Category: Uncategorized (Page 2 of 4)

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.   

Nurses play a big role in caring for the physiologic and mental health needs of patients no matter what setting they are in. A persons mental and physical health impact each other in different ways and it is very important for a nurse to be able to acknowledge that when caring for their patients. Last semester, I went to clinical at New England Rehab facility for my first clinical experience. Since it was our first time, we were not allowed to do much with the patients, which enabled me to have really good and long conversations with them. Although I was able to have many conversations, one of the patients that I had the pleasure of working with really stood out to me. 

            This patient was a younger woman who was in the hospital because she just recently had a stroke. When I used to think of stroke patients I would think of older adults, so it surprised me to see someone her age having a stroke in general. The right side of her body was affected, which was her dominant side. Her speech was impaired and so was the strength and ability to use her upper and lower extremities on her right side. Being young and completely healthy prior to the stroke, I was able to tell she was struggling to this new adjustment and that it was taking a toll on her mental health. Aside from the physical effects this was causing, she was also unable to have any visitors due to the pandemic, which only added to the stress of being in the hospital. I was able to have a conversation with her where she talked about how she was struggling with these adjustments especially because she realizes she’s one of the younger stroke patients on the floor. She was very down on herself, especially because she did not know how this would affect her future. The patient did not directly state that her stroke and its effects were becoming detrimental to her mental health, but I was able to tell by the way she was talking about her current situation. I would say that she did have at least some insight between the connection of her physical and mental health because she was able to verbalize her fears and struggles when it came to dealing with the effects of her stroke. However, she did not clearly state that she sees a connection, so as a nurse I could have (and I wish I had) asked her more about her specific worries regarding how she feels about her treatment process and therapy. Since she already was having negative views I could have used her talking to me that as an opportunity to turn the conversation around. I would attempted to help her into having a more positive outlook by switching her focus onto what motivates her to get better and what she feels her strengths are. Helping a patient turn their thinking around will benefit their recovery process, especially if they are focused more on the strengths they have then their weaknesses. 

            When I had been in the role of the patient, it made me feel really good when the nurse took time out of her day to sit and talk with me no matter what it was about. It made me feel as though she cared about me as a whole person and not just as a patient that needs to be fixed. That is something I want to carry with me throughout my time as a nurse. I want to make people feel comfortable and know that I want to hear what they have on their hearts. That was my goal when talking to my patient that day. She did not tell me too much information about her life outside of the hospital, but she told me enough to understand how this diagnosis could possible affect her. She explained to me how she is married and has kids that I believe are in college and out of college. Going to watch her children play sports is something that she really enjoys along with hiking with her husband. From what I gathered, she seemed concerned about her current physical health will affect what she loves to do. Although she is worried about how this will affect her role in the family, she explained that her family is also what is giving her the motivation to get better. I wish I asked more about the activities she enjoys in order for her to develop more motivation to recover and participate in therapy. She also had a cross on the table and around her neck. Religion/ spirituality was not discussed, but looking back at the situation I could have asked her more about that. I wish I had asked about the cross and the role of spirituality and religion in her life. It would have allowed me to get to know her better and have a better understanding of the way she thinks. A big question regarding the social domain that I should have asked is, “what helps you get through tough times?” That question is very important and can reveal a lot about the patient. It would have also directed her on the path of thinking positively about her recovery and diagnoses. Based on what I knew about this patient (her stories and what she has told me), I would say that there are no elements of the social domain that would need further assessment or nursing attention. I just feel that it is very important for the nurses to be there for the emotional aspects of her care. 

            Thinking about this patient and the challenges she faces I came up with three nursing diagnoses for the social, biological, and psychological domain. For the psychological domain I put situational low self-esteem as evidence by being very down on herself and frustrated with being in that situation at that age.  ADL deficit as evidence by the weakness in her face and right extremities is the diagnosis I have for the biological domain. She is now faced with many challenges regarding the basic activities a person does during the day. For the social domain I have ineffective role performance as evidence by her concerns with how this is going to affect her role as a mother and as a wife. Taking these three diagnoses into consideration, there should be interventions put in place to help meet the goals of the current, long-term, and post-discharge care. The interventions should be based upon the goals of achieving independence and identifying positive aspects of self. In order to achieve those goals, the nurse should encourage the patient to talk about factors that contribute to the low-self-esteem and ineffective role performance, so the nurse is made aware of what needs to be worked on. The nurse should collaborate with other services such as a psychologist and occupational therapist, as appropriate. A psychologist would be a more effective way to turn the patients outlook into a positive one and an occupational therapist will help promote independence. Regarding the ADL deficit, the nurse should give the patient sufficient time to perform tasks and talk to the patient about how much time they feel they need for the ADLs. Also, assist the patient in anything they need while maintaining and sense of independence. That will enable the patient to see what they are capable of doing. It is very important that through all of this, the caregivers do what they can to keep the patient motivated in order to get the results of the care that she deserves. From what I was able to see, the nurses and health care team did a good job with addressing the mental health needs especially because she is not afraid to voice her fears and concerns. I hope they continued to address those needs because the patient did give off signs that she may need encouragement here and there and to be reminded that if she puts in work, her life will change for the better. I was also unable to identify any barriers to the treatment because although she seemed down on herself, she was still ready to get better. 

It would have helped the patient and I in this situation if I had taken the mental health class prior to meeting her. The conversations I had with her that day were the perfect example of how physical and mental health affect each other. If I had taken the class prior, I would have had more knowledge on what to say and what to talk about in order to help her and to change her mindset. She really made an impact on my life because it made me realize not to take anything for granted and that as I nurse I need to be able to help in the recovery of the patient’s mental health along with caring for their physical health. 

  In mental health nursing, it is very important for the nurse to have therapeutic communication and develop rapport with your patient. It also decreases the patient’s anxiety and opens opportunities for optimal patient care. In the simulation experience there were many good examples of how the students demonstrated therapeutic communication. Watching the video over, enabled me to have a better understanding of the role of therapeutic communication in the mental health assessment process and as in intervention. They first started off by making him feel comfortable as he walked in, sitting facing him with arms open along with the appropriate body language. Right after that they all introduced themselves, beginning to form that patient-nurse relationship. Everything they said was with a caring tone, which also makes the patient feel comfortable and safe. They were very understanding with the struggles he was explaining to them and expressed that by saying things like “I understand how this can be difficult for you.” Letting the patient feel that you understand them will make them feel more comfortable in explaining what is going on. 

            The students were asking the patient open-ended questions and gave him time to think of a response and speak his mind. Open-ended questions allow the client to explore their thoughts and feelings and in turn helps the nurse have a better understanding what’s going on. There were specific moments when the students asked things like: “can you tell me what a normal day would look like,” “what do you mean by that,” “can you explain more about that guilt you were talking about,” and “tell me more about how that makes you feel?”  When the patient would answer their open-ended questions, they would reassure him that he is not alone and he is supported. For example, he kept talking about how he feels guilty that his marriage problems are his fault and the students would reassure him that guilt is a common side effect of depression and it is not uncommon for someone who is depressed to feel that way. They also gave him suggestions on different types of therapy he can go to and ways to improve his marriage and life in general, while assessing his willingness to do so. It was also effective to ask the patient to explain to them the medications he is on in order to get a better understanding of his current knowledge and what needs to be taught. Overall, communicating therapeutically with patients will benefit the nurse and the patient. I was able to see that when watching the simulations that my classmates did. I could see progression from the first scenario to the second to the third, and as they got better at interviewing and using that type of the communication, the patient was more willing to talk and express their struggles. 

Through evidence appraisal and synthesis, we discovered more information that backed up what we are trying to prove with our PICOT. The evidence gathered in the appraisal was based off of reliable sources and ongoing studies. However, we also realized that there still needs to be more research done regarding the effects of prenatal alcohol consumption on school aged kids in order to support nursing education points when talking to pregnant women about the future consequences of drinking alcohol while pregnant. The literature appraisal and synthesis did not change our assumptions about the topic, it only made them stronger. All of the articles used in our paper has the same results about the cognitive deficits kids have to deal with due to being exposed to alcohol in the womb. Those were the results we were trying to look for because we want to stress on the importance of educating women about all possible effects alcohol consumption could have on their child instead of just telling them it is bad to drink while pregnant.  Our findings will give us a strong base of knowledge with reliable evidence when having the opportunity to talk to women about alcohol and pregnancy. It will enable us all to feel confident while talking about this matter, and make women really see how important it is to look into what the future could look like for a child before deciding to have a drink of alcohol. 

             The team members and I all came to the same conclusion about the findings because all of the articles found backed up what we assumed in the first place. We all agree that there should be more education for women regarding the future of their child when exposed to alcohol in the womb, and that there should be even more research done to make the education points stronger. Our team came to some confusion while creating the critical appraisals. Since we have 5 people in our group and there are only 4 articles, there was miscommunication between group members on how to split it up. We should have worked more as a team instead of doing the articles we separately found and not communicating about them. The one person who did not have an article did part of one of the group members while another thought she was helping with hers. That lead to there being no critical appraisal for one of the articles and it led to confusion and troubles creating the annotated bibliography. This was solved way too late since half the group did not even know this happened until there were issues with our annotated bibliography. This confusion is something our group learned from and moving forward we are going to better our communication and write the paper while we are together instead of each doing a separate part.

Since choosing our topic and coming up with our originally PICOT question, we have faced some challenges. We started out with a PICOT question that seemed to be looking for information that was too specific. It was asking us to look for maternal alcohol consumption and the effects it has on learning disabilities in school aged children. It was hard to find articles that really focused specifically on what our PICOT question was asking, so we needed to make some adjustments. We changed our PICOT in order to allow more room for research. We changed the wording from maternal to prenatal to make sure we were all researching alcohol exposure while pregnant. We also changed learning disabilities to cognitive disabilities in general because it allows for more information to be included in our paper, while still including possible learning disabilities.

Our team has been successful with working together and overcoming challenges together. When we had troubles with finding research articles, we all figured out a way to change our PICOT question in order for us to find reliable research articles. We keep a group message where we can all communicate about the different parts in our project, which has helped us all be able to work together on everything. Overall, our team process has gone well and we plan on continuing to work together effectively.