While doing my preceptorship at Brighton First Care, I encountered a patient that made me think about community and public health nursing. This young woman was non-English speaking and was alone. This created a barrier of communication between the patient and health professionals. I grabbed the iPad interpreter to assist with communication with the patient. As I was speaking to her, the provider came into the room and took over with her. She had come into the urgent care because she woke up and her tongue was black. This must have been a scary time for her, and she was obviously concerned. The provider just told her that it may have been caused by one of the medications she was taking. When I watched the encounter, I was a little bit upset. The provider gave her no reassurance that her concern was valid, and she would be okay. He just told her it might be from the medication and walked away. In that moment I wanted to go up to her and give her that reassurance that I felt she needed, but the interpreter was already taken away. Looking back, I regret not doing that for her. Seeing the young, seemingly healthy, woman there with a big Ziplock bag filled with many prescription medications, I wondered if this is not the first time this has happened to her. As a nurse, it is important to be an advocate for your patients and I saw the importance of that on this day. This experience made me think about for encounters like this in the future, I want to be an advocate and help reassure that their feelings are valid. I wish I could have done more in that moment, but now all I can do is learn from my mistakes and hope that I can do better in the future.
Death with Dignity
Prior to coming to college, I was unfamiliar with the death with dignity law. The first time I was exposed to it was during my ethics class at UNE a few years ago. We watched a documentary about people who decided to die with dignity and the process that they had to go through to be able to do that. When I first heard about this law, I was not sure what my feelings were about it. I did not know much about it, and I did not want to form an opinion about it until I was able to investigate it more. At first, I think I didn’t completely agree with the law, but after learning about it a few years ago, my opinion changed. The biggest principle that I follow throughout my life is being respectful of others’ opinions whether or not I believe the same things. I also believe that people should be able to make their own decisions, especially regarding decisions that involve life or death. When it comes to healthcare, people make life-saving decisions all the time. I feel like it is fair for them to be able to make life-ending decisions too. As a nurse, it is always important to be respectful of the decisions of the patients even if you do not agree.
The ethical principle of non-maleficence means that healthcare workers should never intentionally cause any harm to the patient. The dictionary definition of harm is to damage or injure physically or mentally. When it comes to death with dignity, people question if it follows the non-maleficence principle. In my opinion, I question if death with dignity can really be considered harm. It is obviously causing their death, but it is not unwanted or has intention to cause harm to the patient. When someone decides that they want to die with dignity, it must be thought through thoroughly and they are given many opportunities to change their mind. Is giving someone the opportunity to make a decision that they genuinely want means that they are intentionally causing harm? There seems to be a fine line between what people believe is right and wrong when it comes to the death with dignity law, and I am sure that this topic could be, and will be, debated for a long time .
Proposing Change
Our group decided to focus on the topic of infection control. We learned throughout nursing school that preventing hospital acquired infections is a top priority of most hospitals. It was not until we got onto the unit that we realized how prominent this issue is. Seeing the statistics on how common HAIs are was eye opening. We found that the best way for reducing these numbers were just by education. The longer I spend in nursing school and being exposed to healthcare, the more I realized how many things can be avoided just by prevention and education.
Our topic was recommended by one group member, and everyone agreed that infection control was a great idea to do our project on. In the beginning, our draft needed to be changed slightly but there was no need to revise the topic. Our team worked well together and made sure assignments were submitted on time. We had a group chat to be able to communicate effectively and there were no issues or challenges that needed to be solved.
The findings of this report can easily be applied for my future nursing practice. Even though I am not a nurse yet, I am a huge advocate in prevention. I love educating patients and family members on health-related issues and how prevention can improve their overall wellbeing. For this project, I learned that it is important for nurses to be educated on how to prevent HAIs. I can now incorporate these methods of infection control into my future nursing practice and hopefully be able to prevent my patients from having complications that can be preventable.
Electronic Health Records
I think the incorporation of the electronic health record in nursing practice has been a great addition. I have never worked in a facility that had paper records before, but I could imagine that it was a lot more time consuming and less organized. It is amazing that information can now be found at just the click of a button. This also makes it easier to have interprofessional communication between nurses, physicians, and CNA’s. I have watched nurses direct message doctors if they need them and get responses within minutes. The only downfall to the EHR is that there is never a guarantee that it will always work and not break down. Another setback can be getting used to using the technology. Time must be taken for the employees to learn and become efficient in the technology. Overall, I think it is an excellent tool to increase efficiency, to have access to patient history, and to provide better care.
Before we had the presentation about HIE, I was unaware that the program existed. I learned that the patient must willingly release their information and can decline it at any time. Initially, I can understand why patients would be reluctant to allow multiple people to have access to their medical information. Through this presentation, I learned the importance of patients agreeing to release their information. Being in nursing school has shown me the importance of collaboration. Sometimes when patients are traveling to different practices, providers do not have direct contact with each other. The HIE allows for healthcare providers to access this information to be able to provide the best care to patients. For nurses in particular, being able to access patient’s records from previous facilities can allow for a more in-depth health history to help guide the plan of care. Getting the full picture of the patient’s current and past health status can help the nurse to provide the best care possible. In my future practice, I will apply what I learned in this presentation to my everyday practice. Now that I am aware of this resource, I will use it to help enhance the health outcomes of my patients.
Trauma-Informed Care
Exposure to trauma can impact someone in many ways. A person who has been exposed to trauma can have a hard time trusting others. This could mean they have a hard time trusting friends, or even healthcare workers. If they do not feel comfortable in a heath care setting, they are not able to be open to receiving the needed care. When consequences of being exposed to trauma lead to mistrust, it also can mean that they will have a hard time connecting with people. This creates isolation for this person which can lead to many other adverse consequences. Some long-term impacts that a person can get after being exposed to trauma include insomnia, GI issues, breathing difficulties, and pain.
As a healthcare professional, it is important to apply trauma-informed care to these patients. As a nurse, it is important to be honest with them about how much time you are going to spend with them, why it is important to be asking them questions, and what you plan on doing with the information they give you. It is best to incorporate brief and open-ended questions to gain the appropriate amount of information. When asking questions, it is important to understand that adverse experiences can not only come from the trauma itself, but the experiences around the trauma. This could include what they did before and after the event and the support systems they had available to them at that time. It is also good practice to ask permission before touching and to alert them each time. These are simple and important ways to being establishing rapport with the patient and being able to provide them with the best care possible.
Public Health and Vulnerable Populations
There are many factors that influence the health of vulnerable populations. The first example is the ability to access healthcare. Many populations do not have health insurance, the means to pay for care, or even located near health care services. A second example is location where these populations live. Communities that are surrounded by air that is not clean, do not have yards to exercise in, or do not live close to grocery stores to buy healthy foods all have an increased likelihood of not being in good health. Historical forces can also prevent communities from trusting health care providers. For example, African Americans may be hesitant about contacting health services due to past unethical studies done on their population like the Tuskegee study.
A way to improve the health of these vulnerable populations include equality, equity, and justice. Equality is the assumption that every person will benefit from the same supports, and that everyone deserves equal treatment. Some parts of equality may be beneficial for these populations, but not all. Equity means that each population gets the supports that they need. This idea shows that different communities need different supports to allow for a healthy community. Lastly, justice means that the root causes of the inequity were addressed. Although there is not much an individual can do about justice, we as healthcare workers can provide better care through the understanding of these concepts.
Planning Change
This team dissemination project is a great opportunity to work together to address a clinical issue and try to implement change. This project will be accomplished through teamwork and communication. We have made a group chat together so contacting everyone will be easier. We are going to breakup the amount of work so that all members can have an equally important part for a successful dissemination. Through direct contact with one another, we can hold each other accountable and make sure all of the work will be done. If someone is not contributing to the group, it is important to contact them and discuss barriers as to why the work is not complete, partially complete, or not done in a timely manner.
A benefit for this project is being able to work in a big group. As a nurse, you are always working in a collaborative environment, so it is important to be able to learn how to work with others successfully. This also can create a challenge due to delegating things to a large group. The best way to overcome this barrier is through communication. Professional and effective communication call allow for a a great work environment and can promote better teamwork for this project and in our future nursing practice.
Influence Paper
This paper was meant to explore the impact of breastfeeding with gestational diabetes on the infant’s growth. The research was based off of a systematic review and 2 cohort studies. An emphasis was placed on patient education to allow for the safest outcomes for infant growth and development.
Final Reflection
I have learned quite a bit from this team project research paper. The first thing that I learned is the value of teamwork. The most important thing I value when working with others is communication. As a team member, I always did my best to communicate about what needed to be done and how to break up the work evenly. Luckily, my partner did the same thing back so we were able to work efficiently. I believe that the best work and best care can be given when many great minds can efficiently work together. The second thing I learned about is the importance of evidenced based practice. In our paper, on thing we focused on was the role of education. Without evidence, it is impossible to accurately educate patents and give them the best quality of care. As a new nurse, I will recognize the importance of EBP and accurately apply what I learn to patient care and education.
Ethical Considerations for EBP
I believe that my assumption about the nurse’s role in ethical conduct was correct. Not only is practicing ethics important, it is also necessary to understand the history of research ethics. By understanding the ethical principles and the history behind them, it allows for the best outcomes. Through researching the history of ethics, it makes it easier to understand why these concepts were established and how they can be best applied. Through taking this class I have learned about these ethical principles and the past history of ethics. I feel more prepared to participate in ethical research much more than before I took this class.
