The Shadow Health virtual patient encounter provided an opportunity to enhance my clinical reasoning and practice focused assessments on the musculoskeletal and neurological systems. This reflection summarizes the experience, highlighting strengths, areas for improvement, findings, and the application of critical thinking. Two scholarly sources are used to support the reflection in addition to the course textbook.
What Went Well
I was able to establish rapport with the patient quickly by using therapeutic communication and open-ended questions. This approach made the patient more comfortable sharing her symptoms. I successfully performed a musculoskeletal examination, including assessing gait, range of motion, and muscle strength. My neurological assessment also went smoothly in testing cranial nerves II–XII, reflexes, and coordination, which allowed me to collect objective data systematically.
What Did Not Go So Well
Time management was a challenge. I spent too much time clarifying general history questions, which limited the depth of my neurological exam. In future assessments, I would prioritize focused questioning to ensure I capture essential information without losing time. Additionally, I occasionally asked closed-ended questions that limited patient responses. Next time, I will aim to balance open-ended questions with targeted follow-ups.
Findings and Effective Questions
Key findings included reports of intermittent lower back pain, stiffness in the morning, and mild hand tremors. Objective assessment showed decreased lumbar range of motion and diminished reflexes in the lower extremities. Questions such as “Can you describe how your pain changes throughout the day?” and “What activities make your symptoms worse or better?” yielded the most detailed responses. These were effective because they prompted the patient to provide contextual information beyond a simple yes or no.
Diagnostic Tests and Differential Diagnoses
Based on the findings, diagnostic tests such as an MRI of the lumbar spine and EMG testing would be appropriate to evaluate potential nerve impingement or neuropathy. Differential diagnoses include osteoarthritis, lumbar disc herniation, and early Parkinson’s disease. Supporting literature emphasizes the importance of correlating musculoskeletal findings with neurological changes to guide accurate diagnosis (Smeltzer et al., 2022).
Patient Teaching
I was able to provide basic education on posture, stretching exercises, and ergonomic strategies to reduce back strain. Additional teaching would focus on the importance of follow-up imaging, medication adherence if prescribed, and lifestyle modifications such as weight management and physical activity. According to Ramasamy et al. (2021), patient education is integral in preventing progression of musculoskeletal disorders.
Medications and Clinical Decision-Making
At this stage, prescribing medications may not be necessary without further imaging results. However, if pain persists, NSAIDs or muscle relaxants could be considered. I chose not to recommend immediate pharmacologic therapy to avoid unnecessary side effects until diagnostics confirm the underlying issue. This demonstrated critical thinking by weighing risks and benefits before intervention.
Conclusion
The Shadow Health exercise enhanced my ability to integrate subjective and objective findings while applying critical thinking to formulate differential diagnoses. Although time management and questioning strategies require improvement, the experience improved my confidence in musculoskeletal and neurological assessments. Going forward, I will refine my approach by using focused, open-ended questions and ensuring efficient use of the encounter time.
References
Ramasamy, R., Williams, G., & Jones, M. (2021). Patient education in musculoskeletal disorders: Strategies for improved outcomes. Journal of Advanced Nursing, 77(8), 3278–3286. https://doi.org/10.1111/jan.14928
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth’s textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.