Author: mmammone

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Reflective Writing

Having clinical rotations at Maine Medical Center has played a big part in enhancing my nursing knowledge by allowing me to get hands on experience. With this, I have been able to communicate with patients, practice critical nursing skills, and collaborate with other health care members. These experiences are invaluable and have given me great experience. With every patient encounter, something always sticks with me. Whether it was a friendly patient or a patient who is truly relying on our help to improve their quality of life, I take away something special from each patient.

            Specifically, I remember an encounter with a patient that has stuck with me since. This patient was critically ill and needed a heart catheterization with a possible coronary artery bypass graft to help diagnose and resolve what was going on. Chronic heart failure was the primary diagnosis along with an acute exacerbation of a kidney injury. The patient was retaining fluid and had difficulty with mobility. They required a lot of assistance with things such as eating, going to the bathroom, and changing position in their bed. This patient, even with all their difficulties, was one of the most optimistic patients I have ever cared for. They were extremely polite and grateful that we were able to help him. I was amazed at how appreciative and happy this patient was even though they were in a critical condition. It made me think about all the little things that may have annoyed me and made me realize that they were not that big of a deal compared to this patient.

            During the encounter, a lot of things went well. I was there to assist this patient to the restroom. Even though challenges in mobility existed, we were able to slowly use the walker and get the patient to the restroom. During breakfast time, I was able to assist the patient in eating. I opened their milk and containers which helped this patient greatly as they hand strength was diminished. This allowed the patient to eat their meal which will provide them will the proper nutrition to help their diagnosis. I was able to help this patient get washed up for the day via a bed bath. Getting the patient cleaned up can help reduce the risk of having the patient’s skin break down which could develop into a pressure sore or ulcer. The patient was very responsive and let me do what had to be done. These things went well for me as I communicated with the patient through each step of the procedures. They were understanding and willing to participate in each process. I was grateful for this as the patient knew the tasks that I was doing and that it was going to help them. Not everything went well through this encounter. The patient was hard of hearing and it was challenging at times to verbalize what I was going to do and if I had any questions. I used the white board on in their room to write out things that I was going to do throughout the day. This helped bridge the communication so that the patient was informed and ready to actively participate. I should have used this method of communication early during my time so that things could of went more smoothly. Another thing that I could also improve upon is my confidence. This encounter happened earlier in the semester and I was not as confident in my skills as I am now. Clinical has provided me with learning opportunities which has built my confidence as a nurse.

            Analyzing this patient in a different perspective, I am able learn more about their demographics and social determinants. Each patient has different health equity and different levels of access to care. The patient that I was taking care of had limited access to care. They lived in an area where health care was not something that was easily accessible. The last time this patient went to the doctor was five years ago. With this, this patient has a lot of new diagnosis such as type 2 diabetes as they have not been able to regularly trend their health. This lack of accessibility could have played a role in their current health by not allowing them to treat issues when early warning signs present. This patient was also at a disadvantage economically and could not afford most of their medications and procedures. This also played a role in the patient’s health. As far as the patient social determinants of health, this patient was educated and is currently retired. They are living off retirement and has a fixed income. This patient’s diet was not well balanced as they only have access to cheap food that lasted a long time. These factors play a big role in the patient’s health. Learning this information on this patient allows me to inquire about what the health care system is doing for the patient. This patient needs more access to health care and could benefit from referrals to primary care offices, physical therapists, and other health care teams that are closer to this patient’s residence. This could ultimately improve the patient’s health as they have the resources to improve their quality of life. The health care team has done a good job at educating and informing the patient on what needs to be done upon discharge. Education on medications, diagnosis, and nutrition is key to maintaining good health. Learning from this patient has allowed me the opportunity to grow as a nurse.

            I am a very different nurse now in comparison to the beginning of the semester. I was not as confident in my capabilities and knowledge as I am now. These skills have been strengthened through each clinical rotation. I got to practice important nursing skills which has built my confidence. Patient and team communication was not as good as it is now. This came from talking to numerous patients and collaborating with different health care members. These experiences are invaluable to my knowledge and have helped me grow as a nurse. Growth is an important part in nursing, and it comes each time you encounter a patient. You learn new things and learn new strategies to help provide the best care possible.

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Death With Dignity

Death with dignity is a very important topic as it can provide patients with a sense of comfort and give respect during their late stages of life. End of life can be challenging for patient as they experience a roller coaster of emotions including pain. Personally, I agree with physician assisted death as it gives the patient the control over their care. Instead of suffering from a terminal illness and waiting for themselves to die, it gives the patient the choice and terms on when they would like to no longer exist. I had a family member who was suffering from cancer and it was very challenging to watch them suffer knowing there is nothing that can be done. This topic can be challenging for some to discuss as they can have personal experiences that influence their viewpoint. Further research can be beneficial as it can provide more information on the topic and how it can affect patient care.

After viewing various literature, I have learned a great deal of information on death with dignity. I was surprised with how many states in the US have this process for patients. I assumed, with it being a very controversial topic, that there would be only one or two jurisdictions that allowed assisted death. With this, I also learned about some of the criteria that accompanies it. The patient must be of a certain age, be diagnosed with a terminal illness, and have decision making capacity. This process can challenge the first ethical principle of nonmaleficence as it directly causes the patient to die. This can a difficult concept as it is counteracting on what nurses and health care providers pride themselves on. Yet, the great picture should be looked at in these scenarios. If the patient can make decisions and a terminally ill diagnosis is made, then the decision should be in the hands of the patient. Death with dignity should be a “treatment” option that of which a patient can elect to go proceed with. This “treatment” option would be accompanied with consent and all other required documents for procedures. Healthcare workers look to help the quality of life in patients and with death with dignity, this can be accommodated. When dealing with terminally ill patient, health care workers are only providing comforting measure and prolonging the patient’s life, yet it may not be improving quality at all. Looking at the big picture can shed light into how a patient is feeling and can ultimately lead to providing the best care that health care workers can.

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Proposing Change

Our project has been very challenging yet interesting as we further discover the importance of maintain and documenting adequate input and output. Tools such as the automated urine output device showed to be helpful in reducing time while providing an accurate urine output. This device could be used throughout health care as the urge to document an accurate urine output increase. The workload for the nurses can be diminished using devices to help with urine output. I was surprised during our research period how difficult it can be to accurately document a patient’s urine output. This could be due to various reasons such as being over worked and fatigued, forgetting to do so, and the patient is not compliant with this process. An easy way to combat this is to document the urine output as soon as it is collected. This is to reduce the documentation errors that can be made when doing so. Education is also a key part we discovered during our research. This is because if the patient and nurse are educated on the importance of urine output, then positive outcomes can come from obtaining and documenting accurate measurements.

This project has made me think of how important it is to trend urine output as it can relate to cardiac and kidney function in a wide variety of populations. There were minimal revisions that we needed to make in our final proposal. We precisely and efficiently described our methods, findings, and evaluating our plan through our use of extensive research.  With this, our project does propose a positive change in the health care industry by strengthening the accuracy of urine output. This use of new devices can happen anywhere and can change the way this process is done in nursing. It will be important to familiarize yourself with these devices and accurately documenting urine output, especially in acute patients.

The process that went into this project was a very well thought out one. We discussed regularly as a group what we wanted to do and how we wanted to execute it. Our team has an immense amount of success through this project. Our research plan set us up with success as we each found an article and went through each one to find the best ones for our project. We went in depth with each article to examine what they testes and the outcomes that came with that. With success comes challenges. Writing out and formulating our thought into a short and precise proposal was challenging. We each had different ideas and thoughts we wanted to include. We had to work through these and formulate the best product that we could. When doing our project, we listened to what each person had to say and tried to incorporate everyone’s views into our project. Communication was the biggest part that allowed us to be successful.

Group-6-Project-Proposal-FINAL-1Download

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Electronic Health Records

The use of electronic health records can be very important in when it comes to patient care. The patient’s information is uploaded in real-time so that all people holding the capability can look when needed. Having the records held online allows for easy access and control over their own records. The health records can include diagnosis, medications, immunizations, allergies, lab results, and so on. The implementation of HIE and electronic health records is a huge jump the medical field. These records can be accessed on smart phones, tablets, and anywhere internet access iv available. This can allow physicians and the health care team to access this data when needed.

HIE allows the health care team to be more efficient and provide better quality when it comes to patient care. Instead of forcing the medical staff to hold records in filing cabinets or in boxes, it is all virtual and at the providers fingertips. Having information such as vital signs submitted in real-time, it can reduce the readmission risk, reduce medication errors, decrease duplication of testing, and improve how physicians diagnose patients. HIE also provides safe and confidential information so that each patient knows who is viewing their information and when they view the information. This tracking system that is apart of HIE is used to prevent any breaches in HIPAA and ensures only the allowed people to view the records. Electronic health records can enhance how care is provided to all patients.

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Trauma Informed Care

Trauma can have a significant impact on psychological, physical, spiritual, environmental, and social well-being. It can be life changing for a person to experience a traumatic event as it can stay with them for the rest of their lives. Traumatic experiences can be very damaging to a person’s mental health. The event or events that have occurred can trigger future negative reactions to things that resemble their traumatic event. Symptoms such as depression and anxiety can be directly correlated to trauma as a secondary diagnosis. A person’s physical well-being is also affected as well. Eating habits can diminish or escalate, sleep schedule can be derailed, and activity levels can plummet. These actions present as a person tries to cope with their traumatic experience or be a lasting effect of going through a traumatic experience. Socially, a person can become reserved and isolate themselves from others. Traumatic events can impact a person in ways that could be crippling. It is important to understand what happened during the event and try to work through the issues that present.

                 Adverse childhood experiences can develop into serious complications. Chronic illnesses, mental illness, and substance abuse are just a few examples of what can happen to an individual later in life due to ACEs. These events can cause things such as heart disease, diabetes, and respiratory illnesses. The stress that is induced from ACEs can cause physical damage to and individual. It can also cause mental inadequacies that can be life changing. It is important to recognize and establish early interventions to reduce further complications and reduce the occurrences of ACEs. Having programs available so that children can feel comfortable and safe when talking about their experiences. Promoting a healthy lifestyle is also very important in reducing the complications of ACE’s. Healthy eating, regular exercise, mindful thinking, and proper sleep can all help to reduce stress and promote well-being. This information is vital when practicing as a nurse.

               The Trauma-Informed Care principles are a key tool to use when handling a traumatic related situation. The principles look at understanding how trauma can impact a person in all facets of life and how that can be incorporated when giving care. The goal of patient care looks at the over all well-being rather than just the individual symptoms. When practicing, it is important to maintain patient safety. Providing the needed respect to allow a patient to feel safe both physically and mentally is key. Developing a trusting therapeutic relationship provokes a more safe and transparent care plan. This is important as a nurse because the patient will be more likely to express themselves which can help with diagnoses and maintaining their well-being. As a nurse, collaboration with peers and other health care professions will ultimately provide an enhanced care plan for all patients. This group work allows for sharing information between professions as well as with the patient. This entitles the patient to participate in their care and develop the course of treatment. Trauma informed care is very important in the healthcare role. It can drastically change the course of the patient’s health in a positive way.

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Public Health and Vulnerable Populations

The health or vulnerable and marginalized populations is widely underestimated which is a public health crisis. Many factors contribute and influence these populations. The individual, the environment, and the societal factors have a strong impact on their health The individual may have religious obligations that require them to not follow through with certain procedures. In the eyes of a health care worker this could be devastating, but it is important to recognize the different beliefs that people live by and how that can affect their health. An individual’s environment may not be able to support their needs. They could not have the needed facilities to treat what is needed resulting in a decreased health status. Society also plays a strong role in how well a person can maintain good health. Someone could live in a region where racial injustice is predominant. That person would not be able to go take care of themselves in the same sense that someone of different color could. All these factors contribute and influence the health of an individual and community. Money plays a huge role when it comes to and individual’s health as well. One may not be able to afford medical insurance and may have to pay out of pocket for procedures and appointments. One may have to choose between going to the doctor and putting food on their table. Individuals are likely to put aside medical conditions to afford more important things. This public health crisis needs to be rethought and changed in a way so that it is fair to everyone.

A keyway to start change is to rewire the way we think. For example, someone could decline getting a vaccine. Rather than just saying they should get the vaccine everyone is doing it; they should ask why. Many key things can influence how someone approaches health care. Not everyone is afforded the opportunity to make the best decisions possible. Does that person have health insurance? Transportation? Education? Resources? These drive the decisions we make yet some must set aside their health for a variety of reasons. As a community, we should look to help those less fortunate. Educate them, give them resources, give them the tools to help themselves. This ongoing public health crisis is important to everyone. We should all be educated and appreciate the things we have. When giving care, this information is important to know. As a nurse, I would educate patients and listen to their opinions. I would listen to what they have to say and try to help them the best I could. These populations are already at risk of decreased health it should be our job to help them.

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Planning Change

This team dissemination project can be completed efficiently and in a timely manner if we all work together. We will have to work on it section by section and in detail in order to receive proper feedback. Communication will be one of the most important things when completing the dissemination project. We currently have a group chat set up to discuss things together. Also, we will be in clinical with each other and have the availability to work on it. Having each person in the group on board and ready to be successful is important. One challenge that can arise is that one group member is not in clinical with us. This challenge can be overcome by proper communication. We all need to be on the same page and ready to adapt. That team member will need to communicate effectively to understand what is going on.

            Conflict within a group project can occur at any point. It is how the group manages that conflict that can determine how successful they are. To minimize this conflict, communication and being flexible is key. Talking through and reasoning with a decision will help reduce conflict as everyone will be on the same page. A group member should not be afraid to go against the majority. This could ultimately help our group by introducing a different point of view. If a group member does not complete work in a timely manner or the work is of poor quality, soothing will be said to correct these issues. It is not personal, rather, trying to push each other to do the best work they can and to care for the project. Ultimately, I believe the group will work together by listening, respecting, and participating to produce the best work that we can. This project will be beneficial as nurse’s work together all the time. They collaborate with other nurses, doctors, therapists, and pharmacists to take care of the patient.

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Influence Paper

Team-Influence-PaperDownload

This team influence paper examines the effects of cannabis on Parkinson’s disease related symptoms. Scholarly studies are analyzed to determine the effect in clinical practice. An exert from the paper is included below.

“Medications, physical therapy, and newly, cannabis, has been reviewed as potential solutions to reduce these symptoms that affect gait, balance, and coordination. The efficacy in clinical practice of cannabis is examined by scholarly sources, as well as, the effects cannabis has on REM sleep behavior disorders in patients with Parkinson’s disease as an alternative form of treatment.”

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Final Reflection

This final project has been very interesting. Going into it, I did not think I would learn so much about the process and my topic. My groupmate and I worked really hard on this project and put everything we had into it. Many challenges presented but through communication and reasoning we were able to resolve it. This project has taught me how to collaborate with others in a way that is not usual. I have never written a paper with another person before but I really enjoyed it. I feel it requires a different set of skills from other collaboration activities. You have to work through every little detail and both agree on it before continuing. This will help me through my career when dealing with similar situations. For a future employer, I would want them to know that I stayed driven and positive during this project. I worked through each assignment diligently and completed it efficiently. From this project, I can contribute to critically appraising articles and help with examining them. I can identify good articles from bad articles by looking over the credentials and reading the article. I can positively contribute to the medical profession by participating in these articles and giving adequate input. Through this team process I was able to identify some of my strengths and weaknesses. I feel like I am strong in designing and articulating words in a way that makes sense and is meaningful. I feel like I need to work on my grammar capabilities as sometimes this was lacking. Over all the team process was very beneficial and provided great cooperation experience.

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Ethical Considerations For EBP

Reviewing the provided resources about nursing and ethics, my opinion has not changed. I understand further that the role of a nurse will entail ethics. This is because patients have a wide view on the practices that they want to participate in. Educating the patient and informing them of recommendations should be a priority of the nurse. With this, it comes down to what the patient feels comfortable doing based on their past experiences or practices. There is a common saying by George Santayana that goes, “Those who do not learn history are doomed to repeat it.” This is the case for ethics in nursing. Understanding what practices have been preformed before will help further the knowledge of the nurse. Taking a deeper dive into these practices can help further progress studies that examine the same variable. A nurse should have a good understanding of the events that have occurred in the past and what lead up to those events. This can help prevent possible complications that could arise. This course specifically has enhanced my knowledge of the relationship between nursing and ethics. This course looks at evidence based practices and how to read, interpret, and explain these articles. It starts with understanding what you are reading. Once you have the ability to interpret results and hold the ability to explain them, the nurse will be able to communicate the results and consider them in their practices. Evidence based practice looks at problem solving in the medical profession while incorporating the patient and family. This should be done with every evidence based article that revolves around care. A nurse should have the capability to participate in these studies once they understand the key concepts of EBP. Contributing can ultimately result in a better experience for the patient by looking at what works and what does not work. This class, along with my ethics class, have delivered home the importance of ethics in nursing. I have the knowledge to examine articles and understand how they can play a role in the care I am providing. In short, the job of the nurse is to provide the most exceptional care keeping in mind the beliefs, values, and morals of the patient.

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