Rotation in a Skilled Nursing Facility

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 10, 2016 Activity: The provision of long-term care and comprehensive rehabilitation to geriatric patients requires evidence-based practice in order to meet patient needs. The activity to determine evidence-based practice in a skill nursing facility involved conducting a research on the statistics, culture, epidemiology, and environmental issues at Golden Glades Rehab Center.

This was a whole day activity carried out at this skill nursing facility and involved interviews of the various stakeholders in this center. I conducted interviews on the facility's staff and patients to gain insights on their views regarding evidence-based practice in the facility. The interviews involved collecting data regarding the facility's patient population and their short-term and long-term care and rehabilitation needs. The facility's staff provided details regarding the patient care measures they adopt based on the specific condition they are dealing with.

Staffs also reported about the existing organizational culture, statistics relating to patients, epidemiology, and environmental issues relative to the desired patient outcomes and efficiency of the facility's operations. On the other hand, patients provided their views regarding the effectiveness of patient care and rehabilitation measures adopted by physicians and nurses. This information was provided based on their expectations and opinions about the facility's operations and care processes. Personal Reflection: This learning activity helped me to understand that most of the patients in a skill nursing facility need short-term care.

Long-term needs in these settings occur among patients with general failure to thrive whereas others stay in the facility because their need for regular care cannot allow them to stay at home. According to Nelson & Baptiste (2004), treatment and care management processes in these settings are seemingly based on conventional and personal experience instead of scientific evidence. As a result, these measures are seemingly ineffective in meeting patients' needs effectively, which demonstrates the need for evidence-based practice in these settings.

Most of the interviewed patients, especially those with long-term care needs, expressed their frustrations with either the care processes or other aspects that contribute to their well-being and recovery. Physical therapy in Golden Glades Rehab Center is not carried out in a manner that helps achieve desired patient outcomes despite the existence of a relatively comfortable environment for working with patients and conducting various psychomotor skills. Evidence-based practice not only involves using procedures with scientific evidence but ensuring other aspects of the care environment contribute to improved patient outcomes.

A skill nursing facility should ensure that research evidence is integrated in clinical practice while care processes incorporate patient preferences and values (Stevens, 2013). Negative Experiences: While the learning activity provided insights regarding evidence-based practice in the facility, there were some negative experiences. First, the activity primarily relied on reports from the various stakeholders and did not entail an observation of care or treatment processes carried out by the staffs. Secondly, the conclusions were not made based on examination of existing practices relative to research evidence.

Recommendations: The learning experience from this activity can be enhanced through incorporating observation of care processes and initiatives in order to gain further insights regarding organizational processes. Secondly, the learning activity requires examining current research evidence on evidence-based practice in a skill nursing facility. This should be followed by examining the facility's operations and processes in light of research evidence in order to determine their effectiveness.

Journal #4 -- Day Events 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.