Author: aboilard (Page 3 of 6)

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.

When I think of electronic health records I think about the easy access and how easy it is to update patient information into them. It helps providers to share information about the patient easily, especially if the patient was admitted into different hospitals. It enables quick access for nurses as well so they can perform more coordinated and efficient care. However, there could be downsides to this such as computer hackers and how easy it is for anyone in the hospital to get into the records.

            Electronic health records will help doctors, nurses, care managers, and others to perform better care. HealthInfoNet is an online health record database that can be accessed by medical personnel who would need the patient’s information to perform better care. It is safe and the patients have a choice whether they want their information on record. In this case, I feel that it is a very good idea. If you think about it in a situation where a patient comes in unconscious and the hospital needs to do care or give medications, it would be very helpful if they can look at the patient’s medical record for their history, allergies, and anything else. HIE can also promote shared decision-making practices by providing different care teams with the patient’s information for them to have all the tools necessary to make their decisions. This can also identify major risk factors through routine screenings to prevent disease and lessen the severity of the illness.

            I learned the importance of electronic health records and how useful it can be when providing care. Looking up patient information especially before providing care to them will enhance their outcomes. I will make sure to look up patient information before going into their room in order to help give the best care to them. It would be very helpful to know their past medical history, allergies, the reason they are in, and any other past reasons for coming to the hospital. Electronic health records are very helpful for any medical staff providing patient care.

Using trauma-informed care is very important as a nurse to get to know your patients as a person and the things that happened in their life to make them who they are today. Using a trauma-informed care approach with help create rapport with your patient, resulting in better overall care and patient outcomes.

People experience and cope with trauma differently and that ends up influencing their psychological, physical, spiritual, environmental, and social well-being.  Trauma survivors end up having an increased risk psychological issues such as: depression, anxiety, and PTSD symptoms. When most health care workers get patients who are suffering from one of these mental illnesses, they do not think about or ask about what could have happened in their lives for it to come to that. Having those conversations may give an understanding of how they are going to do in their plan of care. Suffering from those illnesses and carrying the weight of trauma may lead to a physical health decline. These patients may be constantly worrying, which takes away time that they could be caring for themselves. When it comes to the spiritual aspect, people who experience trauma may turn toward religion or away from it. Having a conversation with the patient about their beliefs and spirituality will help the nurse get a better understanding of their patient’s way of thinking and what could help guide them in their care. Trauma never truly leaves a person and being in the environment could trigger or bring up memories. These patients could be experiencing financial or other losses related to the trauma they experienced, which could affect their health and mentally and physically. Trauma survivors may have trouble in social situations or relationships. That is important to be aware of as the nurse, especially when forming a relationship and trust with the patient. It is crucial that the nurse has all of this in mind when caring for any patient, not just the ones with obvious trauma.

Adverse childhood experiences (ACEs) are traumatic events that happen in a person’s childhood. These experiences could include events involving violence, abuse, neglect, suicide, substance abuse, mental health problems, and more whether they directly experienced it or witnessed it. These experiences can be linked to future mental health issues. Someone who experienced trauma as a child may have a risk of developing mental illnesses and substance abuse issues in the future. It could have a negative impact on a person’s education, occupation, and health. It could also lead to a person going down the wrong path with alcohol, drugs, and violence affecting their future.  Depending on what they have experienced, they may also have trouble developing real relationships with people. They may have trouble trusting others and without others having a background that others may not take the time to let the trust develop. Understanding the prevalence of ACEs is important since it is more common than people think.

Everyone has a story, and everyone has gone through tough times which has shaped them as the person they are today. Understanding that when caring for a patient is very important to achieve the best patient-centered care. I will make sure to keep trauma-informed care in mind when caring for any patient as a nurse. My goal is to start having those uncomfortable conversations about trauma in order to get a better picture of my patient as a whole person. That would enable me to give the best care possible to that patient. I will aim to communicate clearly and be a person the patient feels comfortable talking to. I will not push any conversation on the patient that they are not ready for and be patient with them as they develop a trust with me.

There are many individual, environmental, and societal factors influencing the health of vulnerable and marginalized populations. Individual factors can be identified in each person, and they may vary depending on that person’s lifestyle. Some factors within each individual person could be their attitude toward health and life in general, knowledge, skills, genetics, and their own personal characteristics. Environmental factors could include chemical safety, air pollution, climate change, natural disasters, disease, poor water quality, and global environment issues. Environmental pollutants can cause health problems in the future. Having that irritation in your body could lead to respiratory disease, heart disease, and some types of cancer. Just to put this in perspective of a vulnerable population, the homeless are surrounded by pollution and chemicals in the air within the environment. This could put them at that increased risk for respiratory, cardiac, or cancer issues. Societal factors could be things under our control, but also things that people are born into. Someone’s socioeconomic status, education, neighborhood and physical environment, employment, social support networks, and access to health all effect their health status. People within low-income households may not experience proper education, which could later affect their employment, access to health, and life skills in general. With that being said, they would be at an increased risk of poor health in the future.

            Cultures are a part of life that has a great effect on the health care they receive. Different cultures have different beliefs in the care and medicine they receive. Different perceptions of health, illness and death, beliefs about causes of diseases, approaches to health promotion, and how pain and illness are experienced and expressed are also forces through culture that influence vulnerability and marginalization. Social forces could include disruption of communication, power supply, water supply, public services, and vulnerable residential settings. For example, people in vulnerable residential settings could have a lack of access to crucial services such as: transportation, power supply, water supply, and sanitation. The political forces that could affect vulnerability are changes of tax legislation, consumer protection and employment regulations. If someone was unable to get a proper education, has lack of transportation, and is unable to get a job due to the employment regulations, they would have a greater chance of developing health issues in the future. Employment, community safety, income, housing, transportation, educational attainment, social support, and discrimination are some examples of economic forces that could influence vulnerability and marginalization. The world is ever changing, but history of health care still plays a big role on how health care workers think and act today. History may influence how different people are treated and even how different patients want to be treated.

            Improving access to education in early childhood improves health. The world needs to make sure that children are being educated even if they are born into a low-income housing without transportation. Nutrition, physical activity, and safety within communities can be achieved through urban planning and community development. By being aware of the resources within our communities and making healthy choices, it will improve health behaviors in the residents. Homelessness is a big contributor for becoming part of a vulnerable population. Between all the pollution and lack of shelter and food, it could really have negative effects on health. Getting people off the streets and into housing programs for low-income residents would be a great way to decrease the chance of having bad health in the future. Along with housing in general, being cautious of housing quality is a way to decrease vulnerability. For example, checking lead levels and overall air quality in houses would reduce lead poisoning and the possible development of asthma. These are some strategies I feel would resolve health and healthcare disparities, which would improve the health of vulnerable and marginalized populations.

            By writing about vulnerable and marginalized populations I was able to really think about all aspects that are part of making a population vulnerable. When caring for a patient, it should be the nurses job to look at your patient as a whole person and have these tough conversations with them regarding their life outside of the hospitals. If you had a homeless patient who needed to come back for treatments, we need to be able to work with them and use our recourses in order to get them the access to the health care they need. I feel as though I should start thinking about the background of each patient more than I have in the past. Knowing where the person came from and how they live their life tells a lot about someone and a lot about the reason they are in the hospital. When it comes to culture, that is something I also want to consider more often. We are not expected to know all cultures and all religions but having those conversations with patients and having them teach you about it will enable a care plan to be made that takes their beliefs and needs into account. I think it is very important for all nurses and health care workers to learn about forces that influence vulnerability and marginalization in order to provide optimal patient-centered care.

This course examines the connection of concepts explored in nursing coursework and experiential activities. Active inquiry and engagement fosters clinical reasoning, interprofessional collaboration, and development of leadership skills within professional nursing practice.  

Upon successful completion of this course, the student will be able to:

1. Demonstrate evidence of clinical reasoning and clinical judgment in the plan of care for the individuals, families, and communities across the health spectrum and lifespan.
2. Demonstrate the use of data and resources that impact health outcomes of vulnerable populations.
3. Apply concepts of nursing theory and leadership principles in the planning and evaluation of care for individuals, families, and communities in multiple settings/patient populations.
4. Apply principles of reflective practice, appreciative inquiry, and therapeutic communication across the spectrum of health in multiple settings/patient populations.
5. Integrate the moral, ethical, and legal tenets inherent in the formation of professional nursing values including the role of self-care in for individuals, families and communities.