D224 Final Field Experience Log: Patient Care & Education Summary

Student Name

Western Governors University

D224 Global and Population Health

Prof. Name:

Date

Description of Field Activity on January 25, 2024

During a 10-hour clinical shift, I, a BSN student, shadowed a BSN-prepared nurse preceptor at an outpatient clinic. The day was marked by numerous patient interactions where the preceptor demonstrated essential nursing roles, particularly in education, collaboration, communication, referrals, and resource allocation—all aimed at promoting patient care and wellness.

The preceptor provided care to over 20 patients, administering influenza (flu) vaccines and ensuring safety through a vaccination screening checklist for each patient. Beyond administering shots, the preceptor engaged in patient education about the importance of flu vaccination, highlighting its role in reducing the risk of illness, hospitalization, and death related to influenza. This educational interaction significantly increased patient acceptance of the vaccine.

Additionally, the preceptor conducted focused assessments, such as reviewing blood pressure logs brought by patients. For example, two male patients aged 52 and 56 had blood pressure readings ranging from 120/70 to 137/90 mmHg. The preceptor collaborated with the physician to review these readings and facilitated referrals for laboratory tests and electrocardiograms. Patients were educated on hypertension risks—including retinal damage, stroke, and kidney failure—and advised on lifestyle modifications like exercise, weight management, and sodium reduction. Prescriptions were called in or verified via pharmacy contacts, and the preceptor managed incoming patient calls, offering health and medication guidance.

How Does the Nurse’s Role Promote the Sphere of Care?

Nursing Activity	Sphere of Care	Rationale
Flu vaccine administration	Wellness and Disease Prevention	Vaccination prevents serious flu complications, reduces hospitalization, and lowers mortality rates (CDC, 2023).
Patient education on hypertension	Wellness and Disease Prevention	Education and lifestyle advice help patients manage blood pressure, preventing cardiovascular complications.
Blood pressure monitoring & referrals	Wellness and Disease Prevention	Early detection and lab testing prevent progression of hypertension-related illnesses.
Prescription management	Wellness and Disease Prevention	Ensures timely medication access, supporting disease management and patient safety.
Communication and patient support	Wellness and Disease Prevention	Provides necessary information and reassurance, enhancing adherence and outcomes.

The nurse’s administration of flu vaccines directly contributes to disease prevention by immunizing individuals against a potentially deadly virus. Likewise, managing hypertension through assessments, referrals, and education is critical to reducing cardiovascular disease risks. Timely communication and coordination with physicians and pharmacies ensure continuity of care, demonstrating the nurse’s integral role in promoting wellness and preventive health.

Description of Field Activity on January 26, 2024

On this 10-hour shift, I observed the BSN preceptor closely review patient charts and lab results at the start of the day, coordinating with the clinic physician to address necessary interventions and referrals. Many patients were stroke survivors, ranging in age from 37 to 70, most experiencing unilateral weakness.

One patient, a 67-year-old man, presented with new mild headaches and muscle spasms on his weak side. The preceptor shared his lab finding of hyponatremia (sodium 131 mEq/L) with the physician, who ordered discontinuation of Lasix and prescribed Robaxin for muscle spasms. The preceptor educated the patient on medication changes and scheduled follow-up appointments.

Another patient, a 45-year-old male with iron deficiency anemia, reported difficulty swallowing his iron supplement. The preceptor advocated for changing the medication to liquid form, secured a new prescription, contacted the pharmacy, and educated the patient on a nutrient-rich diet. A referral to a dietitian was also arranged.

Additionally, a 63-year-old traumatic brain injury patient required assistance with health insurance changes to maintain ongoing care. The preceptor collaborated with a social worker to support the patient through necessary paperwork and ensure continuity of rehabilitation.

The preceptor also provided fall prevention education to stroke patients and their caregivers, emphasizing the use of assistive devices, home safety modifications, and signs that require physician notification. Each patient received a stroke guide pamphlet to reinforce education.

How Are These Nursing Activities Related to the Sphere of Care?

Nursing Activity	Sphere of Care	Rationale
Focused assessment and lab review	Regenerative/Restorative	Early detection and intervention optimize recovery and prevent complications in stroke patients.
Medication advocacy and education	Regenerative/Restorative	Ensuring medication compliance supports oxygen transport and prevents anemia-related complications.
Insurance assistance through social work	Regenerative/Restorative	Continuity of care during insurance transitions prevents health deterioration and supports rehabilitation.
Fall prevention education and referrals	Regenerative/Restorative	Education on safety reduces injury risk and promotes patient independence during recovery.

The preceptor’s activities focused on restorative care, aiming to maximize patient recovery and prevent further health declines. Coordinating care, managing medications, and addressing social determinants like insurance support are critical nursing roles in regenerative care.

Description of Field Activity on January 30, 2024

During a 9-hour shift, I shadowed the BSN preceptor who began the day attending an Interdisciplinary Team (IDT) meeting. The preceptor advocated for modifications in patient care plans, emphasizing the need for more therapy time to allow for comprehensive patient education on medication and lifestyle changes. Family members supported these changes.

Throughout the shift, the preceptor administered COVID-19 booster and flu vaccines, providing safety pamphlets and patient education on vaccine benefits.

A critical incident involved a patient exhibiting hypoglycemia (blood glucose 66 mg/dL) with no history of diabetes. The preceptor promptly implemented hypoglycemia protocols, stabilized the patient, and coordinated referrals for food assistance through the North Texas Food Bank and Temporary Assistance for Needy Families. The physician was notified, and lab orders were placed for HbA1c testing.

The preceptor also provided smoking cessation education to patients, discussing risks like lung cancer and emphysema. A nicotine patch prescription was offered and accepted by one patient.

Colon cancer screenings were performed on four patients over 60 years old using Cologuard kits. The preceptor explained the importance of early detection and collected stool samples for lab analysis.

Connection of Nursing Activities to the Sphere of Care

Nursing Activity	Sphere of Care	Rationale
IDT meeting participation and advocacy	Wellness	Adjusting care plans ensures patients receive needed education, improving disease prevention and management.
Vaccine administration and education	Wellness and Disease Prevention	Immunizations prevent illness from rapidly mutating viruses like influenza and COVID-19.
Hypoglycemia management and referrals	Wellness and Disease Prevention	Early intervention and resource referrals address underlying causes, preventing complications and promoting health.
Smoking cessation education	Wellness and Disease Prevention	Educating patients on smoking risks supports prevention of chronic diseases and cancer.
Colon cancer screening	Wellness and Disease Prevention	Early screening improves treatment outcomes for colorectal cancer, a leading cause of morbidity in older adults.

These activities highlight the nurse’s vital role in promoting wellness through prevention, education, and timely interventions, thereby enhancing patient outcomes and quality of life.

References

Centers for Disease Control and Prevention. (2023). Influenza (flu). https://www.cdc.gov/flu/index.htm

National Heart, Lung, and Blood Institute. (2022). High blood pressure (hypertension). https://www.nhlbi.nih.gov/health-topics/high-blood-pressure

American Stroke Association. (2023). Stroke recovery and rehabilitation. https://www.stroke.org/en/about-stroke/recovery