“Using the Evidence” in Practice

In my clinical setting, I have observed our medical director used the Eight Joint National Committee (JNC 8) in diagnosing and managing high blood pressure. The medical director gave me a hard copy of the JNC 8 recommendations, but at the same time, I was given a privileged to study more of the guidelines in further details by accessing it online. I accessed it at National Guideline Clearinghouse website in which it provided me detailed recommendations of when to initiate treatment to a certain population (non-black or black population), certain age group (over 18 years and over or less than 60 years old), and to patient with different kinds of comorbidities (chronic kidney disease, diabetes mellitus, congestive heart failure, coronary artery disease, or history of stroke). (National Guideline Clearinghouse, 2014). To apply it in practice, one example I can cite is a 51-year-old male black patient who has a blood pressure of 158/90. With his blood pressure, he is obviously diagnosed with hypertension and treatment should be initiated. Using the JNC 8 recommendations, the patient should be started with either a calcium channel blockers or a thiazide medication to manage his hypertension. (National Guideline Clearinghouse, 2014). I find JNC 8 recommendations very straightforward, easy to follow and understand. In my part as a clinician, the thing I am responsible for knowing is his blood pressure, age, race, and comorbidities (if any) by doing a thorough history and assessment. From the information I gathered combined with the most up to date JNC 8 recommendations, I would be able to treat my patient correctly and safely. I believe that JNC 8 recommendations’ goal is nothing but a manageable blood pressure to everybody. Its main goal is to prevent future cardiovascular, renal, pulmonary or renal complications. Overall, national guidelines like JNC 8 are being followed at my clinical setting at all times as their way of mastering their mission of health care that is safe, high quality, and effective using evidence-based practices.


National Guideline Clearinghouse. (2014). Evidence-based guideline for the management of high blood pressure in adults. Report from the panel member appointed to the Eight Joint National Committee (JNC 8). Retrieved from https://www.guideline.gov/summaries/summary/48192/2014-evidencebased-guideline-for-the-management-of-high-blood-pressure-in-adults-Report-from-the-panel-members-appointed-to-the-Eighth-Joint-National-Committee-JNC-8


Getting Started

As I remain in my journey in finishing my hours for clinical practicum, I continue to do my preceptorship with my previous preceptor from last semester. I feel that I am in a fortunate position because continuing my clinical hours with the same person facilitates trust, rapport, and confidence. The clinical hour requirements for NURS 679L (240-270 hours) are more than NURS 678L (90-120 hours). NURS 678L experience was very unforgettable from day one to the last. On the first day, I felt like I am starting a new job because of new faces, new place, new processes, new workplace, and a different set of diverse patients. If I am asked to describe my experiences from last clinical practicum, I would say that is was a SUPERB one. I gain a lot of knowledge from everybody in the clinic: from doctors, physician assistants, nurse practitioners, medical assistants, and patients. I would say that NURS 678L helped me develop more of my critical thinking skills and rational about patient’s diagnosis broadmindedly and by thinking outside the box. Some of the diagnosis, procedures, and medications that I have been familiar with during NURS 678L are the treatment of sexually transmitted infections, acute pain management, anemia management, upper and lower respiratory infections management, diabetes management, and hypertension management. This semester, I am assigned to come into the clinic twice weekly to develop more of the skills and knowledge in the FNP Formulary. During the week, I have the chance to precept with a Doctor of Osteopathy and a Nurse Practitioner who focuses on primary care, women’s health, and pediatrics. My learning goals for NURS 679L are: to fully develop my critical thinking skills by using evidence-based studies for a safe clinical practice, to acquire more clinical skills performed in the primary care settings, and to be more experienced in diagnosing patient’s disease accurately. As mentioned, I have two preceptors in the clinic for this semester, some of the thoughts that came to my mind are not two preceptors are the same. Comparing them would not help, but appreciating each other’s strengths will better help me understand and learn new things. Conclusively, I know I just started a new semester but my thought about starting back to my first day of clinical practicum made me feel so excited. Excited not just because I am few more steps in finishing the program, but also I know that this is another learning experience for me that not everybody is given a chance of doing such.