Running head: POST CLINICAL REFLECTION 1

Post Clinical Reflection

Erika M. Payne

University of Tennessee at Chattanooga

After completing several courses in the Family Nurse Practitioner program, it was

exciting to start applying knowledge and skills in the clinical setting with the start of practicum.

Prior to the start of clinical, I identified some personal weaknesses associated with caring for the

pediatric population. My knowledge of growth and development was minimal. I was ignorant

about red flags associated with the growth and development milestones and appropriate

anticipatory guidance for each age group. This created a lack of confidence when caring for the

pediatric population. I was fearful that I may not know the answer when parents ask me

questions regarding the development of their child or ask, "Is that normal?"

It can be much more challenging to complete a comprehensive assessment on a child

compared to an adult. Children are often unfamiliar with the clinical setting and are uneasy with

a stranger in their personal space and trying to touch them. Depending on the age, pediatric

patients may not be able to tell you what is wrong, therefore, you have to ask lots of questions to

the caregiver and complete a thorough assessment. I learned techniques from my preceptor, such

as multitasking body system exams and distracting the child, to make my physical examination

more efficient. Overall, the pediatric clinical exposed me to numerous conditions and treatment

plans which significantly expanded my knowledge and skills.

Transitioning from being a staff nurse to the role of a nurse practitioner can be

challenging. It can be difficult to delegate tasks to a medical office assistant or nurse because

they are tasks that I am fully capable of completing such as vital signs, giving medications, or

obtaining lab work. Learning to delegate tasks to others while working as a team is critical to

provide patients with the best quality care. During my first clinical rotation, I began to adjust to a

new level of autonomy in which I am the heath care provider that is making decisions about what

lab work to order or medications to prescribe. This is exciting, but I recognized that I have much
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more to learn and further clinical rotations will improve my confidence in assessments, treatment

plans, and decision making.

I developed three goals for my pediatric clinical rotation that aligned with the pediatric

course learning outcomes and The National Organization of Nurse Practitioner Faculties

(NONPF) Core Competencies. My first goal was to increase my knowledge of the caregiver role

in providing health care for children. It was very evident that all caregivers, whether it was the

mother, father, grandparents, aunt, or foster parent, play a critical role in the health of the child.

The child is dependent on caregivers to learn, establish healthy routines, have access to

resources, and be taken to health care appointments.

It was clear that children observe and learn habits from their caregivers. Some children

reported drinking soda regularly because they saw their mother doing this. Others reported that

they did not eat fruit or vegetables because they were not available in the home. During well

child examinations, we asked children if they were brushing their teeth twice a day. They often

reported “no”, despite having a toothbrush and toothpaste at home. We provided education to

both the child and the caregiver on the importance of brushing their teeth twice a day. As health

care providers, we rely on caregivers to reinforce healthy behaviors at home.

The most frustrating issue I encountered regarding caregivers was that some would not

understand the importance of attending specialty office visits. For example, we had a child that

was exhibiting significant signs of autism, so we arranged an appointment with a behavioral

health office for further evaluation. This visit would facilitate diagnosis and treatment plans.

Unfortunately, the mother missed this appointment and did not notify the provider for over 9

months. This lead to the child not receiving appropriate care and can result in negative health

outcomes. Furthermore, I achieved my goal during the clinical rotation as I was incredibly
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enlightened about the critical role the caregiver plays in providing health care for children. As a

health care provider, this semester really taught me to recognize the family as a whole and

provide a treatment plan that is realistic.

My second goal was to utilize evidence-based practice guidelines to guide my practice.

This goal aligned with The National Organization of Nurse Practitioner Faculties (NONPF) Core

Competencies. As a nurse practitioner student, I am continuously learning about guidelines for

conditions such as otitis media and streptococcal pharyngitis. We treated these conditions

frequently throughout this semester, so I have become more comfortable with the diagnostics and

treatment plans. However, we encountered some conditions that we were unfamiliar with and

had to utilized reputable databases, such as UpToDate, to learn about guidelines. I spent some of

my own time looking up the most current research and evidence-based guidelines for conditions.

I met my second goal during the pediatric clinical this semester.

The last goal for the semester was to focus on health promotion and prevention during

each patient visit. This goal was definitely accomplished during this semester. During all well

child examinations, we discussed several aspects of anticipatory guidance for each age group.

Education included safety, healthy behavioral choices, and aspects of daily life such as brushing

teeth was reviewed. During sick visits, we provided education on treatment plans and disease

prevention. Education on health promotion and disease prevention is crucial, especially in the

pediatric population. We must encourage healthy behaviors early, so they can be continued

throughout life and be passed down to future generations.

The pediatric practicum significantly expanded my knowledge and skills. I achieved my

goals for the semester. I have a better understanding of how important it is to instill healthy

behaviors in children. I am looking forward to more clinicals and appreciate the opportunity!
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References

The National Organization of Nurse Practitioner Faculties (NONPF). (2017). Nurse Practitioner

Core Competencies Content. Retrieved from

https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreCo

mps_with_Curric.pdf