Reflection on Clinical Issues, Essay Example

I have a great deal of pride in the nursing profession, but I must admit that I have occasionally been extremely concerned about some of the sloppy practices that I have witnessed in medical settings. My most extreme reaction is in the various violations of patient confidentiality: although there is a great deal of emphasis on the HIPPAA regulations taught in school, as well as in staff training, there doesn’t seem to be uniform understanding of how those rules are applied in a practical sense. For example, at the nursing station nurses will freely discuss patients using first and last names, as well as making phone calls to the families of patients to discuss their conditions, and in the meantime, people are walking past the station, including all types of staff, patients, visitors, and others. I have also witnessed this at outpatient medical offices, where the receptionists are sitting behind a desk without glass windows, also greeting patients by name as well is making telephone calls to patients in full hearing range of everyone in the waiting room. Finally, the sign in sheets in medical offices are nearly always violations of the HIPPAA rules because when a patient signs in, after signing all the forms regarding confidentiality, he or she signs his name on a sheet of paper that lists everyone who has been to that office before him that day. Despite all of the training about HIPPAA standards, I witness these violations constantly. There are certainly many ways to improve the issue of confidentiality: training reception staff more adequately about the importance of using first names and last initial only when discussing patients, making sure all reception areas have soundproof glass windows that are kept closed except for when having to communicate with patients, and having the same sort of protections around nursing stations for the same reasons. In addition, I have seen sign in sheets where the patient signs in but the rest of the page is covered with dark paper, which is then lengthened to cover the new patient’s signature.

I have also witnessed the heavy influence that pharmaceutical representatives have on the prescriptions that doctors write. For example, a psychiatrist that I know was frequently prescribing a certain antidepressant to all of the patients that needed medication for depression. At a certain point, I noticed that he began prescribing a different antidepressant to all of his new patients. I also noticed that on his desk, he had all types of items with the logo of the newer antidepressant on them. I asked him if he felt that the newer antidepressant was better than the first one, and he replied, “I’m not really sure yet… I think it’s going to be good, I purchased stock in that company.” In hindsight, I believe he blurted that out without thinking because it was clearly a conflict of interest for him to be investing in a new antidepressant, knowing that each time he prescribed it for a patient, he stood to gain a few cents in his own pocket. I find this appalling. I believe that doctors or medical professionals should not be able to invest in drugs that they might conceivably be prescribing.

Finally, I have experienced how difficult it is to find an outpatient therapist for adolescents who have been hospitalized; very few therapists are willing to work with teenagers for one reason or another. The reason most often given is that they are too difficult, frequently have mood disorders, or are simply too complicated to manage. I think it takes a special kind of personality and understanding on the part of the therapist to be able and willing to work with teenagers. Granted, it is a difficult time of development, and frequently adolescents are the patients that require much contact in between appointments, have difficulty trusting many adults, and are often suicide risks. I believe that the way to cope with this is to find therapists who specialize in working with adolescents; although they are rare, I have found that the best people to work with teens are those who spend most of their professional time with that age group.