Attaining and Protecting Your Professional Nursing

I plan to become licensed in the state of Massachusetts. Currently, Massachusetts is pending to become a nurse licensure compact state but is not currently. The application has been moved to online where a paper license is no longer issued. The application process can be done via paper but requires further steps to obtain and send the application. Massachusetts requires that you graduate from a board approved nursing program, have good character, and have passed the NCLEX. Background checks are also conducted that an individual meets the requirement to become a nurse based on any criminal activity. An individual must not have criminal convictions for a minimum of 5 years and have completed all court ordered stipulations a minimum of 1 year. Fingerprints are not a requirement under the Massachusetts Board of Nursing.

Substance abuse causing nurses to be impaired can be a dangerous thing for the nurse, other nurses, and the patients. Being impaired can correlate with making mistakes that can be life threatening to patients as well as the nurse. It is under legal obligations that a nurse must report other nurses who are impaired by substance abuse. When a nurse is suspected of substance abuse, it is important to conduct a thorough investigation and evaluation. This will look at safety, stability, and provide the person safe transportation to a safe environment. The nurse can be at risk of self-harm as they may experience shame and guilt when they realize what they have been doing. There are various resources available within and external to the organization. If unionized, they can provide support and there should be written policies based on the employer for incidents like these. External resources can look at the Massachusetts Nurses Association Peer Assistance Program, weekly nursing support groups, Massachusetts Substance Abuse Rehabilitative Program, self help groups, and SMART Recovery. If a nurse is found to be impaired, then termination of work may be the disciplinary action. Followed by this, a return-to-work agreement may be required to resume duties per protocol of employer.

In a world that is full of mistakes, it is important to always cover your back and your license when you are a nurse. Malpractice, protecting patient rights, refusing treatment, and abuse are things that  can be seen to cause a nurse to lose their license. As a nurse, you should take the proper measure to ensure that you don’t loose your license. Communication is a key part of protecting yourself and your license. Following protocols, minimize relying on coworkers, ensure social media is private, and always staying focused are keyways to protect yourself. At any moment a slip up can occur and taking the proper measures that are outlined by the employer is key.

Presenting Change

This project has taught me an immense amount of information on the nursing process and quality control. As a group, we got to identify a current issue within the hospital and collaborate to resolve this issue. When searching for ideas for this project, we collectively agreed on researching the importance of accurate documentation of input and output. Documentation can be a tedious task and consume valuable time that could be used on face-to-face patient care yet, should not be underestimated. Adequate documentation of input and output can play a tremendous role in directing the course of treatment for patients. For example, patients with congestive heart failure tend to gain weight via the accumulation of fluid. This fluid increases the weight of the patient causing them to experience edema. These patients tend to be put on a diuretic which will reduce the amount of fluid within their system. Input and output come into play when determining how much fluid is coming out of the body versus being put in. If a diuretic is used, the patient should experience an increased output. Documentation of this output should be done adequately so that doctors can properly dose their medications and have an accurate representation of the patient’s current condition. Recording a patient’s input is just as important as it can give insight into if a patient is potentially dehydrated or malnourished. This information is vital in keeping the patient safe.

Through this project, we learned more than just what input and output is and how important it is. We also came up with a potential solution and key points to help health care staff to accurately document it. Devices such as an automated urine output device (UOPs) can allow for precise measurements of output from a patient. These devices can help reduce the tedious task of checking the patient’s urinal and allows for accurate handoff when reporting. We discovered other methods that can assist in making sure the health care team accurately documents input and output. This can include increasing the amount of education that is being done via a class online or in person. Classes are an efficient way to educate team members so that they can understand why it is important and how they can do their part in providing accurate documentation. These methods can be implemented to help increase the accuracy of the documentation that is being done.

A lot has been learned through this process and this information can be utilized later on during my practice. Nursing is an ever-changing occupation that requires extensive research and education to be successful. New technology is constantly coming out that can influence proper documentation. This project has taught me the importance of recording what a patient takes in and what they put out. This information can be shared with coworkers while being a nurse which will ultimately provide a positive benefit to the patient. This project has taught me how to collaborate with my peers to achieve a common goal in the health care setting. Quality control will always be a part of health care as we are constantly looking for new and more efficient ways to provide the best care possible. This project required extensive research and critical thinking to interpret and resolve a current issue. With this newly acquired knowledge and skill set, I will be able to further improve my future employer by participating in quality control and evidence-based practice initiatives.

Reflecting on the team process, I am able to see how I performed as a member of the group and how that affected our overall project. I have discovered that I am very effective when it comes to communication. I can help resolve conflict between members by being a mediator. I hold the capability to listen to both sides effectively and be able to help come down to a decision. These qualities can also help me later on when I am practicing as a registered nurse.

Currently, feedback on our dissemination project has yet to be completed. We await the feedback from our clinical instructor and floor personnel.

Disaster Nursing

Nurses play a valuable role in health care but they can also play an important role when disaster strikes. There are various tasks that a nurse can do to help any disaster situation, whether it is natural or man-made. A key job that a nurse can do is assessing patients. This can be done to determine how severe patients are from the disaster. Assessing patient’s helps doctors organize who they need to treat first. Things can get pretty hectic when a disaster occurs. It is important that the nurse remains calm and collected when assessing patients. Nurses also can’t hold be afraid to tell it like it is. If a patient is near death and has a low probability of survival, the nurse needs to make the decision to provide comfort and let the patient live out the remainder of their life. Nurses can also contribute by providing patients with first aid and medications. If people are in need of help but their injuries aren’t as extensive as others, a nurse can jump in and provide first aid. This could mean stabilizing a patient with a suspected spinal cord injury or tying off a gushing wound by providing pressure. These tasks can help save patient’s lives. Medication administration is also valuable in providing comfort to patients. Pain medications can be used to help alleviate immediate pain. When dealing with all of this commotion, a nurse needs to be able to step back and think about their own safety before jumping into something that can danger themselves.

The ANA Code of Ethics can present conflicting Provisions as a nurse has a duty to care for a patient yet, care for themselves. These two Provisions can conflict each other in times of disaster. In these types of situations, a nurse has to think about themselves and the issue at hand. If saving someone’s life is going to cost your own life, then that is not worth it. A nurse can only do some much in certain circumstances. It can be challenging for a nurse to make this decision. When a nurse spends their whole career helping people in need, these decisions do not get any easier. Sometimes, a nurse may need someone else to explain to them that helping someone in a certain situation can lead to harming themselves. The judgement is left up to the nurse as they should do what they feel comfortable doing. It would not be considered a breach in one code over another when they involve endangering yourself or the patient. 

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.

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.

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.

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.

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.

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.

Influence Paper

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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