Free Paper with a Journal of a Nurse Practitioner in a County Jail

Journal Entry 1-September 4-September 6, 2018

A snip view of my workplace: I currently work as a nurse practitioner in a county jail, and I only see patients in need of chronic, preventative and emergency care. My schedule runs from Monday to Thursday. In my first week, I dedicated my residency hours towards reviewing the Chronic Care Model (CCM), by seeking to understand how the organizing framework can be employed in improving chronic disorders care especially diabetes type 1 and 2, utilizing it as an excellent tool for improving the quality care granted patients at both the population and individual levels in the County jail.

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I, later on, applied the CCM model when a patient with diabetes presented himself in my office, to assess and design a meal plan by collaborating with a registered dietician, ultimately enabling m to conduct an individual counseling session for the patient regarding a healthy diet.

The CCM framework is an evidence-based practice appropriate for use by advanced practice nurses and nurse practitioners because its interventions are ideally suited for chronic disease management in a multitier nursing environment. In light of the knowledge provided in Essential I, it is important for nursing practitioners to employ evidence-based theories drawn from research studies that incorporate system level, provider and patient-level interventions in disease management. By using Essential I: Scientific Underpinnings for Practice, the CCM model was employed to help determine novel nursing actions that can be employed for a diabetic patient in prison or corrective facility environment to help promote positive changes in the health status of affected patients. In this regard, I was well prepared to face current and future challenges underpinning issues in diabetic patients through developing and implementing middle-range theories in guiding nursing practice in the wake of evolving realities in nursing practice.

During my work hours, I spent time with three patients complaining of a headache and wanted painkillers. However, I did not find it advisable to administer any painkiller because, upon reviewing their prison records, I realized that they had a history for drug abuse. So I advised them to take plenty of hot water and have enough rest. The patients were unhappy with my prescription, but I did not see them again in my office. Next week I will be focusing on scheduling meetings with some policymakers and clinicians to share my reservations on the proposed reduction of medication lines in correction facilities as this poses significant problems in the provision of appropriate medical emergency intervention.

References

American Association of Colleges of Nursing (2006). The essentials of doctoral education for advanced nursing practice. American Association of Colleges of Nursing, 1-27.

Moran, K. J., Burson, R., & Conrad, D. (2016). The doctor of the nursing practice scholarly project. Jones & Bartlett Publishers.

Journal Entry 2 September 10-13, 2018

This week I plan to share my proposals on improving care for inmates with emergency and preventive care needs. In the meeting with the clinicians and government officials from the ministry of health, I suggest that the proposal to reduce medical lines in correction facilities be withdrawn as it contravenes the standard ADA clinical practice recommendations which promote the well-being of an inmate, clearly outlining that access to quality and improved healthcare is a fundamental human right to all inmates. While infirmaries and prison clinics are provided with medical resources accommodating acute care needs, it becomes clearer that through effective communication and collaboration with inmates, the decision to administer or allow access to medical resources should be left with the medical staff. I trust my judgment in this regard owing to the facts outlined in DNP Essential V that encourage nurse involvement in policy. To adhere to the guidelines of Essential V, I believe that as DNP graduate, I am supposed to design, innovatively create, and influence the implementation of health care policies that entail health care financing for correctional facilities from the state treasury. It was agreed that the evidence-based practices underlying the safety, medical access and efficacy of healthcare delivery in correction and detention facilities would be disseminated to responsible state healthcare dockets to ensure that the vital issues of equity in the quality of healthcare afforded inmates and policies on their basic social justices were granted the attention it deserves.

Having achieved my objectives for the week, I spent the rest of the work hours attending to one female inmate who is at the fifth month of her pregnancy, tending to her usual complaints of a headache, backache and too much vomiting. In my work hours, I was able to conduct eight follow-ups on three obese and five diabetic patients ensuring that they adhered to their diet plan and exercise schedule. Next week, I will be starting a nutria-exer (Nutrition-exercise) program where I talk to the inmates on the importance of eating healthy while in prison and exercising to keep their states of mind at peace while staying away from diseases.

References

American Association of Colleges of Nursing (2006). The essentials of doctoral education for advanced nursing practice. American Association of Colleges of Nursing, 1-27.

Chism, L. A. (2017). The doctor of nursing practice. Jones & Bartlett Learning.

Journal entry 3 September 17-20

This week was a lot more flexible for me as I was involved in preventative nursing care. My schedule involved interacting with prisoners in providing primary, secondary and tertiary preventative care. I was well informed on preventive care knowledge acquired during The DNP program conference which fostered the AACN Essentials of Doctoral Education for Advanced Nursing Practice (2006) in preparing all DNP graduates to use preventative measures is wellbeing of the prisoners in detention facilities. On preventive care, I was able to provide counseling sessions for 2 hours daily for the three days and educate the inmates on disease prevention skills as well as a bow to detect illness at the onset for early treatment. I also formulated a Programme for exercise and types of activity to be carried out every day to maintain body fitness. Additionally, I had the opportunity to respond to questions about preventive care for 30 minutes every day.

In secondary care, I was able to measure the blood pressure, sugar levels and the calculated the BMI of the inmates. During the screening, those with high-risk factors for tertiary treatment were provided for further education on how to modify their lifestyle and moderate their harmful habits. I was able to place 15 inmates with preclinical diseases on the close monitoring program.

In the process of screening and counseling, some were already displaying symptoms of advanced illnesses and required immediate medication or tertiary care.

References

American Association of Colleges of Nursing (2006). The essentials of doctoral education for advanced nursing practice. American Association of Colleges of Nursing, 1-27.

Sperhac, A. M., & Clinton, P. (2008). The essentials of doctoral education for advanced nursing practice. Journal of Pediatric Health Care, 3(22), 146-151.

Zaccagnini, M., & White, K. (2010). The doctor of nursing practice essentials. Jones & Bartlett Publishers.

Journal Entry 4 September 24-27

This week's residency hours were directed towards collecting appropriate and accurate patient data to help generate valuable evidence on the frequency of injuries, colds, and flu within the correction facility. By employing Essential III- Clinical Scholarship and Analytical Methods for Evidence-Based Practice. I was able to conduct an in-depth analysis of data from nursing practice in other correctional facilities while designing evidence-based interventions for head injuries from blunt objects, knife injuries, and cold cases of flu. In line with the facets of Essential III, I predicted and analyzed the outcomes in the data from other nurse practitioners, examined patterns of results and behaviors and lastly, identified gaps prevalent in evidence for practice. I spent most of the hours this week practicing as a specialist/consultant in listening to my patients to help establish a collaborative and all-inclusive knowledge-generating research. In my work hours, I managed to bandage six male inmates who had knife injuries, four female inmates with injuries from blunt objects. I tended to 11 cases of cold flu assessing, diagnosing and administering preventive medicine to avoid coughing through individualized treatment plans. None of the cases was severe, so I did not recommend a patient for transition into external outpatient clinics. I achieved my objective by establishing the fact that the patients and inmates, in general, needed someone whom they could talk to, more of a psychiatrist, who is not currently available in the correction facility. Consequently, I disseminated my findings to the prison administrators who promised to take the results into serious consideration and act accordingly to help reduce the increasing levels of offenses within the correction facility.

References:

American Association of Colleges of Nursing (2006). The essentials of doctoral education for advanced nursing practice. American Association of Colleges of Nursing, 1-27.

Butts, J. B., & Rich, K. L. (2013). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.

Journal Entry 5 October 1-4

This was an exciting week because of the launching of the nutria-exit program, which was rather appreciated by the inmates, especially ladies of the middle-age range. Essentials III-Clinical Scholarship and Analytical Methods for Evidence-Based Practice was met during the implementation of the nutritional and exercise facts of the program as we introduced new evidence-based practices in nutrition and lifestyle in preventing lifestyle diseases. Through the facets underlying Essential III, I have made extraordinary steps in my career development promoting the application of research to practice while enabling me to pose questions whose context lies in nursing practice. Essential III fosters participation in clinical research, evaluation, and development of practice guidelines, critical evaluation of existing literature in the determination of best practices.

The DNP program brought forth the idea of employing innovative and interesting methods of attracting inmates to exercise effectively and practice healthful healthy eating. It is in this process that I presented the paper on how to employ evidence-based research on smoking cessation to create positive outcomes for smokers through health education. Essential III upholds the use of social and natural sciences such as human physiology, biology, and psychology to best accomplish nursing as a human caring practice through understanding human needs. During my work hours, I was able to assess, diagnose and create treatment plans for 12 patients who visited the infirmary for acute medical care.