Month: November 2021

Since reviewing the ethics assignments and watching “Miss Evers’ Boys”, my overall understanding of a nurse’s contribution to ethical conduct of research and implementation of research finding has been overall changed and improved. Prior to these assignments I did not think that a nurse’s role was as important within research. Through the various assignments and movie, I saw that EBP is needed within today’s practices to improve, implement, and evaluate ethical standards. The key aspects of safety, equity, efficiency, and patient-centered care are encapsulated core ethical principles, and without the use of evidence-based practices we as future medical professionals cannot be successful. Within “Miss Evers’ Boys”, we saw how the nurses struggled to comply with what the doctor was ordering, and the actions being asked of them. Although it was a study, it was not providing them with the cure for their Syphilis. Instead, it was determining if African American individuals would have similar reacts to the medications in comparison to white individuals. The difficulties that Eunice Evers’ faces is that overtime she begins to realize the truth behind the “treatment” and the struggle within the lack of communication that was given to her. The entirety of the movie is the truth behind one of the most well-known violations of basic bioethical principles within the respect of autonomy. Within today’s medical field autonomy is something we as medical professionals learn in the classroom and must carry over into practice. Every patient has the right to independence, freedom, and to morally and ethically be taken care of, and it is our job to provide all areas that encapsulate these. 

I personally believe that as nurses we must have a full understanding of how research ethics and the evolution of research has become what we know today. This movie displayed the exact reason as to why ethical conduct is a key aspect within a nurse’s actions and behavior’s today when caring for a patient. Nurses need to be well educated on how evidence-based research around ethical standards have evolved and their importance moving forward. 

My achievement of the course objectives has contributed in many ways to the capacity to participle in the ethical conduct of research, quality improvement, and evidence-based practice initiatives. Through this course I have grasped onto the concepts of what evidence-based practice means and the tools needed to further grow into a better, well-rounded nurse. Although I am unsure, I will progress further into conducting research, I will do my part in the overall within quality improvements and how collaboration within the medical field can improve our patients care. The knowledge and tools I have built through these course objects will provide me with better skills as I progress forward in my nursing career.

My personal understanding around the nurse’s role on evidence implementation and generation has been very limited but with the expansion of EPB and how we implement it seems to have clarified the aspects necessary. Taking into consideration the various aspects that are involved in an evidence-based process, we can align those with how a nurse implements their role ethically in the care giving setting. As a nurse we are the first line of defense, we are the key player in making sure the needs of the patient are met. Through evaluating and implementing interventions that are beneficial for the care of the patient. This being said a nurse can contribute to ethical conduct research by providing feedback and showing proof of how these implementations of positive care helped to benefit the patient. Most hospitals are highly collaborative, this means that the nurse is not alone, they must share their implementations and findings with the entire team so that the patient can have a well-rounded care plan moving forward. Nurses play the largest role in patient care because their number one job is to build a nurse-to-patient relationship and with that close relationship it can only benefit the team members to provide holistic care to patients. 

Portland Jetport ~Full Scale~ Emergency Exercise: SL Opportunity on 9/18 from 7:30am until 12:30pm, at the Portland International Jetport. The priority focus of this event was simulating an aircraft crash emergency situation for firemen, police officers, and EMT’s to train/practice this situation. Volunteers are adding to the learning and intensity of this situation for the Fire/Police Department as we each play a role within the emergency. 

1. Health Care Access and Quality
2. Social and Community Context Objective 

Two areas of social determinants of health that I feel as though connect well with the population associated with the Portland Jetport Emergency Exercise were health care access and quality, as well as social and community context. The Portland Fire, Police, and EMS Departments came together to test and perform their skills around different emergency scenarios. This experience gave each department a time to practice and test both skills and knowledge around what to do in emergency situations. Social and community context discusses the importance of interactions with communities and the relationships built around them. As an emergency department I believe that the areas of communication and control of a dangerous situation is key. Building positive relationships and areas of safety is what I feel this experience provided. It tested the departments in their skills but also allowed for the community to come together to see how to interact with these departments. Reducing overall fear and anxiety of areas of concern within the community and knowing that the departments of rescue are knowledgeable and skilled. 

The other area of social determinants of health covered within the Portland jetport emergency exercise is health care access and quality. This area is to improve access, quality and knowledge around health care. I feel as though health care is limited within our communities. The access and knowledge around what an individual needs or should be allowed access to, can become blurred. “About 1 in 10 people in the United States don’t have health insurance.” I believe that this is due to knowledge deficits around what proper care is. People and communities that are struggling within the cycle of poverty, although want health care, and want care to be provided, have limited money and resources. If we can provide proper services at a lower cost and give each patient education around health, we can overall improve our communities. It is key that our Police, Fire and EMS departments understand the community that they are servicing. Knowing the poverty, the struggles and the available resources, so that they can provide better care. It takes multiple areas of care and willing people within health care or health services/safety to make a change. I feel as though the Portland Jetport Emergency Exercise gave the community and volunteers a chance to interact with these department and understand their roles within our community. 

As a community we must learn and connect collaboratively to improve our health outcomes, within interprofessional teamwork and team-based care. Applying these areas of a team care within communities can makes the communication within them more open. Having volunteering and community-based activities with health care and departments of safety personnel present can allow for people to have these conversations and voice their needs. Giving the community a plan and a time evaluate their overall needs can ensure that safety is in place within the community and improvement of healthcare.  

Day One Residential Treatment: SL Opportunity on 9/27 and 10/16 both from 6pm until 7pm, both held over zoom. The priority focus of this event was what impact, we as volunteers, could have on individuals going through recovery of substance use and mental health, with providing services designed to connect with each individual through growth, nutrition, wellness and many other areas. 

1. Social and Community Context 
2. Education Access and Quality 

Two areas of social determinants of health that I feel as though connect well with the Day One Residential client population are social and community context, and education access and quality. Social and community context discusses the relationships and interactions within different communities and how these relationships impact an individual’s health and well-being. The individual’s that are apart of Day One Treatment are young adults who struggled growing up and turned to substances when they felt like there was nowhere else to go. We as the UNE community got the chance to step up and support the areas that they need extra support within. As a united community, UNE has been able to offer positive and supportive activities to implement with the young adults. My group specifically developed a Nutrition PowerPoint that we want to implement within the residents of the treatment home. Taking time to talk about the importance of nutrition and how a balanced plate of proteins, veggies, fruits, and carbs all enfold into a person’s well-being. 

            On the other hand, the aspect of education access and quality is an area of social determinants of health that I feel affects a wide range of individuals who are struggling and turn to substances or alcohol. It is stated that people with higher levels of education are more likely to live a longer and have a fulfilled life, but with areas of low-income, disabilities, and social discriminations it makes it harder on the entirety of today’s society. Children of low-income families struggle to have the same access to education and the benefits that other children may have. It causes for children to fall through the cracks of bullying, dropping out, and turning to substances because they feel defeated. As a community we need to come together and intervene to support these areas of schooling that are lacking. Not only for children but with adolescents who are struggling to discover who they are and what they want to do with there future.  

            When looking at how we as a community must work together to progress with adolescents and their struggle with substances and mental health, we must look at how interprofessional collaboration takes place. Specifically, within roles and responsibilities for collaborative practice, this meaning as a community or a team we must come together to discuss the issues within our society that we need to address to minimize adolescents turning to substances. Looking at the larger picture of how poor communication could have led us down a road that we can’t see the issues presented to us. Every young adult should have open opportunities for their future, and we need to support them by providing access to areas of growth. 

Home Fires: Incarceration & Children: IPE Event on 11/3 from 6pm until 7pm, presentations and discussions over zoom. The priority focus of this event was to have an open conversation around the effects of incarceration, whether it be your father, mother, or sibling that has been incarcerated. Discussing how we as a community can bring awareness and support to those in need.  

1. Economic Stability and Quality 
2. Neighborhood and Built Communities 

Two areas of social determinants of health that I feel as though connect well with Home Fires: Incarceration & Children are the aspects of economic stability and quality, neighborhood and built environments. Looking at economic stability, this plays a key role in all of our lives. 1 and 10 people today live-in poverty, which places a large number of stressors in a person’s everyday life. From housing, health care, and access to food, these are just the larger factors that contribute to an individual’s economic stability. With these aspects, comes a large amount of stress on the provider’s to be able to care and keep their family together. Which in turn leads to many people turning to breaking the law just to survive. People tend to go to great lengths for the people they love, just to keep them afloat. I personally believe that someone’s stability within their finances and ability to provide, 9 times out of 10, can result in making rash decisions.

The other aspect being neighborhood and built environment, this places an increasingly large factor in incarceration. With unsafe neighborhoods and communities comes the increasing rates of crime. With increasing crime rates this is a never-ending cycle of poverty for the community and the individuals who cannot break out. This speaks highly to the school systems; it is seen that adolescents struggling in school often end up in the juvenile justice system and this speaks to many families within poverty. As a community we need to step up and insert early prevention and interventions to break the cycle of poverty.

As a community we see where we are struggling and what needs to be done, but we have limited resources in place to break these cycles. The aspect of communication within interprofessional collaboration is an area I feel lacks for the families and communities of individuals incarcerated. If we as a community can implement prevention at the level of the healthcare providers, this can fold over into other areas of poverty. Initiating mental health screening, providing education, providing lower cost care, these are all small steps in helping families within poverty. Incarceration effects not only the individual but there family, so as a community it is our job to understand what is needed to support and develop strategies to assist everyone effected. 

For my medication reconciliation I thoroughly enjoyed doing it on my grandmother. It has been great to connect what I have learned in the classroom to the outside world, specifically around these medications. When going through her list of medications I quickly noticed some safety concerns with her medication reconciliation list. I saw that overall, her prescription of Lisinopril has many drug interactions with her current daily medication list that caused me to question other areas of my client’s care. She is on a prescription of Furosemide, as well as Prednisone, that when combined with Lisinopril can have the adverse effect of causing an individual’s blood pressure to lower.  Which can cause them to feel dizzy, faint, increase of headaches and reducing their heart rate. For my client’s conditions of congestive heart failure, as well as arthritis, these medications are conducive to her health, so it is important to monitor her symptoms. Monitoring her blood pressure manually, assessing her gait, as well as educating her on taking her time when getting up suddenly and dangling her legs prior to stepping down or making any sudden movements. 

My client is 93 years old, so the areas of concern for these adverse reactions with her medications are for general safety for fall risk and proper nutrition. This is based upon the fact that older adults tend to be more dehydrated and have less strength, limiting their general sense of feeling dizzy or faint. As well as being aware of Furosemide’s action of losing potassium and increasing an individual’s needs to urinate. Making sure my client includes more potassium rich foods in her diet and understands the education around urgency and incontinence while on tis medication. 

I feel as though my client had a general sense of her medications. Knowing why she has been taking them and a general sense of their education, but my Aunt is one of her general care providers, her being a nurse, so my grandma relies heavily on her. This being said my grandmother is also 93 years old, so there isn’t much changing her mind on things. She knows her health, but I think is limited in her general education due to being on so many medications for so long and not having a full understanding of what the medication may or may not cause for adverse reactions.  

After analyzing our group finding and reflecting on our topic within different theories of articles, I personally feel as though my assumptions about our topic did not change. Our topic of “Elderly patient who suffers from COPD, does deep breathing exercises in conjunction with current standards of pharmacological treatment significantly improve quality of life, as compared to current pharmacological treatment without deep breathing exercises”, stayed consistent throughout our research into the articles we chose. I think as a PICOT question we narrowed down the specific areas of deep breathing exercises and really focused in on specific effective exercises. As well as focusing in on the aspect of treatment associated with it. 

The findings within our articles I feel helped us as a group discover the many different aspects of breathing techniques a patient with COPD can have access to. Moving forward I think the various studies are to be brought forward and studied more thoroughly. I could see myself possibly using them in my future nursing. COPD is a complex diagnosis that causes a blockage of airflow and multiple breathing-related issues so any areas that can improve an individual’s ability to breathe easier should be taken into consideration. 

I feel as a team we came to the same conclusions that our findings of these articles were conducive for our PICOT question and to further develop our Influence Paper. On the other hand, I do feel although we have solid articles, we limited ourselves with specific breathing exercises that enhance a patient’s breathing. Instead of finding articles that dove into the pharmacological treatments. This was due to the aspects of medications, we felt brought us down a deeper rabbit hole, rather than focusing on the actual concept of COPD and its treatments. Overall, I think our team process has been thorough and to the best of our ability. We are all trying to manage our time together and stay on top of each assignments, working weekly together to make progress. 

Through my experience here at UNE I have been lucky enough to meet some very kind and interesting patients. Prior to beginning nursing school, I had worked within a psychiatric hospital with the geriatric population. This experience, although I learned so much, was limited on the care I was able to apply. Through my time during this semester and the clinical experience, I was lucky enough to have even more hands-on care with patients that I have never had the chance to experience. One of the most memorable moments, where I felt as though I truly made a difference was any time I got quiet moments to sit down with my patients and give them my full attention. Being able to give my full focus to them and complete their care was something very special. 

One patient in particular I connected with was one that was “stuck” in the hospital. Her family did not come back to care for her and there was no plan in place to go home or to move to assisted living. It was sad to see that a plan of care was not in place, but when seeing how the nurses and CNA’s came together to surround the patient with care and love was unlike anything I had seen. It gave me a sense of hope, that although the world we live in right now with Covid is filled with a lot of unknowns, there is still a sense holistic and well-rounded care. Each nurse knew this patient and made sure she was safe and as comfortable as possible through her day to day.

 As future nurses we have limited opportunities to sit one on one with a patient and give them all of us.  This time for learning and a slower pace hands-on experiences has allowed me to become the best nurse I can hope to be by focusing on the patient solely. I thoroughly enjoyed my time this semester and all of the patients I met, and I hope to continue my learning going forward.