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Throughout the semester we have examined the complex challenges and adaptations that aging adults face through a holistic and caring perspective. The past two summers I have had the opportunity to be a CNA at two different nursing homes, where I have experienced a lot. I feel as though this class really brought my understanding to the next level and I constantly found myself thinking back to personal experiences I have had. An insight that I will keep in mind when caring for this population is that although their body is aging, they may not feel they are that age mentally. Another insight I will keep in mind is how medication can affect the older population and is at times mistaken for the “normal” aging process.

            I feel as though it is very important to keep in mind that some older people may be in their 90’s but will not mentally feel that way. I think back to a resident at the nursing home I work at who is 102, still walking around and tells me every day that she does not feel 102 and that she still feels younger. This is important because it may have an impact on their mental health, they may feel trapped at times. Having empathy for this population and listening to their concerns and how they are feeling is very important. I do not feel that conversations regarding mental health are had enough with the older populations especially in nursing homes and it may improve health outcomes if those topics are discussed.

            Until this class, I did not realize the effects that medication could have on an older adult. This could be common since they are on so many medications. The polypharmacy presentation really opened my eyes and made me realize that medications should be looked into with all older adults and their health care providers should be more aware of everything they are taking, even over the counter meds. I will always keep that in mind when caring for the older population as well as developing rapport, so they feel comfortable having conversations regarding their mental health.

My goal from the last ATI I took, which was ATI Pharm practice B was that I would study a little bit every day to prepare for the proctored pharm exam. I did follow through with that and I would look at practice ATI’s and quizlets to prepare for the exam. I was very proud of myself for doing that because this was the first ATI assessment where I felt confident going into it. That is something that went well for me the fact that I studied and felt prepared. Something that did not go well was that I had been studying for the hours before taking the exam, so by the time I went to take the exam I felt a little bit burnt out. Reflecting on all my smart goals in the past, I will make sure to take a break before taking the next exam, so I do not already feel burnt out before I take it. I have had problems with losing focus during these exams in the past, so I have to make sure I do everything I can to make sure that does not happen.

            Taking Pharmacology ATI’s are always more challenging for me. However, in this case I feel like taking the ATI Pharmacology CAT practice exam prior to this helped me do better. I was thinking back to the questions that were asked on the previous exam and any remediations I did that may have helped me answer questions for this exam. Since there were only 60 questions I felt as though I was able to keep my focus for the whole exam without losing any. That is something I felt went well and something I hope to carry with me for the next ATI exams I take. In general, I would like to improve on my knowledge of pharmacology. I will take practice exams and retake previous ATI exams prior to our proctored ATI exam in class. I do not have any input on course adjustments at this time, I feel as though this will help with our proctored exam overall. When it comes to my SMART goals, I continue to strive to keep my focus for the whole exam time in order to do my best work. This will be measurable based mostly on how I felt I did, and it should be attainable by the next time I take an ATI exam. This is relevant to taking ATIs, but also to nursing in general. We need to be able to keep our focus for 12-hour shifts and for the NCLEX, so this is helping me with that.

I liked the theme that I had because I am familiar with it and I find it easy to navigate. I changed the writing in my home page and also edited the About Me page by changing my paragraph and adding pictures. I also added my resume to the tool bar and made sure that a person from the outside looking at my portfolio would be able to navigate it.

During this interview I learned so much about my grandma’s time as an oncology nurse. She shared many stories explaining all she has done for the nursing community, which gave me a greater insight into how much of a leader she really is. My grandma said she knew she wanted to be a nurse since she was 5 years old because she always loved to care for people. Once she fulfilled her dream of becoming a nurse and realized she wanted to do oncology, her love for it pushed her to get more involved. At Cooley Dickinson Hospital my grandma started a cancer care support group, cancer care fund, and a celebration of life. The cancer support group was held in the hospital, and she would have patients and families come and surround themselves with people going through the same thing. She wanted to do this to make the patients and their families feel less isolated and alone. In the hospital, patients would have to pay to watch TV and other activities they should not have to pay for. When they are in the hospital for a long-time getting cancer treatment, they are going to want to do anything they can to distract themselves. With that my grandma created the cancer care fund where people or past patients would donate to the fund and it would cover any of those types of expenses in the hospital. The celebration of life was held in her back yard, and she would have patients and families come who have beat cancer and are on the path of recovery. Also, outside of the hospital she would tutor new grad nurses to help them pass the NCLEX. She was also once the women of the year in Northampton MA while all of this was going on. I am very honored and proud to have her as my grandma.

            When I asked my grandma to describe what she feels a leader is, she said she felt her views were much different from some of her peers and most of her superiors. She felt that her superiors would say that a “good nurse” would get all their care and paperwork done within a timely manner or before the time that it is due. She feels a “good nurse” and a leader is someone that fights for the patient’s and their families’ rights, advocate for them to collogues, and stay true to your own beliefs as a nurse. With that being said, this has led her to come into conflicts in her work life. During most of her time as a nurse, she would stay late after her shift is over to hold the cancer support group and would spend hours unpaid at the hospital trying to make patient’s lives better. While she was at work, she would make sure to spend free time getting to know the patient and their family and making sure that they were always satisfied and felt heard. She has had to report other nurses for treating patient’s poorly and she would always be on the lookout. Eventually, the hospital hired a new oncologist who would get angry with my grandma for staying past the end of her shift and coming in on her days off. She would also get angry at my grandma for not getting her paperwork done fast enough when she was in with patient’s trying to form relationships with them. Due to this situation and her beliefs, my grandma thought it was best to step away from nursing. She felt that if she could not be in an environment that would allow her to be the nurse that she wanted to be, then she could not be there at all.

            My grandma is very strong willed and always stood up for what she believed in. She was always self-aware and socially aware when it came to the hospital and management. I was surprised with some of the stories she was telling me just because I did not know them, however I am not surprised that she did any of that because she has the biggest heart and is the most selfless person. I have always looked up to my grandma and I will continue to look up to her. Her story has motivated me to want to get more involved in whatever unit I end up working on. This has also reminded me that the patient and their families are the priority when you are at work and better care will be given if I take the time to develop a relationship with them. I hope to be half the nurse that she was one day.

When this project was announced, I immediately knew who I would want to choose to interview as a nurse leader. Throughout nursing school, and even before I came here to school my maternal grandmother has been supporting my love for nursing. She has been the biggest support system for me as I went through school especially these past two years. She has helped me with assignments, given me confidence, and has been able to calm me down when I was left feeling like I should give up. The stories she has told me regarding her experience as an oncology nurse and how she would help new nurses study for the NCLEX, made me look up to her even more. It is very interesting hearing the stories she shares because of how much health care and hospital settings have changed since she was a nurse. She is an amazing person and was an amazing nurse and I hope that one day I could be half the nurse that she is.

Since I have had the honor of growing up with her in my life, I have been able to observe qualities and characteristics that she has that makes her a leader. She is a mother of 6 children and has many grandchildren. She puts all of us before herself and has so much compassion and empathy for everyone. She is hard working and did everything she could to support her 6 daughters as they grew up. If any of her children or grandchildren have a problem, she is able to critically think and step in to try to help fix it, she is a natural leader. As an experienced nurse, she would tutor new grad nurses to help them pass the NCLEX and get them as prepared as she could. My grandfather would say that she taught them so well that even he could take practice exams and pass them. I find that so inspirational that she went out of her way to help new grad nurses in my position succeed. I feel as though she is a perfect example as a nurse leader.

Although I have talked to my grandmother about some of her experiences as a nurse, I am looking forward to learning more. We have yet to dive in on how culture and structure in a clinical setting has changed over the years, and I am very interested in learning more about that. I am also excited to learn more about how she was a leader in her own workplace. I want to ask her about a time she felt hopeless due to a situation or an accumulation of situations at work and how she got out of it. I would also like to know if she ever helped a colleague who is struggling in the workforce and how she did it. These are all situations I may encounter, and I am so honored to be able to have this conversation with her and learn from it.  

She never had a formal leadership position where she had structure, authority, or power over anyone in a clinical setting. She was an informal leader that made a difference in the nursing/ clinical world when she did not have any authority over anyone in her setting. She genuinely loved doing what she did and loved and still loves to help people wanting to get into the field. I have no doubt that she will continue have my back throughout my job search, studying for the NCLEX, and beginning my new job.

Disasters could happen at any time whether it be natural or man-made. When something like this happens, we need people to come together and help make things better/ easier. Nurses could be a big help when it comes to caring for victims of a disaster. Nurses are leaders, educators, responders, policymakers, and researchers when it comes to disaster preparedness and the response. Although nurses will be assisting with the aftermath of a disaster in a health care facility, emergency preparedness and disaster planning could also come in handy when not at work. For example, if a registered nurse is driving by and sees an accident that just happened, they should stop and use their skillset to make sure the people in the accident are stay stable enough until they are taken to the hospital. They could use their knowledge on how to feel for pulses and assess the state of the victims so when the first responders come you could give them a small report. We also were told in class that it could come in handy to leave a blood pressure cuff, a stethoscope, and a first aid kit in the trunk of your car since you never know when or where you will need it. You always want to be prepared as a medical professional to help.

            Using the accident as an example when also talking about Provision 2 of the ANA Code of Ethics. This states that the nurse’s primary responsibility is to the patient, yet Provision 5 states that a nurse owes the same duty to self. I am thinking about if the accident had a car that was on fire, and the person was still in the car. Obviously as a nurse you want to help and you want to make that person your priority however, it may be dangerous to attempt to get that person out. In a natural disaster such as a tornado, a nurse may help with the victims. There may be people under rubbish or under a building that is not very stable. In these situations, you must think about the chances of you as the nurse getting hurt. Nurses will not be able to save patients if they are the ones getting hurt trying to care and save people in disaster situations. I feel as though emergency preparedness is a very important skill a nurse could have. It would enable them to be ready to help in any given moment at any place. There are crazy incidents that happen all the time that no one is ever prepared for. It would make the lives of the people effected easier if we had experienced nurses trying to help.

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.