Competency Narrative Nursing Essay.

The first day of my pediatric clinical rotation had me feeling nervous. This was in response to being faced by a new clinical practice environment as I was transitioning from the adult medical-surgery department to the pediatric department. I had no prior experience working in this new department and the unique nature of the pediatric population made it such that I did not know what to expect. I tried to anticipate what to expect in the new practice environment and had many thoughts. Having worked in the clinical practice environment for a total of 141 hours as part of my learning experience, and been through different encounters with the preceptor, nurses, patients and other medical personnel and students, I expected that my relationship with these stakeholders would not be any different from my relationship with them in the other departments.Competency Narrative Nursing Essay.

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At the pediatric clinical, my first task entailed recognizing cold symptoms between older and younger children. I noted that older children exhibited a unique set of cold symptoms to include a stuffy nose, runny nose, watery eyes, nasal congestion, mild fever, and lack of appetite. Infants present similar symptoms in addition to reporting trouble sleeping, fussiness and poor feeding, as well as occasionally reporting vomiting and diarrhea. In addition, some of the children with colds reported other more serious complications to include ear/sinus infections, pneumonia, and throat infections. In fact, ear infection was the more common complication among children. Besides that, it was not uncommon for a child to report a cold even as other family members reported the same medical condition. For the patients who reported having a sore throat in the pediatric clinic, the first line of intervention that was supported by my preceptor was to have a rapid strep test conducted to determine whether the sore throat was caused by a strep infection or other germ strains and whether the treatment would require antibiotics.Competency Narrative Nursing Essay.

The recent events in the medical and global arena have caught up with health concerns, particularly for patients reporting cold symptoms in which case the added concern is Covid-19 infection as colds and Covid-19 have similar symptoms. Most parents are concerned that if their children report having a fever, cough, runny nose andsore throat, then they would bring the child in for a health assessment to determine whether he/she suffered from a common cold or Covid-19. In the pediatric clinic, one of the physicians (Dr. Qureshi) would typically be in the same shift as me and he would order both Covid-19 and strep throat tests for children with concerning combinations of symptoms for cold. In such cases, it was my responsibility to swab the child and entire family for the strep throat and Covid-19 laboratory tests. Even as the testing proceeded, some of the parents would ask if their children could go to school in which case the physician would advise that staying at home until the symptoms subsided was the best option instead of spreading the virus (whether a cold of Covid-19) to other members in the school community. On the occasion that Dr. Qureshi offered advice, he would recommend that the CDC guidelines be observed for social distancing, use of personal protective equipment (PPE), self-quarantine, and hand washing and sanitization for suspected cases and as a precaution.Competency Narrative Nursing Essay.

Other than colds and Covid-19 concerns, another significant concern among patients in the pediatric clinic was impetigo, a skin condition typically reported among children between two and five years of age. It is characterized by red solid bumps that are mildly swollen and itchy. The red bumps appear anywhere on the patient’s body, but most of them appear on the face, arms and legs. I can still vividly remember my first encounter with impetigo presenting on a patient in the clinic. I was unsure on whether to diagnose the condition as eczema or impetigo. However, my preceptor who was in the vicinity came into the room at the time I was in a dilemma, examined the bumps and declared that the patient had impetigo.Competency Narrative Nursing Essay. I was amazed that my preceptor was able to issue the diagnosis within a short time by simply examining the patient for a short while, and understood that his skills and experience had come into play. The preceptor helped me with informing the patient’s parents about the diagnosis and explained that impetigo is caused by bacteria (Group A beta-hemolytic streptococcus and Staphylococcus aureus). His explanation about the cause of the condition identified the cause of the bacterial infection as the skin getting cut, an insect bite or being in close contact with a person who has impetigo. The explanation also noted that the condition could easily spread in social settings, such as a daycare center where one child having the condition could easily spread it to other children. To treat the condition, the preceptor prescribed an OTC antibiotic cream/ointment (such as mupirocin) and care of the infected area to include cleaning the skill with mild soap and water before applying the cream, as well as ensuring that hands are washed before and after caring for impetigo. Apart from impetigo, another common skin condition among children was insect bites and stings from bees, mosquitoes and ants. For some of the children, insect bites and stings would cause a severe allergic reaction presenting as hives and rashes.Competency Narrative Nursing Essay.

Diagnosis: To catch a cold, a child must come in contact with someone who is infected with one of the cold viruses. The cold virus can be spread through the air from sneezing or coughing. Also, the virus can be spread by being in direct contact with infected surfaces such as toys. A diagnosis is established by evaluating subjective data and physical exam findings. I found that infection can easily spread within a family. Also, children are easily infection within social settings such as daycare centers. Additionally, symptoms for allergic rhinitis, acute bacterial sinusitis, influenza, bacterial pharyngitis and Covid-19 are similar. The differential diagnosis for impetigo was more difficult to determine with possibilities such as herpes simplex virus, insect bites and varicella.

Therapeutic Alliance/Culture:  Cultural sensitivity is my greatest challengein the delivery of nursing services or interactions with others, especially since I emigrated into the USA. Whether at school or work place, I see people from different countries, languages and background, for this reason I try as much as possible to be aware of the cultural differences and similarities. In other word, I try to put myself into the position of the persons I interact with so that I can see the world in their viewpoint.Competency Narrative Nursing Essay.

When I walked into a room, I would introduce myself to the parent and patient. In the introduction, I use the individual’s name in the conversations. I also make sure that the patient has privacy while I provide care. I actively listen to the patient and make sure I understand the patient and his/her parent’s concerns by restating what has been verbalized. I speak calmly and slowly in terms and vocabulary that they can understand while clarifying confusing points. I also maintainprofessional boundaries because of culture differences even as I recognize that some of the patients may need more therapeutic touch and some patients prefer no touching. I have improved by communication skills and competencies and feel I now listening more closely to patients. I find myself using more open-ended questions. So the experience, for me, has been very positive and rewarding.

Treatment: Psychopharmacology:  Regarding the treatment plan for colds, I explained to the patient and family there is no cure for the common cold. The treatment plan focuses on relieving the presented signs and symptoms. In my experiences with Dr. Qureshi, I noted that he usually told the parent whose baby was aged between 3 months to one-year-old to use a suction such as syringeto pull out the liquid out of the child’s nose. In addition, the parents would be advised touse saline nose drop (older children used a saline wash), keep the child hydrated and use a humidifier. Also, they would use a Tylenol if there was a fever. If the cold symptoms worsened or did not abate, then my preceptor would prescribe antibiotics treatment.Competency Narrative Nursing Essay.

For Covid-19 positive patients who had a cough and shortness of breath, I saw the preceptor prescribing Azithromycin, prednisone, and ProAir HFA inhaler, which is similar to the treatment for Asthma. The preceptor also advisedthe patient’s parent to follow up in 3 day or as needed.

For Impetigo treatment plan, Dr. Qureshi prescribed mupirocin 2% topical ointment. He would tell the patient’s parent to follow up in 5 days or 7 days.

Professional Role: Before addressing the treatment plan with the patient and their parents, I usually spoke with my preceptor and asked questions regarding what to watch out for the patient’s age. In this situation such as impetigo for a 10-year-old child the body image is a big concern. Thus, we will ask them to follow up in 5 days for reassessment the lesions. Dr. Qureshi would advise that the patient be referred to a dermatologist if the symptoms worsened or did not abate.Competency Narrative Nursing Essay.

Practice Inquiry CompetenciesTechnology: I used Davis’s Drug Guide application to check/look for the side effects, adverse effects, recommend dosing, and drug class. This is a great application that also shows the image of the drug and pronunciation. This is my go-to-app at work and is very user friendly.

Practice Inquiry CompetenciesTechnology:  My preceptor’soffice uses the NextGen Healthcare EHR in coordinating of care through patient engagement. He also uses Doxy.me telemedicine for E-visit. I think it’s not too difficult.  The outline is similar to NextGen Healthcare EHR. Both systems are user friendly and simple to use.Competency Narrative Nursing Essay.

Health Delivery System Competencies: I have been shadowing my preceptor for 141 hrs. I feel that I have created a preceptor-preceptee relationship. In addition, I trust that I have grown stronger over time. There are zero-stress environment learning with him. He sometime gives us scenarios about patient conditions and asks forpartial diagnosis with differentials to include treatment thus creating a good learning environment. In addition, he listens calmly before making suggestions on how to improve. Besides that, he treats all preceptees with respect and support, always open to questions and ready to offer advice and answer questions when required to do so.Competency Narrative Nursing Essay.

The first day of clinal for my pediatric clinical rotation I was feeling nervous. I felt like a new transition from adult med.surge to pediatric. I have had no experience in pediatric so I didn’t know what to expect. There were many different thoughts come through my mind. Today, I earn 141 hrs of pediatric clinical and every encounter with patients, the preceptor, nurses and other medical students has become soothing.At Pediatric clinical, I start to recognized the cold symptoms between older children and a baby. For example, older children show symptom of stuffy nose, runny nose, watery eyes, nasal congestion, mild fever, and lack of appetite.Competency Narrative Nursing Essay. Adding to those symptoms, for baby/infant symptoms includes trouble sleeping, fussiness, poor feeding, and occasionally vomiting and diarrhea. In addition, these children may have some complications such as ear/sinus infections, pneumonia, and throat infections. But mostly seen in the clinic is ear infection.  At the clinic, I see a lot of one family member ( child) in a household get a cold, the rest of the household also get a cold.In addition to cold symptom, patient complain of sore throat, my preceptor will order rapid strep testto help quickly see whether a child’s sore throat is caused by a strep infection vs. other germs that don’t require antibiotic treatment.In any event, parent is more concern about Covid-19 because it is hard for them to differentiates the symptoms of cold or Covid-19. They said that if their child has fever, cough, runny nose, soarthroat, they would bring the child to the clinic to confirm the symtomp of Covid or symptom of regular cold. In the clinic, Doctor Qureshi will test both for Covid-19 and strep throat. Certain day, I have to swab the entire family for Covid-19 test. Some parent want to know if their child can go to school, Doctor usually advise to stay home until the symptoms subsides, this to prevent the virus spreding to others. Adding to Dr. Qureshi advised, I suggest the patients and parent to follow the CDC recommendation such as frequency of hand washing with soap and water or hand sanitizer, cover mouth and nose with face mask, and practice social distancing.Competency Narrative Nursing Essay.

Impetigo is another skin diagnosis for children in this clinic, esp. children age 2 to 5. I see children came with the red solid bumps, mild swollen, and  itch.  The red bumps appear anywhere on their body, but they are more on the face, arms, and legs.I am still thinking is that Eczema or impetigo. Meanwhile my preceptor came into the room and said patient has “ impetigo” by looking at the bumps within a few second. The preceptor amazed me with his experienced and skilled. The preceptor told the parent that impetigo is caused by bacteria (Group A Group A beta-hemolytic streptococcus and Staphylococcus aureus).Competency Narrative Nursing Essay. He said that it can occur where the skin got cut, insect bite, or close contact with someone who has impetigo, especially in a daycare center. The preceptor prescribe his patients with OTC antibiotic cream/ointment such as mupirocin and teaching patients/family of patients about cleaning affected skin with mild soap and water before apply the ointment I added to patient and his parent to wash their hands before and after caring for impetigo.Another common skin diagnoses for children in the clinic are insect bite and stings such as bee, mosquitoes, ants,etc.  For some children, insect bites can cause a sever allergic reaction such as rash or hives which I see a lot in the clinic.Competency Narrative Nursing Essay.

Diagnosis:To catch a cold, a child must come in contact with someone who is infected with one of the cold viruses. The cold virus can be spread through the air from sneezing or cough; or by direct contact via toys that have been touches by infeted person with a cold. After obtaining the subjective data and physical exam findings, I found that patient get infected from one of family in the same household. However, the  most majority patient such as toddler get infected while they are in the day care.  The differential diagnoses of cold and Covid-19 could be vise versa. For example,  I considered alleric rhinitis, acute bacterial sinusitis, Influenza, bacterial pharyngitis, or Covid-19. The diferemntial for impetigo such as bullous impetigo, I think it is difficult to identify. In the differential diagnosis, I considered Herpes simplex virus, Insect bites, or Varicella.Competency Narrative Nursing Essay.

Therapeutic Alliance/Culture:Cultural sensitivity has been my biggest challeng since I arrived the United States. At school or work place, I see people from different countries, languages and background, for this reason I make sure and quite aware of both cultural differences and similarities.  In other word, I try to put myself into the shore of another person so that I can see the world in that person’s viewpoint.

When I walked to the room I introduce myself to the parent and patient.  I use his/her name while talking with him or her. I also make sure patient has privacy while I provide care. I actively listen to the patient and make sure I understand patient and their parent concern by restating what he/she verbalized. I speak calmly and slowly in term that they can understood. I also maintainprofessional boundaries because of culture differences. Some patient may need more therapeautic touch and some patients prefer no touching.  I think I find myself, maybe, listening more closely to patients now. I find myself using more open-ended questions. So the result, for me, was very positive and very rewarding.Competency Narrative Nursing Essay.

Treatment: Psychopharmacolog:  Regarding the treatment plan for cold symptom, I explained to the patient and family there is no cue for the commom cold. The treatment is focusing at relieving signs and symptoms.  Dr. Querashi usually told the parent whose baby age between 3 month to 1 yr old to use a suction such as syinge pull out the liquid out of the child’s nose, saline nose drop (older child use saline wash), staying hydrated and use humidifier. And using a Tylenol if there is a fever.  If cold symptoms becomes worse or does not go away, my preceptor may prescribed antibiotic. For Covid-19 positive and symptom with cough and shortness of breath, I saw preceptor often prescribe Azithromycin, prednisone, and ProAir HFA inhaler. which is similar to treatment for Asthma. The preceptor also told patient’s parent to follow up in 3 day or as needed.Competency Narrative Nursing Essay.

For Impetigo treatment plan, Dr. Qureshi prescribed mupirocin 2% topical ointment. He would tell patient’s parent to follow up in 5 days or 7 days.

Professional Role: Before addressing the treatment plan with patient and their parent, I usually speak and ask question with my preceptor regarding the patient age. In this situation such as impetigo for 10 yr old child. At this age, the body image is a big concern. Thus, we will ask them to follow up in 5 days for reassessment the leasions. Dr. Qureshi said that if patient symptom is not getting better, he will referral to dermatologist.Competency Narrative Nursing Essay.

Practice Inquiry CompetenciesTechnology: Using Davis’s Drug Guide app  to check/look for the side effect, adverse effect, recommend dosing, and drug class. This is a great App. It also shows the image of the drug and pronunciation. This is my go-to-app at work and very user friendly.

Practice Inquiry CompetenciesTechnology:My preceptor ‘soffice use the NextGen Healthcare EHR in coordinating of care through patient engagement. He also use Doxy.metelemedicine for E-visit. I think it’s not too difficult.  The outline is similar to NextGen Healthcare HER. Both systems are friendly user when you become familary with the system.

Health Delivery System Competencies: I have been shadowing my preceptor for 141 hrs., I feel that I am creating preceptor-preceptee relationship. Trust that I grew stronger over time. There are zero-stresss environment learning with him.  He sometime give us scenario about patient condition and asking potial diagnosing with differentials include treatment. He listen calmly, then make a suggestion. He is treating us with respect and support.  I actually said to him, please provide me a guidance and correction if I am needed. He said I can ask him any question as neededs.Competency Narrative Nursing Essay.