Category: Uncategorized (Page 2 of 3)

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.   

COVID-19 began as an unknown form of pneumonia that began in Wuhan, China. We knew that this disease was deadly due to statistics that occurred in China and other countries; however, nobody really knew how this terrible disease was going to impact the United States. It has affected our economy, social lives, livelihood, food systems, agriculture, mental health and most importantly our health care. Individually, the pandemic has hit people in multiple different ways. It is important to acknowledge how it has affected us and how it has helped us learn about ourselves and the future.

            With the onset of the pandemic, I went from living at school being able to hangout with my friends whenever I wanted to living at home with my mom, dad, and sister, unable to see anyone besides them. During that time, I began to self-reflect and realized that I had a responsibility as a future nurse. Although nursing can be portrayed as this glamorous career, there is a daunting side to nursing as well, especially during times like this. Nurses go in to work with uncertainty of how many of their patients could die today. It can be overwhelming thinking of the numbers of lives that could be put into my hands. However, I have realized that it is my job to advocate for these patients and care for them as if they are family with compassion. I did not want to sit around and do nothing; I felt like I had to do something to help the front-line workers. I decided to spend my summer working as a nursing assistant at a local rehab hospital. I really enjoyed being able to be the reason that some of these patients smile. With that being said, it would also break my heart seeing how depressed some of my patients were. Some of them had gone months without seeing their families or even just hugging someone. It became physically and emotionally draining trying to stay positive for my patients. I realized that I needed to focus on myself during my days off to adequately care for my patients. In seeing how many nurses suffered from “burnout” after the spikes in COVID cases, it is evident how important self-care and wellness is in the health care field. This is something that I will take with me throughout my nursing career. The pandemic has taught me what it means to be a nurse to great extents. I am honored to be entering a career that are the superheroes of this pandemic.

As a nursing student, the COVID-19 pandemic has greatly affected my education. Online school became the new reality which is difficult in nursing school as is it a hands-on major. It has brought about new ways to gain clinical experience including virtual simulations and different observation days. This restricted learning opportunities for myself and my peers. Clinical experience is where patient care is taught and where the application of material we learn in lecture is put to the test. Luckily, Maine Medical Center has allowed students back to their facilities this semester and I feel prepared entering my senior year of nursing school. I have learned the basics of patient care and how to use my therapeutic communication when interacting with patients, while also observing medical management of certain diseases. I am not taking any of this clinical exposure for granted and am looking forward to gaining more experience during my senior year.

The COVID-19 pandemic has brought about multiple public health debates in which highlight the leadership role of nurses and altered education provided to nursing students. While education for nursing students has focused on providing acute care in hospital settings, it is now evident that health outcomes at a population level should be incorporated. Additionally, an emphasis on how to manage a pandemic should be included in education of both current and future nurses. This should encompass how to manage both patient care and self-care. Nursing schools primarily focus on the role of nurses in a hospital-based environment. The pandemic showed me the variety of settings that nurses could work in. Public health nurses working in communities are needed more than ever right now. For example, a quick adoption of telehealth technology was necessary to serve patients safely. These nurses can care for patients from the comfort of their own home. Professionally, the COVID-19 pandemic has given me a different perspective on a nurses’ scope of practice and the variety of settings that they may work in.

The pandemic has impacted the future wellness needs in our communities. First, and most importantly, mental health counseling will most likely be more accessible to those who need it. Quarantining and the lack of social interaction can increase severity of symptoms of depression and other mental illness. Additionally, after over a year of social distancing from others, overall wellness may be permanently altered. It has revealed that taking care of yourself and taking control of your own health is extremely critical. Post-pandemic wellness will be more focused on the idea of “self” where self-reflection and actualization are key. Health and fitness on a virtual scale has become the new normal and even after restrictions have loosened up, it is still continuing to be popular. Many individuals have adapted new ways to achieve their idea of wellness with new ways of doing things along with new hobbies.

With regards to community health, nurses get the chance to play more of a leadership role. The pandemic taught us that proper sanitation can help decrease the spread of contagious diseases such as COVID-19. I foresee there will be added nurses hired in schools to educate students about proper hand hygiene. Additionally, I think we will need nurses specifically for the COVID-19 vaccinations and information about COVID. This will help to get vaccinations to the public more quickly and provide information to those who have questions about it. Telehealth will become a more common form of medical care. Overall, COVID-19 will provide an increased number of jobs for nurses and give them the recognition that they deserve.

Therapeutic communication is the foundation of any successful interview with an individual suffering with mental illness. With this case, therapeutic communication would help to potentially get down to the root of the client’s issues and figure out why he is feeling the way that he is. During assessment, therapeutic communication helped to gain as much information as possible. The individuals who performed the assessment did a great job with asking open ended questions. Throughout each interview, the student’s responses got more therapeutic over time. Rather than not giving much of a response when a client answered a question, they responded by showing acknowledgement and understanding of what they are going through. This tended to create the trusting patient-nurse relationship. Additionally, frequent follow questions to an unclear response helped to gain a significant amount of information from this client. Throughout the assessment, the students used great therapeutic communication to develop rapport with the patient and to get as much information out of the conversation as possible. Using therapeutic communication as an intervention itself was essential during the interview with Mr. Riley. His main issue is the guilt that he is experiencing around his symptoms of depression. Therapeutic communication is important because it will help to allow the patient to be heard. Specifically, in Mr. Riley’s case, he expressed how he felt a isolated. In that moment, the students acted as support system but justifying the reasons for some of his symptoms and giving recommendations on how to better himself. Having someone actively listen to how the patient is feeling is important in recovery because it allows them to feel heard.

The students in this interview had multiple instances where they used therapeutic communication. Specifically, when Mr. Riley expressed his feelings of guilt, one of the student responded with something along the lines of him not being alone with that guilt and that it is a common symptom of depression. They asked about what could be triggering the guilt and gave him ways to help with it. The students used open ended questions such as, “What would a normal day look like? What do you mean getting back to normal? Tell me more about how it makes you feel.” Multiple times, the students would used interpretations and reflecting statement. This technique was used specifically when the student restated and summarized the patient’s feelings of guilt. She began the restating with, “From what your saying it seems…” Overall, this group did a great job with therapeutic communication throughout their interview and it got better as the interview went on.

COURSE DESCRIPTION: This course explores the philosophical and theoretical underpinnings that inform
nursing knowledge relevant to the role of the baccalaureate-prepared nurse. Emphasis is placed on use of the
best available evidence, clinical expertise, and patient preferences to improve healthcare quality.
COURSE OBJECTIVES: At the completion of this course, the student will be able to:

1. Apply knowledge from the art and science of nursing, the natural/behavioral sciences and humanities to
   nursing education, practice and research.
2. Utilize theoretical frameworks as a basis for nursing and interprofessional practice, research, and
   education.
3. Examine the assumptions and conceptual frameworks inherent in nursing’s core values that influence
   the quality of health care for individuals and families.
4. Demonstrate knowledge and skill in utilizing research evidence for nursing practice.
5. Recognize the important leadership contributions that each nurse can make to implement EBP to
   promote quality and safety.
6. Explore the use of theory and evidence based knowledge to guide a systematic approach to nursing care.
7. Analyze and evaluate selected nursing theories for translation into practice, research and nursing
   education.

The stigma associated with mental health has the greatest contribution from the media. Media portrays those with a mental illness as erratic, dangerous, unpredictable, and incapable. Because the media portrays mental illness in this manner, it causes people to begin to associate these characteristics with any mentally ill patient. It complicates the lives those who suffer greatly. Although media plays a huge role in the stigma behind mental illness, I also believe that a lack of understanding can also contribute to the association. The misleading portrayl of patients with mental illness in TV shows or movies causes the public to believe exactly what they are seeing. The picture that society paints of a mentally ill patient causes the world to discriminate against them and blame them for their illness. The public stigma that society has created associated with mental illness causes those who suffer to experience self- stigma. Self- stigma is when the patient internalizes the negative stereotypes surrounding mental illness. The stereotypes surrounding mental illness causes these patients to be misunderstood. This misunderstanding makes everything harder for them. For example, employers may not hire them,  landlords may not rent to them, and health care workers may not care to their best ability. These actions of society destroys the self esteem of the individual. It makes them feel unworthy and they apply the negativity associated with mental illness to themselves. Sterotypes associate with mental illness has a ripple effect. It begins with the negative portrayl of a mentally ill individual, leading to public stigma, then progressing to self-stigma. Self- stigma has many harmful effects in recovery of those with mental illness and will steer them away from treatment. 

A person’s culture can greatly impact their response to mental illness. There are different views on mental illness and how to cope with it based on culture. There is something called the cultural idiom of distress which is a term used to describe the suffering within a cultural group based on cultural explanations. For example, Hispanic individuals use the word “nervios” as the cause for a variety of symptoms including headache, irritability, nervousness, insomnia, and difficulty concentrating. These symptoms could also be seen in mentally ill patients but is masked by a cultural belief. Additionally, there are some cultures who create a stigma around seeking health care, specifically African Americans and Hispanics. They will only visit health care professionals if all other resources have been used, which will delay recovery. Also, there are cultures who refuse to believe that mental illness exists. The Asian cultures has a tradition of disguising or denying the presence of mental illness and shame those who are treated for it. Belief and spirituality may also impact an individuals response to mental illness. Different religious beliefs will approach mental illness differently. Some may seek direct help, while some believe that a greater being will heal them. Understanding the patients religious beliefs and spiritualities will help to find a common course of treatment for the patient. 

When assigned the goal sheet at the beginning of the semester, I made sure to choose goals that would benefit me overall as a person. One wellness goal that I set is taking a couple of hours out of my week for myself to do yoga and meditate. The second goal that I set is learning to handle controversy and stick up for myself. I chose these goals because I am working to focus on myself more.

Throughout the summer, I was able to set aside time every day to workout. Some of these days I did cardio, some strength, and some yoga or stretching. The yoga and stretching days helped me both physically and mentally. It allowed me to release any stress that I had weighing on me while allowing my body to heal and recover from the previous workouts. Eventually, it became a routine. Knowing that my junior year of nursing school would be stressful and time consuming, I wanted to make yoga or meditation a part of my busy schedule to help to maintain a healthy mental status. The exercise that I could gain from it was just a bonus to positive effect it had on my mind set. Although, mental illness prevention measures can be different for everyone, yoga and meditation seem to work best for me.

Dealing with controversy is something that I have struggled with my whole life. I am not one to call people out if they have done something wrong or stick up for myself if I disagree with something. I always think of the worst possible case scenario that could come out of conversations. I never want to lose any friends or put stress on my relationships with others. This is something about myself that I want to change because I deserve to be heard. I am getting to an age in my life where I am going to be more independent. With independence comes difficult and uncomfortable situations that I may encounter. It is essential that I share my opinions on certain matters and not just go with the flow all the time. In just about a year and a half, I will be graduating college. I need to start focusing on myself and set these goals so that I come out of school as a stronger, more independent woman. With that said, taking on uncomfortable situations and being able to handle them accordingly is a life skill that I must work on.

Since creating these goals for myself at the beginning of the semester, I have been decently successful in meeting them. I have had a bit of difficulty incorporating the yoga and meditation into my schedule. There are weeks where I surpass the guidelines of this goal; but there are also weeks that I am not able to practice yoga due to a heavy workload. My second goal, regarding the appropriate actions during controversial situations, is a work in progress. This new skill is something that could take years for me to meet. I continue to keep this goal in mind and work on it when necessary.

The strategies that I had created when formulating these goals have helped me to get to the point I am at now. At the beginning of each week, I plan out which days I will do my school assignments. This allows me to create “to-do lists” for each day. I tried to incorporate the yoga and meditation into days where I had the least amount of work. This helped me not let my workload interfere with my yoga practice as much. A strategy that I had in my second goal about handling controversy was to think in the bigger picture. This mindset becomes the basis of achieving that goal. I have been working at this throughout the semester which has helped me to gain more confidence in sticking up for myself.

While I do have many strategies that I am working on to help me to see my goals, there are also things that get in the way of reaching them. Time management was the biggest barrier to reach my yoga and meditation goal. Multiple times I would plan to practice yoga but then get too wrapped up in an assignment or studying and feel that I did not have enough time. Barriers in reaching my goal involving controversy is the fear of the potential harm that could occur in my relationships. Additionally, I could potentially be changing myself. When working to achieve this goal, I need to be sure that I find a happy medium; by sticking up for myself and speaking my mind while also being sure to respect the thoughts and opinions of others. I feel that I am finally ready for this change in my lifestyle. Identifying the readiness in change is just the first step in reaching my goals.

According to the Prochaska’s Transtheoretical Model, there are six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. When filling out the goal sheet, I feel that I was in the action phase for the goal about committing to a couple of hours a week to yoga or meditation. I was achieving this goal throughout the whole summer, hoping to continue that goal once I started school. With my goal of learning to stick up for myself, I believe I started in the contemplation phase. I have always known that I was not good at handling any sort of controversy and that I needed to change. It was not until I had filled out this goal sheet that I decided I was going to be committed to making the change. I feel that throughout the semester, I have changed from being in the contemplation phase to the action phase in the change to being able to handle controversy. I am more committed and am thinking of realistic ways to help me reach my goal. Both goals that I had picked are still a work in progress. I will continue to be in the action phase and work towards fulfilling both of my goals. It is essential that I hold myself accountable when there are times that I do not practice my yoga or when I do not stick up for myself when necessary. Self-accountability is a necessary change that I need to work on for next semester if I want to meet my goals.

These goals both indirectly are associated with patient care. Connecting with myself and the world around me spiritually with yoga or meditation will help to maintain my mental health and decrease stress. This will help to decrease risk for burnout. Nursing burnout is characterized as severe mental, physical, and emotional exhaustion caused by prolonged stress. Burnout will affect both a nurse’s and a patient’s life. Incorporating yoga into my life will help to prevent burnout by allowing myself to disconnect from my work and just relax. This will allow me to be able to provide adequate care for my patients. Throughout my career as a nurse, I will most likely encounter some individuals that will not necessarily like me or the decisions that I make. Whether it be a patient or a coworker, it is important that I learn to stay true to myself and be able to handle situations with these individuals. The goals that I have chosen will help me in many aspects of my life and will help me to be the best version of me that I can be.    

During my clinical experience, my classmates and I were a bit restricted on what we were able to do with our patients on our own. We were able to do vital signs, perform some assessments, and makes lots of beds. This allowed us time to really get to know the patients we were working with. I will never forget one woman, who was not even one of my patients, but a roommate of one. I was making the bed for her neighbor and began talking with her. She talked to me all about her family and how it was killing her to not be able to see them due to COVID-19 and her hospitalization. I could see the pain in her eyes when she talked about how much she missed them. I empathized with that and it made me realize how hard it must be for the patients right now. They are unable to have any visitors, so the health care professionals are their only source of socialization and support. We continued speaking and bonded over our love for our dogs and how we could not imagine our lives without them. We ended up talking for almost a half hour. Towards the end of the conversation, she thanked me. She thanked me for just talking to her about something other than her illness, something she states that she has not had in a while. Now that I think of it, I don’t even know what her illness was. She explained that it was people like me who are keeping her going and pushing her to get better. That day felt rewarding; it was the first time that I had been acknowledged for making a difference. It made me realize that these conversations are what could change the whole dynamic of patient care. I am glad that this woman said this to me because it really made me realize how just taking a little time out of our day to talk with the patients can make their whole entire day.

The Medication Reconciliation was interesting to me. I enjoyed being able to apply the knowledge that I have learned throughout the semester to someone’s actual medications. Before beginning pharmacology, I would have never known how these medications worked or even what they were. Most of the medications that my client takes are drugs that we have previously been tested on, so I was able to apply that knowledge while adding some more information from research to the Medication Reconciliation. I also felt more invested in the research because it was specific to my client, who is a loved one of mine, so I was committed to providing the most accurate and effective information possible.

I did notice safety concerns about the medications that my client was on. Majority of the concerns had to do with her age. She is in her 70s which put her at risk for more adverse effects. The client did know why she was on each of her medications. This is important because she takes several different medications and knowing why drug is essential would increase likelihood of patient following prescription plan. The patient did that two medications that had a similar effect. She is suffering from a herniated disc, so she is on tramadol and meloxicam to treat pain. These drugs both reduce pain but do them in different ways. Meloxicam is an NSAID and tramadol is a narcotic painkiller. They can be used together to have adequate control over the severe pain caused by the herniated disc. The client did know why she was on both. She was in unbearable pain before prescribed both pain relievers, so understanding what each drug did to decrease this pain was important to her. There were no major medication interactions between the drugs that the patient was taking.

Art is a visual way of transmitting a message of meaning and emotion to another. Throughout the pandemic, art has been used to acknowledge and appreciate the work of the nurses working on the front lines. This graffiti mural is a piece of art the really spoke to me. It encompasses the reason why I have chosen to pursue a career in nursing. Nurses always have been, but are just finally being recognized, as the “superheroes” of our health care system. They are the ones who work tirelessly in protecting the well-being and health of the patients by putting themselves and those around them at risk to help those suffering. That is what a superhero does; they put others before themselves. The selflessness and determination of nurses, especially during COVID-19 times, is something that is truly amazing. Something that really stuck out to me in this mural is the eyes of the nurse. There is a combination of emotions that I can read from these eyes. I see sadness, will power, pride, exhaustion and so much more. During the pandemic, the role of nurses has been greatly impacted. They are giving the patients the adequate care that they need while also implementing the infectious disease prevention needed to control spread of COVID-19. An important part of the nursing role during this time is spending time with patients, listening to them, and getting to know them. This has been a terrifying time for both patients and their families due the restrictions in visitors entering the hospital. Nurses were put into the family role for the patients by advocating for each individual and providing the support that they need. With this role being emphasized during the pandemic, it put a lot more emotional stress and exhaustion on these nurses. Despite the sadness and exhaustion associated with being a nurse during this life-changing time in health care, nurses are more determined than ever to provide the best care possible for their patients. This mural has so much underlying meaning emphasizing that times during coronavirus is an unknown for everyone and nurses are the front-line workers that are there to provide support and strength for everyone. It is something that I truly admire and I hope that one day I can have even half courage of the health care superheroes.