Just Go With It

Author: mlittlefield3 (Page 2 of 5)

Electronic Health Records

I think the electronic health record is a productive way of attaining a thorough health history of a patient, especially in instances in which a patient is unresponsive. The electronic health record improves efficiency between hospitals- no need to track down and contact the hospital for records. 

Health Info Net is an organization that allows health care providers to access patient information from any hospital that a patient has visited or been admitted to in the state of Maine. The way in which health information is accessed is called the Health Information Exchange (HIE). Health Info Net was incorporated in 2006 and since then has been advocating for patient care by combining health information from unaffiliated healthcare organizations to create a single electronic health record, the HIE (HealthInfoNet 2021). This health record is accessed by providers across the state of Maine in order to provide better patient care. The health information exchange improves communication between providers and helps prevent pertinent information from being overlooked or forgotten. The HIE improves nursing care by providing a patient history that nurses can refer to when providing patient care. 

As a nurse, knowing that the notes and data that I record will be embedded into a single health record, I will want to make sure that what I am recording is as accurate and detailed as possible. This exchange allows for quick access to previous assessments and could allow me to trend vital signs and labs from the previous data and compare them to current data. Prior health history can be critical in determining the path a patient is heading towards and helping to prevent it.

Bearor, S., Yeo-Fisher, N. (2021). Maine’s Health Information Exchange. [Powerpoint Slides]

Post-Interview Reflection

Leadership is a concept that is critical in all professions. In nursing, it is especially critical as it influences others to provide quality care and also helps mitigate the pressure of making difficult decisions for the welfare of the patient. The emotional intelligence of my interviewee is high, but not without its flaws. She has all the qualities of emotional intelligence, including social awareness, social management, self-management and self-awareness. Her only shortcoming was that her great empathy towards her patients leaves her vulnerable to becoming overly emotional when they pass away. While we both know death is something that we will experience often, there is a fine line for healthcare staff where we must protect ourselves from becoming heartbroken while also expressing our sympathies in a reserved manner. Although she is in a leadership position, her democratic leadership style leaves her open to receiving feedback from the individuals she manages. Additionally, she is also able to confide in her peers who are in similar positions. 

After just recently having her first child and being out of work on maternity leave, she is unsure of how she will manage her life as both a provider and a mother. Although she misses being at work and is eager to return, she recognizes that she has a new position and must face the challenges that come with both work and her personal life. This interview has led me to believe that the path that you had initially started in life doesn’t always have to be the path that you finish with. With nursing as a second degree, I am eager to employ my current life experiences with the new knowledge that I have learned. I am hopeful that as I continue on my path I may find new avenues that I hadn’t expected to become involved in and I take the opportunity to travel in any direction that this career leads me in.

Trauma-Informed Care

Trauma exposure, whether experienced as a child or an adult, has the ability to create a lasting impact on someone’s life just by the way the situation was handled or the events leading up to the trauma. Trauma can cause long-lasting psychological effects, such as anxiety and PTSD. If the trauma had caused a physical malformation, it may be more difficult to move forward in life. Spiritually, individuals may believe that they deserved the trauma, that their higher power had intended it for them. Victims of environmental traumas such as hurricanes or tornados may fear specific regions that are more likely to experience those weather events. Overall, traumas can impact our ability to form relationships, or to even maintain them. Some may fear leaving their home and some are not allowed to leave, especially in instances of domestic violence. The inability to develop new relationships or maintain current ones can lead to isolation which is neither healthy for the body or mind.

An adverse childhood experience is a traumatic or negative event that specifically happens to individuals as young as a newborn to seventeen years of age. Long term impacts of adverse childhood experiences immediately predispose adolescents to the risk of substance use problems, mental illness and chronic health conditions. As well as the potential for the adolescent to continue the trauma they experienced into adulthood. 

As a future nurse, it is important to remember that every patient, whether a victim of trauma or not, deserves respect. One of the first things a nurse should do, and perhaps the most important things to do, is to establish trust and rapport with the patient and family members, if applicable. As a nurse, I will have to investigate the impact of trauma on my patient while maintaining respect and establishing boundaries. I must also be aware that it’s okay to ask direct questions about trauma, as it is unlikely that those questions will send them reeling back into the trauma.

Leadership Pre-Interview Reflection

My subject is a close relative who recently came into her leadership role. As she is much older than I, I have always looked up to her and only wished I could be as kind. She has always been a safeguard of my eldest brother who is on the Autism Spectrum. I chose her because we are both aware of the challenges that a disabled individual can face and her decision to make a career out of helping others is an inspiration that I wish to follow. 

As the oldest of three sisters, she has always been a fair and kind person. As a teenager, she experienced a life-altering event that would forever change not just her appearance but also her perception of herself, if only she had allowed it. She was in a tragic accident that would leave her with a prosthetic eye. This was a defining moment in her life in which she could have chosen to give up but instead, she persevered. She never let this impairment change her path in life, she simply adjusted to it and it became her new normal. Her recent role as a leader wasn’t always apparent as her initial degree was in history. Eventually, she had gone back to school and earned her degree in Occupational Therapy, it was at this point that her leadership role was just beginning.

Formally, she is the Director of Rehabilitation at a 64-bed skilled nursing facility. In addition to being an Occupational Therapist, she is also a Certified Dementia Practitioner and a Certified Ergonomic Assessment Specialist. As a director, she plays a critical role in not only the guidance of her staff but also in the life of her residents as she helps them adapt to their own physical and mental changes. Informally, she is a friend above all else and has a first-hand view of what it means to adapt to unforeseen circumstances in life. What I am most interested in learning from this individual is how she overcame her mischance as a teenager and whether this was pivotal in her current role as an Occupational Therapist. I would also like to further understand her leadership style and the importance of reciprocity and patience in this particular profession. Furthermore, I would like to know what she sees herself doing in the future. Will she continue in her leadership role or does she see herself taking a step back as her family begins to grow. 

Public Health and Vulnerable Populations

Public health nurses are an elite group of individuals whose purpose is to integrate themselves into their communities and act as resources and educators specifically for vulnerable and marginalized populations. Their role is all-encompassing, which also includes new Mainers and asylum seekers. These nurses bear witness to the impact of the opioid crisis and gun violence on families and their communities. These individuals fall into a category known as vulnerable populations and this is because these communities are more susceptible to violence and abuse due to low socioeconomic status. Community health nurses watch as families are torn apart and kids orphaned as parents find themselves bound to their chemical addiction. These nurses are also responders of the climate crisis. As temperatures rise, individuals find themselves struggling to not only stay cool but to also afford it. Nurses are privy to these issues because more people are seeking treatment for heat stroke, sun burns, and dehydration. 

The social determinates of health are economic and social conditions that influence the health status of individuals. From high-income to low-income communites, there is a clear disparity in health due to the ability to not only access care but to also afford it. This disparity is predominant in low-income communities comprised primarily of African Americans and is influenced by a history of racism and continues to be an issue as our past has led to a mistrust of future care. Culturally, some medical conditions are not seen as a condition at all, they are simply a spiritual connection (Hmong). Often times western medicine is regarded as the standard of care, and from this arises the issue of when medical intervention is warranted. This is because of the varying expectations of individuals of different nationalities, cultures, and religions as western medicine may not be their idea of medicine. 

Strategies for improving the health of vulnerable and marginalized populations would be adequate access to healthcare, affordable healthcare, and education. Individuals should be aware that emergency rooms cannot be utilized for check-ups and to combat this, clinics need to be made available in these areas. However, this isn’t so easy as clinics require manpower and currently there is a lack of healthcare workers. There is where education can play a powerful role in preventing recurrent healthcare visits. If these individuals can be made aware of the lifestyles that put them at risk for health conditions, they could make the changes to live a healthier life (i.e. no smoking, minimal alcohol, exercise). 

To manage the care of an individual who lives and/or has different beliefs than I do requires that I hold myself accountable and refrain from judgment. It requires that I am well-rounded and well-informed of the communities around me and that I have effective communication skills.

Final Reflection

What I have learned from the team project is that nursing requires collaboration and equal contribution from each member. I’ve also learned that nurses can be the pioneers of composing or enforcing new skills that can contribute to patient care. It is also important to recognize that instituting new guidelines into large corporate-run hospitals can be a difficult task and requires persistence, which I think is a trait that all nurses should have. Quality improvement projects not only seek to contribute to patient care but to also protect those of whom providing the patient care by giving them the best resources available to provide that care effectively. I think I am a strong resource in analyzing articles and being able to find the qualities that make the article relevant and qualities that may work against it (such as sample size, longevity of study, etc..) Overall, as a team member I believe I bring good perspective, am reliant, and feel as though the group I worked with to accomplish this paper would willingly work with me again.

Final Reflection Excerpt

I was instantly drawn to my patient as I always find it inspiring when someone has been married to the same person for decades, nonetheless, 65 years, as it isn’t all that common anymore. My patient was an 85-year-old female who was recently widowed and had also recently moved into an assisted living facility shortly after the passing of her husband. I had the pleasure of meeting her as she was placed in the psychiatric unit I was working on. She was placed there with the diagnosis of major depressive disorder as evidenced by a suicide attempt with melatonin related to the recent death of her partner. I was saddened to hear that she had tried to commit suicide, I had sympathy for her and I understood her motive behind the attempted overdose. Some may say that she still has her boys to live for but they have now grown into men and share their lives with other people, striving to have the same connection that their parents had.

I can only imagine the loneliness she is feeling being a widow after 65 years of marriage with the same person. I don’t believe there is a lot of acknowledgment of the physical and emotional dependency that grows between people when spending a lifetime together.

I believe my patient to be in the depression phase of grief. The emotions that my patient is feeling are a normal part of the death and dying process. She is able to speak of her husband in the past tense and but doesn’t discuss the cause of his passing. She doesn’t become teary-eyed when speaking of him but I bet she does when she’s alone.

She would benefit from education regarding the grieving process and the normal mindsets that come from it. For the risk of convenience, I would not allow her to continue to have free access to OTC medications as there are much more harmful agents than melatonin that can be accessed over the counter. Unfortunately, she has crossed a line and therefore any trust that she may have had at her facility is gone. I fear she may experience more of a loss of autonomy than she had when she first went into assisted living.

 Nursing interventions would include ensuring that the patient is in a safe environment and does not have access to objects with which they can harm themselves or others. Inform the patient on the therapeutic use of prescription medications to help facilitate the coping process. Educate the patient regarding the harmful effects of negative self-talk (believing she is better off dead) and its impact on self-esteem. Finally, be available, apply active listening, and let the patient freely express their emotions and feelings

Appraisal and Synthesis

From developing and researching our PICOT question, I have gained an acute awareness of the worldwide crisis of maternal mortality. Our findings have shown that of all industrialized countries, the United States ranks last for the effective management of maternal mortality. This is, in partial, due to the lack of developed protocols and the trepidation of hospitals to take it on. Hospitals may be apprehensive to take on the implementation of maternal hemorrhage protocols, also referred to as safety bundles, because of lack of appropriate studies, funding, and resources, or is not a large maternity hospital. Our analysis of many studies found that utilizing maternal hemorrhage protocols did not change the outcome of maternal mortality. However, we did find evidence that the ways in which these studies were performed contained limitations and are in need of multiple study replications. Due to there being one maternal health to 100,000 births, this would need to be formatted as a large-scale longitudinal study to ultimately determine if safety bundles would effective. As a future nurse, I think I would be more confident having set guidelines if a emergent situation were to occur. Yet, there is always a possibility that a patient may not meet the protocol guideline requirements and in those instances it would be up to the physicican to determine the appropriate care.

Team challenges included formatting the synthesis portion and maintaining a ‘one voice’ kind of writing style. Ultimately, our group worked well together and maintained an open dialogue that helped us turn our draft in on time.

Assumptions

My thoughts of ethics in nursing was the implementation of HIPAA and maintaining confidentiality of all patients unless circumstances warrant otherwise. Nurse’s have a role to do no harm and not allow biases to cloud their judgement and treatment implementation. All patients deserve the same standards of care.

Medication Reconciliation

“Provide the patient (or family, caregiver, or support person as needed) with written information on the medications the patient should be taking when he or she is discharged from the hospital or at the end of an outpatient encounter (for example, name, dose, route, frequency, purpose)”.

Upon discharge, the patient will be given prescriptions for the following medications: Risperdal, Mirtazapine, Buspar, and Omeprazole. The prescription for each medication reads as follows:

  • One 2mg tablet of Risperdal, taken by mouth, every night at bedtime for relief of rigid thought processes and irritability/overstimulation.
  • One 45 mg tablet of Mirtazapine, by mouth, every night at bedtime with Risperdal to aid sleep and improve mood. 
  • One 20mg capsule of Omeprazole, by mouth, every morning 30 minutes to one hour before breakfast to prevent an overabundance of acid production in the stomach and treat acid reflux.
  • One 10 mg tablet of Buspar, by mouth, every morning with Omeprazole, every afternoon with a snack and every night at bedtime with Risperdal, and Mirtazapine. For a total of 3 tablets (30mg) daily. This medication will help with severe anxiety and compulsive tendencies. 

Medication reconciliation is a tool utilized by healthcare providers to evaluate a patient’s medication regimen, determine the effectiveness of the therapies, and observe the patient’s understanding of their medications. It is in the patient’s best interest to understand the medications they are being prescribed, their potential effects, and the opportunity to refuse or question the therapies being prescribed to them. Reconciliation also identifies potential problems with current medications and seeks to resolve them. Fully evaluating a patient’s prescriptions is especially important when the patient is seeing more than one provider. In some instances, a patient may unknowingly be taking a medication that can interact severely with another medication they are being prescribed. It is also a good opportunity for providers to investigate medication adherence. 

From this assignment, I have learned that there are multiple components that need to come together in order to safely and effectively treat patients. The end goal is for the patient to receive care in a safe manner. Safety ultimately starts with education which is why patients are given written information on the medications they are prescribed. This includes the name, dose, route, frequency, and purpose of the therapy. Medication administration, from prescribing to dispensing, requires a multidisciplinary team with effective communication that must also include the patient. I have seen firsthand how easy it is for medications to become confused with others and for incomprehension to become life-threatening. Not only is it important for medications to be prescribed correctly but also for them to be taken correctly and one cannot work without the other. 

Boyd, M. A., Luebbert, R. (2020). Psychopharmacology, Dietary Supplements, and Biologic Interventions. In M. Kerns., M. L. Brittain (Eds.), Essentials of psychiatric nursing. (2nd ed., pp. 128-162). Lippincott. https://phoenix-app.thepoint.lww.com/content

« Older posts Newer posts »
css.php