The most important immediate response of a nurse during a disaster is to activate the disaster plan in their hospital. This includes triaging patients, coordinating evacuations, and communicating effectively with other healthcare providers. Perhaps one of the most important factors when it comes to any emergency situation is maintaining organization and teamwork, which is seen in The Story of Hurricane Sandy and NYU Medical Center.
Although nurses have a duty to care for their patients, it should not extend to the point where a nurse must feel as though they must negate their own needs for that of others. Situations in which a nurse may be faced with making a decision that prioritizes themselves or their patients include mass casualty events in which triaging becomes necessary, or if a scenario warrants that only one person may survive. It is the decision-making process of the nurse that needs to be refined to deal with emergency situations. All nurses should be trained in emergency preparedness, as it is unknown when these situations may occur and this training may help prevent a nurse from having to struggle between the code of ethics and their duty to self. However, nurses must also recognize the power that they hold from the viewpoint of their patients. A patient has a strong reliance and trust in their nurse to do what they believe is best. If a nurse decides to choose themselves over their patients, how will patients be able to trust not only nurses but the healthcare team? In these situations, we must remember that no single life is more important than another, it simply must come down to the professional opinion of the nurse to decide which life is more viable at that moment.
Al Harthi, M., Al Thobaity, A., Al Ahmari, W., & Almalki, M. (2020). Challenges for Nurses in Disaster Management: A Scoping Review. Risk management and healthcare policy, 13, 2627–2634. https://doi.org/10.2147/RMHP.S279513
Everyone is going to die, it’s just a matter of when and how. Every day, people choose whether they want to live. My opinion of death with dignity is that it allows an individual to have autonomy over their life. If someone no longer wants to live, they’ll find a way regardless of the law. My belief has always been quality over quantity because otherwise, what’s the point.
Death with dignity does not challenge my beliefs of the first ethical principle of nursing. I believe that the purpose of a nurse is to promote a healthy lifestyle and to improve health. Despite the great lengths that nurses go to to help avoid a patients’ deterioration in the hospital, it happens, especially in cases in which a patient is immobile or comatose. I feel like a nurse would be doing a great disservice to their patients to believe or promote life when it is no longer feasible. Nurses can not always improve life and when they can’t, they should promote comfort and autonomy. Although I agree with the death with dignity act, it doesn’t come without its complications. At what point can it be determined that someone is within their mental capacity to consent to physician-assisted death.
Smith, M. A., Torres, L., Burton, T. C. (2020). Patient Rights at the End of Life. Wolters Kluwer Health, Inc. 25(2), 77-84.
I accessed a 40 question Emotional Intelligence test through the Global Leadership Foundations’ online website. The specific levels of EI, self-awareness, self-management, social awareness and social management each had 10 questions. From each of those questions, I scored accordingly:
Self-Awareness
Self-Management
Social-Awareness
Social-Management
4/10
8/10
7/10
5/10
From these scores, I interpret that I have fair emotional intelligence. It is neither good nor bad but it certainly has room for improvement. Prior to this test, I had thought myself to have better self-awareness than what I had scored. However, after reflecting on my score, there have been occasions where I’ve been told that my body language doesn’t match my tone and it can come across as rudeness or disinterest. I am aware that my social skills could use improvement and perhaps the best way to improve my self-awareness skills would be to have someone mirror my body language. In this case, I would be able to see how my body language could be off-putting or deceptive. “Seeing is believing”, if I can see how I act, I can accept that it truly occurs and I can reflect from it. Reflecting would allow me to put myself in someone else’s position and witness how self-awareness and body language play a critical role in how we are perceived by others, especially in a professional environment. Self-awareness is not only important for everyday interactions, professional or nonprofessional, but also in being a successful leader. The body language of others impacts the way we respond in social situations. A successful leader can portray confidence despite feeling unease. The ability to have self-awareness is critical in maintaining poise in stressful situations.
In terms of self-management, I have always been an organized and deliberate person. I suppose this is my form of maintaining control and alleviating anxiety from not being able to predict the unknown. Ironically, this could explain my poor score in social management. Being unable to control or predict the actions of others is something that I struggle with and therefore I am not always receptive to what others say or do. Improving my self-management skills would require me to actually contradict my score by decreasing it. If I have less of a focus on controlling myself and the others around me, then perhaps I would be more receptive to unplanned events or actions. I believe this to be most of the reason why I find an interest in emergency medicine, it allows me to step outside my comfort zone.
I have always thought of myself to be patient. I attempt to consider all sides of a story before I begin to judge or take action. I know that I was not always like this and I think the majority of that change has to do with not only personal growth but also entering into the medical field. The medical field has taught me that not everything is as it seems. Interpreting a statement on paper doesn’t allow for a thorough understanding of someone’s circumstances when compared to physically speaking with them. There’s always room for improvement, I know that I still jump to judgment on occasions but I am able to reorganize my judgment when it is not appropriate. There is always room to improve my social awareness, especially in an ever-changing society. I believe someone’s level of social awareness can be contributed to the way in which they were raised (open-minded or close-minded). Improving social awareness can be difficult, especially if it contradicts the ways in which someone was raised, but it is never a bad thing to open up our minds and be privy and respectful of how someone else lives. I also believe judgment cannot and should not interfere with the ability to provide safe and effective care to every patient.
I didn’t believe myself to have poor social management skills. I am courteous of others and their beliefs. I am completely capable of being focused in an emergency situation and not allowing emotions to overwhelm me. I value teamwork and I always appreciate input from others. I think perhaps my poor social management skills are a reflection of how I feel about myself when I’m not in situations where I must care for others. I am very much someone who prefers to bury my emotions until they peak and resurface at my most fragile times. I don’t like to be vulnerable and I associate emotions with being vulnerable. In social situations, such as working with others, I am very flexible and I enjoy brainstorming as a group. My 5/10 score is very much reflective of my personal feelings of myself and not a reflection of my ability to work with others. From this, I recognize the importance of improving my psyche so that it does not interfere with how I care for others. I imagine this is only improved with counseling but acknowledging that it is a problem is a good start.
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]
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 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.
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 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.
