09May/17

Pins and Circumstance

I don’t think there’s been a day where I haven’t thought about graduation this semester. TWO DAYS LEFT! My eyes have pored over page after page of disease processes, treatments and research and my hands have discovered a new dexterity at the bedside. Beyond theory, nursing school has given me a new perspective on people, cultures and a new approach to solve problems and challenges. I’ve gained a new confidence in my identity as a nurse and individual but was also humbled by the realization of my weaknesses and knowing that I’ll never know everything! Nevertheless, knowing that the knowledge and possibilities in this field are boundless is exciting. I’ve been researching a few organizations and I see myself working in the public health sector in the very near future. I don’t know where or when, but that’s part of the fun. I’m grateful for the friends, instructors and even family that I have formed new or renewed relationships with. God has blessed me with so much support! I know that God has plans for me and I don’t want to forget that he has brought me to this point for His glory!

…Goodbye ugly white shoes!

07May/17

Class of 2017

As I look back on the last three years, I am astounded at how far we have come. I knew we would become nurses but as I reflect on all of our work and accomplishments it is easy to see we are so much more. What we have learned from the text and skills lab is minuscule in comparison to what we have learned about ourselves, each other, and the populations of people we will be caring for in the hospital. I don’t think many of us were prepared for exactly how exponential our growth would be or how much we would learn from working with patients and families that is so vital to fulfilling the roles of a nurse. We have become nurses, researchers, teachers, and patient advocates. We have grown into health care professionals that are prepared to build the future of nursing and healthcare. I am so incredibly proud of where we have ended up and I look forward to seeing what students continue to do with their nursing careers.

07May/17

End of Life

Death is a common occurrence in my family. It seems as though a family member or close family friend dies at least once a year, so the topic of end of life is not new to us. My family members are very vocal about their wishes and speak openly about how the feel about burial options, funerals, and hospitalizations. It seems a bit morbid but when it is so prevalent, these kinds of conversations are common. Our family has never argued or been against making health decisions based on quality of life rather than quantity. I think part of this is because of the faith basis of my family. People are less likely to hold onto one’s physical body when they know the spirit is no longer there. There is also the understanding that when God deems it is time for them to go, it is not our place to make drastic medical decisions to keep them holding on. Yet, this interpretation is not the only one of families of faith. Other families believe so strongly in the power of prayer and miracles that they refuse to let go in hopes of a drastic turn around. My takeaway from this is that you cannot assume a family’s reaction based on their religious beliefs or previous experience with death and dying. Every family dynamic is different and every scenario may be responded to differently.

29Apr/17

There’s a certain Slant of Light

There’s a certain Slant of light,

Winter Afternoons –

That oppresses, like the Heft

Of Cathedral Tunes –

 

Heavenly Hurt, it gives us –

We can find no scar,

But internal difference –

Where the Meanings, are –

 

None may teach it – Any –

‘Tis the seal Despair –

An imperial affliction

Sent us of the Air –

 

When it comes, the Landscape listens –

Shadows – hold their breath –

When it goes, ’tis like the Distance

On the look of Death –

There’s a certain Slant of light, (320)

BY EMILY DICKINSON

Image from http://images6.fanpop.com/image/photos/36000000/Emily-Dickinson-image-emily-dickinson-36077093-900-727.jpg

Bring up end-of-life care to a family and you’ll be needing a knife to cut through the tension when you return to the room. As I’ve witnessed in the clinical setting, death is a sensitive subject but one mostly surrounded by ambiguity. People just don’t know what to do with it. It’s become a casual subject in my family. My mother has made it clear that she wants a DNR and her remains cremated after organ donation (assuming she’s a candidate) so that her ashes can be scattered on the hillside behind our house. There may be a few barriers to the latter part of her will… Sometimes these conversations turn into a joke. We don’t think death is trivial, but we also don’t think we have to fear it. My parents organized the logistics to prepare me and my siblings financially, emotionally and spiritually for the day they would leave this earth to be with Jesus. I think starting this conversation early can help reduce the discomfort of this difficult reality.

According to Barriers to Goals of Care Discussions With Seriously Ill Hospitalized Patients and Their Families A Multicenter Survey of Clinicians, nurses, residents and staff physicians identified the following as the greatest barriers to end-of-life goals and discussions: 1) family members’ or patients’ difficulty accepting a poor prognosis, 2) family members’ or patients’ difficulty understanding the limitations and complications of life-sustaining treatments, 3) disagreement among family members about goals of care, and 4) patients’ incapacity to make goals of care decisions (You et al., 2015). In addition, all three clinician groups perceived that it was part of their professional responsibility to participate in end-of-life discussions and goal setting (You et al., 2015). However, “staff physicians and residents were more willing than nurses, and staff physicians more willing than residents, to engage in communication and decision making about goals of care” (You et al., 2015). This study suggests an emphasis on helping clinicians improve communication about end-of-life care through training and classes, however, there were also reports of “discomfort in responding to the emotional reactions of patients” (You et al., 2015). Perhaps, it would also be beneficial to emphasize the psychological components related to these discussions to anticipate associated repercussions such as stress, guilt and emphatic fatigue. Early preparation is key in successfully and effectively achieving end-of-life goals and increasing quality of life as the patient transitions out of this life.

References

Dickinson, E. (1999). There’s a certain Slant of light, (320). Retrieved April 29, 2017, from https://www.poetryfoundation.org/poems-and-poets/poems/detail/45723
You JJ, Downar J, Fowler RA, Lamontagne F, Ma IWY, Jayaraman D, Kryworuchko J, Strachan PH, Ilan R, Nijjar AP, Neary J, Shik J, Brazil K, Patel A, Wiebe K, Albert M, Palepu A, Nouvet E, des Ordons AR, Sharma N, Abdul-Razzak A, Jiang X, Day A, Heyland DK, for the Canadian Researchers at the End of Life Network (CARENET). Barriers to Goals of Care Discussions With Seriously Ill Hospitalized Patients and Their FamiliesA Multicenter Survey of Clinicians. JAMA Intern Med. 2015;175(4):549-556. doi:10.1001/jamainternmed.2014.7732

 

27Apr/17

End-of-Life Nursing Care

Here is a great article that is directed towards nurses to discuss end of life care and also includes the framework, barriers to advocacy, and the grieving process.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241064/

 

20Apr/17

2007 San Diego Wildfires

During October and November of 2007, a series of wildfires known as Firestorm 2007 spread through San Diego County, causing the largest evacuation in the history of California as 12 fires burned simultaneously in the county. There were over 2,200 medical patients evacuated including patients from 3 hospitals and 12 skilled nursing facilities. Multiple shelters were established and the medical reserve corp responded with 66 healthcare professionals. The Emergency Operations Center, Medical Operations Center, and EMS all responded to the disaster, as well. Barriers to care were related to access to victims and medical supplies. Environment affected this disaster as fires were difficult to contain during this fire season related to the ongoing California drought. Trauma services rendered related to burns and air quality/respiratory symptoms. I would like to think that emergency services are better prepared for the onslaught of fires seen in California because of the success of medical care during this operation, however, the wildfires themselves are still difficult to maintain because of the warm and dry California climate.

https://www.arb.ca.gov/carpa/meetings/summit08/presentations/firestorm07_wwooten.pdf

17Apr/17

The Louisiana Floods

 

over the course of 5 days 6,900,000,000 gallons of rain fell and lead to one of the biggest disasters in the U.S. since hurricane Sandy. 11% of the states population was affected by this flood and 13 people lost their lives as a consequence. In looking at the healthcare perspective the demand for medical care, resources, food, shelter and clean up help were great but the amount of resources available were insufficient. Because of a delay declaring a state of emergency it took several days for the people in Louisiana to get the help and resources they so desperately needed. In addition, due to the massive power outages it was difficult to communicate with the people in the flooded areas and assessing the damage was further complicated by the massive amounts of water that prevented any personal from reaching the area other than via boat. The main health care needs included small injury treatment, sanitation resources, and preventing infection from stagnant water and mold which quickly became the biggest threat to the health and well-being of the population. Moreover, mental health needs were also found to be in great need as many individuals suffered PTSD as a result of the floods and having lost everything many people in the area became depressed. In the months following the suicide rate increased significantly as a result of this disaster. The Red Cross and FEMA were first on scene after which the US department of Health and Human services deployed two national disaster medical assistance teams to aid in the management and clean up efforts required to help the numerous communities of people who lost everything. Socioeconomics played a role in this disaster in several ways, however, the most notable being that because of the low income in the hardest hit areas very few had home insurance. The trauma care that was required for this disaster included basic first aid and infection prevention. Given the slow response time and public scrutiny at how this situation was handled, it seems that the next disaster would be handled differently specifically in response to response time by governmental agencies.