Alicia Dumont

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 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.

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. 

Throughout the world, many natural and human-caused disasters and crises take place, which leads to multiple injuries, disabilities, and death. In the face of disasters, nurses have a significant presence and play crucial roles encompassing a multitude of responsibilities. They strive to help save the lives of others while trying to keep themselves safe from harm in disastrous situations. With natural disasters increasing, such as tornadoes and hurricanes, as well as crises involving diseases, such as the current pandemic, nurses’ responsibilities include providing acute patient care, triaging patients, and assisting in evacuations of patients to other facilities according to need. Nurses play a significant role with their hospital’s disaster plans. They triage cases, provide emergency room treatment, and manage complex clinical demands that occur during a crisis.

At the beginning of a disaster response, it is critical that nurses help activate the disaster management plan designed for their hospital. A disaster management plan, also known as an Emergency Operations Plan (EOP), describes in detail how a healthcare facility is going to respond to emergencies of different causes, size, and duration. To be ready for disastrous events, preparation is provided through education and training so that healthcare workers are poised to respond efficiently and effectively if the situation arises. They are trained to implement the EOP in a timely fashion so to provide the best possible patient care to those individuals suffering injuries or illness during a crisis. An EOP typically has nurses working with other health care providers to identify roles and responsibilities needed to best respond to the crisis. Nurses plan for risks and anticipated adverse complications; gather and allocate necessary materials, resources, and equipment, and they implement treatment interventions. Nurses are often the first support system injured or ill patients see, and it is a nurse’s job to provide comfort and care during the scary and stressful experience.

            Notably, some disastrous situations occur in dangerous terrains and territories that not only risk the safety of the patients but nurses as well. Nurses are trained to help all those individuals in need, but they also need to recognize their own personal needs and whether it is a major safety risk to themselves to provide treatment to others. Other emergencies, such as long-term health crises like pandemics, can overwhelm nurses emotionally and physically due to lack of staff and resources resulting in them needing to make hard decisions that are opposite of core beliefs. In these ways, ethics play a major component for disasters. In Provision 2 of the ANA Code of Ethics, it states that a nurse’s primary responsibility is to the patient, however, in Provision 5 of the Code, it states that a nurse owes the same duty to self. This can be an extreme dilemma for a nurse in a crisis situation. A nurse is trained to save a patient at all costs, but if it is so risky that it jeopardizes their well-being, they need to consider themselves as well. This is an extreme example but if there was a gas explosion involving a huge factory, a nurse should not jump into the burning building to save someone regardless of how badly they want to help. There is a line a nurse cannot cross when it comes to self-risk. During a fast-spreading pandemic, when staff and resources are limited, a nurse can only work so many hours in a row under stressful conditions before they step back and take care of themselves for sleep deprivation, emotional duress, and physical exhaustion.

         In conclusion, there is no question that a nurse’s primary commitment is to their patients. Nurses have a duty to provide the highest quality healthcare, but it cannot come as an expense to themselves. Nurses owe the same duties to themselves as they owe others including preserving their own safety and integrity. They are resolute professionals who take all measures possible caring for the ill and injured, but they should never sacrifice their well-being for the sake of anyone or any situation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bowel Diversion/Ostomy Reflection Assignment

The purpose of an ostomy diversion is to allow a person to pass stool safely from the body when experiencing a diseased part of the bowel, or a segment of the bowel is removed due to injury or disease, to allow the bowel to heal adequately. If the diagnosis is severe, it can be permanent in some cases. An individual living with an ostomy diversion faces many physical, emotional, and psychological challenges that many people are unaware of because most have not experienced this life-changing event. Therefore, the purpose of our assignment was to wear an ostomy pouch filled with materials that mimic fecal matter so that we, as students, can better understand and experience what it would be like to be an individual living with an ostomy appliance.

 Prior to wearing the ostomy appliance, I was aware of its importance for an individual’s physical well-being. However, I was unaware of the multiple challenges an individual encounters with an ostomy for bowel diversion. For instance, my previous personal perception of the challenges one would encounter primarily pertained to managing the ostomy appliance itself, including the physical discomfort of the appliance, preventing a breakdown of the skin surrounding the stoma, and the need to empty or change the ostomy pouch frequently. But, of course, as a nursing student, I was aware of the psychological impact an ostomy may have on an individual. Still, I was not consciously aware of how impactful it could be on their daily living experience. Therefore, wearing the pouch for only a day was an insightful experience for me and one I am grateful for because this simulation raised my awareness of a person’s challenges physically and emotionally. When an individual undergoes an ostomy, they have to function in a new way, which can be an uncomfortable adjustment. As a result, it raises serious concerns, including maintaining good hygiene, managing daily routines, and dealing with the stigmas involved. Thus, as a nurse, I will ensure that I not only care for the physical needs of a patient with an ostomy appliance, but I will also pay great attention to their psychological and emotional needs. This critical experience gave me an understanding of how difficult the transition is for a new patient with an ostomy device. Each person is unique in their experience; as a result, this insight will help me provide the best care possible for my future patients.

The minute I put on the ostomy appliance, I had so many questions. Will anyone see the pouch under my clothes? Will there be a smell? Can I resume normal activities? The questions were endless, and I understood how a patient undergoing an ostomy could feel awkward and uncomfortable due to the overwhelming changes in their life. I can only imagine how challenging it must be for a patient to have to learn to look at the stoma, apply and empty a pouch, maintain proper skin care and hygiene, and manage any complications related to the device. The new responsibilities for caring for themselves are daunting and scary. I felt a little sad initially for anyone facing this experience. Although I was part of a simulation, I realized this could realistically happen to me, a family member, or any of my future patients, and I needed to completely grasp the whole experience.

Admittedly, I was very self-conscious on the first day I wore the ostomy appliance. I thought everyone was looking at me and could see my ostomy appliance and realized this is how my patients will feel. I wore a loose-fitting shirt over my yoga pants and rested my arm over the pouch so no one could see it. It was not only that I was self-conscious, but the bag itself was uncomfortable under my tightly fitted stretch pants. I realized clothing is key to comfort both physically and emotionally.

Regarding the physical experience, the first day wearing the bag caused my skin to feel itchy and irritated, especially when it got wet after my shower. Thus, this observation will allow me to adjust my nursing care priorities, interventions, and client education based on this knowledge. In addition, I will encourage my patients to keep the stoma clean and the skin around the stoma dry to prevent skin breakdown and irritation. Also, I will educate my patients to empty the drainage bag when it is one-third full to prevent it from leaking, which can further prevent skin irritation. Aside from the physical discomfort, I did not feel like myself for the first few hours and wanted to avoid my regular activities, such as seeing my boyfriend, going to the gym, and grocery shopping, because I was embarrassed by the ostomy appliance. I felt like it was so obvious I was wearing it. Like many new patients with an ostomy appliance, I was experiencing facets of a disturbed body image. I felt anxious, and I was frustrated with the way in which it was impacting my life, and I wanted to withdraw from my daily activities. Because of this experience, I have gained a greater understanding of the emotional impact the ostomy appliance will have on my patients, which will allow me to provide improved client care and education in the future. I now recognize that one of the most critical care considerations I must employ as a nurse is to identify how drastically an individual’s perception of their body image is impacted. I will ensure to emphasize that coming to terms with a new stoma and ostomy appliance is a vital part of the healing process, but too, I will be sure to validate their feelings of concern and empathize with their fears. From my experience of only a day, I was extremely discouraged initially. My world was completely different and if I had an ostomy appliance attached for months while I healed, I know I would need support to adjust to my new situation. Thus, I will reassure my patients that adapting may not happen quickly and I will reiterate that learning to accept their new body is a gradual and sensitive process. As needed, I will encourage patients to seek support from loved ones and join support groups with others who are experiencing the same journey.

After wearing the ostomy appliance for several hours and adapting to it a little more, I realized that I could do many of the same activities before wearing it. For example, although hesitant to go to the gym at first, later that evening on the first day, I attended a local gym near me, Planet Fitness. I felt confident in my skin with the proper clothing, and it was physically more comfortable. Nevertheless, it was a difficult adjustment. Due to the weight of the ostomy appliance on my stomach, I chose to walk for a few miles on the treadmill instead of running. I also chose pants with a band to support the ostomy bag on my stomach as I feared it would fall off as I walked on the treadmill. After a mile or so, it did start to feel more comfortable. I was also fearful that individuals around me could smell an odor from the ostomy appliance. However, I learned the fear of going to the gym was far worse than my experience.

Furthermore, this experience at the gym gave me further insight into client care and education. In the future, as a nurse, I can share with my patients how to make accommodations to raise their confidence, as did the clothing that helped me to adjust to wearing the ostomy appliance. If they are able, I would recommend non-tightly fit clothing, such as stretch pants, yoga pants, or athletic shorts for the first few days if the patient feels uncomfortable with their new ostomy appliance. I would also address foods available that help prevents gas and odor of the ostomy appliance to ease their concerns. Eating a lot of leafy greens and avoiding gassy foods, such as broccoli, Brussel sprouts, cabbage, and gum, can be highly beneficial. I wondered what I could eat and learned that I could eat anything, but as with any food, they digest differently, and a patient should treat food like they would typically to lead an active life. For example, suppose spicy food, for example, bothered them digestively before the ostomy it will bother them afterward. So, if they have special activities planned, I can suggest they may want to avoid such foods to avoid a negative digestive experience just like they would have in the past. This would be something I would gently teach my patients as I would with recommending other adjustments.

Additionally, when I was wearing the ostomy pouch, I started thinking about how my future days would be affected if I continued to have the ostomy appliance. Since it is summer now, I immediately became concerned about going to the beach and swimming, something I love doing in the warmer months. It was a bit heartbreaking knowing, at least for me, that this was an activity I would avoid doing while wearing the bag because there would be no way to hide it. Then it dawned on me that I could wear one-piece bathing suits rather than a two-piece. At this moment, I immediately tried on my one-piece bathing suit to see how it would feel and look. Truthfully, it hid my ostomy pouch very well, and I would suggest this helpful tip when educating my patients.

In conclusion, this valuable simulation raised my awareness that there is a level of self-consciousness that comes with wearing the ostomy pouch, and I know as a nurse, I will have to be incredibly supportive and empathetic with my patients who undergo ostomy procedures and that helping them with planning will be critical and beneficial to them. This experience will help me become a better nurse because I have been able to gain perceptions regarding nursing care priorities, nursing assessment, nursing interventions, and client education. Although it was only a simulation, this event gave me insight that will transfer to my nursing protocol, including assisting patients with their body image and how to manage their situation best while validating their concerns about their bodies and the reactions of others. As mentioned earlier, I was extremely uncomfortable with the new adjustment at first. My advice to future students and patients, who may have an ostomy appliance, is that it takes time, and everyone adjusts differently. To adjust emotionally, a person needs to do what is best for them. I realize that everyone is unique. Every procedure and the experience of wearing the ostomy appliance will be different for each patient, and I understand that everyone will go through various trials and tribulations. I can use this experience in other areas of nursing as well because any changes a patient may experience that alter their lives are challenging. Therefore, I will not only be there to assist them with their physical adjustments, but I will be there for their emotional challenges as well. 

During this semester, my clinical rotation has been a fantastic experience. It has been a privilege to meet various patients and take care of them in the best possible way. As a student nurse, I am not yet able to conduct many nursing procedures, but I have had many opportunities to be the support system for my patients. I have used genuine empathy, kindness, and compassion to help each of my patients through their difficult times. I have been eager to lend a listening ear or a helping hand, which has brought both joy to my patients and myself. In particular, because of the pandemic, visiting hours for patients have been unavailable or limited as a precaution to protect them from COVID-19, so patients are often craving human contact and communication. Realizing this, I take extra time attending to each patient’s emotional needs and spend time talking to them about their conditions and how it affects their daily lives, which they are often eager to talk about. With each friendly smile and gentle touch, I believe I have made a difference in my patients’ lives because I have been a source of comfort and support for them. I have learned that giving them a shoulder to lean on is a special part of being a nurse. 

In one situation, a patient I connected with during my clinical rotation had been at the facility for an extended period due to suffering an injury from a fall and appeared to be emotionally struggling. When I entered the patient’s room to assess her vital signs, I noticed she was quiet and seemed upset. Instead of immediately collecting her vitals, I took a moment to sit down and talk to the patient. I started the conversation by asking the patient about her life, why she was there, and how she felt. Immediately, as our conversation began, there was a spark in my patient’s eye, and she seemed thrilled to share her story with me. It was evident it was a relief to have someone to talk to about her current situation. As our conversation continued, I realized her mood began to change. It became clear that my patient was yearning for personal interaction, and it directly affected her emotions as she went from sad to happy in a brief time. It was as rewarding for me as my patient because I knew I had made a positive difference. All semester, experiences like this one have made me realize that being a positive support system for our patients is one of the greatest virtues of being a nurse. Not only is physical well-being essential, but so is the emotional as well. Positive support is beneficial to physical healing and expedites a patient’s recovery time.