Practicum Journal Entry Week 1-3, 4-7 and 8-11
Clinical Time Log and Journal
Practicum Placement Agency’s Name:
Preceptor’s E-mail Address:
Note: Add rows as needed.
Total: Weeks 1-3:
Total: Weeks 8-11
Total Practicum Hours Completed for Course
Description of the Observed Activities
In my first week at the Mercy Medical Center, there are various activities that I observed. For instance, I spent a better part of my time watching and participating in the process of updating care plans for the labor delivery unit. The administration of the Mercy Medical Center focused its attention on familiarizing nurses with its new policies and procedures.
Consequently, meetings were held to discuss the phasing out of old policies that are still being observed in the Epic. The agenda of the meeting was to advise nurses to avoid referencing old policies. After that, I met Karen, a nursing professional to discuss specimen collection. During this period, Karen audited the specimen collection information and instructed the nursing informatics to send it out. This session familiarized me with how nurses coordinate their tasks to generate positive patient outcomes. For an organization that is increasingly embracing information technology to support quality of care, concerns were also raised about switching from the Mobilab specimen collections system to the Epic. There were complaints that the Epic EHR system is still limited. Therefore, nurses have to revert to two nurses’ signoff for the specimens as labels no longer print at the patient bedside. Other meetings were held to explore care plan issues that were not built correctly in the Epic EHR.
Analysis of the Problems/ Issues
Mercy Medical Center is currently facing the challenge of slow implementation of its epic Electronic Health Record (EHR) system. The hospital recently transitioned from Meditech EHR system to Epic. The transition was not successfully implemented; as a result, many issues have arisen from the poor implementation of Epic as well as the Mobilab specimen collection that is marred by numerous inefficiencies. Nurses have also not yet familiarized themselves with the new EHR environment. Therefore, there is the slow pace of adoption of the system, thereby reducing operational efficiencies and quality of patient care (Tavana, 2014). EHRs are information systems that generate significant impacts on the usual clinical and administrative workflows, affecting users and the administrative systems. While significant planning may be undertaken before they are fully implemented, many challenges before the go-live and during the weeks and months after the initial date of full operation may be observed. Some of the issues that pose potential difficulties to nurses and other user groups include failure to train and familiarize nurses with the Epic EHRs, vendor challenges, and the general resistance by some nurses to the change process because they are not used to the new system. Furthermore, departmental coordination becomes a challenge when one department uses EHRs while others still operate on a pen-and-paper information system.
How the Real-World Mirrors Program-Related Evidence, Concepts, and Theories
In light of the rapid proliferation of evidence-based practices, there has been increased call for the identification of the core underlying mechanisms that are common to the many different evidence-based practices in the real world. With the growth and development of large databases, the utilization of EHRs, and sophisticated statistical techniques, the process of examining practices in the real world and comparing the effectiveness of interventions is often enhanced (McDaniel, 2009). Nurses and clinicians may face challenges associated with situations that lack definitive information regarding a course of action. I was exposed to information methodologies that can help inform practice decisions by evaluating outcomes in the real world. Patients may not be the same.
Given the above, the application of intervention may have multiple variations. Thus, the focus should be on external validity. It responds to the issue of whether similar outcomes can be attained on a broader population, in different contexts, with different clinicians, and most likely with limited resources.
McDaniel, J. G. (Ed.). (2009). Advances in information technology and communication in
health (Vol. 143). New York: Ios Press.
Tavana, M. (Ed.). (2014). Healthcare Informatics and Analytics: Emerging Issues and Trends:
Emerging Issues and Trends. New York: IGI Global.
There are various activities that I had observed in my experience. For instance, in my first week, I visited a Quality Council meeting with my preceptor, after which I participated in the Practice Council meeting. The fifth week kicked off with by attending several meetings in the entire day. Some of the issues that we discussed in the meeting included the negative findings of the Joint Commission’s recent visit of the Mercy Medical Center towards the end of December 2018. One of the outcomes of the Joint Commission was the fact that nursing professionals are not correlated to patients’ diagnosis or primary diagnosis to the patient individualized care plan. In the sixth week, discussions were aimed at exploring the Epic electronic health record system tickets that were sent out to the nursing informatics unit. The key issues that affected the mother-baby units relating to breast milk donor documentation. There included workflow issues related to feeding babies. Finally, in the seventh week, the Quality Council Meeting was convened. During that session, we found that the orthopedic floor is ranked leading above Johns Hopkins and the University of Maryland Medical Center Unit.
Analysis of the Issues, Problems, or Situations
The main problem that Mercy Medical Center faces is poor design and implementation of their new Epic electronic health record system (EHRs). The mother-baby unit is especially experiencing issues related to slow documentation of the breast milk donor which can take as long as 20 minutes because there was no bundle designed in their Epic EHRs related to donor breast milk, therefore, impeding the workflow for the nurses causing them to create workarounds. The health institution should re-engineer its processes by integrating EHRs in all its units and operations. This medium should be undertaken through a dynamic and iterative process. One of the most important issues about process reengineering is that not all steps in a process should be optimized. Some inefficiency should be designed into the workflow to improve the overall efficiency of the system. The Epic EHRs that has been introduced should be modified to enhance the quality of the outpatient clinical documentation (Skolnik, 2010). As such, all the components and prime quality scores should be remarkably improved. The critical elements that health care professionals should focus their attention on include chief complaints, history of present illness, physical findings, evaluations, and careplans. Since this health institution has poorly implemented its Epic electronic health record, it is still facing the challenge of low-quality scores on core elements. The electronic health records should have checkboxes to make it simpler for doctors and nurses to complete a comprehensive note.
How Real-World might Mirror the program-Related Evidence
The real world mirrors the program-related evidence in many ways. For instance, I have observed that integrating evidence-based real-world information into the care of patients necessitate having the correct information accessible at the right time. This correct time may include diagnostic procedures while providing care at the bedside of the patient or any specific point within a small period (Fowler et al., 2014). Nurses and physicians are often under pressure to attend to more patients within a short period (Silvia, Valerio & Lorenza, 2012). This medium is the precise problem that nurses are facing at Mercy Medical Center’s mother-baby unit, where they have many patients to attend to, but they spend at least 20 minutes with each patient. Nurses who are already experiencing pressure to see more patients in fewer periods would probably not look for information to inform their decisions when the search processes interrupt the flow of their work (Fowler et al., 2014). A mechanism to rectify this issue is to develop a clinical decision support system, which connects appropriate evidence-based data resources that can be retrieved straight from the EHRs (Fowler et al., 2014).
Fowler, S. A., Yaeger, L. H., Yu, F., Doerhoff, D., Schoening, P., & Kelly, B. (2014). Electronic health record: integrating evidence-based information at the point of clinical decision making. Journal of the Medical Library Association: JMLA, 102(1), 52. Doi: 10.3163/1536-5050.102.1.010
Skolnik, N. S. (Ed.). (2010). Electronic medical records: A practical guide for primary care. Springer Science & Business Media.
Silvia, B., Valerio, D., & Lorenza, G. (2012). The reflective journal: A tool for enhancing experience-based learning in nursing students in clinical practice. Journal of Nursing Education and Practice, 3(3), 102. Doi: https://doi.org/10.5430/jnep.v3n3p102
Practicum Journal Entry Week 8-11
The Observed Activities
The activities in week 8 involved a discussion of agendas about informatics in the Nursing informatics department that we were to present in the upcoming meetings. We attended the super-user clinical documentation meeting and took part in planning the Substance Use Screening and Brief Interventions meeting for the Labor/Delivery and Postpartum units. In the ninth week, I took part in auditing the patients’ charts to trace the inpatient nurses who have not been correlating standardized care plans to the patients’ diagnosis or primary problems upon admission. In week 10, I participated in the auditing of patients’ charts to track nurses who do not add standardized care plans to the patients’ diagnoses or primary problems. I also participated in the discussion about the best possible approaches to solve the situation, primarily through building an educational tool for the affected nurses so as they can be sufficiently educated on the matter. Through this approach, nurses who do not comply with the inpatient admission requirements in the affected departments will be held accountable for noncompliance.
Analysis of the Issue
There have been problems in the process of screening for substance use and brief interventions for the Labor and Postpartum units. Different challenges lead to this problem. The main ones include insufficient expertise and skills by some nurses in handling or operating the electronic equipment needed to accomplish this task, a large number of patients in these units, and noncompliance. The issue of poor understanding of the modern equipment that is required to be used for screening may appear simple, but some nurses are not sufficiently knowledgeable when it comes to operating this equipment (Clark, Raffray, Hendricks & Gagnon, 2016).
Consequently, such nurses may prefer to skip this step to avoid embarrassment by exposing their ignorance. This medium indicates that a good number of nurses are not sufficiently educated on standardized patients’ care plan documentation and need to be retrained more on the latest developments of health technology. Lack of enough knowledge on electronic systems such as the clinical decision support and other electronic health record (EHR), and noncompliance are also the main factors that make nurses fail to establish correlations between standardized care plans to patient diagnoses upon admission (Shin, Park & Kim, 2015). This issue calls for retraining and supervision to avoid such problems in the future.
How the Real World might Mirror or Diverge from Program-Related Evidence/Concepts
In clinical practice, the real world can uphold program-related concepts in many ways. These include: working with a patient-centered approach through avoiding cases of noncompliance. Healthcare providers also mirror program-related practice through constant training on the latest technologies that help to improve patient care. The regular training on health information technology ensures that nurses do not ignore crucial medical stages or processes due to insufficient knowledge or incompetence in handling electronic equipment (Clark et al., 2016). Nurses also mirror the program concepts through upholding ethical and moral values in their practice through treating all patients with dignity and respect irrespective of their cultural backgrounds and avoid negligence when handling patients. Nevertheless, there are some cases in which some nurses in some institutions are negligent possibly due to poor management policies, personal prejudices, or lack of sufficient training. Other ways through which nurses divert from what is required is through working without passion and ignoring their duties (Clark et al., 2016).
Clark, M., Raffray, M., Hendricks, K., & Gagnon, A. J. (2016). Global and public health core competencies for nursing education: a systematic review of essential competencies. Nurse education today, 40, 173-180. https://doi.org/10.1016/j.nedt.2016.02.026
Shin, S., Park, J. H., & Kim, J. H. (2015). Effectiveness of patient simulation in nursing education: meta-analysis. Nurse education today, 35(1), 176-182. https://doi.org/10.1016/j.nedt.2014.09.009