Alicia Dumont

Core Competencies: Communication as well as roles and responsibilities

On October 19th, I had the opportunity to observe a lecture, called “Non-Fatal Strangulation”, presented by Shaun Johnson, University of New England’s Regional Sexual Assault Nurse Examiner (SANE) Coordinator. Although I was aware of strangulation, I did not have a detailed understanding about it or what to look for in a patient; therefore, as a result of Johnson’s lecture, I enhanced my awareness about the different types of strangulation, the effects it has on the human body, signs and symptoms of an individual who experienced strangulation, how to provide patient care for this vulnerable population, and how strangulation impacts different age groups. As a result, I will be better prepared, as a nurse to provide better care for these individuals. Specifically, throughout this reflection, I will discuss how I have gained knowledge to strengthen two core competencies including ‘communication’ and ‘roles and responsibilities’. Overall, Non-fatal strangulation (NFS) is more common than we assume especially with domestic abuse victims, so this education was important for me in my future in nursing.

Johnson went into great detail explaining NFS, and in short, it occurs when one person places excessive pressure around another person’s neck, which compresses the blood vessels as well as the airway, all of which impairs oxygenation. Strangulation can occur via several methods, including the use of hands, body weight, and other appliances to cut off an individual’s ability to breathe. Prior to this lecture, I did have previous conceptions that strangulation referred to an individual using their hands, or another object placed around in individual’s neck. But it could also be a person using their knee, for instance, to block someone’s airway. I knew if a person’s airway is blocked, it can endanger their life. However, prior to this lecture, I was not aware how the term strangulation differs from the term choking which is important. For example, a reference, “he is choking him”, thought to strangulation is not medically considered actual choking. It was my preconception that acts of choking and strangulation could be one in the same, however, I appreciated learning from this lecture that the two terms are medically different. Both mechanisms block the airway, but they are significantly different otherwise. Today, in society, because these words are often used interchangeable, it is important, as a future nurse, to learn to use the proper terminology when referencing the exact mechanism of injury. Although both choking and strangulation impede blood flow and airflow which prevents oxygen from reaching the brain, the term “choking” is caused by a blockage inside an individual’s throat blocking the airway while “strangulation” is caused by an external pressure applied to someone’s neck causing a blockage to the airway.  Thus, after hearing the difference in this important lecture, I recognized how terminology can be used interchangeably these days and how critical it is as a future nurse to increase my awareness about differences when referencing mechanisms of injury because it is critical for proper diagnosis and treatment. Although this may seem minor in general use, using proper and accurate terminology in the medical field is of utmost importance, so there is no miscommunication when providing and planning patient care as well as during discussions about strangulation or choking with other members of the medical field. As a result, I have strengthened my communication skills, which is a core competency.

In addition, during this lecture about non-fatal strangulation, I learned how to identify victims by assessing signs and symptoms of strangulation. This is an example of strengthening the core competency of roles and responsibilities of a nurse, specifically associated with assessing for manifestations of strangulation. These include a raspy and/or hoarse voice, coughing, the inability to speak, the total loss of voice, swallowing impairments, neck edema, drooling, and nausea/vomiting. It can also lead to strained breathing, hyperventilation, and life-threatening inability to breathe. In addition, there can be brain trauma including subsequent confusion and memory loss. Lastly, strangulation can also lead to seizure which was new information to me.

Accordingly, because I was able to participate in this lecture, I have enhanced my skills and knowledge on how to provide optimum care to strangulation patients which is important in my future practice as a nurse. I understand now that a strangulation patient’s traumatic situation is difficult, so as part of their support system, I will be graceful, empathetic, and provide any form of support they may need. I will lend a helping hand and be a good listener which I understand can provide comfort in violent cases such as NFS.

In addition to being compassionate and gentle with NFS patients, Johnson expressed the importance of proper questioning during assessment. By learning about proper questioning, I have strengthened both core competencies, roles and responsibilities as well as communication. I learned that getting critical information will not only help with an optimum care plan, but it can help with the prevention of future events. I will tailor my questions so that they are gentle but effective including, who was inflicted their injury; where did the event occur?; how were they strangled? (object or hands/which direction/how often/duration); what positions were both of them in?; where specifically did they feel pressure on their neck?; was this the first time or occur prior times?; any preexisting neck surgeries/injuries?; was the person wearing a ring?; how long did they hold your neck/throat?; was there shaking involved; how did the attack stop? what are their current symptoms?. The goal is to be as thorough as possible, so all these questions are imperative to ask to comprehend the patient’s situation/condition so as a nurse, I am better able to provide the appropriate care and to allow information to be documented for legal purposes in the event the matter is pursued.

And, lastly, because NFS is so traumatizing, I learned from Johnson’s pertinent lecture that it is important to assess and offer any applicable resources according to the patient’s needs including consultation with a social worker, law enforcement, counseling, support groups as well as resources for the patient’s family as well. Because strangulation is usually the result of a violent crime, I understand now how vulnerable these patients can be following an event. Therefore, my role as nurse is not important not only in a strangulation victim’s physical care but their emotional as well.

Core Competencies: values and ethics as well as roles and responsibilities

The presentation, Needle Exchange Program, delivered by Kerri Barton, was a wonderful opportunity to learn about the harm reduction and substance use prevention services in Portland, Maine. Substance use disorder (SUD) is a chronic disease involving the inability to control one’s use of legal and illegal substances such as street drugs, alcohol, or medications. SUD is a challenging disease to overcome, and it often takes various treatment interventions and numerous attempts to achieve long-term recovery with many individuals relapsing multiple times and some never fully recovering. Typically, individuals suffering from SUD are in and out of treatment programs throughout their lives. Therefore, harm reduction is critical for these individuals to alleviate the negative social and physical consequences of substance use. Harm reduction incorporates strategies that promote safer drug use, abstinence, and it is about bringing people together who use drugs for support in their continuum of recovery and ensuring that they are safe throughout the process. Harm reduction has been shown to reduce drug-related deaths, life-threatening infections due to unsterile needles, and chronic diseases such as hepatitis and HIV. 

For this section, I am going to focus on how this lecture is associated with the core competency of ‘values and ethics’. Prior to this lecture, I was aware that harm reduction concentrates on a set of practical strategies that are directed at lessening the negative consequences associated with substance use disorders with particularly focus on six generalized principles utilized in health care, including humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination. However, my preconceived thoughts about harm reduction and the Needle Exchange Program focused primarily on ways to educate the public on the harms of illicit and licit drug use and to prevent harm from happening to individuals suffering from SUD, but truly, this program focuses on the fact that society needs to accept, for better or for worse, that drug use is a phenomena, whether illicit or licit, that needs to be managed. It is a public health crisis that cannot be ignored. Thus, in this lecture, I learned that these programs focus on working to reduce SUD’s harmful effects instead of overlooking or condemning them. Although this program does supply aid to help those with treatment and recovery, it is not simply preventing drug use from occurring and forcing people into treatment but educating individuals on safer ways to use drugs and allow them access to resources to keep them as safe as possible to reduce harm from happening. The programs also promote wellness and recovery. Harm reduction is a strategy involving approaches that engage directly with those suffering from SUD’s to prevent overdoses and infectious diseases while improving the physical, mental, and social well-being of those suffering and to offer substance use disorder treatments and health care services. As a nurse, I intend to educate those suffering from SUD about various proactive and preventive programs. I will work diligently to assist people to find harm reduction services such as the needle exchange program to help them reduce risks such as overdoses and transmissible diseases.

Regarding values and ethics, one important takeaway I learned from today’s lecture is that health and health inequalities play a huge role in substance abuse, which I believe is not readily acknowledged by the public and it should be part of the discussion. For example, poverty, trauma history, gender discrimination, class, race discrimination, and several other social inequalities play a crucial role in affecting an individual’s vulnerability to substance abuse and can also affect how successful or unsuccessful they may be in accessing/continuing treatment and achieving recovery. Lack of education, and support mechanisms as well as socioeconomic disadvantages often influence SUD outcomes. As a nurse, I will therefore, ensure that I assess all these factors for a patient suffering from substance abuse and will take efforts to assist them to access treatment throughout their potential recovery. 

Furthermore, as a nurse, I will ensure to implement many techniques I have learned today and include them in my patient care for those suffering from SUD. I will ensure to uphold the roles and responsibilties associated with a nurse working with those suffering from SUD. For example, I consider including harm reduction by promoting access to safer use supplies and use of drugs counseling on how to be aware of and respond to an overdose- blue lips and nails, slow, shallow breath, slurred speech, and pinpoint pupils. Also, I will discuss antidotes such as naloxone to reverse the effects of an overdose. Finally, I would educate the individual to seek assistance immediately in such a situation if needed. I would also help with access to community-based groups, counseling, etc., to help them with recovery and treatment. I would also teach them prevention strategies, such as never using drugs alone, reducing the frequency and intensity of drug use, going slow when using a substance, and testing it first because strengths can vary. Overall, because of this excellent presentation, I have learned to do all I can to assist my patients in achieving the best outcomes possible for each individual. Therefore, this lecture reflects the roles and responsibilities of a nurse working with patients who have SUD as well as the ethics and values associated with these situations.