Journal Entries Week 1, 2, 3, 4
Journal Entries Week 1, 2, 3, 4
Journal Entry Week One
During this week, we met with my supervisor for one hour to discus about my objectives and goals of this project. In addition, it was during this week that I selected a nursing theory to guide my work through the entire project. During this week’s practicum experience, the Integrated Theory of Health Behavior Change (ITHBC) will be used to guide by clinical practice. The ITHBC theory posits that health behavior change can be improved through increasing self regulation skills and abilities, promoting knowledge and beliefs, and for the above all, improving social facilitation (Ryan, 2010).
Based on this theory, getting involved in self-management behaviors is viewed as a proximal outcome, which eventually affects long-term outcome for an enhanced health status. Individual-centered interventions emphasized in this theory are use solely to increase beliefs and knowledge, abilities, self-regulation skills, as well as, social facilitation skills (Ryan, 2009). This theory contend that people are more likely to practice recommended health behavior if they have adequate information on the required health behavior, as well as, are ready to embrace health beliefs that are consistent with the behavior (Ryan, 2009).
ITHBC theory asserts that beliefs and knowledge tremendously impact outcome expectancy, behavior-specific efficacy, and the goal congruence (Ryan, 2010). According to this theory, self-regulation is a mechanism used in changing health behavior and entails activities, such as self-monitoring and reflective thinking, goal setting, planning, as well as engaging in a specific behavior, decision making, self evaluation and management of emotional, physical, as well as, the cognitive responses linked to health behavior change. On the other hand, Social facilitation encompasses concepts of social support, social influence coupled with negotiated collaborations amid families, individual, and the healthcare professionals.
This theory is based on the assumption that behavior change is an iterative and a dynamic process, and that motivation and desire are precondition for change while self-reflection aid progress. Therefore, positive social influences an individual’s interest, as well as, his or her willingness the same way positive relationship supports and sustains change. Further, this theory asserts that person-centered interventions are efficacious compared to standardized interventions, in terms of encouraging health behavior change (Ryan, 2010). Moreover, the proponents of this theory hold that engagement in healthy behavior is an outcome capable of being realized in a proximal or short-term, and that engagement in health behavior affects, as well as, leads to enhanced health status, which constitutes the distal outcome realized over a given time frame (Ryan, 2010).
Goal and Objective
The goals and objective of this practicum activity will be as follows
- I will critically and coherently analyze strategies that can be put in place to positively influence behavior changes to ensure positive health outcome.
- I will b able to demonstrate learning, as well as, apply the ITHBC theory to foster positive health behavior in an individual.
- Collect, summarize, as well as, analyze data that are appropriate to the health issue addressed during the practicum experience.
- To analyze pertinent challenges that are thwarting effective implementation of the documented clinical practice guidelines, as well as, how theories can be use to influence changes in patient risk behaviors by the end of the practicum project.
- To constructively contribute in the design of the clinical information systems, which promotes quality, safe, and for the above all cost-effective means through utilizing modern technology to improve organizational safety, as well as, monitor health status of individuals.
- To efficaciously participate in, as well as, contribute to the public health by fostering positive behavioral change critical for ensuring positive health outcome.
- To effectively communicate both orally and in writing to ensure that health message is delivered appropriately.
- To coordinate health care with families, individual, communities, and groups across lifespan using communication skills while collaborating with health care team members.
Strengths and Weaknesses
My strengths are rooted on my superb communication and listening skills. According to Boykins and Carter (2012), effective communication both written and oral coupled with listening skills is critical for a nurse practitioner. Therefore, I strongly believe that my excellent ability to effectively communicate with the patients will enable me to probe my patients to get detailed information concerning their health status and to deliver the right prescription. In addition, I am a powerful critical thinker able to think critically to make sound decisions regarding health problems. The ability to think critically is critical for nurses who are always faced with pertinent choices often, and therefore, must be able to use their critical thinking skills to ensure sound decision making.
In addition, critical thinking skills would enable me to contribute in making health policies crucial for enhancing health care for members in the society. Moreover, I am always confident in anything I am undertaking. Being confident is critical for a nurse practitioner because it enables the practitioner to deliver best care. Another crucial strength is being adaptable. I am flexible, and therefore, able to adapt to the changing nursing environment. I believe that just like Doctors, Nurses also sometimes encounters situations that require them to be highly flexible if they are to deliver excellent services. For instance, nurses sometimes have to work with schedules that are fluctuating or for long hours. On the other hand, I have a problem with maintaining my cool because I am highly emotional. I need advice on how I can control my emotions to enable me provide excellent services.
Week 2 Journal Entry
Just like week one, this week was also highly interesting as I had the opportunity to apply my classroom discussion to my practicum setting. During this week, I examined the guidelines for detection of osteoporosis. Osteoporosis refers to a progressive bone disease, which is always characterized by a reduction in bone density and mass, and which increases the risk of fracture (Sinnesael, Boonen, Claessens, Gielen, & Vanderschueren, 2011). For individuals suffering from osteoporosis, the bone mineral density is greatly reduced. In addition, the level and variety of proteins in bone is greatly altered while bone micro-architecture deteriorates (Cotter et. al., 2011).
According to Watts et al., (2010), Osteoporosis is considered a growing health issue with impacts crossing social, medical, and economic lines. Watts further notes that their guidelines to osteoporosis was developed by the American Association of Clinical Endocrinologists (AACE) purposefully to reduce the risk associated with osteoporosis related fractures hence enhancing the quality of life led by the victims of osteoporosis. The importance of the AACE guidelines rests on the fact that they employ the latest updated scientific evidence taking into account the need for efficient and effectual treatment and evaluation, as well as, the economic impact of the disease.
The decision to conduct bone density assessment ought to be based on an individual’s skeletal risk assessment, as well as, fracture risk profile. The National Osteoporosis Foundation (2010) recommends testing all women who are aged 65 and above. The National Osteoporosis Foundation (NOF) also recommends testing men who are 70 years and above. Regarding the measures that can be taken to prevent bone loss, AACE (2010) recommends maintaining sufficient calcium intake, as well as, the use of calcium supplements where needed to attain the minimal required intake. Moreover, the AACE recommends maintaining sufficient vitamin D intake, as well as, supplementing it where necessary. This is done majorly to maintain the level of serum required for normal bone growth. It is also recommended that that an individual maintain and active lifestyle besides avoiding or completely stopping smoking. Limiting caffeine intake is also recommended.
Regarding the Nonpharmacologic measures for the treatment of Osteoporosis, AACE recommends use of proper body mechanics, maintenance of adequate protein intake, as well as, taking measures to reduce the risk associated with the risk of falling. AACE also recommends considering referrals for occupational and physical therapy. Concerning who needs to be screened for Osteoporosis, the AACE guidelines recommends women who are 65 years and above, as well as, younger postmenopausal women who are at an increased risk of fracture depending on the list of risk factors.
Concerning how Osteoporosis is diagnosed. AACE recommends using central dual-energy x-ray absorptiomety (DXA) measurement. This guidelines also show that Osteoporosis is defined as a T-score of -2.5 or below in the spine (Watts et al., 2010). The AACE also recommends evaluating Osteoporosis based on secondary osteoporosis and for prevalent vertebral fractures. According to National Osteoporosis Foundation (2010), there are plethora of interventions that can always be recommended for general population with the sole aim of reducing the risk of being diagnosed by osteoporosis, including lifelong engagement in regular weight-bearing, as well as, muscle strengthening exercises, adequate intake of vitamin D and calcium, identification and treatment of alcoholism, avoiding tobacco use, and treatment of other pertinent risk factors for fractures like impaired vision.
National Osteoporosis Foundation (2010) argues that provision of daily adequate vitamin D and calcium is not only safe, but also inexpensive way of reducing fractures risk. This is because several clinical trials conducted have shown that a combination of vitamin D and supplemental calcium is capable of reducing the risk of fracture. The aforementioned guidelines are extremely critical as they are often used in different clinical settings to provide clinical advice for the victims of Osteoporosis on how they can effectively manage the diseases. In addition, the guidelines are crucial for the general population because employing them help them to avoid attracting Osteoporosis.
Week 3 Journal Entry
During this week my schedule was extremely tight as several patients flocked in for visits. Reflecting on the patient I saw in my practicum setting experience who presented with symptoms of risk behavior (Obesity) (Farhat, Iannotti, & Simons-Morton, 2010). This patient by the name Fidel was 15years old American citizen. The self-determination theory was applied for the case of this patient. Obesity is majorly promoted with intake of foods that are rich in fat content implying that advising the victim on appropriate behaviors can help to prevent people from developing obesity. I strongly believe that Self-Determination Theory (SDT) of motivation is appropriate for this case since this theory plays an integral role in supporting individual’s intrinsic tendencies to behave not only in effective, but also in healthy ways. Therefore, utilization of this theory will help Fidel positive health behavior to reduce the negative health outcomes associated with obesity.
Within the construct of self-determination theory, personal autonomy role in the context of human agency is given primary attention as a feature of motivational quality. Motivation is examined in the context to which behavior or a given course of action is endorsed personally, as well as, engaged with a sense of volition and choice rather than being linked to the feelings of pressure or need to comply. Motivation as used in the self-determination theory is described as being regulated by either external contingency, such as expected negative consequences from the behavior or individuals internalized introjects, such as the need to maintain self-esteem.
Using the self-determination theory, the patient in question, Fidel was able to engage in healthy behavior that enabled him to personally control his behavior. Instead of being placed on medication, Fidel opted to engage in physical activities to reduce the level of fats in his body. Fidel was motivated by the mere fact that engaging in physical activity could help to reverse his obese condition. Fidel was then advised to consider coming back to the health center for follow-up on a weekly basis to ascertain how his body was reacting to physical exercises. The follow-up results showed that Fidel was gradually losing weight, and therefore, he together with medical practitioners was hopeful that his normal condition was going to resume soon. Fidel was further advised on the importance of a balance diet on avoiding such condition in the future. The importance of self-determination theory in helping individuals adopt positive behavior was evident in the case of Fidel as his engagement in positive behavioral activities helped him assume normal body weight.
Week 4 Journal Entry
This was another exhilarating week as engaged in conducting windshield surveys in my neighborhood where within the jurisdiction of my practicum setting. I conducted systematic observation of the community through walking around to assess the physical, social, political, and economic factors shaping the community. Miss Joan, aged 23 who had come to the health center was a drug addict (tobacco). Therefore, the patient had a long-history of drug (tobacco) addict that was threatening to cut short her precious life and was from the Hispanic population. The self-determination theory was used in this case to help Joan overcome his tobacco addict owing to the fact that too much smoking was almost costing her lungs. Self-determination model emphasizes on self-motivation as a tool that can be used to prompt an individual to make better choices regarding what is best, in terms of improving his or her own life.
Therefore, by using self-determination theory, Joan was advised to develop self-regulating mechanism to avoid spending time with friends who are smokers, avoid visiting areas where people are smoking, and to involve herself in activities that might prevent her from smoking whenever she fills like smoking. For instance, she could watch a movie with devastating effects of smoking as doing this could discourage her from engaging in smoking.
Boykins, A., & Carter, C. (2012). Interpersonal and Cross Cultural Communication for Advance Practice Registered Nurse Leaders. The Internet Journal of Advanced Nursing Practice. 11 (2).
Cotter M et. al (2011). “Human evolution and osteoporosis-related spinal fractures”. PLoS ONE 6 (10).
Farhat, T., Iannotti, R.J., Simons-Morton, B. (2010). Overweight, Obesity, Youth, and Health-Risk Behaviours, 38(3), 258–267.
National Osteoporosis Foundation (2010). Clinician’s Guide to Prevention and Treatment of Osteoporosis. Retrieved from http://ift.tt/2CbBLqI.
Ryan, P. (2009). Integrated Theory of Health Behavior Change. Clin Nurse Spec, 23(3), 161 172.
Ryan, P. (2010). Testing the Integrated Theory of Health Behavior Change for Postpartum Weight Management.
Sinnesael, M., Boonen, S., Claessens, F., Gielen, E., Vanderschueren, D. (2011). “Testosterone and the male skeleton: a dual mode of action”. Journal of Osteoporosis, doi:10.4061/2011/240328.
The Community Tool Box. (2013). Windshield and walking surveys. Retrieved fromhttp://ctb.ku.edu/en/tablecontents/chapter3-section21-main.aspx.
Watts et al., (2010). American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Postmenopausal Osteoporosis. Endocrine Practice, 16 (3).
The post Develop goals and objectives for the Practicum Experience in this course. Consider the Nurse Practitioner Core Competencies, as well as your personal strengths and weaknesses in terms of your Practicum Experiences (e.g., what have you done, what have you not done, where are your gaps, etc.).