Peer Response – Clinical Rotation
Response 2
Hello Krizelle,
Thank you for the comprehensive and informative post on the clinical rotation experience at Adoracion A. Reyes, MD, in Long Beach, California. The description of the specific patient population and the nature of the diseases they present with offers a useful background for approaching the healthcare problem in a low-income setting. As for medication and treatment compliance, it is also important to discuss compliance in relation to more varied approaches. Another approach is patient education programs, where patients are encouraged to follow doctors’ recommendations strictly. Informing patients on the consequences of non-adherence can improve the knowledge and support for health care plans, as explained by Thummak et al. (2023). Furthermore, there is a possibility of using mHealth technology to send reminders of appointments and medication compliance, which will enhance the results.
Meeting the issue of limited insurance access is crucial. Engaging in policy advocacy to fight for increased health coverage and actively partnering with local establishments to assist the uninsured patient population can go a long way. Community health worker programs, where qualified personnel help patients find their way through the medical world, have been effective in increasing the quality of life of the needy population (Knowles et al., 2023). Chronic disorders like cardiovascular illness, diabetes, hyperlipidemia, and obesity, therefore, require an integrated approach. Lifestyle changes like diet and exercise in combination with medications can improve patients’ status, as Wadden et al. (2020) have pointed out. MI techniques have been employed in the treatment of chronic illnesses.
Moreover, identifying new guidelines and research related to pharmacological treatments is important. The American Heart Association and the American Diabetes Association revise clinical practice guidelines based on new evidence-based practices. Rabizadeh et al. (2019) provide a comprehensive review of the use of SGLT2 inhibitors like Jardiance in glycemic management, CV, and renal protection. Notably, staying current with these advances can be useful in clinical practice and benefit patient outcomes.
References
Knowles, M., Crowley, A. P., Vasan, A., & Kangovi, S. (2023). Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States. Annual Review of Public Health, 44(1), 363–381. https://doi.org/10.1146/annurev-publhealth-071521-031648
Rabizadeh, S., Nakhjavani, M., & Esteghamati, A. (2019). Cardiovascular and renal benefits of SGLT2 inhibitors: A narrative review. International Journal of Endocrinology and Metabolism, In Press(In Press). https://doi.org/10.5812/ijem.84353
Thummak, S., Uppor, W., & Wannarit, L.-O. (2023). Patient compliance: A concept analysis. Belitung Nursing Journal, 9(5), 421–427. https://doi.org/10.33546/bnj.2807
Wadden, T. A., Tronieri, J. S., & Butryn, M. L. (2020). Lifestyle modification approaches for the treatment of obesity in adults. American Psychologist, 75(2), 235–251. https://doi.org/10.1037/amp0000517
Response 2
Hello Ijaz,
Thank you for sharing your post on the clinical rotation at Cascade Family Practice Clinic in Portland, Oregon. Cultural competence is essential in healthcare due to the patients’ diverse backgrounds. Engaging interpreter services, providing culturally appropriate patient education, and educating the employees on cultural sensitivity would enhance communication and patient care. Conditions such as hypertension, diabetes, and arthritis need to be managed in a team-based model. Depending on the patient, care teams may involve dietitians, physical therapists, and mental health specialists. The incorporation of behavioral health in the primary care setting can help manage the psychological component of chronic illnesses (Staab et al., 2021).
The focus on patient education and self-management is quite laudable. Promoting engagement in self-management strategies and support groups enables patients to play an active role in the management of their condition. The given literature points to self-management education as an effective intervention that enhances health and decreases healthcare use in chronic diseases (Allegrante et al., 2019). Technologies like telehealth and remote monitoring can improve patient communication and follow-up care beyond clinic appointments.
It is crucial to follow the new recommendations and adhere to the best practices for the treatment of chronic diseases. The Journal of the American Association of Nurse Practitioners and the Journal of the American College of Cardiology are helpful. Newer developments in the management of cardiovascular diseases focus on lifestyle changes and newer pharmacological interventions for hyperlipidemia, including PCSK9 inhibitors (Kosmas et al., 2020).
Knowledge of SES factors is important because it helps in explaining health inequalities. The integration of social determinants of health inpatient evaluations and the care management process offers a more holistic approach to managing chronic illnesses. Understanding and addressing these determinants, lobbying for the right policies, and engaging with community-based organizations can greatly influence patient outcomes.
References
Allegrante, J. P., Wells, M. T., & Peterson, J. C. (2019). Interventions to support behavioral self-management of chronic diseases. Annual Review of Public Health, 40(1), 127–146. https://doi.org/10.1146/annurev-publhealth-040218-044008
Kosmas, C. E., Skavdis, A., Sourlas, A., Papakonstantinou, E. J., Peña Genao, E., Echavarria Uceta, R., & Guzman, E. (2020). Safety and tolerability of PCSK9 inhibitors: Current insights. Clinical Pharmacology: Advances and Applications, 12(24), 191–202. https://doi.org/10.2147/CPAA.S288831
Staab, E. M., Wan, W., Li, M., Quinn, M. T., Campbell, A., Gedeon, S., Schaefer, C. T., & Laiteerapong, N. (2021). Integration of primary care and behavioral health services in midwestern community health centers: A mixed methods study. Families, Systems, & Health, 34(21). https://doi.org/10.1037/fsh0000660
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PEER RESPONSE 1:
My clinical rotation will be at Long Beach, California and the clinical site is Adoracion A. Reyes MD. The clinical site location is in a low-income area of Long Beach and the patient demographics mostly consist of Hispanics but also White, Black, and Asian populations. I previously have done clinical rotations at this site for both FNP 572 and FNP 574 so I am familiar with working with this set of patient demographics. Common issues I encounter at this clinic are lack of medication and treatment compliance, lack of insurance access, and chronic conditions such as cardiovascular disease, diabetes, hyperlipidemia, and obesity. This clinic’s role in the community is to provide affordable healthcare for the underserved and low-income community of Long Beach.
My learning goals and interests regarding chronic care treatment are to continue learning how to decide which pharmacological management is best depending on the patient’s co-morbidities. During the past clinical rotation, I have learned that Jardiance is the medication of choice for patients with type 2 diabetes mellitus and chronic kidney disease. I plan to hopefully learn more about new pharmacological interventions that can be useful in managing patients with multiple co-morbidities. Two primary care provider-appropriate journals known for U.S. practice guidelines include the American Heart Association and the American Diabetes Association. The American Heart Association has a clinical practice guideline on the primary prevention of cardiovascular disease and discusses key elements such as statin therapy, aspirin use, and lifestyle changes (Arnett et al., 2019). The American Diabetes Association has a clinical practice guideline on the classification and diagnosis of diabetes and discusses the various forms of diabetes such as type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes, and diabetes secondary to other diseases (ElSayed et al., 2023).
PEER RESPONSE 2:
Clinical rotations are an essential element of training for prospective nurse practitioners (NPs). According to MacDonald et al. (2021), clinical rotations provide nurse practitioner (NP) students with the opportunity to apply their academic knowledge, gain practical experience, and refine their clinical skills. To develop proficiency and transition from being a registered nurse (RN) to a nurse practitioner (NP), these rotations are necessary. Overall, there was an increase in student satisfaction in several key categories. It would be particularly beneficial to comprehend the impact of these variances on students’ skills and self-assurance throughout their clinical rotations and when they start working, considering the wide diversity in training programs for nurse practitioner students. Overall, these clinical rotations are quite beneficial for students to gain practical experience in a clinical setting (MacDonald et al., 2021).
Clinical Rotation Setting: I am presently completing my clinical rotations at the Cascade Family Practice Clinic in Portland, Oregon. This healthcare facility is essential for the local health system and the local community, as it provides services to a diverse population. This clinic is in the region and offers services to both insured and underinsured patients. Patient demographics at Cascade Family Practice are diverse, encompassing individuals of all ages, ethnicities, and socioeconomic backgrounds. This is a learning opportunity and a challenge to interact with individuals from a variety of backgrounds, languages, and ethnicities. The Cascade Family Health Clinic is the primary point of contact for non-emergency medical concerns. It ensures that its patients receive comprehensive and coordinated care by collaborating with local hospitals, specialists, and community resources. Numerous providers in this region effectively manage chronic conditions, including hypertension, diabetes, and arthritis. Patients with acute or chronic conditions necessitating a higher level of care are referred to local hospitals and specialists. Additionally, the healthcare settings in question are not equipped to conduct sophisticated tests. These settings are referred to as Legacy and Kaiser health care systems, which are situated in the same region.
Common Issues and Chronic Conditions: The clinic often deals with prevalent health conditions, including respiratory infections, minor injuries, and preventative care. The patient population commonly has chronic illnesses such as hypertension, diabetes, constipation, and arthritis-related chronic pain. Additionally, there are smaller operations available, such as basics stitching. These disorders frequently need continuous monitoring and coordination of care between the primary care doctors and specialists.
Community Referral for Chronic Care: The Cascade Family Practice Clinic maintains robust referral networks with area specialists, hospitals, and mental health care facilities in order to provide community people who are looking for specialized treatment for chronic diseases with access to that care. Furthermore, patients are encouraged to participate in community health programs and support groups that are centered on certain chronic diseases at health care settings that are part of the Cascade system. A few patients are referred to the Legacy health care system, the Providence health care system, and the Kaiser health care settings, all of which have a very large network.
Learning Goals and any Apprehensions: Throughout this rotation, my objective is to enhance my knowledge in managing chronic illnesses within a primary care setting, refine my communication and collaboration abilities with patients, and stay updated on the latest guidelines for effectively managing chronic diseases. I am very captivated by the all-encompassing strategy in healthcare and patient education that promotes self-management. I aim to acquire essential proficiencies during my practicum. A crucial skill for generating differential diagnoses is the ability to conduct comprehensive patient assessments that take into account both psychological and physiological aspects. Alawani et al. (2022) state that a precise diagnosis and a positive rapport with the patient may be achieved by employing conventional techniques such as obtaining a medical history and conducting a physical examination. Nevertheless, the physical examination remains a crucial instrument for cardiologists to possess. Given the high accuracy of physical tests in distinguishing between normal and diseased hearts, it may be feasible to reduce the unnecessary use of echocardiograms in busy outpatient settings. This would result in a reduction of healthcare expenses. Another effective method for assessing cardiac conditions is to conduct a comprehensive physical examination. This is particularly advantageous in family medical practices where ultrasonography may not always be accessible (Alawani et al., 2022). One concern I have is ensuring efficient allocation of time and priority of treatment, particularly when treating patients with various chronic diseases. Furthermore, I want to improve my expertise in effectively utilizing electronic health records to optimize the coordination of patient care.
Topics of Interest: I am especially intrigued by investigating novel methods for making changes to one’s lifestyle and developing tactics to actively include patients in the management of chronic diseases. Furthermore, I am highly interested in comprehending the influence of socioeconomic determinants of health on the frequency and control of chronic illnesses in our group of patients. Álvarez-Gálvez et al. (2023) assert that the distribution of chronicity and health inequities is influenced by socioeconomic variables. Similar to infectious diseases, social and economic disparities across populations also influence non-communicable diseases (risk behaviors, lifestyle choices, educational attainment, and economic hardship, among other factors). While the specialist literature clearly identifies the negative effects of social inequality on health, the pattern of relationship between the many chronic illnesses that comprise multimorbidity and their corresponding social and behavioral causes is less evident. even though social and health policies may most readily address these problems. According to recent research, social and economic variables that influence the early start of chronicity and consequent multimorbidity among disadvantaged social groups are substantially correlated with multimorbidity (Álvarez-Gálvez et al., 2023).
Recommended Journals:
- Journal of the American Association of Nurse Practitioners
MacDonald, B., Floyd, O., Dowd-Green, C., Bertram, A., Fingerhood, M., Sharps, P., & Stewart, R. W. (2021). Measuring the contribution of clinical rotations to skills confidence in primary care nurse practitioner students. Journal of the American Association of Nurse Practitioners, 33(12), 1247–1253. https://doi.org/10.1097/jxx.0000000000000562
- Journal of the American College of Cardiology
Wang, A., Green, J. B., Halperin, J. L., & Piccini, J. P. (2019). Atrial fibrillation and diabetes mellitus. Journal of the American College of Cardiology, 74(8), 1107–1115. https://doi.org/10.1016/j.jacc.2019.07.020
- American Journal of Cardiovascular Drugs
Sheikh-Taha, M. (2024). The use of drugs that should be avoided or used with caution in patients hospitalized for acute decompensated heart failure. American Journal of Cardiovascular Drugs. https://doi.org/10.1007/s40256-024-00663-3
These journals are reliable sources of U.S. practice guidelines and high-quality research papers that are relevant to the nurse practitioner’s area of practice in primary care.
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