and easy to document. I want to become proficient at focused assessments. To become proficient, I will practice assessments every day, and by the end of the term, I want to perform a focused assessment based without any prompts from my preceptor. I also want to ensure I take on as many opportunities to learn as I can. As such, I will work with my preceptor at the beginning of every shift to determine which patients will be appropriate for me to take on by myself initially and continue to add additional patients to my patient load with every shift I have.
It is vital to implement evidence-based practice into the day-to-day of an advanced practice nurse. Evidence-based practice allows for the best combination of a practitioner’s expertise with a patient’s wants (AHRQ, 2018). I plan to utilize the ASK Patient-Clinician Communication model, or something similar, in my interaction with patients to create the optimal evidence-based environment. The ASK, or AskShareKnow, Model, poses 3 questions: “what are my options?”; “what are the possible benefits and harms of those options?”; and “how likely are each of those benefits and harms to happen, and what will happen if nothing is done?” (Ginex, 2018). By balancing this format with each patients’ unique factors, such as time constraints, health literacy, gender, race, and sociocultural influences, an ideal evidence-based environment can be achieved.
References
Agency for Healthcare and Research. (2018). Evidence-based decisionmaking. AHRQ. Retrieved 2022, from https://www.ahrq.gov/prevention/chronic-care/decision/index.html
American Academy of Family Physicians (AAFP). (2019). Family Medicine, definition of. Home. Retrieved 2022, from https://www.aafp.org/about/policies/all/family-medicine-definition.html
Ginex, P. K. (2018). Integrate evidence with clinical expertise and patient preferences and values. ONS Voice. Retrieved 2022, from https://voice.ons.org/news-and-views/integrate-evidence-with-clinical-expertise-and-patient-preferences-and-values
