Clinical Experience: Professional Capstone and Practicum Reflective Journal

For this capstone projects, I will provide a practicum reflection on DVT prevention during and after a major orthopedic surgical procedure. When identifying this project for my capstone project, I found DVT problem to be a major medical condition facing the healthcare outcome for patients with major surgical procedures. The patients susceptible for DVT include those with hip fractures (HFS), Total Knee Arthroplasty (TKA), and Total Hip Arthroplasty (Kurmiss, 2010). Establishing of evidence-based procedures is the best clinical approach to preventing and managing incidences of deep venous thrombosis (Florescu, Anastase, Munteanu, Stoica, & Antonescu, 2013). Again, I found this project useful because DVT incidences are life threatening after a major surgical procedure concerning orthopedic patients. From my literature search, I found that 60,000 to 100,000 Americans dies following the development of DVT (CDC, 2017). In the subsequent paragraphs, I will illustrate my clinical experience, knowledge, and skills that I gained through this project.

New practice approaches

In the clinical practice, the new practices that I experienced included three preventive measures namely primary preventive, physical, and preventive drug measures. All the above measures were being applied to reduce the chance of DVT. The primary preventive measures that I came across included; educating the patient on this condition, the required practice such as exercises, frequent turning of the body, and drinking plenty of water to mitigate dehydration. Regarding the physical measures, the new approaches that are used include venous pumps and pneumatic compression. The physical preventive measures are not suitable for patients with bleeding disorders. Lastly, the new practice combined the above measures with preventive drug strategies such as administration of unfractionated heparin. In the new practice approaches, the nurse applied primary precautions before administering the drug due to prevent excess bleeding when preventing DVT. Additionally, another strategic practice was close monitoring of the patient and applying the related departments for consultations such as laboratory and imaging (Zalpour & Hlaing, 2015).

Inter-professional collaboration

Regarding inter-professional collaboration, it was one of the effective strategies for achieving the better patient outcome. The clinical practice for major surgical patients involved a team of healthcare professional each with a distinct purpose. A team of nurses, doctors, laboratory technologists, pharmacist, and imaging technicians participated in the procedure. From this clinical approach, I realized the effectiveness of inter-professional collaboration. Nurses also played a paramount role in ensuring good communication among the team of healthcare professionals. The laboratory professionals also contributed significantly in the primary preventive measures by evaluating bleeding disorders, levels of Hb, and presence or absence of coagulation disorders. The drug prescription from the pharmacy professionals was another collaboration strategy including dose calculation when controlling excessive bleeding. Through teamwork practice for preventing DVT, all the professionals included in the team were helpful, and they played a significant role in patient outcomes. This approach reduced the stress experienced by nurses when managing major surgical procedures.

Ethical considerations

From the clinical practice concerning preventing DVT, I came across different ethical considerations that were followed to ensure the better patient outcome. One of the ethical considerations applied during the surgical procedures was the patient consent. Regarding the patient consent, the patient was informed about the procedure, and their decision was highly considered. Patient consent is a very significant ethical consideration before conducting any surgical procedure. Additionally, the relatives were also informed regarding the surgical procedure since it is a very critical procedure. Another ethical consideration that I experienced was patient safety. Ensuring patient safety is an effective procedure that is used to ensure the better clinical outcome. For the major surgical procedures, it was quite necessary to put all the safety procedures in place before beginning the procedure. Another ethical consideration regarding preventive measures used to prevent DVT included ensuring well preparedness. The surgical procedures involving an inter-professional collaboration approach ensured every department was prepared especially the laboratory regarding blood for transfusion.

Population health concerns

The population health concerns for this project concentrated on those patients at risk of having a DVT as a post-operative outcome. DVT is a risky medical problem that can be life-threatening. The surgical procedure is again quite expensive, and therefore a better patient outcome is ensured to promote the intended outcome. Preventive measures are therefore essential for the better patient outcome concerning this population. Additionally, this procedure is conducted for this population as the only intervention to save the life of the patient. In the clinical practice, I experienced the personal commitment required to ensure patient safety as well as better outcome following the surgical procedures. Some of the surgical procedures such as THA and TKA are accompanied by excessive bleeding which is managed through strategies such as blood transfusion (Malato, et al., 2015). Controlling the bleeding was a core concern in my capstone project. Additionally, this population has a potential of developing DVT when controlling the bleeding and therefore it required a personal commitment.

Role of technology in improving healthcare outcomes

Technology measures also allowed better patient outcome regarding the population that presented for major surgical procedures. The contribution of technology regarding this medical procedure involved communication and promoting inter-professional collaboration. Through technology, the teams involved in the preventive measures concerning DVT provided their services accordingly. The surgical procedures that I encountered such as THA and TKA, the machines used for carrying out these procedures were up to date with the current technology. Additionally, the contribution of EHR was highly significant for this medical procedure. Through the use of advanced EHR, all data essential for surgical procedures was easily accessible especially from the collaborating departments such as the laboratory and imaging departments. The EHR also provided the nurses with reminders concerning the treatment of these patients. Technology is the cornerstone of these complex procedures whereby, some image aided surgical procedures were facilitated by the application of advanced machines thus improving patient outcome.

Healthy Policy

In the major surgical procedures, healthy policies were highly applied in these medical interventions. The healthy policies involving this medical procedure included the provision of guidelines that were followed to make decisions and the necessary actions. Some of the encountered health policies include safety guidelines, ethical considerations, and code of conducts regarding the surgical procedures since it is a complex medical procedure. Another instance of health policy that I encountered during the capstone clinical practice is that which involved administration of opioids. Since the population of concern experienced chronic pain after the procedure, the administration of the strong painkillers was highly regulated to ensure better patient outcome and minimize healthcare irregularities. Additionally, other healthy policies included in this procedures included strict adherence to ethical practices such as ensuring patient safety and respect.

Leadership and economic models

In this capstone practicum, leadership is an essential aspect of achieving the patient outcome. Leadership strategies are intertwined with the safety strategies before carrying out the surgical procedures. Regarding the application of leadership strategies in promoting better patient outcome, the surgical procedure involved some various professionals from different departments. Coordinating is one of the leadership elements that were highly effective for ensuring there was a good patient outcome. Through the application of leadership skills, the expected outcomes were highly achievable. Regarding the economic models, they were intertwined with the healthy policy used in the main surgical procedures to acquire a better patient outcome. Additionally, some of the leadership models that were applied in the surgical procedures provided the involved professionals with the effective cooperation that promoted patient outcome. Leadership and economic models also provided good insights for decision making, planning and taking the necessary actions depending on the intervention outcome.

Health disparities

Patients undergoing major surgical procedures are among those disadvantaged patients with the burden of disease. From the capstone practicum to prevent DVT from taking place, I noted that these patients were at risk of death or experiencing suffering. Management of the Surgical also put their lives at risk of getting infected with nosocomial infections while in the hospital thus compromising their treatment outcome. Again, the population of concern is among the minority groups seeking healthcare services. The population is again vulnerable regarding the chances of survival. In the capstone practicum, the strategies discussed above which included inter-professional collaboration and the new practice approaches were used to decrease the health disparities experienced by this specific group of patient. Additionally, this group of patients scheduled for THA, TKA, and back surgeries require expensive procedures for them to get well thus disadvantaging those without medical insurances.

In conclusion, the clinical experience had a wide scope of study although the experiences were related and had essential contributions in achieving better patient outcomes. From the capstone practicum, it was quite a helpful experience that exposes one to the real practice regarding managing the complex medical conditions for nurses.

References

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Florescu, C., Anastase, D., Munteanu, A., Stoica, C., & Antonescu, D. (2013). Venous

Thromboembolism Following Major Orthopedic Surgery. Medica, 8 (2), 189-194.

Kurmsis, A. (2010). Thromboprophylaxis after Total Hip Replacement . Journal of Orthopedic

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Malato, A., Dentalli, F., Siragusa, S., Fabbiano, F., Kagoma, F., Boddi, M., & Peris, A. (2015).

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