DNP education and practicum experience

Practicum journal entry

Student’s Name

Institution Affiliation

Practicum experience

Falls are frequent and common among geriatric patients, having a significant effect on morbidity and mortality of elderly patients worldwide. It is quite common for the caregivers to underestimate the incidence and manifestation of falls in geriatric patient considering the fact of clear cognitive impairment and other possible dynamics. Furthermore, 40 to 60 % of falls happens in the absence of witnesses (Ungar et al., 2013). However, the pathogenesis of fall is often multifactorial, combining environment and the psychological factors related to aging.  Identification of risk factors, therefore, becomes crucial in management and prevention of falls in geriatric patients. As a leader, it is important to devise and monitor such clinical manifestation and design evidence-based practice with a patient centered outcome. This practicum experience is in line with the DNP essentials characterized by practice demand associated with increasing complex health system.

During my 8th week of practicum experience, I focused my effort in formulating a care plan for diabetic and hypertension patients of several patients in the geriatric ward.  Such interventions included administering vasodilator medications required for meeting parametric md for blood pressure, and frequent and regular blood pressure assessment. In a similar way, I performed headache assessment every four hours for the hypertensive patients, as well as medical education on medication and nutritional care. Other interventions that I included in my care plan included functional status assessment, diabetic retina check and patient medication review to consider any possibility of polypharmacy.

In my 9th week, my focus was in reviewing fall examination protocols and treatment. As described earlier, there is a frequent tendency to underestimate cases of falls manifestation, particularly in geriatric patients. My effort included a multidisciplinary intervention and emphasis on predisposing factors and most effective intervention for risk of falls (Ungar et al., 2013). In the same week, I organized a multi-disciplinary meeting of nurses, pharmacists and a geriatrician physiotherapists and social workers to evaluate and assess the fall protocol to improve intervention and treatment. Among the potential issues identified included the effective use of training path, hip protectors and support tools such as sticks and walkers as well as a reevaluation of drug therapy.

The next week that followed (10th), we evaluated the fall intervention protocols presented in the practicum experience. Although the setting followed the guidelines of the American Geriatric Society that included modification of environmental hazards and dozed adjustments, there was, however, inadequate intervention towards other risks of falls including intensity and prevention of falls (Karlsson et al., 2013). Similarly, there was a high likelihood of geriatric patients presenting falls, hypertensive and diabetic to receive multiple medication and drugs hence case of polypharmacy. In particular, such patients received double doses of diuretics and benzodiazepines drugs and medication. To prevent such polypharmacy cases, we concentrated in education patients on appropriate self-medication and nursing proper patient evaluation.

In the 11th week, we concluded the fall intervention and care plan project designed and started in the 8th week. In the same week, I requested to meet my preceptor to discuss my leadership’s role especially in the geriatric care plan, and revision of protocols towards minimizing polypharmacy cases in the practicum experience. In the last days of the weeks, I attended a multidisciplinary meeting aimed at addressing management of chronic disease like hypertension, diabetic and cancer.  Proper patient education, dietary plan and continuous assessment of the condition as well as precise utilization of international guidelines were some key issues that proved useful in the management of long-term geriatric patients.

I spent the better part of my last week of my practicum experience reviewing geriatric intervention programs designed during the first few weeks. In this practicum experience, I learned how to use my leadership role as a nursing leader in the clinical intervention at complex health system, spearhead protocol evaluation and revision as well facilitation of evidence-based practice.  In the same week, I engaged my preceptor to discussion my possible future project and intervention programs.

References

Karlsson, M. K., Magnusson, H., von Schewelov, T., & Rosengren, B. E. (2013). Prevention of falls in the elderly—a review. Osteoporosis international, 24(3), 747-762.

Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A., Tesi, F., & Marchionni, N. (2013). Fall prevention in the elderly. Clin Cases Miner Bone Metab, 10(2), 91-5.

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