Journal #2

1. What goal did you meet this week that you and your preceptor discussed? What

areas does your preceptor feel that you need to work on for next week?

In order to meet the goal we discussed my last clinical day, I have made a point to look up each

procedure or medical term that I cannot remember or not familiar with. I knew that we had

several colposcopies scheduled today, so before I went to clinical I read again about

colposcopies. Next clinical day we have several pap smears scheduled, she suggested that I

refresh myself with the procedure and the guidelines for pap smears in order to be best prepared

for the day.

2. What did you do this week that made you feel you gained confidence in a particular

area of patient care?

My preceptor showed me a website and app available to aid in staying current with guidelines for

colposcopies, American Society of Colposcopy and Cervical Pathology (ASCCP). She said that

she frequently refers to this site when she has abnormal pap test results. I shadowed my

preceptor preforming a colposcopy utilizing Telehealth. The clinical site is set up for Telehealth

and makes use of this with many procedures. I was unfamiliar with Telehealth, and felt that I

learned and gained valuable experience today. OB/GYN physicians, specializing in gynecologic

oncology, at University of Virginia in Charlottesville are consulted for the colposcopy procedure.

The nurse assists in setting up the Telehealth session. The physician in Charlottesville, Dr.

Taylor, introduced himself to the patient, the patient was prepared and positioned for the

colposcopy. Dr. Taylor was able to view the room as well as the colposcope view of the patients

cervix. I was able to assist in consultation with him about the patients current vital signs,
pertinent medical history, and abnormal pap result. The patient had nabothian cysts present on

the cervix, which Dr. Taylor reassured the patient what they were and that they were benign and

harmless. In collaboration, Dr. Taylor nor my preceptor was able to view the transformational

zone, and no acetowhite changes were noted, therefore an endocervical curettage (ECC) was

performed, using the curettage as well as the brush. After the colposcopy, the patient was able to

speak with Dr. Taylor via video conference, and have any questions that she may have answered.

I was able to counsel the patient on post procedure instructions. This clinical site does these

procedures once monthly through Telehealth. Unfortunately, a few of the other scheduled

colposcopies were no-shows and were rescheduled for next month. I feel that this experience has

given me a better insight about the colposcopy procedure as well as Telehealth, and its

significance in rural areas.

I also had the opportunity to review diabetic labs and assist in setting up diabetes education

classes for the patients whose A1c levels are not properly controlled. I feel this allowed me to

gain more confidence in speaking to and educating patients about their disease process, test

results, and importance of utilization of health education classes in order to promote improved

health.

3. Reflect on a challenging clinical situation or a situation where you did not feel

confident in a particular area of patient care. How did you handle the situation?

What have you done or will you do to make you feel more prepared for this same

situation in the future?

I knew before clinical today that there were colposcopies scheduled, and that I have never had

the opportunity to previously observe this type of procedure. As stated before, I reviewed and

refreshed my memory on this procedure before arriving at clinical, I knew that by doing this, it
would give me the opportunity to have the best learning experience possible, as well as

appropriately know which questions to ask. After the procedure, while waiting on the other

scheduled patients to show, I familiarized myself with the recommended website and guidelines

for colposcopies. I read a recommended article, Cervical cancer screenings in low resource

settings, published by The Committee for Healthcare for Underserved Women by American

Congress of Obstetricians and Gynecologists (ACOG), in order to gain a better understanding of

treatment in rural areas. I also viewed a digital learning series-training course by the World

Health Organizations International Agency for Research on Cancer about colposcopies,

cryotherapy, and loop electrosurgical excision procedure (LOOP), in order to better familiarize

myself with these procedures in order to feel more prepared with what types of procedures will

be of most benefit for the patients condition.

4. Reflect on some areas of learning while in the clinical area that will benefit you the

most in your own practice.

I had the opportunity to familiarize myself with guidelines, further my learning about

procedures, and gain a better understanding what each of the specific procedures entail. I feel

that by doing this I gained a clearer perspective, feel more prepared, and comfortable with the

proper sequencing of testing, as well as which tests are warranted in certain situations.

5. What course objective did you address this week?

Objective 1: Apply knowledge and research findings from the pathophysiological,

pharmacological, behavioral, and nursing sciences to the management of primary care problems.

I feel that I met this objective through the observance of the procedure, as well as being able to
speak with the diabetic patients about their test results and encourage their upcoming

participation in the diabetes education course offered.

Objective 3: Perform an individualized risk assessment to identify the health maintenance and

health promotion needs.

I feel that I met this objective through the speaking with the diabetic patients.

Objective 8: Collaborate with other health professionals and Objective 9: Demonstrate

accountability for advanced practice nursing actions based on professional integrity

The advanced practice nurses in collaboration with the on-site pharmacist assist in development

of the diabetic education courses.

6. Describe how you integrated one of the SONs Professional Pillars during your

clinical experience this week.

The patient scheduled for the colposcopy was very anxious and unsure. I spoke with her and

about the procedure and my preceptor explained each step of the process before the patient even

undressed for the procedure, in order to help the patient feel more comfortable and confident. By

this, I feel that we demonstrated service, compassion, and integrity.