Clinical rotations are vital to the academic and professional development or nursing students. These provide insights into practical applications and procedures of learned material and provides the unique experience of interacting with patients with faculty supervision. This paper will focus on a personal reflection in a clinical rotation occurring in a nursing home, including an encountered case examination and influence of the experience.
The clinical rotation occurred in a mid-sized nursing home with approximately 158 beds. At one point, a call was placed by a staff member that one of the patients felt lightheaded and fell, continuing to retain consciousness. The patient was a 72-year-old male, which will be referred to as MA. Upon arrival, MA was already helped by staff and was laying on his bed. At examination, the patient retained consciousness and was not injured from the fall. MA described symptoms of having a headache for several hours, along with fatigue, eventually experiencing light-headedness. Patient history revealed that the patient is diagnosed with type 2 diabetes mellitus.
The patient had been diagnosed of what is known as adult-onset type 2 diabetes. In type 2 diabetes, the pancreas is unable to produce enough insulin, or the body does not utilize it properly. Insulin is a hormone which regulates glucose and directs it to cells to provide energy. With this condition, excessive glucose remains in the blood which can cause a range of other serious conditions such as cardiovascular issues (stroke), nerve damage, kidney damage. However, since glucose regulation is inconsistent, there may be periods of low blood sugar as well. Older individuals are a risk of type 2 diabetes, particularly with presence of obesity, lack of exercise, and family history of the disease (NIDDK, 2020). Therefore, taking higher doses of insulin and other medications, as well as not partaking enough nutrients to maintain the glucose levels, will lead to blood sugar levels to drop. This instigates hypoglycemia which is commonly characterized by symptoms seen in the patient such as fatigue and dizziness (InformedHealth.org., 2020).
The primary objective of diabetes medication is to achieve glycemic control, which is inherently difficult. There are oral medications such as Metformin which decreases hepatic glucose production as well as Sulfonylureas that stimulates insulin release from beta cells in the pancreas. More severe forms of type 2 diabetes or specific cases use insulin intake directly to achieve glucose control with measured doses (Raval & Vyas, 2018). In the case of MA, the patient received an insulin dose, but also chose to take Metformin, which was recommended by his provider to have on hand in case of severe spikes of blood glucose levels. The combination resulted in hypoglycemia. The patient was provided with a glucose supplement dextrose to raise blood sugar levels as recommended for hypoglycemia. His condition, diet, and insulin intake were carefully monitored for several days to establish stability in glycemic control.
The process of describing the event does not necessarily drive any strong emotions or feelings. As I recall the situation, I am experiencing relief that the situation was quickly resolved due to professional actions of the staff, without more series consequences. However, I am also aware that type 2 diabetes could cause more serious complications, and that the elderly population in a nursing home are more susceptible to a variety of chronic or severe conditions. The experience of the clinical rotation and the incident did invoke concern and general sadness regarding the consistently fragile state of these patients due to their age, and many having chronic diseases. Nevertheless, the clinical staff of the nursing home demonstrate such care, kindness, professionalism, and awareness of the needs of the patients that it becomes evident that they are receiving some of the best care possible.
In terms of how the experience will affect my nursing school education, I hope it has taught me the importance of 1) caring for vulnerable populations that may require specific care and 2) understand the critical burden of chronic diseases. Also, witnessing the clinical staff in the nursing home highlighted the importance of being well-rounded in professional development and being prepared to provide care for all types of cases and patients. Therefore, in my time in nursing school, I hope to dedicate more time and attention to my professional development, becoming familiar with all aspects of medical care provision as well as patient-centered care. As for my future as an RN, I was inspired and moved by the experience during the rotation. It is possible that I may pursue a position in a nursing home or some other type of geriatric care. It is an important aspect, particularly as the COVID-19 pandemic revealed that nursing home facilities are highly under-supported.
The patient was a Caucasian male with no evident cultural or religious restrictions. However, cultural competency should always be considered. In cases of type 2 diabetes, cultural considerations may provide perspective on an individual’s diet, medication adherence, and potentially use of non-traditional treatments. These elements can impact the health and primary treatment of the patient and should be evaluated. No biases for the patients were present during the rotation, but it is necessary to consider the concept of ageism which may be openly displayed or covert prejudice against older people. However, as a future clinician it is necessary to approach treatment of all patients equitably according to medical ethics. Even if elderly patients may struggle with understanding certain medical treatments and commit health-threatening mistakes such as the case in this paper, it is vital to practice patience and patient-oriented care. Any immediate care as well as post-discharge treatment should be explained in the best manner possible that is accessible and understandable to the patient.
References
InformedHealth.org. (2020). Hyperglycemia and hypoglycemia in type 2 diabetes. Institute for Quality and Efficiency in Health Care (IQWiG). Web.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2016).Type 2 diabetes. Web.
Raval, A. D., & Vyas, A. (2018). National trends in diabetes medication use in the United States: 2008 to 2015. Journal of Pharmacy Practice, 33(4), 433–Web..