Author: esimpson3 (Page 3 of 8)

Throughout my clinical experience, I have taken care of a variety of patients, all from many different backgrounds. The care that I provide to my patients is all the same, no matter what. However, not all health care workers are the same. During clinical, I took care of a patient who is homeless who had suffered from cardiac arrest at a pop-up clinic and was then admitted to the hospital. This patient is a “frequent flyer” on the floor that I am on and not all of the staff necessarily liked this patient. When going in to care for this patient, I tried to think of the hardships that he must have gone through and the obstacles that could interfere with him reaching optimal health.

Homelessness is a health hazard in society and individuals in this population may be predisposed to worsening health outcomes and challenges to access healthcare. Demographically, homelessness can affect men, women, and children of all races and ethnicities. According to American Family Physician, there are more than 610,000 people who are homeless in the United States on any given night (2014). Their situations are anything but simple. Health problems among homeless individuals can result from various factors such as barriers to care, lack of access to adequate nutrition, lack of proper resources, lack of transportation, unemployment, lack of education, and limited services. Unemployment can go hand-in-hand with homelessness and can be associated with food insecurity, inability to pay for healthcare, and poor social capital. These individuals are unable to buy nutritious foods or pay for the healthcare that they need. This could decrease the probability of this population seeking healthcare. Due to the social determinants of health that homeless individuals may go through, they are prone to both mental and physical illnesses. Homeless people are prone to many chronic conditions including arthritis, asthma, chronic obstructive pulmonary disease, diabetes, HIV/AIDS, hypertension, vascular disease, pneumonia, STIs, and tuberculosis. Mental health disorders that homeless individuals are prone to include bipolar disorder, dementia, depression, personality disorder, PTSD, and schizophrenia.  The homeless population is also susceptible to substance abuse disorder and increased risk of injuries and violence. It is essential that health care providers keep the hardships that this population may go through in mind when caring for a homeless patient.

In my experience caring for a patient who was homeless, there were assumptions about him prior to me even meeting him. Health care workers would warn me before going into the room that he is frequently a patient and “doesn’t do anything to help himself”. I found this really difficult to hear, especially after meeting this patient. He was a great guy who was just in a tough place and was scared because he does not have the access to the resources he needs to take care of himself once he is discharged from the hospital. I am proud of how I handled this situation. Even though, I was told negative things about this patient prior to taking care of this patient, I did not let it affect how I cared for this patient. I think that the stigma behind the homeless population needs to be changed and the health care system needs to do something to help them. We, as a society, are failing the homeless population. Something needs to be done to help provide these individuals with adequate health care, regardless of the social determinants they may face.

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.

I have never really thought about death with dignity and my thoughts on it because I hope to never be in a position where that is an option that I am considering. However, when asked, my initial thoughts are that I have no idea my thoughts on it are, whether I believe it is right or wrong. I feel that it is impossible to really have a viewpoint on it unless you are in the patient’s shoes. I know that if I was in a position where my daily life function would slowly deteriorate, I would not want people to remember me that way. As I thought more of this idea, I began to support the idea that, when faced with a terminal illness with only a certain amount of time left to live, the patient should have the option to pass with dignity or live all the way until their last day. Once it gets to the point where no turnaround is possible, it should be an option for patients. This is a view on it as a free American citizen. On the other hand, my viewpoint on it as a health care provider, I would struggle with the fact of giving a patient something that would kill them. I know that there is so much more that goes into this process but putting it in simple terms of killing the patient is something that I would greatly struggle with.

The first ethical principle, non-maleficence, or do no harm is directly tied to the nurse’s duty to protect the patient’s safety. These principles dictate that nurses do not cause injury to our patients. The death with dignity does challenge these principles because as nurses we are supposed to promote health and wellness of our patients. Death with dignity goes against everything within our scope of practice. As nurses, we are supposed to take care of our patients with individualized care plans to keep them comfortable and alive. It my final year of nursing school, the death with dignity concept has never been talked about until now. We are always told to respond to end of life commentary with therapeutic responses and not actually collaborating with physicians to give patients medications that will grant their wishes. My take on death with dignity is conflicted by my beliefs as a human being and my beliefs as a nurse.

Electronic health records (EHRs) support that documentation with data can help to enhance patient safety, maximize efficiency, and evaluate care quality. It helps to provide accurate, up to date, and complete information about patients are the point of care. It allows for quick easy access of patient information and health status. Not only will EHRs help nurses on admission with help in seeing past medical history and other pertinent information, but it will help throughout their shift by giving medication administration reminders and potential drug interactions. EHRs allow more effective communication between those in the health care team. It will give everyone the same information on each patient to look at and allows the ability to write notes regarding the patient’s care that everyone looking at the chart would have access too. Basically, utilizing EHRs will keep everyone on the same page which would help promote adequate, wholesome care and positive patient outcomes.

Health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically. It improves the speed, quality, safety, and cost of patient care. Some common challenge that clinical work flows may present include updating patient care plans when multiple providers are caring for them, piecing together medical history, readmissions due to lack of communication and engagement, and gaps in patient information which increases the change of creating a care plan that can cause adverse effects. HIE can help to solve these solutions by creating a better, safer, and easier solution for the healthcare environment. It does this by improving communication and care planning among healthcare providers during transitions of care, providing assurance that care teams have accurate information at point of care, enabling improvement in both quality and cost outcomes through reduction in duplicate testing, medical complications, readmissions. HIE also will assist in targeting care for patients with chronic diseases, risk for future utilization, and quality measure gaps to put care plans in place more quickly. Overall, the evolution of where we are now with HIE has great improved communication within the healthcare system and therefore, patient outcome.

Learning about Electronic Health Records and HIE will help me to enhance the thoroughness and accuracy of my charting throughout clinical experiences. I did not know that what is charted within my facility can be seen by the other providers of my patients. This will improve the overall quality of my charting because gaps in the EHRs can negatively impact a patient’s plan of care. I will also utilize the EHRs during my nursing career to help make sure that I am efficient in caring for my patients. It will allow me to not forget to administer any medications and be sure that all medications given are compatible with each other. EHRs will also help me to know my patient before actually meeting them. It allows me to make a rough outline of my plan of care for the day for each patient. At the beginning of each shift, I will be sure to look at each my patient’s EHR to prioritize each patient’s needs and see which patient that I should check in with first. EHRs will be extremely beneficial to my future nursing career and I am excited to be able to learn even more about it.

Trauma is an emotional response to a terrible event that has happened in someone’s life. This can range from an accident, rape, or a natural disaster. Trauma can have lasting effects on your mental, physical, and emotional health. It can affect how your feel about yourself and others and cause increased risk of developing a mental health condition including depression, anxiety, or PTSD. Trauma can affect your physical health by triggering endocrine and immune problems leading to increased risk of chronic illness including chronic autoimmune illnesses, heart attacks, diabetes, strokes, or cancer. It can result in many physical reactions including fatigue or exhaustion, nausea, vomiting, dizziness, or insomnia. Spiritual well being can be affected because the individual could feel that they are being punished or abandoned by God, lose faith, decrease participation in religious activities, or feel a loss of meaning and purpose for living. Social well-being can be effected because it can cause an individual to withdraw from family and friends leading to isolation. The emotional distressed experienced can also make it difficult to relate to others.

Adverse childhood experiences (ACES) are potentially traumatic events that occur in a childhood and can include violence, abuse, and growing up in a family with mental health or substance use problems. ACES can have several long term impacts of adverse childhood experiences. It can change the brain development and affect how the body responds to stress. Additionally, ACES are linked to several chronic health problems, both physical illnesses and mental illnesses. It can cause chronic health conditions including depression, COPD, asthma, kidney disease, stroke, coronary heart disease, cancer, diabetes, and obesity. Health risk behaviors that can result from ACES include smoking, drinking, and other forms of substance abuse. Socioeconomic challenges that may be impacted include unemployment status, education level, and health insurance. Preventing ACES can help children to thrive and potentially prevent the chronic health conditions, risky behaviors, unemployment, low education levels and prevent ACES from being passed on from one generation to the next.

I will apply the Trauma- Informed Care (TIC) principles to my future nursing practice to help to prevent and identify ACES. I will anticipate and recognize current risks for ACES in patients who are children and understand the history of ACES in adults. I will establish rapport with my patients so that I am able to fully engage with the patient and get all of the information that I would need to properly care for the patient. I will respect the patient and their boundaries on what they are comfortable talking about. Additionally, I will treat my patients as actual people who I care about by taking my time with them and allowing them to feel heard and valued. Allowing the patient to be in control of these difficult conversations can also help. Overall, being aware of TIC in my practice will help to prevent and identify ACES in my patients.

Individual, environment, and societal factors influencing health of vulnerable populations is also known as determinants of health. Individual determinants of health include our genes and biological make up. Individual behavior and coping strategies like whether we smoke, exercise regularly, or have a balanced diet can also affect health. Although individual characteristics will play a obvious role in health status, there are many other determinants that can have a huge impact on our health. There are many aspects of your life that you may not think can affect your health, but they do find a way to affect your ability to make healthy choices and therefore be a healthy individual. Education status is a major determinant as it gives you the tools to make healthy decisions by understanding the effects of certain behaviors. Additionally, higher education will tend towards higher paying jobs that may come with health insurance and healthier working conditions. Going hand in hand with education is income. Income is a determinant of health due to living situations. Those with higher incomes with stay in safer neighborhoods, can purchase healthier foods by having access to a grocery store, and having their own mode of transportation to get from place to place. Those with low incomes tend to live in more unsafe housing, without close access to grocery stores, less time for exercise, and influences the ability to pay for health care whether insurance is present or not. Where you live has such a great impact on your health as those who are exposed to poorer living conditions can be exposed to toxins in the home. A specific example of a health issue that occurs in lower income housing includes lead poisoning because many older buildings are painted with paint that has lead in it. Adding to that, lower income housing also could be set in more unsafe neighborhoods where there is increased crime and violence. This would decrease the chances of someone going out to get exercise. Thriving neighborhoods can offer employment, transportation, and good schools. Access to health care is a major determinant. It is affected by majority of the other health determinants. Culture is another health determinant due to certain cultures having different beliefs regarding decisions in healthcare. Political determinants are big in the public health terms including social democratic regimes, lower income inequalities, or higher public spending. With all of that, determinants of health create much inequality in the health care but there are ways that we can fix it.

            Resolving health and healthcare disparities is an ongoing issue. In an ideal world, resolving these issues would include everyone having close access to health care at no cost. Unfortunately, we do not live in an ideal world and these health disparities are still present. There are ways that we can work to minimize these health disparities. On a large scale, nurses and other health care professionals can work with large public health organizations such as the CDC to creating free pop up health care clinics in lower income towns so that they can have access to healthcare closer to home. On a smaller scale, individuals that live in these lower income places can work with the town to help promote a healthier life style. This could include the creation of safe parks and green areas for people to exercise in, playground for children to play in, and occasional farmers markets in these neighborhoods with healthy food options. Additionally, we could provide a space for support and collaboration for those that strive to help improve the health of the vulnerable populations. Everyone can bring in different ideas on how to help with this public health issue and find ways to put them into play.

            I will bring what I have learned about health disparities into my career as a nurse. It has made me feel more compassionate and understanding of what other are going through. I have always been lucky enough to be less than five minutes from the health clinic in my town. Now understanding the inequality that the health care system has and the disparities that some people deal with, it pushes me to really get the full story of what brought my patients to access health care. Getting this full story, I can see any factors in their life that may affect their health and give any recommendations to help improve the obstacles they may face regarding their health. can also use this knowledge to educate potential colleagues about the potential health disparities that our patients have gone through and to assume anything about anyone just because of where they come from or how they look. Finally, learning about health disparities has increased my interest in public health nursing. I feel passionate about equality in health care because everyone deserves to be healthy, no matter their situation at home. 

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.