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Month: February 2023

VR Assignment- “Eden Lab- Trans Health & LGBT Aging

VR Assignment- “Eden Lab- Trans Health & LGBT Aging

For this virtual reality assignment, “Eden Lab-Trans Health & LGBT Aging”, I had the wonderful opportunity to witness the life of a 72-year-old transgender woman as well as the LGBAT perspectives of Eden’s new community. It was an insightful experience that allowed me to ponder the idea of about the brain-body connections that determine an individual’s gender identity. Prior to this video, my understanding of gender identity was that it was primarily influenced by personal experiences gained through socialization. However, this virtual reality enhanced my understanding of gender identity by reflecting on a combination of influences, nature versus nurture. In the video, the narrator expressed that “gender identity, the internal sense of being male or female, is also biological and based on factors in the brain”. The narrator further expresses that after the first trimester of pregnancy, the external anatomy that determines our sex is formed, however, the brain continues to grow throughout the last two trimesters of pregnancy which can result in variations of gender identity. A person who identifies as a transgender person is when their external anatomy depicts one gender, while their brain anatomy depicts another. Thus, even at young ages people may identify with a gender opposite of their external anatomy, and it is our role in society to respect, support, and honor their identity preferences.

As LGBT individuals are becoming increasingly more understood and favorably recognized in our society, it is a nurse’s role to honor and dignify them including elderly identity preferences by providing culturally competent care and communication. There is an elderly LGBT population that deserves as much empathy and understanding as do their younger counterparts and there are numerous ways a nurse can provide the best possible patient care while at the same time honoring elderly patients’ identity preferences. Nurses need to be aware of the gender in which an elderly patient identifies and not make assumptions based on biological anatomy alone.  A nurse should practice active listening and ask the patient about their preferences, which consequently can allow the nurse and the LGBT client to establish trust and a good rapport. For a nurse to provide the most competent care, they need to be non-judgmental because being unbiased is critical in order for the client to receive the best quality of care.

Like all elders, transgender individuals should be provided equal, proficient optimum healthcare.  We must not assume anything, and we need to obtain as much information as possible to ensure transgender patients receive the necessary care as would be provided any patient.  For example, as a nurse, we would never assume that an elder patient has deficits in hearing, vision, or mobility. Instead, we ask the patient a series of questions to determine if they experience difficulty with daily tasks, or have hearing, vision, health, and/or mobility issues. If a patient indicates physical deficits, we nurses would implement interventions that will assist them in those areas as well as to increase their comfort and overall well-being. The same would apply to all patients including transgender elder individuals as well.

In addition, many transgender individual’s undergo hormone therapy and gender affirming surgery, and therefore, as nurses we must be mindful and educated on these procedures in order to be sensitive to the patient’s needs and to provide high quality care.  Hormone therapy is when people take hormones that will produce physical anatomical changes, while gender affirmation surgery refers to surgical procedures to change a person’s physical characteristics according to their identified gender. Overall, one way that nurses can provide competent care is to be educated on the LGBT community and know what the current medical practices are for transgender patients that may need to be attended to while receiving other medical treatment.  Awareness is the key to good nursing, and it applies to all people including transgender people as well. 

Furthermore, if I were to ever identify discriminatory behavior related to an individual’s identity/sexual orientation or for any other reason for that matter, I would intervene and advocate for the best patient because it is my job as nurse to provide optimum care to all patients regardless of their choices or beliefs.  In order to insure we do not practice any discriminatory behavior, as nurses, we must reflect within ourselves, and regardless of what our beliefs are, we must be open-minded and sensitive to the differences of others.  It is our job to be compassionate, kind and to provide a gentle hand to all patients equally, and it is our job to intervene if ever I witness discrimination. It is critical the discrimination of any kind be stopped because personal and societal biases can have adverse consequences in the outcome of a patient’s care.  Transgender individuals should not be treated any differently than any other patient, and I will work to ensure that my transgender and transgender elderly patients are treated equally and fairly because they deserve the best care possible. 

VR Assignment – ‘We Are Alfred” 

VR Assignment – ‘We Are Alfred” 

 Acute Macular Degeneration & Hearing Deficits 

NSG 409 Spring 2023 

A largely age-related disease process, known as Acute Macular Degeneration (AMD), is an eye disease that causes vision loss. Specifically, this eye disease causes the loss in the center of the field of vision, which is a gradual deteriorating process. Moreover, sight details when looking straight ahead are blurry or wavy. Individuals are unable to see finer details in the center of their vision. In other words, there is a blind spot in the middle of their vision field. When treating someone with AMD, a nurse faces challenges with the patient coping with the diagnosis and lifestyle management. The patient will likely be frightened when they receive the diagnosis of AMD and then challenged with adjusting their lifestyle while they adapt to the changes in their eyesight. Overall, the opportunity to see the world through Alfred’s eyes, the 74-year-old man with suspected mild cognitive impairment (MCI) as well as age-related vision and hearing loss for this virtual reality assignment was a wonderful opportunity to understand how individuals with this condition see and feel throughout their daily lives.  

As a future nurse, if I were to encounter a patient who was experiencing these symptoms, there are some diagnostic assessments and exams a nurse is able to assist with include bothFluorescein angiography and indocyanine green angiography, which are tests used to determine signs of macular degeneration. Nursing management in regard to these exams primarily depend on patient education preoperatively and postoperatively. For instance, to name a few, the nurse can counsel the patient to wear dark sunglasses in the daylight as well as to avoid direct sunlight exposure for five days after treatment. The patient should be warned that bright lights should be avoided such as tanning booths, intense room lights as well as halogen lights. Notably, as a nurse, I can assist the patient with a variety of testing that may be needed, such as the Montreal Cognitive Assessment, which was an assessment conducted with Alfred. 

Not only can a nurse be of assistance with diagnostics and treatments, but a nurse also offers interventions to help a patient manage AMD during their daily life. A nurse is part of a patient’s support system, so to provide someone suffering from AMD with resources and tools as part of their lifestyle management is important. I can only imagine how greatly this disease impacts a person’s mental and emotional well-being as well as their connection with others and the outside world. An individual losing their central vision causes it to be more difficult for them to see people’s faces, read newspapers or books, drive, cooking, or housework. For instance, experiencing the virtual reality simulation through Alfred’s eyes, I was able to witness first-hand what these patients see and how their vision is affected. Alfred was unable to see his surroundings clearly, faces across the table as well as faces at his doctor appointments. For these individuals it can be emotionally, physically, and mentally debilitating and it is of utmost importance for a nurse to assess how this condition impacts them in order to help implement strategies that will assist them with daily life activities and to help them cope with the changes in their vision loss.

This experience will impact how I assist my future patients suffering from AMD and I will be empathetic and supportive so that these patients receive the best care possible. For instance, I will offer recommendations for supportive lifestyle changes to help compensate for the patient’s AMD and ask the patient how they already perform daily activities and make recommendations for ways that the patient can maintain an independent lifestyle. I will educate the patient to ensure that they keep the floors clutter free, avoid moveable and slippery rugs, avoid cords on the floors and offer any other recommendations to reduce the patient’s risk of falling at home. I will also counsel the patient about the use of proper lighting to improve their vision in darkness by using such tools as night lights and having lamps or lighting adequately placed throughout the house. In this way, lighting can help enhance their ability to see and tackle daily life activities. If reading is a challenge for these patients, I can assist them with lenses or other seeing devices that will enlarge images or words to allow them to see more effectively. I will recommend the use of handrails in risky areas in the patient’s home such as in the bathroom or for unlevel areas. Tools such as a cane can assist with walking and enlarging the fonts on all electronics, such as the patient’s phone and computer, can assist as well.

In the hospital, if I were a nurse caring for a client with visual impairment, I would also ensure to orient the individual to their room and the hospital by demonstrating where the call light is if they were to need assistance, where their belongings are located, where the hospital equipment is located, where the tv and tv remote are located, and where the bathroom is located to name a few. I would also ensure to keep the room as clutter free as possible in order to avoid patient falls as well as ensure the room has proper lighting. And, most importantly, I would discuss with the individual how to best accommodate them with their visual impairment. I will make sure the patient is aware of all resources and tools to best ensure that they can maintain their independence and their normal routine.

As a future nurse, I perceive my nursing practice will be affected in various ways when caring for patients with AMD. I will need to be aware that such patients will have limitations such as with navigating their surroundings during appointments or in a hospital setting, and I will be aware that patients with AMD will unlikely see me or others well and that accommodations will be needed such as with assistance walking and showing them where to sit.  I will read any instructions and correspondence that are provided to ensure they have a full understanding of their diagnosis and treatment plan and will do so with any other information they may need to know. Being a nurse, I realize I have a critical role in providing quality and safe care for those with age-related conditions such as AMD, so I will be conscientious of any needs that the patient may have so that they have a successful caregiving experience.

NURSES If Florence Could See Us Now Reflection

NURSES If Florence Could See Us Now Reflection

The movie, “Nurses: If Florence Could See Us Now”, was a wonderful way to see the incredible roles nurses play in the lives of their patients and their families. Throughout time, nurses have laid the foundations that has led to today’s clinical practices. Nurses are innovative and transformative leaders who not only treat patients physically, but they consider all aspects of patient care, including emotional and spiritual, while at the same time considering the patient’s family and environment in which they live. The movie highlighted the ways in which nurses exemplify skills of nursing leadership as I have learned in my nursing courses. Nursing leaders inspire, influence, and encourage other nurses and other associated professionals while working as a collaborative team to ensure optimal patient care. The primary goal of a nurse leader is to maximize the potential of the team and achieve the intended goal. Nurse leaders are motivators, mentors, and advocators for themselves, their patients, and their associative medical team all-encompassing. As a future nurse, I will strive to develop these leadership qualities to provide the best possible healthcare. I can build on my previous learning by seeking out continuous education and working with inspirational mentors. Leadership requires the highest knowledge and competency, so lifelong learning will be important in order to stay up to date on the current advancements in medicine and patient care. To acquire this level of experience, nurse leaders continue their education and coursework throughout their careers as well as attending training sessions, nursing conferences and working on special projects which continuously helps advance their clinical and leadership expertise.

            Throughout nursing school, I have participated in several clinical rotations, however I have not had the chance yet to work with the vulnerable patient population suffering from cancer. At the beginning of the movie, I had the opportunity to witness a nurse caring for a young child with cancer. In the movie, the nurses stresses how wonderful an opportunity and a privilege it is to help these children through their difficult times, but how there are some barriers that exist when working with this critically ill population. For instance, the nurse in the video voiced that when treating pediatric cancer populations in critical condition, you are not only treating the patient and their painful disease, but you are treating the whole family as well. Pediatric oncology nurses are invited into the patient’s family at their most difficult and vulnerable time, and it can be challenging for the nurses because not only is the child patient scared and emotional, but so is the child’s family, so a nurse can be comforting the family as often as they are comforting the child. Another challenge for a pediatric oncology nurse is that they also are often experiencing a host of emotions especially during times when a child is critically ill and in severe pain or if a young patient dies. It is hard for nurses to witness these difficult moments and it can take its toll on them overtime. Witnessing the vulnerable children, who are so ill, afraid and in continuous pain, can be emotionally exhausting and heartbreaking. At the same time, it is a rewarding time for the nurses as well because they know they helping sick children by providing a gentle hand, a reassuring voice, providing comfort and reducing anxiety.  The pediatric oncology nurses are a support system for the whole family which is so important to the well-being of all. Also, it is so rewarding to witness a child recover and there is always a renewed hope when a once critically ill young patient is ultimately discharged from care and goes home.  Nurses are such a big part of the recovery process and because they are so special, they often leave a lasting impression on the child and their entire family long into their lives.    

Other barriers noted in the movie was about how critically ill children do not understand about their disease or the treatment they receive at the same level adults do which makes it challenging for the nurses because the small patients are often upset due to their fear, stress and confusion. It is often hard for nurses to overcome these issues to bring ease to their young patients which can be overwhelming and stressful for the nurses because their goal is to provide support and comfort. For instance, drawing blood or administering medications using a needle are often scary for young patients as are treatments which are critical to recovery, such as chemotherapy, that are frightening and painful. It is the role of the pediatric oncology nurse to help these children through these challenging moments by comforting them and trying to alleviate their fears and to reduce their pain if possible but it is not always easy for the nurse so being patient and creative is important. For instance, in the movie, one of the nurse’s wears a Disney costume which appears to help make the children feel safe and brightens their moods as they experience an interaction with a ‘need-stick’.  It is the little gestures such as this one that can make all the difference to a suffering child and their family when they are experiencing difficult treatments.

            Furthermore, the movie emphasized the importance of the practice of cultural humility, which readies nurses to care for patients of vulnerable populations. Cultural humility allows nurses to form a therapeutic relationship with a patient by honoring their beliefs and values. This requires empathy, self-reflection, and respect for others. By practicing cultural humility, care givers are able to understand what it might be like to walk in someone else’s shoes by understanding the other person’s perspective and their world view. The practice of cultural humility is especially important when working with diverse populations because it gives healthcare providers a greater understanding about cultures and beliefs that are different from their own. Patient populations are becoming increasingly diverse, so it is important that healthcare providers are increasingly empathetic and understanding as well.  Being aware of and sensitive to a patient’s viewpoints, beliefs and culture can help create deeper connections between caregivers and a patient which can help to optimize care outcomes.

            My goal, once I graduate, is to work in the Neonatal Intensive Care Unit at Maine Medical Center or in pediatrics, so this movie was special for me because it involved caring for vulnerable, critically ill young patients.  As a future nurse wishing to work with the young, I want to learn as much as I can about this patient population and how to improve my communication with them and also to learn how to help bring the most comfort and positive support. A hospital setting can be scary, especially for the very young, so as a future nurse, I want to be sure I have all the skills possible to reduce the stress and anxiety of a sick child and their family and to provide the best care giving to those young patients who are seriously injured or  enduring a life-threatening illness. 

For the latter part of this reflection, I will be discussing how I will be preparing for completing future job applications and interviews after having the wonderful opportunity to listen to the guest speakers based on career preparation as well as listening to the recorded career services presentation. During the application/interview process, I will research an organization’s mission statement and priorities in order to demonstrate that my own skills and values align with theirs and to present myself as someone who would be  a valuable addition to their team.  

Effective communication skills are critical during the interview process as well as when I will be working as a nurse. During my interviews, I will be sure to actively listen and clearly articulate my responses. I will be aware of my body language and be sure my tone of voice is friendly and confident yet respectful. My goal is to build a rapport during the process just as I will do with my future patients.

 In addition, I will be prepared to fully convey effective responses with the ability to outline my strengths including my clinical skills and how I am a team player who is adaptable and willing to go up and above to provide the best healthcare care possible.  I will be prepared to advise the interviewer that it is my desire to make a difference in the world and improve the lives of others which is why I am pursuing a career in nursing and be able to outline the multiple skills I have learned during my rewarding experience at the University of New England including how I have excelled while developing a solid foundation in nursing concepts including evidence-based practice, holistic and client-centered care as well as critical thinking, clinical judgment, and nursing leadership.  

Furthermore, if asked, I will be able to discuss any potential challenges I anticipate, such as adapting to a new culture and learning the healthcare provider’s policies and procedures, as well as, how I will manage conflicts and stressful situations which I am aware I will face especially as a new nurse. I will describe the importance of self-care and working to avoid burnt out as well as outline how I stay organized and manage my time well. In addition, I will be ready to answer how I will stay up to date on the latest advances in healthcare and newest treatments as well as how I see my career progressing over time if asked.  My goal is to confidently convey that I have the overall skills to be a significant contributor to their organization and that I am excited and ready to work hard in partnership with their colleagues to help make their organization a successful one.

I will be prepared to describe my strengths which are my strong work ethic, effective organizational and time management skills and the ability to adapt and thrive in even the most stressful environments. I will be ready to discuss that I have successfully completed rotations at Maine Medical Center, New England Rehab Hospital and Spring Harbor Hospital and that I am a Helene Fund Scholar being inducted to the Sigma Theta Tau International Honor Society, Kappa Zeta-at-Large Chapter in October 2022 and that my dedication and hard work has rewarded me by making the Dean’s List. I have worked as an emergency medical technician for the Gray/New Gloucester Fire Department which exhibits my ability to effectively work as part of a team and it has given me experience in the field dealing with acutely sick and injured patients.

Being a new nurse, I realize that there will be a number of challenges that will I face. The first is that I have never been a full time employee of in a hospital setting so I do have clinical skills but understand there will be a learning curve adapting to a new environment. I will need to learn everything from policies and procedures to the hospital layout and personnel. During my training, I plan to listen attentively, ask questions whenever necessary and take detailed notes as I job shadow during my onboarding process. I will not hide challenges I face and look for direction and consultation to insure I proceed effectively.  Furthermore, I will look for a mentor that I can use as a resource and routinely ask for feedback from my supervisor so that I can improve myself.  My goal is to seek out any resources that are available to overcome any challenges so that I can quickly meet and ultimately exceed expectations.

Pre- Community Partnership Assignment: ‘HELP’

Pre- Community Partnership Assignment: ‘HELP’

Prior to participating in my first community partnership with the “Hospital Elder Life Program” (HELP), I was aware that this program was created to prevent delirium among acutely ill elderly hospitalized patients. The aim is to maintain the cognitive and physical function of the patient so that he or she is as independent as possible when discharged. In doing so, this program includes several protocols, including therapeutic exercise, good nutrition, stress reduction, and sleep improvement, to name a few. Hence, this program utilizes interactive techniques involving patient conversations, which keeps them engaged. Thus, this wellness program is designed to support both mind and body healthy for optimal results, which has been proven to be very successful. Notably, with this program, I recognize that safety is of utmost importance. However, I am aware that patients who fall have a higher chance of suffering delirium, so it is critical to avoid falls as part of prevention.  
Although I have limited experience caring for patients who are part of the elderly population, I completed clinical rotations at New England Rehab, where I assisted in the care of the elderly and witnessed first-hand the effects of delirium. In one example, an elderly patient endured a long-term recovery after a broken hip, leading to an episode of confusion and agitation. In another case, a male patient was recovering from a stroke, and he, too, was confused and frightened. The staff worked diligently to give the patients as much normalcy as possible in a healthcare setting. In addition, the entire team provided care for the patient with kindness and focused on therapies to reduce the symptoms experienced by the patient. The aim was to help the patient not only recover physically but also to be released with cognitive independence as well.
Due to my limited involvement in working with elderly patients suffering from delirium, it is essential for me to gain an understanding of the aging and elderly population. From a health perspective, the elderly have a higher risk of illness and injury due to aging. Hence, as a nurse, it is highly likely I will be significantly involved with the treatment of this population due to the higher percentage of elderly patients treated each year. The experience with HELP will be rewarding for my future in care for the elderly. Furthermore, being involved in the program will give me insights into the complex condition of delirium and how to prevent it. Delirium can significantly impede recovery in the elderly and even lead to long-term consequences and death. Therefore, having a good understanding of this condition is crucial for my future success as a nurse working with this population. HELP is a wonderful opportunity. After all, I am incredibly excited to help the elderly because I often know their conditions can go untreated or they receive inferior care for one reason or another. My goal is to be highly conscientious and compassionate so that the elderly patients I care for acquire the highest level of care so that they have the best chance for a successful recovery.
 As an individual who works hard and is committed to achieving optimum results, I am prepared to be involved in this program, HELP.  I am anxious that I have never volunteered in a program such as this one in the past, so I have some fear of the unknown, but I am highly motivated to participate and help in this worthwhile and rewarding program.  I am confident that my nerves will be put to rest once I receive my training and have some time to acclimate to the process and protocols I will be practicing.  
Moreover, I am excited to help those in need and will do all I can to prevent delirium in my elderly patients and to provide the best care possible. I am ready to meet this population of patients and to help increase their mobility, maintain and improve their cognitive ability, and make their patient experience a positive one.  I realize many of these patients are nearing the end of life, and I am prepared to be a kind voice with a gentle hand and provide as much support as possible so that they can recover and be discharged from care with a high degree of independence.     
In Maine, I have not been involved with community programs caring for this population, but I have heard of the positive effects of pet therapy within nursing homes. Interaction between an elderly patient and an animal, whether it’s theirs or a support animal, can help physically and mentally. It can improve personal interaction, communication, movement, and willingness to exercise. The elderly may be more motivated to practice their therapy, and there may be increased optimism when they work with a pet.  In addition, spiritual care is a therapy for the elderly community. Staying involved in their religion and receiving spiritual counseling can be very important to an elderly patient. The use of spirituality enables an elderly patient to maintain meaningful faith-based relationships, which can help improve physical and emotional health.  
I am genuinely inspired to make a difference in my community and assist with Hospital Elder Life Program. I intend to positively impact each patient and work diligently to prevent delirium so that the elders I am involved with successfully recover and are released from care as independently as possible.

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