Reflection on Virtual Patient Encounter: Strategies for Improvement, Assignments of Nursing

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Week 2 iHuman Assignment Reflection Worksheet

Julia Elaine Miller

Chamberlain University College of Nursing

NR 509: Advanced Physical Assessment

Dr. Pierce

November 12, 2023

Week 2 iHuman Assignment Reflection Worksheet

Please read the assignment guidelines and rubric. Respond substantively to each self-reflection

question below. Write on this template.

A. Assess your ability to gather information on your client within the iHuman Virtual

Patient Encounter.

1. Use the iHuman score sheet to review your results for the focused health history

and focused physical exam. How did you perform?

Based on the iHuman score sheet, I did much better the second time practicing with the virtual patient after reviewing my mistakes from the first visit. Regarding the health history assessment, 50 questions were asked, 21 were correct, and 0 were missed relative to the list. Regarding the physical examination, out of 65 exams performed, 9 were correct, 1 was partially correct, and none were missed relative to the case’s list. I was able to establish an organized assessment using the OLD CART acronym within the program and list key findings of subjective data while interviewing the patient. Videos that were made available before my first attempt were very helpful and gave me a little confidence. I feel prepared to engage with our next virtual patient and plan to narrow questions down a bit as well as use a more focused physical assessment.

2. What did you find easy or difficult about navigating through the focused health

history and focused physical exam sections of the case?

A challenge that I face is asking questions that focus on the chief complaint and ensuring that I provide a thorough assessment for my patient. It is difficult to switch back and forth to the EHR, but at the same time, being able to do so is quite helpful. The physical exam gives many different systems to assess, and I found myself clicking on the “assess fetal heart tones”, not once… but twice. By the time I reached that assessment option, I just clicked on it, not really thinking. The physical assessment was easier to navigate through than the focused health history assessment in my opinion.

3. Describe one strategy to improve your performance in the next Virtual Patient

Encounter.

I plan to improve my performance in the next Virtual Patient Encounter by staying focused on the patient’s chief complaint. Questions asked when completing a focused health history should be directed toward the chief complaint. Patient answers should then be used to collect data that can guide the

C. Assess your performance in determining key findings and reviewing the most significant

active problem.

1. What did you find easy or difficult about navigating through the key findings and

organization section of the case?

The key findings section was helpful to use for organizing findings throughout the case. Once I gathered information on how to use the key findings section to list priorities correctly, I was able to gather and record the patient’s thoughts and answers in real time. This helps to decrease errors and ensure higher quality care.

2. How did your key findings compare with the expert’s findings?

My key findings were not in correct order regarding priority and there were several more compared to the expert’s findings. This helped me to understand how to narrow down questions and concerns that need to be addressed during the focused health history assessment. During my second attempt, I recorded fewer key findings and detailed the patient’s complaints rather than a wide range of subjective data.

3. Describe one strategy to improve your performance in the next Virtual Patient

Encounter.

During the next Virtual Patient Encounter, I plan to handwrite all findings and then record them in the key findings section. Organizing the information in a manner that helps me to prioritize findings is key to my success and my patient’s care. Multiple headings may be used to label different body systems and then I will list the key findings under those headings. Once completed, I will transfer the information to the key findings with the virtual encounter and hope this will help me to not miss any pertinent information.

D. Assess your performance in creating and documenting a problem statement within the

iHuman case.

1. What did you find easy or difficult about creating the problem statement?

Creating the problem statement was not a difficulty task and I was able to use information from modules in class to develop one. Also, the information provided by the patient helps to guide the provider when writing the problem statement. Data collected during the focused health history and physical assessments should be used to create a thorough but rather short problem statement (Bickley, 2020).

2. How did your problem statement compare with the expert’s response provided?

My problem statement is longer and more detailed than the expert’s response. I did not use the same terminology as the expert and my information was written in a different order. However, I feel that I completed the problem statement accurately but also very glad to have an expert’s response to compare with. According to Oyeleye (2019), documentation is the clinician’s responsibility and should be complete, accurate, easily read and understood, and written within a timely manner.

3. Describe one strategy to improve your performance in the next Virtual Patient

Encounter.

One strategy to help me improve my performance in the next encounter is to read more problem statements. Understanding how they are developed by different clinicians is important because we all do things differently. I want to learn how to use terminology more appropriately so that I may shorten the problem statement and use my time more efficiently. On the other hand, I do not want to make a habit of not recording pertinent information. The problem statement should justify your management plan and diagnosis (Bickley, 2020).

E. Assess your performance in creating and documenting a management plan within the

iHuman case.

1. What did you find easy or difficult about creating the management plan?

The management plan was created using the problem statement and research obtained from the Centers for Disease Control and Prevention (CDC) on how to treat the flu. Information from the patient’s previous visit also helped me to create the plan and discharge information. Using the problem

References

Bickley, L. S. (2020). Bates' guide to physical examination and history taking (13th ed.). Wolters

Kluwer Health.

Oyeleye, O. A. (2019). Examining board discipline of nurse practitioners for medical records

infraction s, 15 (9), 613-617. https://doi.org/10.1016/j.nurpra.2019.06.009.