Orientation experience and staff integration at Golden Glades Rehab Center

Community Site Orientation

Activity: The activity for this day involved carrying out a community site orientation in order to familiarize myself with the site. Since I am doing rotation in a skill nursing facility, my first activity was an orientation to help me understand the setting. The orientation was conducted at Golden Glades Rehab Center which is located at 220 Sierra Drive in Miami Garden, Florida 33162. This nursing and rehab center is a 180-bed facility that focuses on providing long-term care and comprehensive rehabilitation. It is considered an ideal location to live because is located in South-Florida region, which has favorable year-round climates.

I was taken around the facility with one of the facility's receptionist who explained to me the different departments and other issues relating to this nursing home. The other activity involved participation in an orientation program in which the facility's policies, practices and procedures were explained. The program focused on explaining the facility's mission, vision, and organizational culture. The orientation program was based on coaching and instruction that help in promoting an understanding of the work setting and processes so that new staffs are effective in their work (Eliopoulos, 2012).

Personal Reflection: The orientation enabled me to understand that Golden Glades Rehab Center has several departments including Gym Rehab (which includes occupational therapy, physical therapy and speech therapy), Business Office for billing purposes, and Kitchen for dietary and food director, environmental/laundry/maintenance. The other departments are Nursing Department which includes risk manager, infection control, restorative, MDS and care planning, Medical Record Department, Transportation Department, and Recreational Activities Department.

I didn't know what to expect during the orientation because this was my first experience and time in a skilled nursing facility. However, by the end of the day I was thrilled with the experience because it helped me understand the setting before commencing my work in the subsequent days. The setting has a relatively high proportion of long-term care patients because of its main focus on offering such services. As a result, most of the patients admitted in this center have long-term care issues such as neurological injuries and complex joint replacements. Based on its structure, Golden Glades Rehab Center seemingly has a comfortable environment for patients and staffs. Consequently, it's a safe and comfortable working environment that contributes to a great experience in a skill nursing facility.

Negative Experience: Despite being a comfortable work setting and suitable for patient recovery, there were some negative experiences about Golden Glades Rehab Center. First, the orientation program does not incorporate a mentoring program that helps improve staff satisfaction, motivation, and productivity. Secondly, the orientation program is not ongoing, which makes it difficult to achieve successful orientation.

Recommendations: To improve this learning experience, Golden Glades Rehab Center needs to enhance its orientation program through several recommendations. First, this facility should establish a comprehensive mentor system that serves four major roles i.e. social support, peer resource, role model, and tutor (Sabogal, Farrell & Lourido, 2006). This will help in successful orientation through providing continuity in the orientation process and enhancing staff motivation. Secondly, the program should incorporate opportunities for new employees to meet with the various heads of departments in order to obtain a wider perspective of the facility and departmental functions. Third, career ladders should be developed and established in the facility since they are educational programs that ultimately results in improved efficiency.

Journal #2 -- Theory/Model/Educational Tools

Date: June 10, 2016

Activity: Learning involves the use of different theories, models, and educational tools that are geared towards enhancing critical enquiry. To enhance critical enquiry, the learning activity involved participating in simulation, which is one of the experiential learning modes that is frequently used in the clinical setting ("Approaches to Teaching," n.d.). The simulation activity was provided after the teacher introduced nursing procedures relating to working in a skill nursing facility. The simulation was based on the premise that behavior objectives may be in the cognitive, affective, and psychomotor domains.

For the simulation, I was required to work in a team whose main task was to provide long-term care to an individual in need of complicated joint replacements. Based on knowledge gained from the course, we developed a treatment program that focused on meeting the patient's needs within a stipulated timeframe. In this case, we developed highly-repetitive and low-weight exercises that were not very challenging for the patient. In addition, we engaged the patient in all kinds of psychomotor activities in order to improve his skills during the comprehensive rehabilitation process in the facility.

Personal Reflection: The simulation activity was helpful in learning to apply theories and models in clinical practice. This is primarily because it provided a premise for learning and developing clinical decision making skills, competence acquisition, and clinical practice skills. Even though class work is crucial towards learning and student development, practical learning is more important for students to develop decision making skills and learn how to make relevant theories practical.

The simulation was important for me to enhance my competence in the clinical setting because it provided an example of a real-world scenario in a skill nursing facility. Actually, the simulation was vital in learning applicability of knowledge and skills into real life situations. This activity essentially helped me to demonstrate, explain, and utilize knowledge while drawing conclusions, making comparisons, and finding connections.

Negative Experience: Despite being helpful in developing clinical decision making skills and learning applicability of knowledge, there were some negative experiences associated with this learning activity. These experiences that were negative originated from the fact that we were practicing a situation that wasn't real. First, the learning activity did not involve the use of necessary educational tools because it was not real. The application of necessary educational tools and resources wasn't possible because the scenario was only a simulation. Secondly, the simulation took place in the classroom setting rather than an actual clinical setting. Therefore, the activity was carried out in an environment that is different from a real-world clinical setting. Third, the simulation did not incorporate a supervisor who could help determine the effectiveness of the measures taken by the team in addressing the situation.

Recommendations: Learning through simulation can be improved through several ways that contribute to better decision making. First, the simulation should include a clinical supervisor who analyzes and determines the applicability of measures adopted by students. Secondly, such activities should be conducted in an actual clinical setting rather than classroom environment to help improve clinical practice. Third, mannequins should be included in simulation to help in performing clinical procedures (Aliakbari et al., 2015). Mannequins will help enhance competence because they enable students to perform harmless trial and error procedures until satisfying results are achieved. The trial and error procedures conducted on mannequins help students to ultimately reach the appropriate procedure for the situation.

Journal #3 -- Evidence-Based Practice

Date: June 12, 2016

Activity: Day events when doing rotation in a skill nursing facility revolves around helping residents to realizing their highest potential based on their specific needs. The learning activity for this objective involved conducting observations of the various care practices at the facility and engaging in these practices. This task involved observing and engaging in medical care practices at the hospital and participation in recreational services offered to patients in the nursing facility.

During this process, I worked in the nursing department, gym rehabilitation, and recreational activities departments. In the nursing department, I observed and participated in care planning processes involving patients requiring complicated joint replacements and those suffering from injuries from falls. This was followed by observing and engaging the patients in physical therapy processes at the gym rehabilitation department. For patients requiring long-term care, I participated in recreational activities like an outing and visit to their family members and friends.

Personal Reflection: This learning activity enabled me to understand how skill nursing facilities operate like hospitals in providing care services to geriatric patients. Based on my observations and involvement in clinical processes at the facility, I learned that skill nursing centers are relatively similar to hospitals despite contrary beliefs. These centers are similar to hospitals in terms of clinical practices, patient rights, and approach towards meeting patients' needs ("Skilled Nursing Care," n.d.). In clinical practice, a skill nurse facility provides a home-like environment that is less-structured. This helps in achieving desired patient outcomes through promoting patient autonomy and choice. Recreational opportunities are crucial aspects of rehabilitative care since it a means through which patient preferences and values are incorporated in clinical practice to achieve desired outcomes. Consequently, skilled nursing facilities provide a suitable environment to offer aging seniors with mobility issues the necessary level of attention that may be difficult to provide in the home setting ("Why is a Skilled Nursing Facility Community a Good Idea?" n.d.).

Negative Experience: The negatives about this learning experience include the lack of adequate time to participate in clinical practice and rehabilitative activities. In this case, prolonged engagement in these activities could have helped generate more accurate conclusions from the learning process. Secondly, the effectiveness of the processes was generally determined from the nursing service perspective and did not incorporate patients' view about these processes.

Recommendations: The first recommendation to improve this learning activity based on desired objectives is to create more time for the observations and involvement in clinical practice and rehabilitative activities. Secondly, discussions with patients should be incorporated in the observation to help understand their insights about care practices undertaken by the nursing staff in the facility. Third, day events should also incorporate observations and involvement in activities carried out in the other departments to help understand their role in the overall process of meeting patients' needs.

Achievement of Personal Goals and Objectives: My goals and objectives for the semester included examining the difference between a skilled nursing facility and a hospital and understanding the operations of these facilities. These goals and objectives have been achieved through these learning activities since I've had first-hand experience in observing and participating in clinical processes in a skill nursing facility. While there are some negatives about the experience, the learning activities have generally helped me achieve my goals.