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Preparation for Licensure and Transition to Professional Practice Reflection

Preparation for Licensure and Transition to Professional Practice Reflection

Over the course of this semester, this class has significantly prepared me for my licensure and future professional practices through the multiple practice exams we have taken as well as helpful lectures guiding us through job application and interview processes. I am extremely grateful for all the wonderful and helpful information that this class has provided me with as well as for the excellent education and experience I received while at the University of New England (UNE). It is with great pride that I am graduating with a degree in nursing and this class has given me worthwhile tools and skills to assist me as I look forward to starting my career.

For instance, I learned early this semester to develop SMART goals which entails creating specific, measurable, achievable, relevant, and time-bound goals. In doing so, throughout the course of the semester, I have aimed to achieve these goals throughout my completion of each ATI assignment to improve my individual outcomes. In order to continue improvement with each individual assignment, I created a calendar to plan my weekly goals for completing assignments and other needs each week. Then, I outlined them daily with specific times applicable to complete required tasks while making them achievable and relevant to class material. Then, I included other obligations on my daily schedule to ensure that I met my other responsibilities, personally and educationally. Keeping my priorities and responsibilities organized helped me avoid feeling overwhelmed, which was important for my mental, emotional, and physical health. Planning my weekly schedule allowed me enough time for each assignment, and I noticed that as I improved my time management skills, I took each test slower, which allowed me to concentrate more and prevent silly errors from occurring. I read through each question slower, which minimized misreading the questions and allowed me more time to think through my answers. My exam scores continuously improved, and I realized that effective time management is so important because it helps increase efficiency and goals are achieved with greater ease. Time management can also reduce stress because it helps ensure that important tasks are completed in a timely manner which results in improved performance.

Not only did mastering time management help to improve my proficiency with nursing content, but so did practicing several ATI quizzes, taking the assigned ATI exams, and completing ATI remediations. I identified several content gaps, which I needed to improve on by taking additional practice assessments and quizzes, and I took the time to realize why I chose the incorrect answer and to understand why the correct answer is correct. In addition, I spent several hours outside of completing the assignments reviewing nursing concepts, previous power points from lectures in other semesters, and meeting with faculty to discuss areas of weaknesses and ways to strengthen any nursing knowledge I am lacking. Overall, I noticed that as I continued to take practice questions, it helped strengthen my knowledge that I was not overly strong with which helped me improve on all the exams I was taking.  

At the same time, although this semester was extremely demanding and stressful, I took time outside of school to focus on self-care, exercise, and spend time with family and friends. In this way, I utilized several self-care strategies that better prepared myself for studying for licensure and practice because I am not as burned out as I once was and I feel better prepared to be the best nurse possible. Improved time management, mindfulness practices and improved work/life balance has resulted in me being a better person. I have noticed changes in myself over the course of the semester, and I feel more organized, better prepared, and I am in an excellent state of mind because my life is more balanced, and I am achieving my goals with greater ease due to skills I have acquired that help me better manage my work and personal life.

Overall, I will utilize what I have learned. and demonstrate the skills I have gained this semester, to continue my preparation for licensure and transition to professional practice following graduation by continuously completing practice questions, studying with peers, taking the time to recognize content areas that are weaker than others, and continuously strengthening nursing knowledge by watching videos, reading the textbook, and reviewing PowerPoints from previous semesters.  

Clinical Exemplar

Clinical Exemplar

It was a Monday morning, around 7 a.m., when I was given my assignment to float to the Special Care Unit (SCU) at the hospital where I was completing my medical-surgical rotation. It was my first time going to this unit, so I was nervous but eager for the new experience at the same time. As my preceptor and I walked through the doors to the unit, my preceptor cautioned me that it had been a challenging and demanding night for the nursing staff on the unit, so I was a little anxious about what I was about to walk into. My preceptor then guided me into a female client’s room where the nurse I would be working with that day was receiving a handoff report from the nightshift nurse. The moment I entered the room, I could sense their immense concern and I could see the worry flooding their eyes.

The nightshift nurse voiced that the client was transferred to the SCU around 6 a.m. that morning from a different floor in the hospital because her status had been radically deteriorating. The nightshift nurse continued to explain that the client had been suffering from a severe case of chronic obstructive pulmonary disease (COPD) for a very long time, which has been noted to be due to the client’s chronic history of smoking cigarettes. Notably, the significant damage to the client’s lungs caused her to retain high carbon dioxide levels and low oxygen levels and led to a depressed level of consciousness, so as a result, the client was placed on BiPAP in the attempt to normalize the carbon dioxide levels. At the same time, the client’s worsening condition of COPD led to chronic inflammation in the pulmonary vasculature, which consequently led to an excessive strain on her heart and failure of her right ventricle. In attempts to optimize the functioning of the client’s heart, the client was placed on a continuous IV drip of amiodarone for some time which had thus far been unsuccessful.

Following the receipt of the handoff report, the nurse and I conducted an assessment on the client. My adrenaline surged and I was able to fully digest how profoundly the client was decompensating. The client was unresponsive, had a respiratory rate of 18, a heart rate in the 140’s, a blood pressure of 71/56, and saturation pulse oximetry of 90% on BIPAP.  She had bilateral diminished breath sounds with inspiratory wheezes. In addition, the client was pale and clammy with ABGs of 7.21/93/35/4.9/62/86.4, and there was no urine output since their arrival on the unit despite fluid resuscitation. The nurse and I locked eyes, and we swallowed hard as we sadly realized the sad truth that the client was nearing end-of-life.

Immediately, the nurse and I contacted the attending physician to voice our concerns about the patient’s current health status. The physician took a moment to review the client’s chart and assess the patient, and consequently, came to the decision that the damage to her heart and lungs were so extensive that it appeared she did not have much more time to live. In that moment, the physician took a deep breath and looked at us in the eyes with a sad gaze. The physician advised us to contact the patient’s family to educate them on the client’s condition and to advise them that it was important they come to the hospital as soon as possible. Subsequently, the nurse called the family, and, in that moment, I could feel my body go pale and my stomach felt as though it was in my throat. I never imagined that my first day on the special care unit would be to assist a client and their family with end-of-life care. Admittingly, initially, I felt sick to my stomach as I was overwhelmed with emotions, however, I shortly realized how important my role was about to be as part of the client’s and family’s support system. I walked to the nursing lounge for a moment to collect myself, and the nurse I was working with that day came out to check on me. We spoke for a short time as she allowed me to express my feelings of sadness as I wished I could do more for the patient and about the uncertainty of what was about to occur, as I had never been involved in end-of-life care prior to this case. The nurse said that in the client’s history, it was known that she had been fighting her disease for a long time and had already considered hospice prior to the transfer on the unit as there is nothing more that can be done for her condition. The nurse explained further that the client will rest peacefully with the support of the medical staff and love from her family by her side as she passes. Everyone has their time, she said, and sadly this patient has reached that point, and she explained that it is our role to ensure that she is comfortable, and her last wishes are honored. The nurse stressed it can be difficult to separate our own feelings from the situation at hand, but what helps her through these difficult times is remembering that she is doing everything in her power to ensure that her patients pass peacefully, and it is gives her pleasure to be a support for both the family and the patient during such a difficult and vulnerable time. Consequently, this conversation gave me peace and comfort, and taught me a lesson on how to care for myself and manage my emotions with end-of-life care. Now I know that during such a time I will need a moment to gather my thoughts and emotions so that I can be prepared to be the best support possible for the client and their family. Recognizing that this experience was about to be an extremely sad and emotional time for the client’s family, I became grateful that I was about to be given the opportunity to be there as part of their support system that day.  I knew I would have an important role that day which would be so meaningful, which would be a gift, as sad as it is, that not all nurses are able to experience.  

After our brief discussion, the nurse and I returned to the unit to monitor the client’s status as we awaited the family to arrive. Per physician orders, we also provided the client with morphine to ease her pain through her transition to the end of life. Shortly afterwards, the client’s family arrived, and we brought them to see their loved one. The room was filled with tears and expressions of sadness, but they were understanding of the client’s condition and expressed that they have been preparing themselves this past week as they were aware that hospice was nearing. The physician and the nurse, both with caring and compassionate voices, expressed to the family of the process that would take place during that day. They communicated with the family that the hospital chaplain would visit to provide pastoral care and spiritual guidance and emphasized that the family can take as much time as they desired, and when they are ready, they will discontinue the current interventions assisting their loved one to live and transition her to comfort measures. I recognized how significant it is for the nurse to communicate to the patient and her family sensitively and comfortingly, all the information involved with the process so that they could be well-informed. Communication plays a profound role on the outcome for both the patient and the family. Accurate and sincere communication is key to the family’s understanding about the reality of their loved one’s situation, and it assists them with coping so that they can experience meaningful goodbyes with their loved one.  Likewise, a kind touch, offering a tissue to wipe away tears, and listening to the family express their feelings are simple gestures a nurse can offer to the family which can mean the world to them.

For the remainder of my time on the unit, I spent time with the family and the patient by providing them with support and comfort until modes of life support were sadly discontinued. During this time, I was able to identify the priority goals and focus of nursing care for terminal/end- of-life patients, which I recognized is not only to provide proper communication and support for the family and the client, but to provide exceptional nursing care as well.  One of the major priorities of the nurse is ensuring the client experiences the best quality of life while they transition. Therefore, the nurse and I frequently assessed the patient’s current condition and comfort through physical assessments and monitoring vital signs. At the same time, we followed the physician’s orders to administer morphine to ensure optimized comfort and the elimination of pain.  Not only were the interventions of care to treat the client physically, but measures were taken to treat the client holistically, including her mental and emotional state. Although the client is unconscious, the nurse I was working with emphasized it is never truly known what the client can hear or feel, so it is imperative we treat them like any other patient. So, we sat at her bedside talking to her, holding her hand, and rubbing her arm gently giving her comfort and reassurance.

Sadly, the time came. The time where I was moments away from taking my patient off life supportive measures. The tears and the crying of the family was all I could hear in that instance, but I continued to remind myself of the gift I was given. The gift to support and ease the pain of a family and a patient at their most vulnerable and dreadful time. It was this personal experience that became the catalyst that led me to an undeniable realization that my passion is to work in a critical care setting. Being with this patient during their final breaths was both an honor and a privilege. I learned many valuable lessons this day. I learned how to care for myself and the family of the deceased client during these treacherous times. But, most of all, I learned how to care for the client by applying supportive nursing interventions that were not aimed to prolong life, but to optimize comfort.  As a result of this experience, I plan to dedicate my life to ensuring people receive the best possible patient care when faced with the life-changing moments of transitioning to the end.

Adult Health IV Reflections on the Older Adult

Adult Health IV Reflections on the Older Adult

Throughout the course NSG 409 Gerontology, I have had the wonderful opportunity to strengthen my nursing care skills with respect to the elderly population. By acquiring knowledge regarding the age-related changes an elderly population endures, I have gained insight into the interventions I should implement in practice going forward to provide holistic care, promote safety, and help foster an overall better life for these individuals. Subsequently, throughout this reflection, I will reflect on three key insights I have learned from this course and how these key insights will influence my practice going forward so that I can provide the best possible patient care.

One insight that I have taken away from this course is that elderly individuals face unique physical challenges and changes, which can affect their safety and overall well-being. Therefore, a nurse must perform a thorough physical evaluation to implement applicable interventions in order to optimize patient safety and overall health.  For example, during this course, I have learned that an older individual will undergo changes physically including alterations at the cellular level, as well as to the thermoregulatory system, respiratory system, cardiovascular system, gastrointestinal system, urinary system, reproductive system, musculoskeletal system, nervous system, sensory organs, endocrine system, integumentary system, and immune system. Likewise, age-related changes to the mind, including personality and memory, occur within the elderly population. Thus, a nurse must perform a thorough physical and mental assessment to identify potential complications an elderly patient may experience due to the many age-related changes that they could be enduring.  For the sake of the length of the reflection, I will provide one age-related example and subsequent nursing interventions. Because the elderly have a reduction of intracellular fluid, which makes them susceptible to dehydration, a nurse should encourage 1500 mL of water daily, monitor the consumption of water and output of urine, as well as, to assess the level of consciousness, skin turgor, mucus membranes, and lab values that indicate dehydration (e.g., specific gravity, BUN, etc.). As a result of this course, the knowledge I have gained, regarding the potential physical changes that the elderly population may experience as well as the nursing interventions that optimize safety and overall well-being I have learned, will influence my nursing practices going forward so as to allow me to provide the best patient care possible.

Another important component of this lecture that will influence my practices going forward is the importance of doing a medication reconciliation with elderly patients which is when a nurse identifies the most accurate list of all the medications the client has been prescribed in order to identify the correct medications the client should be taking. In the lecture, I heard about the common issue of polypharmacy, which is when a patient takes more than 5 or greater than 10 medications daily. With high volumes of medication, patients may experience the issue of taking more than one medication for the same diagnosis or taking a medication that may worsen a condition which both can cause negative consequences if not corrected. Moreover, I learned about other adverse effects of polypharmacy, including the high costs of medications; enhanced risk of adverse drug reactions; increased risk of patient falls; enhanced risk of dementia, and increased client susceptibility to be hospitalized all due to the adverse effects of medications. Moreover, if the client cannot afford their multiple, yet necessary, prescriptions and it results in them not taking their medication as a result, their condition(s) can worsen.  Consequently, after gaining knowledge and awareness of the danger polypharmacy poses to the elderly population, I will ensure to perform a thorough medication reconciliation with my elderly clients to enhance the overall well-being and quality of life of the elder population. Specifically, I will collect the names of all the patient’s medications; as well as, the strength of each medication; the formulation (XL, CD, extended-release, etc.) of each medication; the dosage of each medication; the route of each medication; and the frequency of each medication; the indication of each medication; and duration of each medication, for all over-the-counter medications, herbal supplements, vitamins, implanted/depot medications, radioactive therapies, respiratory therapy medications, diagnostic and contrast agents, and prescribed medications. In this way, I will provide the best possible care to the elderly population to enhance their safety and overall well-being.

Lastly, I have acquired further knowledge regarding delirium in elderly patients. Delirium has been recognized as a commonly occurring problem with increasing geriatric age. Specifically, delirium is a unique disorder of attention and cognition that occurs within minutes to hours and fluctuates throughout the day. Individuals with delirium may present with disorganized thinking, acute disturbance in cognition, psychomotor disturbances, disorientation, inattention, and fluctuating/acute mental status changes. In the lecture, I learned that causes of delirium include dementia, electrolyte disorders, medications/drugs, injury, pain, stress, unfamiliar environment, infection, metabolic conditions, and lung disorders, liver disorders, heart disorders, kidney disorders, and brain disorders. Thus, several factors can cause delirium and it is being overlooked more than fifty percent of the time, and therefore as a nurse, I must assess for delirium within patients to act promptly to treat them in attempts to reverse the condition. I have learned the key component of delirium within a patient is prevention. As such the nurse should ensure that the patient engages in frequent mental and physical exercise, gets adequate sleep, maintains hydration and good nutrition. The nurse should also provide the patient, if necessary, with glasses or hearing aids and manage their pain appropriately. Consequently, I will be able to help prevent and treat delirium in my future profession because of the valuable information I have learned during this lecture.

Overall, this course allowed me the opportunity to strengthen my skills and knowledge when caring for the elderly population, and these valuable insights will influence my practice going forward to allow me to provide optimum patient care.

End Of Life VR Assignment- ‘Clay’

End Of Life VR Assignment- ‘Clay’

End of life situations are both extremely difficult for the family and the patient. This VR experience of end of life with Clay allowed me to witness this process in order to better myself as a nurse. As a nurse, it is imperative that physical, social, spiritual, psychological, cultural, religious, and physical needs are met when assisting with end-of-life care. During my clinical rotation at Southern Maine Health Center (SMMC), I was given the opportunity to float to the Special Care Unit where I experienced and assisted with end-of-life care. The patient sadly had severe COPD among other heart conditions and was on an IV drip of amiodarone for a couple of weeks as well as on a ventilator, but sadly neither intervention was successful, and her vital signs and condition continued to worsen. The morning I arrived at the unit, the doctor had informed both the nurse I was working with and myself to call the patient’s family and advise them that sadly it is her time and that she might not make it through the day, so it was important that they come to the hospital as soon as possible. As a result, we followed the doctor’s orders and once the family arrived and the difficult decision to end life was made, we provided the patient with morphine to ease her pain through the transition and life support was subsequently discontinued. This experience was an extremely sad and emotional time for the family, but I am so grateful I was given the opportunity to be there as part of their support system. My passion is to work in a critical care setting, and my opportunity to care for this vulnerable individual and their family, although emotional, was inspiring. I realized afterwards that nurses have such an important role during such a difficult time not only with the patient but as support for the family as well.  As someone who intends to dedicate my life to ensuring people receive the best possible patient care, I want to be the nurse who is there to support families and the patients through their most vulnerable and painful times.

After my experience with end-of-life care, I feel that the priority goals or focus of nursing care for terminal/end of life patients is not only to provide superior healthcare but to be a support system for both the patient and the family. Once it is identified that a patient is at end-of-life, it is of utmost importance that the nurse communicates to the patient and the family sensitively and comfortingly the information for them to make hard decisions. This is an extremely difficult time for the patient and the family, and it is the role of the nurse to inform them accurately in detail about all the facts and to gently provide them with the reality of the situation. Often, it is very hard for these families to understand the difficult decisions needed regarding end-of-life care and about the treatment that will support their loved one in their last stage of life. The nurse needs to ensure to remain being the patient’s number one responsibility and ensure to make sure their wishes regarding end-of-life care are honored. The focus becomes allowing the patient to have the best quality of life in these situations. The nurse should ensure to continue assessing the patient via a physical assessment and vital signs, as well as perform all orders directed from the doctor. To ensure optimized comfort, the nurse should ensure the patient is not experiencing discomfort or pain through administration of pain medication (e.g., oxycodone). The nurse should also ensure that the care plan for the patient includes adequate hydration and nutrition. Notably, the nurse should not only perform interventions to treat the patient physically but should ensure to enhance their emotional and mental health as well by sitting at their bedside talking with them, holding their hand, rubbing their arm. End-of-life care is often lonely and distressing for the patient, and as a nurse we can do everything possible to ease that transition for them.

Overall, this VR experience helped me practice nursing care for patients who are at the end of life as well as in supporting their family/friends. This experience gave me an understanding what it would be like for a patient and their family experience during this tragic period at the end of a client’s life.  Having these opportunities to support end-of-life care, both in virtual reality and real life, I have tried to be empathetic and have imagined myself in the shoes of the patient and their family. In doing so, I recognize important priorities that should be consistently maintained through the end-of-life process for both the patient and their family. I especially understand that it is important that I am an advocate, making sure that the patient is as comfortable and pain-free as possible as well as helping ensure their final wishes are met. And I will be sure to do all I can to maintain the patient’s dignity and allow them have control over decisions involving them for as long as possible. And for the family, I will be committed to working with them, helping support them during this difficult time. It is a period in life that is painful for everyone involved, and it will be my job to ease both the patient’s and family’s pain as much as I possibly can.

Preparation for Licensure and Transition to Professional Practice

Preparation for Licensure and Transition to Professional Practice

After I complete the NCLEX-RN exam, I plan to become licensed as a registered nurse in the state of Maine with a compact nursing license. The Maine State Board of Nursing declares that Maine is a compact state, which means once I am licensed in Maine, I would have the ability to practice nursing in a total of 39 states throughout the United States without having to be licensed separately for those states.  Therefore, if I decide to leave Maine at some point later in life, I will have the opportunity to practice nursing in any of those applicable states.  The application for licensure I plan on attaining is a web-based application. This application I am filing does not require official transcripts because I have received my education through The University of New England (UNE) in the state of Maine. However, the application will require a verification sign off by the director of the UNE nursing program, which will be done May 14, 2023, when grades are finalized for the semester.

In addition, as part of the licensing process, the State of Maine Board of Nursing requires a criminal background check, which is done through The Maine Department of Public Safety. Licensure also requires finger printing, which is done through the Federal Bureau of Investigation, which costs approximately fifty dollars. For this process in order to become licensed, I will have my fingerprinting conducted through “IdentoGo” which is an electronic digital scan of my finger using “Livescan”.

Also, the State of Maine Board of Nursing requires mandatory reporting for suspected impairments, disciplinary measures, and resources for recovery. As a nurse in Maine, failure to do so can result in serious consequences for our licensure, such as suspension or termination. Therefore, I must ensure to document all suspected harm as well as harm I have witnessed. As a nurse, I am aware that legal issues commonly associated with licensure involve patient safety, informed consent, patient refusal of treatment, patient personal belongings, malpractice, negligence, mandatory reporting, abuse, and overall unsafe nursing practices. Therefore, as a nurse, it is of utmost importance to protect myself and licensure from a vast array of legal issues. Consequently, to protect myself, I will ensure to prioritize patient safety at all times by using restraints properly as needed; turning my patient every two hours to avoid skin damage; ensure proper disposal of needles; ensuring to use patient transport equipment properly (e.g., wheelchair); ensuring side rails are down on the bed and that the bed is locked. I will ensure consent is fully explained and granted by the patient. I will ensure to use the five rights of medication administration to ensure patient safety as well as proper disposal of patient medication. In addition, I will ensure to monitor the patient before and after treatment is administered. I will ensure to document anything and everything. In addition, if I were to witness improper treatment of a patient or suspect improper treatment, I would report it.

Overall, it is my ultimate intention to provide the best patient care possible as a nurse in my future career, and therefore, I will practice safe protocols at all times while caring for my patients and report any questionable issues should I encounter any.

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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