Alicia Dumont

Being involved in the mental health simulation, on August 4^th, 2022, was an incredible experience. Throughout my experience working with individuals with mental illness this semester, at Spring Harbor in Westbrook Maine, I have not yet encountered patients with severe suicidal ideation, schizophrenia, borderline personality disorder, or a significant pattern of alcohol use as I did in the simulation. Although the four patients were actors in the simulation, they were incredible and truly appeared to be real patients whom I was able to access and interact. Their appearances, mannerisms, behaviors, and communication styles accurately depicted patients suffering with mental illness. With each patient, I faced anticipated challenges as all of it was unfamiliar territory for me but in the end the process was a success. The simulations were an insightful and knowledge gaining experience for which I am incredibly grateful.

One of the major challenges I experienced was that every patient is so different, so the nursing approach for gathering information is varied and individualized for each. In this way, I have learned that the nursing process for every patient is incredibly unique, even for those patients who share similar conditions. For instance, the patient with schizophrenia was uncommunicative and extremely distracted by auditory hallucinations, so receiving information was exceedingly difficult. Prior to the simulation, using the case study we received a week earlier; I formulated multiple questions to ask the patient in the domains of psychological, biological, and social. Prior to interacting with the patient, I had assumed I would be able to ask these questions and receive information easily from the patient, however, I soon realized it was the furthest from the truth. From then on, I learned how difficult it can be to obtain information from some patients. As a means of overcoming this challenge, my group and I strived to establish an early rapport with the patient, so they could feel engaged in the conversation and feel more comfortable opening up about their current situation. Also, we would reorient the patient to keep them engaged, and we would repeat the questions in a different format if the patient had difficulty answering some of them. The simulation raised my awareness that reorienting is important with some patients, and this will help prepare me for future experiences in the nursing field. I recognize that I need adapt unique styles according to the patient’s needs to reach the best possible outcome.

Additionally, by participating in this simulation, I have learned the importance of regulating my internal feelings when working with patients as our own personal judgements and bias can be a barrier. I did not feel as though I was being judgmental, and I try to be empathetic but sometimes, I feel frustrated and anxious working with some patients, such as the borderline personality disorder as well as the alcoholic. Both patients were lucid, yet they were in denial they have medical conditions. For the sake of the case study, they were sent to see us by their family members and did not willingly want to receive help. It was challenging because it was frustrating that we were trying to help patients that do not want to receive help. They were reluctant to talk about their current situations and felt as though there was nothing that could help them, primarily because they did not believe they needed help. However, after a period talking and counseling them about support groups, medication, and therapy, both patients in the end agreed to begin treatment. Because of this simulation, I realize that I need to be patient with some patients because their perceptions are not always reality. It is important to adapt and consider various presenting options to establish trust and instill hope with the patient while at the same time establishing a rapport that builds a relationship which is one of the keys to helping guide the patient towards appropriate care and treatment.

Overall, through this rewarding simulation, I have learned that the nursing process is individualized for every patient. Being understanding, flexible and adaptable is key to developing a needed rapport with a patient to achieve the desired outcome. After completing this simulation, I feel more confident how to address mental health issues that I may face in a clinical setting. I am better prepared to manage complex situations with patients suffering from mental illnesses and that adjusting my nursing style is important to provide comfort and to assist patients.

  Through the process of completing this medication reconciliation, my client gained a greater understanding about their medications and the potential for adverse reactions as well as about the importance of safe medication administration. In the same regard, I gained a greater understanding of the purpose of the various medications and the risks associated with their potential side effects. I learned how to counsel a patient regarding their medication use as well as how to best educate a client regarding safe and timely medication administration which is so beneficial in preparing me to be a nurse in the field. This was not only critical to my education, but it raised important awareness about the combinations of medications and how they can impact patients uniquely based on their individual needs and circumstances. Subsequently, in this reflection I will highlight on the key concerns that were discussed with the patient and provide a brief overview of my medication reconciliation paper.

   Overall, the client was aware of the purpose of each medication and counseled how to take their medication as well as the potential for adverse reactions. The client was familiar with Allegra as well as Adderall. However, the patient was a bit unfamiliar with safe medication administration regarding Synthroid. The client was unfamiliar with the adverse reactions of some medications that could potentially cause them harm. For instance, the client was not aware that Lexapro causes weight gain as well as potential sedation with the consumption of alcohol. As a result, the client stated that he will be cautious of their alcohol consumption to avoid potential harm. Furthermore, they are committed to eating a healthier diet as well as exercise more frequently. 

  In addition, the client was unaware of the importance of safe medication administration regarding Synthroid, their thyroid replacement medication. The client admitted that they do often forget to take this medication, and as a result they will take 2-3 pills sometimes within a day to make up for their missed days. The client was not aware that they could experience adverse reactions because of this, and I counseled the client that the need to post reminders to ensure they take this medication each morning with only water and 30-60 minutes before other food, drinks, and medications to ensure safe medication delivery. Likewise, the patient also shared that he often takes a higher dosage of Adderall than prescribed somedays, and I informed him about the cardiac complications that can arise as well as all the other adverse effects associated with all his medications. We discussed at length the importance of lifestyle modifications in adherence to the recommendations and warnings associated with all their prescribed medications.

 Overall, this was an insightful experience for both me and my client. Understanding the purpose of medications, their risks for potential adverse effects, the importance of a healthy lifestyle and safe medication administration was a vital lesson for not only the client but for me as well. It was rewarding for both of us to gain this new awareness that will help ensure the patient’s health and safety going forward.

Service-learning Project. “Run Across America“. The priority focus was to advocate for and help those facing hunger across America.

Over the course of this semester and continuing through September, I have had the privilege of participating in a collaborative service-learning project, Run Across America, which is a social enterprise that began in May 2020 because of the pandemic. Run Across America was formed to support causes, such as feeding vulnerable families across America, those who are food insecure because of COVID-19. Since its inception, there has been as many as 68,000 participants who have raised money and resources to supply more than four billion meals annually for individuals and families facing food insecurity in our communities and across the country. Because countrywide lockdowns resulted in unemployment and businesses closures, the pandemic has created widespread food insecurity especially in families with young children. For the last two years, the everchanging COVID-19 virus has progressively changed our society and taken a toll on our economy. Consequently, two social determinates that I have advocated for during my involvement with Run for America includes economic stability as well as increased health and healthcare. Many citizens cannot afford food or healthcare, so my efforts with Run Across America has been rewarding, and I am grateful for this positive opportunity because it has allowed me to help not only my community but those in need across the country.

Joining Run Across America, I signed up for the event early this past July with members of my family, friends, and peers with the goal of completing a total of 50 km (about 31.07 mi) or more of running, walking, or bike-riding by Labor Day and ultimately raising money for individuals who are food insecure. As a group, we have run in neighborhoods all over Falmouth and Portland as well as Mackworth Island, Back Cove and Eastern Promenade Trails all located in Maine. We have already made great strides by exceeding the hours of 8-10 required for this course, and I am excited to continue my efforts for this wonderful cause. Overall, this service-learning opportunity aims to immerse us in the community to provide valuable support while promoting emotional, physical, and mental health for those facing hunger today. By helping those in need, as an Interpersonal Practice (IPP), our coordinated effort is also consistent with the values and ethics inherent in nursing. It has been our goal to help reverse the challenges of hunger by providing food to those in need while at the same time promoting a healthier lifestyle as well. In doing so, I have had the opportunity to deepen my understanding of IPP and I have strengthened my skills involved with the roles and responsibilities in collaborative practices including values and ethics for interprofessional practice, interprofessional communication, interprofessional teamwork and team-based care.

Throughout my experience with Run Across America, I have worked closely with family members, friends, and peers to learn about and assist individuals facing food shortages, poverty, and hunger within my community and across America. This effort has simulated my future in the interprofessional world of nursing. As a group, we delegated roles and responsibilities to ensure our efforts were successful. They pertained to deciding about the running/walking trails, maintaining suitable time management, supplying snacks and water, as well as the assignment of a leader who focused on the overall coordination of the event. At the same time, effective interprofessional communication was utilized which increased efficiency and fostered us working better as a team. For instance, we created a telephone group-chat in which we could designate times and locations, and every Sunday, we developed a weekly plan of action. In addition, we communicated online each night to ensure everyone was aware of developing details. This ensured there were no miscommunications, everyone showed up on time and was prepared which made for a smooth implementation of our plan.

Our effort with Run Across America is an example of how an IPP collaboration with effective communication can facilitate a positive outcome for those in need within our communities and across the country, such as those facing food insecurity. Although the communication was within our small group to raise awareness of the issue of hunger, additionally we can further communicate with others within our community to advocate for marginalized populations. To further facilitate positive outcomes for individuals in need, we could utilize social media platforms, such as Instagram and Facebook to raise awareness about the benefits of Run Across America, so others may join this wonderful cause and raise additional money and resources for those in need.

Consequently, this rewarding experience, Run Across America, has further educated me on the benefits of IPP and I now recognize that IPP is highly focused on working together cohesively to explore and improve values and ethics while striving to make a positive impact on the lives of individuals in need in our communities and across our country.