Page 2 of 4

NSG 444 Final Presentation

November 28, 2021 / ecarrell

The Marginalization of Veterans in America

Veterans are often victims of silent discrimination because they are perceived as damaged individuals due to their wartime experiences. Many times, their services go unnoticed and unappreciated, and can be met with disdain for their roles in controversial conflicts. Nurses can serve as advocates for this population by recognizing these disparities and providing just and quality care.

**We were unable to upload our recorded presentation due to the size of the file**

What is a vulnerable population?

Social groups of people with an increased risk of health problems

Veterans as Damaged and Forgotten Individuals

Veteran sues state corrections alleging discrimination

Health Care Needs

Mental Health Services
Trauma Related Injuries

Resources & Services for Veterans

VA Hospitals
Building Homes for Heroes
Tunnels to Towers
Military Child Care
Woven Women Veteran Network

Important Numbers for Veterans

Readjustment Counseling Service Combat Call Center
Veterans Crisis Line

Ethical Principles

Justice
Autonomy

Legal Rights

Americans With Disabilities Act
Veterans Access, Choice, and Accountability Act of 2014

Nurse’s Role

Collective Bargaining
Patient Advocacy

References

Death and Dying

November 17, 2021 / ecarrell

Death with dignity has historically been a widely debated ethical issue. I have done several projects on this concept over the course of my schooling and have always maintained the belief that everyone deserves to die when and how they want, especially if they have a particularly aggressive disease. Terminally ill people will find ways to die without the assistance of medical personnel, so I think allowing the option to die with dignity is important to maintain autonomy. I was excited to read about Maine adopting this practice, as previously only a handful of states in America had legalized it.

I don’t think the death with dignity laws clash with “do no harm”. In the case where the patient has six months or less to live, they are 18 or older, and have the mental capacity to make healthcare decisions, I think the healthcare team has an obligation to help them quietly and peacefully end their lives. I think in this case, nurses and doctors would be doing more harm by refusing to assist in a patient’s death than actually following through with it. The nurse’s oath also states that we must devote ourselves to the welfare of our patients, and that includes their happiness. If dying before their brains and bodies start shutting down is what will make them happy, then I think we owe them that.

Emotional Intelligence

November 6, 2021 / ecarrell

I chose to take the emotional intelligence quiz created by GlobaLeadership Foundation. This quiz examines four different parameters of emotional intelligence including self-awareness, self-management, social-awareness and relationship management. It was made up of 40 questions each with two options for which action to choose in a given scenario. Before starting, I thought that I was emotionally intelligent, and that I would score well. All four of these parameters reflect different capabilities of a nurse, and they must individually be strong in order for a person to act with their own interests in mind, as well as others’.

My results told a bit of a different story. I scored a 4/10 for self-awareness, 5/10 for self-management, 9/10 for social-awareness, and 9/10 for relationship management. I was mostly surprised that I scored so low for self-awareness, because I had previously thought I was better than most at being aware of my own thoughts and feelings. Self-awareness is measured by emotional self-awareness, accurate self-assessment, and self-confidence. I never realized how many components went into the concept of self-awareness and learning that self-confidence plays a part helps me understand my low score, as I have always struggled to see my own self-worth. People close to me have also noticed that I struggle to discuss and identify my emotions for the sake of others, which also fits into the fact that I lack emotional self-awareness.

My 5/10 self-management involves my ability to use self-control, be transparent, take initiative, and be adaptable. I think I tend to be shy in certain situations, which causes me to hesitate, not share my opinion, and be less transparent. Additionally, I lack a strong desire to seize opportunities and act. I tend to be cautious and am more likely to overthink and become absorbed by my options before I make a decision. This may not prove to be the best trait in the nursing profession, which often involves fast decision-making that may impact my own mental health. My 9/10 score for social awareness reflects my ability to use empathy, be organized, navigate politics, and recognize other’s needs. I think based on my previous points, this makes sense, as what I lack in self-awareness, I make up for in social awareness. I tend to be far more concerned with other people’s feelings than my own.

I also scored high on the relationship management competency, which involves my ability to guide groups of individuals, give feedback, manage conflict, and influence others. I have worked in many customer service jobs and have learned quickly over the years the best ways to deal with other people, even when they are particularly difficult.

Moving forward, I think my social awareness and relationship management will serve me well in my future nursing career. However, if I want to be a good leader, I need to work on my self-reflective skills and improve my self-awareness and self-management. The ability to lead other people doesn’t just involve understanding others, it also means you have to understand yourself and be able to keep yourself healthy. Nursing is all about caring for other people, and working well as a team, but I can’t forget that my own emotional needs come first.

HealthInfoNet

October 20, 2021 / ecarrell

My thoughts about the use of EHR have pretty much always been positive. I have worked a few different jobs in the healthcare field, and it is very convenient to be able to look through a patient’s chart electronically and see their entire history. I understand that for some patients, it may be concerning to have all of their personal information in one place and may make them feel vulnerable.

HIE is a relatively new service available to medical professionals, as it was only introduced roughly twenty years ago. It has proven to be much more effective than other methods of data sharing such as fax, telephone, mail, or relying on the patient to bring their own medical history with them everywhere. For nurses specifically, HIE has completely revolutionized the care process. It allows nurses to get a complete picture of a patient’s past, whether it be surgical, medical, or their medication list. It simplifies the process of gathering data immensely, and it gives updated information, so that no matter where a patient goes to receive care, nurses will have the whole picture of their health. In the same vein, electronic health records can be used to detect major risk factors that may contribute to severe illness, which means that they also can help prevent medical events before they occur. I think that aspect of the EHR is most applicable to my future nursing practice. Being able to look at a patient’s history and see how they’ve trended over any number of years will not only save me time, but it will streamline the process of getting that patient the proper care that they need. As previously stated, EHR also improves the communication process between healthcare providers, which will definitely allow me to enhance care, as I can get answers and put in requests much faster.

Post-Leadership Interview

October 14, 2021 / ecarrell

From the interview with my nurse, I learned that being a strong leader in nursing is a day-to-day decision that one makes. I never considered that someone that feels they can be a strong leader one day, can have a dip in self confidence the next. My nurse has not been out of school for very long, so I expected some level of limit to her knowledge, but she never once faltered if she didn’t know something. So, it surprised me when she revealed in the interview that she sometimes feels doubted and incapable in her career and as a leader due to her young appearance. Although, she is clearly a very competent nurse. We talked about how she has trained many new grad nurses and has acted as a clinical instructor. She also plans to further her education and take more classes, join committees, and obtain further practice certifications. She also mentioned her interest in being a charge nurse in the future.

As far as emotional intelligence, my nurse does a great job of empathizing with patients and coworkers and is easily able to put herself in their shoes. As a leader, it is vital that a person be able to manage and identify their own emotions and be able to understand how those emotions impact others. This is a critically important part of nursing and based on her responses during our interview and what I’ve seen in practice, I think she does a fantastic job of maintaining a level head and putting her patients first. She also spoke about the importance of safety when it comes to dealing with conflict as a nurse leader. Emotional intelligence plays a huge part in de-escalation, which she says is the primary approach she uses. Putting herself on the same physical level as a patient and validating their emotions is a great way to calm a patient down and resolve a situation. It shows them that you are there for them, on the same team as them, and are willing to listen and work with them to resolve the issue. She explained that getting a more senior staff member is warranted if the situation gets out of hand, which also shows EI, as she knows her limits and knows when to get help.

Furthermore, maintaining a balance between work and home life is a big part in maintaining a healthy mind. During the interview, my nurse discussed getting outside, spending time with family, friends and pets, and listening to music. These things help her decompress after work, but she also mentions how it’s nice to get to know her coworkers and make strong connections with them in order to gain trust and a feeling of reliability.

This interview, while at points enlightening, was not unexpected for me. I had a wonderful experience with this nurse as my clinical instructor and could see immediately that she maintained a strong presence on her unit as a leader. If anything, this interview strengthened my belief that she will continue to do great things and lead by example in her field. I aspire to have done as much as she as at this point in my career when the time comes and will use my knowledge of her practice and techniques to mold my own practice in the future.

Trauma-Informed Care

October 6, 2021 / ecarrell

Trauma exposure impacts everyone in myriad ways, impacting the mind, body, spirit and surroundings. I think the way that trauma impacts us involves the kind of trauma we experience. For example, trauma can be psychological, such as a threat of death or injury, which may result in feelings of fear, helplessness or lack of hope. Additionally, the trauma could cause such stress that it impacts physical wellbeing, resulting in head or stomach aches. This stress could further impact a person’s spirit, resulting in grief, disengagement or disconnection. A person may socially isolate themselves, changing their environment, or even displace themselves geographically to create distance between themselves and the trauma.

Adverse childhood experiences have been proven to impact us further down the road, even in adulthood. Not only do traumatic childhood experiences impact us psychologically, overtime, the stress can increase risk of heart problems, diabetes mellitus type 2, obesity, depression or anxiety, and poor life choices such as substance abuse and smoking. Over time, ACES can also result in bad grades, more time off of work, and even early death.

As a future healthcare provider, it is vital that I have a strong understanding of how trauma impacts us throughout the life span. That includes the ability to apply the Trauma-Informed Care principles to my practice. This includes safety, trustworthiness, peer support, collaboration, empowerment, and cultural/historical/gender issues. In other words, I must be able to keep my patients’ individual needs and background in mind during the care process, while also acting as a source of support and guidance. Healing from trauma is a team effort and requires other care team members to collaborate in order to provide support, empowerment, and a sense of safety to the client. All in all, everyone experiences and deals with trauma differently, and therefore may need different methods of treatment in order to regain peace.

Pre-Interview Reflection

September 23, 2021 / ecarrell

The health professional I have chosen was a clinical instructor of mine in a previous semester. I chose to write about her because she demonstrated a strong dedication to her practice, a vast wealth of knowledge, and a commitment to learning from her patients and her peers. I could tell that all staff on the unit, regardless of status or rank, were drawn to her and felt comfortable around her. I know that she worked on the unit for several years as a CNA before becoming a nurse, which strengthened her relationship with the staff and helped her to establish herself as a member of the care team.

The difference between formal and informal leadership is the presence of official authority. Formal leadership comes from structure and authority, and it is usually methodically appointed. On the other hand, informal leadership may not have the traits of an official role and may just be a known status that a person has grown into. Often, informal leadership is more of a position of influence rather than a different title. The nurse I chose to write about is more of an informal leader, as she is still very young and relatively new to her nursing role. She has not been formally appointed as a leader on the unit itself, however, I think her status as a clinical educator speaks volumes about her influence in the hospital, as she is clearly a trusted source of knowledge.

I am most interested in learning about how this nurse feels she is supported on the unit, and how she may be able to turn her informal leadership into formal leadership over time. I am curious to find out more about conflicts and ethical dilemmas she has faced, and how her informal leadership role has helped her to handle certain situations.

Public Health and Vulnerable Populations

September 22, 2021 / ecarrell

The health of vulnerable and marginalized populations is impacted by myriad factors including an individual’s socioeconomic status, and what kind of community they are immersed in. Individual factors also include sexual orientation, gender, ethnicity, religion, geographical location and disability, all of which contribute to the way that people view and receive care. Lack of income can influence level of education, transportation, stress levels, mental health, and lifestyle choices. Current healthcare systems don’t cater to individuals regardless of these factors, which creates a lack of access to resources, as well as opportunities. With healthcare not readily available, marginalized populations are less likely to seek out care and are more likely to face discrimination when they do, which creates a cycle of them not receiving necessary care.

Historically, healthcare in the United States has been disproportionately available to white, English-speaking, job-holding citizens, which creates a stark contrast between those with and those without access. In America, access to care has almost always been contingent upon either having money or having a job that comes with good benefits. Not everyone has the capabilities needed to acquire wealth or security, largely because of the factors mentioned above. In order to resolve these disparities, we must first tackle the systems that exacerbate the problems faced by vulnerable and marginalized populations. Ideally, America would have universal, publicly funded healthcare, which would allow for complete coverage of most healthcare services. This creates an equal playing field for citizens and non-citizens alike, regardless of race, gender, sexuality, financial status, or religion. However, the problem of access can still be a problem when we factor in geographical location, and profession. If someone is the sole breadwinner in a household that supports multiple family members, and they work all day and can’t make time for healthcare, then it’s important for healthcare workers to come to them. Making healthcare more accessible may mean that offices, businesses, or individuals need to be more flexible with when and where they offer care. I think another aspect that would be helpful is the implementation of case workers or social workers. Vulnerable or marginalized populations often have difficultly following up with healthcare professionals for many of the reasons previously discussed, and therefore may benefit from having a caseworker specifically assigned to make sure they have transportation, time off, and anything else that helps get them to their appointment.

I think that having a strong foundational knowledge about the social determinants of health will help me understand all future patients I may have. Our society tends to blame the individual rather than the system, and it’s important to gain insight into a person’s background before making assumptions or judgements. Someone’s life choices do not directly reflect their intentions, and as a future nurse, I must remember that it’s my responsibility to advocate for and understand where my patients are coming from.

Ethical Considerations for EBP

August 6, 2021 / ecarrell

Before EBP, my perception of the nurse’s role in ethical practice was veery narrow, and only consisted of concepts like HIPAA, and patient advocacy. However, I now understand that they have a much more involved position. Nurses spend a significant amount of time with all of their patients, which means they know them on the most intimate level. In that respect, they can identify and screen potential patients for research candidacy. Therefore, they also need to make sure that patients and their families have all of the information necessary to be able to make an informed decision about participation. Much of the informed consent process is done by nurses. In terms of the research itself, nurses make sure that data and evidence is well-constructed, has relevance, significance and is valuable. They also assess the quality of the research and work to improve the methods that aren’t efficacious based on their past experiences.

Knowing the process of the research ethics is helpful, as being able to plan and execute a clinical investigation is a very valuable skill in the field of nursing. Clinical research is the reason that modern science is as advanced as it is. Nurses see firsthand what is and what is not therapeutic, and this can become a trial-and-error sort of process in itself. So, it is very important for nurses to be a part of clinical research, as they are the primary data gatherers in the patient care setting. They are familiar with patterns of symptoms and outcomes and have great intuition about their patients.

The Evidence Based Practice course allowed me to get a better sense of what clinical research looks like, as well as what the initiation process entails. I learned that nurses have far more responsibility than I originally thought, but it makes complete sense that we do, as we know the patient care process better than anyone. I feel that my confidence has grown as far as my ability to gather and evaluate journal articles. Being able to identify the strengths and weaknesses of a study is a very good skill to have moving forward!

Assumptions

August 5, 2021 / ecarrell

The nurse’s role in evidence implementation and evidence generation is an important one. As nurses have such a critical and close relationship with their patients, they are the ones that monitor outcomes vigilantly. Therefore, they ensure that research is well-constructed, significant, and valuable. Additionally, since nurses maintain such an intimate relationship with their clients, they can use their experiences to guide clinical research, in order to improve patient outcomes, or evaluate current interventions. That includes identifying which of their patients may benefit from inclusion in a research study. Nurses also make sure that the actions of medical professionals are in conformity with the ethical standards of their practice.

Nurses are also typically the ones to get their patients’ informed consent about clinical research. That means that they are the ones to explain the implications of the study to the patient and their loved ones, meaning that they are responsible for being well-informed about the purpose and details of the research being conducted.