Reflection

During my rotation in Long Term Care, I was given the opportunity to engage with patients who resided in a skilled nursing facility. My days were split between working with nurse practitioners, doctors, physical therapists, and occupational therapists. In these five weeks I learned the importance of interdisciplinary education and how each member of the team plays an important role in optimizing the patient. For example, physical therapy and occupational therapy were imperative for patients who were on the subacute rehab floors. These patients were able to improve their mobility and functionality after several weeks of engaging in exercises, which allowed them to be discharged home safely. Something I struggled with during this rotation was modifying my physical exam to evaluate patients who were bed bound. Many of the patients I was assigned to were unable to turn on their own, others were unable to follow instruction due to cognitive issues. I found myself consulting my preceptors on the best way to examine my patients for the first few days. By the time my rotation ended, I felt more confident performing my physical exam, and I was able to develop a sound assessment and plan based on the clinical presentation and my findings. One thing I wanted my preceptor and colleagues to notice about my work on this rotation was my ability to interact with patients. I enjoyed talking to patients at the bedside and making sure they felt comfortable, addressing any issues they may have experienced overnight. Having these types of conversation made the rotation extremely meaningful and I gained perspective on a patient population that I did not previously have. For instance, during my internal medicine rotation, I dealt with older patients who were chronically ill and not able to converse, which was not the case for this rotation.

One of the most challenging aspects of this rotation was interacting with patients who were receiving palliative care. I learned to handle my emotions while remaining sympathetic, but it was definitely challenging. I’ve never been exposed to palliative patients before so managing them was initially difficult. I made sure to attend rounds with the palliative fellows each week to learn more about these patients and how to make their stay at the facility as comfortable as possible. Seeing how the palliative care fellows interacted with the patients taught me which strategies can be implemented to demonstrate understanding and sympathy, not only for my upcoming rotation but for the rest of my career. Prior to this rotation, I was unaware of the role and responsibilities that palliative care providers have, but this has definitely changed. The experience I gained working at a skilled nursing facility for my long term care rotation was extremely valuable to me. I know I will carry this experience with me as I go further into my career.

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