Male child who presented a condition of c/o rash and a swollen right check Essay Assignment Paper

Male child who presented a condition of c/o rash and a swollen right check Essay Assignment Paper

Male child who presented a condition of c/o rash and a swollen right check Essay Assignment Paper

Journal Two

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Journal Two
An Interesting Case Scenario
Recently, I had a 10-year-old male child who presented a condition of c/o rash and a swollen right check for two weeks. The boy’s mother was quite aggressive and requested a series of tests and treatments as she believed the condition resulted from an allergic reaction, infection, or a tumor. As a nurse practitioner student and with the aid of my preceptor (the doctor), I took the child through a facial assessment that revealed that there were no rashes or swellings, hence no need for treatment. The 10-year-old male patient equally affirmed that he did not feel any rush or swellings within the said areas and implied that her mother had a formed opinion in her head. The mother began yelling at the other patients and us. The mother of the patient soon turned to verbal aggression, as she claimed. “I am sure that my son is suffering from a condition I can tell, and it is clear to me that all of you lack the merit and required skills to diagnose the condition.” At this point, there was very little opportunity for me and my team to predict a case of violent outbursts from the patient’s mother who hurled abuse at the nurse practitioners and the preceptors who made rounds in the clinic to access patients. While it was tempting to retaliate to the verbal aggression with a verbal response in self-defense, such action was ill-advised. Having worked as a nurse for close to 15 years may be considered unprofessional conduct or rather professional misconduct and often result in disciplinary actions. The 10-year-old patient, however, took the initiative to affirm to his mother that he was well and there was no cause of alarm.

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Challenges Exhibited in the Case
Dealing with aggressive and violent patients remains an area that presented a challenge for me as a nurse practitioner student, given the level of uncertainty that came with the situation (Swit et al., 2018). Standing at an interface between psychiatry, law, and medicine, establishing the best actions proved challenging for me, while the guidelines to addressing such a case seemed consistently explicit and applicable. Through the guidance of my preceptor, it dawned on me that handling aggressive, abusive, and violent patients details the need for nurse practitioner students to understand that difficult behaviors often represent or unearth the communication of an unmet need or distress. According to my preceptor, “the prevention and de-escalation of such situations require an understanding of the triggers and the identification of a need by trying to communicate and with the irrational caregiver over an unmet need. In addition to this, my preceptor necessitated the need to integrate a person-centered approach to understand the issue and address the emotional and psychological distress as required. Relationship building, skilled communication, non-confrontation, and negotiation play a fundamental role in remedying and avoiding such occurrences within a provided setting (Sibiya, 2018). These measures safeguard the involved party’s human rights, physical health, and mental wellbeing.
Actions that I may Integrate Differently from that of my preceptor
As a nurse practitioner student with 15 years of experience in the domain, I have noted several causes of such aggressive actions, detailing a combination of different factors that are intrinsic to the perpetrators. Such factors from my experience include attitudes, the behavior shown by the involved party, extrinsic factors, and the perpetrator’s personality. My preceptor (Dr. Grant) continued going back and forth, debating with the parent’s mother. However, I would have first resorted to using different communication skills and trying to control her emotions during the process. From my perspective, a good starting point revolves around assuming aggressive actions serve as an indicator of an individual’s attempt to communicate frustration or an excessure in an individual’s coping abilities. Addressing this situation from where I seat details the need to follow the NHS’s policy guidelines of 1990 on zero tolerance to any form of aggression and violence to the staff. Therefore, this may call for the need to communicate and set explicit boundaries that define acceptable behavior while earning on confrontations in the event of a breach. A breach of such boundaries from a personal view may result in the coercive enforcement of the security staff or the law enforcement officers or rather the judicial sanctioning of the transgressor in repeated cases (Mercurio et al., 2021). However, using these measures would be the last resort, especially when determining the degree of culpability and control may prove challenging.
Cultural Differences I Found Challenging
I did not notice any cultural variances between the patient and me and his mother and originated from the same race. However, under different circumstances from my experience, the environment of care remains profound in caregiving. Cultural differences may have a profound impact on the delivery of care to the patients. This is because different cultures often express unique beliefs and values that may impact the continuum of care within a provided trajectory. Shared beliefs and values that are observable in multiple spheres play a fundamental role in influencing decision-making and patient-provided interaction. These factors are distinct in the delivery of a person-centered approach to care. As a nurse practitioner student working with complex systems, I am often unlikely to directly control the environment, with precision to addressing cultural differences that impact the behaviors of different vulnerable groups.

Swit, C. S., McMaugh, A. L., & Warburton, W. A. (2018). Teacher and parent perceptions of relational and physical aggression during early childhood. Journal of Child and Family Studies, 27(1), 118-130.
Sibiya, M. N. (2018). Effective communication in nursing. Nursing, 19.
Mercurio, M. R., & Cummings, C. L. (2021). Critical decision-making in neonatology and pediatrics: the I–P–O framework. Journal of Perinatology, 41(1), 173-178.


Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you identify opportunities for improvement in your clinical skills while also recognizing your clinical strengths and successes.

This week, you will write a Journal Entry reflecting on your clinical strengths and opportunities for improvement.

Journal Entry (2–3 pages):
Based on your experience,

• Describe an interesting case or a case that you have never seen before.- i had a10 yr old male who came into the visit with c/o a rash and swollen right cheek x 2wks. The mother was very aggressive and wanted various tests, treatments etc.. as she thought it could be an infection or tumor or allergic reaction. However, the assessment was a normal facial assessment with no rash or swelling noted by me the Nurse practitioner student or my preceptor (the doctor). The visit became very uncomfortable because as the providers we explained there was no swelling or rash and therefore no treatment. The 10yr old male patient said he didn’t feel the rash or swelling and said to the mom it was in her head. The mother started yelling at us and the patient. (Add quotes and examples of behaviors etc)

• Explain what you found challenging.Trying to effectively communicate with an upset and irrational parent …

• Explain what you would do differently from your Preceptor. My preceptor (Dr. Grant) was going back and forth debating the parent. I would have used different communication skills. (Provide examples of types of communication skills)

• Explain the cultural differences you found challenging. I really didn’t find any cultural differences since we are all the same race.

I am completing a pediatric rotation at a primary care clinic. Please complete the journal entry using the encounter above in grammatically correct sentences and format

Remember I am not a nursing student, I am a Nurse Practitioner student. I have been a nurse for over 15yrs. A nurse practitioner is like a physician.
Any questions email me.

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