Month: November 2021

Reflecting on my clinical experience I think back to the variety of patients I have encountered. I have had the ability to meet people with different genders, ages, socioeconomic status, health status, mental status etc. Reading the prompt about identifying a patient I encountered makes me automatically think of this one male patient I had. When you walk into a room and meet your patient for the first time, you do not know the extent of what they have been through or where they came from, so it sometimes comes as a shock to me when I find out.

One of the patients I had was a homeless man who was found unconscious near a gas station covered in maggots and his own feces. Seeing him for the first time you would not think that he just came from a situation like that, and it broke my heart when I heard. When I think of community and public health nursing and what we have learned throughout the semester I think of this patient. We have learned about the struggles people go through with health care when they do not come from money or a good life. I really try to think of what we learned in class to try to begin to understand what the homeless patient I had goes through.

I went on the CDC website to revisit what social determinants were and how my patient would fit into them. The five social determinants listed on their website are economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context (Social Determinants of Health). When I think of my patient and the first social determinant of economic stability, I think about how poverty could affect his life. I was told that he has been homeless for a long time and that this is not the first time they have seen him on this floor at Southern Maine Med. Being in poverty would affect his access to health care, healthy food, and housing. Not having access to those things greatly increases the risk of returning to the hospital with more and more issues. There are policies put in place to help people like him pay for food, housing, health care, and education which would improve their health and overall wellbeing. He does not heave health care insurance so he may also not be able to afford the medications he needs as well. Without the insurance, he may also not be able to afford a primary health provider that would do his routine checkups and that increases the chances of developing diseases and complications they may not know about until it’s too late. He lives in Biddeford where there tend to be more homeless people in some areas than others. There are not many sidewalks, but there are in some areas so depending on where he stays there may be safer places for him to walk and travel than others. Interventions and policy changes and the local, state, and federal levels could help reduce the negative health and safety risks in order to promote health.

Based on his assessment we could see that he has not been living a good life. His skin is breaking down and he has many wounds on his back and his bottom. On both of his feet his ankles have deep wounds and those both needed a dressing change. His feet are breaking down because he does not wear shoes and the weather has been getting colder. He seemed to be bitter and not wanted to be bothered, which was hard for me to understand because he was in a warm bed with people caring for him. When issues like that arise, it was good to think about what he comes from and what he must deal with on a day-to-day basis. I felt as though the staff did an awesome job accepting him and treating him well from what I saw. They made him feel comfortable and made sure all his comfort needs were being met. When he was being difficult, they explained why they had to do each thing, which made him more cooperative. I am unsure about how the health system/ hospital deals with it when he comes in. I looked it up and I was finding that if a person is homeless and has no source of income then the hospital pays for their stay.

As a student, I have had nice and cooperative patients for the most part. When I went into this patient’s room, I was surprised that he was so rude and unwelcoming when he is getting cared for. I feel like I did a good job with interacting with him and being as understanding as possible. Even knowing what condition, he was found in made me feel so much empathy for him. I would never be able to understand what he goes through on a day-to-day basis, but I knew that I had to chance to be kind and welcoming to him. I had to give him a covid swab and he was not happy about that and fought it. That was my chance to be patient and take a step back and explain why we needed that and the importance of it. He ended up letting me do it and it was a sense of relief that because of my patience we were able to get the covid swab.

 It is a good skill to have as a nurse to be able to walk into a patient’s room and treat them like your own family member. We need to understand that everyone has a story and has been through so many things in their life. The way that I watch other nurses interact with patients as a student and I have seen all different forms of communication. I have learned over my time at clinical that no matter what the patient is going through or been through, having an understanding and patient presence always works better with having the patients cooperate and want to participate in their care.

References

Social Determinants of Health. Social Determinants of Health – Healthy People 2030. (n.d.). Retrieved November 23, 2021, from https://health.gov/healthypeople/objectives-and-data/social-determinants-health.

When we were asked to create a project on vulnerable populations in health care, both of our minds automatically went to people suffering from a mental illness. Even though we are not even nurses yet, we have both been in situations in hospitals where we have seen mistreatment first hand. If we both have seen this mistreatment, then just think about how often this happens. We feel strongly that this is an issue that needs to be worked on and addressed throughout healthcare. We created an outline (which is linked below) which answers questions regarding this topic, and facts about it as well. Along with the outline, we prepared a 15 minute podcast briefly going over this topic and what we put in our outline. We tried to have a real conversation on the podcast, talking about information that was not even in our outline. We used examples from what we have seen as well as movies we have seen to give people a better insight on the effects of this issue. We talked about the ethics in health care and how this goes against it as well as hospital/ state policies and patient rights as well. We feel strongly that a change needs to be made regarding the treatment of this population in health care.

When I think about death with dignity, I realize that I have never really thought about it much before. As you go through school and think about becoming a nurse you know of certain topics that seem like would never actually happen during your career. This is one of those topics, where I knew about it but never thought too much into it because it is a situation that seems as if it would never happen. With that being said, I have a general knowledge on what it is and did not realize that it happens. I just learned in class this year that if a patient is nearing the end of life and the nurses are treating their symptoms and a patient is in pain, but the pain med may kill them, you are supposed to give it anyways. That is a crazy concept to me, and I do not know how I would feel doing that or being the reason that someone’s life ends sooner than it was supposed to. I understand the topic and if it does happen, I just hope the patient has full knowledge on what could happen, so they can make those choices. I do not disagree with death with dignity, but it is something that I do not know if I would be able to do. I feel as though it would be hard for me to knowingly give someone a medication that could end up killing them, whether they are approaching the end of their life or not. We are taught to keep our patients safe and keep them alive, and this is the opposite of that. This topic does challenge everything we have learned about ethics in school, but I do understand to an extent of why it is a thing.

            Something that could be an issue with this and that I see as a big ethical dilemma is if the patient is getting end of life care, but they are unable to make any decisions. If a patient was in and out of consciousness or unable to communicate, that would be hard for me. I would want to be able to communicate anything that I am doing or giving to them. If they are unable to understand it would not feel right and really challenge my beliefs on the first ethical principal. Personally, being a nurse in a situation like this would make me uncomfortable because I would feel like I am doing something wrong the whole time.