Weekly journals and their purpose

Overview
Working at the Primary Care Clinic at the Veterans’ Administration (VA), nurses are exposed to a range of diagnoses and patient care concerns. The experience helps evolve core competencies in a range of practice areas. The VA calls the Primary Care services “the foundation of VHA healthcare,” as well as the first point of contact with the VA healthcare system for most veterans,” (U.S. Department of Veterans Affairs,” 2016). Therefore, the clinical environment is varied and challenging, revealing the different ways healthcare providers and nurses establish long-term relationships with patients and coordinate care services across a broad spectrum of needs.
Week 8 Journal
This week, I fulfilled the DNP objectives during clinical practice with the Primary Care Clinic at the VA. Several instances showcased the nurse’s role as patient advocate. Clearly, advocacy plays a critical role in VA healthcare, with nurses increasingly being called upon to help empower patients and their families by offering information and mobilizing resources. Communications competencies also proved highly effective and important in the VA Primary Care setting, requiring active listening and working also as liaison between several parties including patient, administration, and other members of the healthcare team. The role of patient advocacy improves my overall understanding of how healthcare policy directly impacts individual patients’ lives, impacting what treatments are covered by veterans’ insurance policies.
Week 9 Journal
Screening of PTSD remains a core concern for the VA Primary Care clinic, and this week I learned the relevance of the core competencies related to clinical prevention and population health, as well as organizational and systems leadership in the healthcare system. Veterans at the primary care clinic remain critically underserved for their mental healthcare needs. Yet research continually reveals the strategic importance of PTSD screenings (Magruder, Frueh, Knapp, et al., 2004). Screenings are integral to the principle of clinical prevention, which helps improve the nation’s overall healthcare and public health objectives. Linked with the core competency of patient advocacy, it becomes apparent that a nurse working in primary care in the VA system needs to strongly speak out in favor of improved mental health and PTSD screening services. Organizational leadership in the primary care facility promotes quality improvement through official policy, but actual practices and day-to-day care does not necessarily reflect the stated goals, objectives, and mission of the organization.
Week 10 Journal
This week, the importance of health informatics, information technologies, and information systems became especially relevant in the primary care setting. One of the systems went down, creating a temporary sense of chaos among the nursing staff. Backup systems helped restore some of the databases needed to manage patient information, but the situation nevertheless gave rise to considerable and controversial discussions related to the need for increased funding for improving the VA’s health informatics and IT systems. Health information systems are becoming critically important for reducing medical errors and ensuring continuity of care for patients seeing multiple practitioners spanning different geographic regions. Witnessing first hand the need for improvements in this area also shows how nurse leaders and patient advocates can work closely with policymakers who are dedicated to freeing up funding and resources for the VA and the VHA. Finally, one of our competencies relates to the central importance of merging scientific practice within the overarching concerns of the VA. This week, I was impressed by the overall dedication of the primary care facility in their ability to integrate evidence-based practice seamlessly into the system.



References

Magruder, K.M., Frueh, B.C., Knapp, R.G., et al. (2004). PTSD symptoms, demographic characteristics, and functional status among veterans treated in VA primary care clinics. Journal of Traumatic Stress 17(4): 293-301.
U.S. Department of Veterans Affairs (2016). Patient care services. https://www.patientcare.va.gov/primarycare/index.asp