All posts by Natalie T


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.


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.


Caring for the Aging Population

The culture in America allows for much different practices in caring for the aging population than many other countries. Oftentimes when people are ill, we put them in a nursing home or assisted living, paying strangers thousands of dollars a month to take care of our loved ones. Others pay home health nurses to visit the person in the home; bathing them, giving them medicine, cooking for them. These care tasks are the things our loved ones did for us as children, yet when they are in need of care at an advanced age, it seems to be the norm to have someone else do it for us. In the next 5-10 years, the “baby boomers” are going to be coming into a time where they will likely need advanced care and support. For us to meet the growing needs of this population at the current standard, there will need to be an increase in nursing homes, assisted living, and home health services. However, it is likely those will simply raise their prices in the newly competitive market, making 24/7 care for the elderly a very costly and exclusive. Low income and lower middle class families may have to choose between their job and caring for their loved one due to the lack of services currently for low income families and adult care.

Another major issue we have discussed in class is that of life and death. An aging population means more patients with chronic, life threatening diseases and in turn, ICU patient, ventilator patients, and more talk of extraordinary measures. The time to start advocating for patients and talking to families is now, not once their loved one is dying. To reduce healthcare costs and Medicare spending, it is important for families to understand the concept of life support and the appropriate time to use extraordinary measures so that they can make informed decisions on care in the future. As healthcare professionals, we are responsible for educating patients and families and, in a compassionate way, talk to them about their wishes in tough situations.


Nasopharyngeal Intubation Improving Respiratory Outcomes in Robin Sequence Infants

Children born with severe Robin Sequence often present with significant anatomical respiratory obstruction. I reviewed a study from 2015 evaluating the outcome of these infants after nasopharyngeal intubation for maintenance of airway patency. 107 infants from the Hospital for Craniofacial Anomalies of Sao Paulo with severe RS treated with NPI were followed for their first year of life.  Of 223 infants with RS, 149 had severe respiratory distress and 107 were used for the study. NPI lasted an average 57 days and mean hospital time was 18 days. Due to the diagnosis, all infants faced feeding issues, but 85% were able to be fed orally. Infants following the RS treatment protocol using NPI had shorter hospital stays, improved respiratory and feeding functions, reduced number of surgical procedures, and reduced morbidity and mortality in the first year of life.

You can read the full article at

The video below is from the Children’s Hospital of Philadelphia for more information on Robin Syndrome.


What It All Means

I asked a friend of mine about CPR, MI’s, and and cardiac arrest. My first response was, “Cardiopulmonary arrest…Cardio means heart and arrest means stop so, it means bad stuff? MI means muscle something? I don’t know.” The words myocardial infarction meant nothing to him and when asked about CPR he said, “I assume during CPR that you try to get the heart to start pumping again. I’m not sure why you blow in their mouth but who cares? If it works it works. I saves lives. That’s why they teach it to people.”
It was interesting to me to hear these responses and hear terminology that we health care workers use on a daily basis be so foreign to someone else. The friend I spoke to is very educated, hears most my nursing school stories, and watches plenty of Grey’s Anatomy, so I just figured he would have a descent understanding of these very common terms. Clearly I misunderstood. This exercise was a perfect example of how important it is for us as nursing students, and in the future as nurses, to accurately asses our patient’s level of understanding of the terminology and literature we present to them. The hospital setting is very overwhelming and people oftentimes feel out of place, potentially not comfortable asking what they feel may be a “stupid question.” In my experiences, very educated adults with or without previous hospital experience may still not have a basic understanding of medications, assessment tools, and plan of care components. It is our job as nurses to make patients feel comfortable in the hospital setting, educate them on their plan of care, and ensure they understand they are free to ask as many questions as they need to.


Cellular Cardiomyopathy and Cardiac Regeneration

Heart failure is a significant adverse outcome of an MI. Other than a heart transplant, not many treatments have been identified as significant methods of improving outcomes. One new treatment on the horizon is cardiac cell regeneration, also known as “cellular cardiomyoplasty.” Testing has not yet reached human subjects but has proven to be promising in animal studies. Some potential uses include acute and chronic ischemic myocardial damage, cardiomyopathy, and as pacemakers. Stem cells that have been identified as most effective for the treatment include embryonic stem cells, umbilical cord stem cells, amniotic stem cells, and cardiac stem cells. Clinical trials continue to work towards a common standard of practice for this treatment, so I am looking forward to how the research may be utilized in cardiac care in the upcoming years.

Check out the photo below with information about stem cell sources and read the article to learn more at

First Week of the Last Semester

I cannot believe we have made it to the end! It feels like just yesterday I walked into SIM lab on the very first day of school, Monday morning at 8 am, and sat down in front of Dr. Nevins for Fundamentals of Nursing lab. I was so nervous but grateful and eager to start my nursing school journey. It feels as though it has been an eternity, all the while flashing by with the blink of an eye. It is truly incredible how much we have all learned and grown, and I am looking forward to the remainder of this semester to complete what we all began together.


A Day Without Technology

Our class assignment from last week was to attempt to spend a day without the use of technology. For me, this included Facebook, Snapchat, Instagram, and Pinterest. Unfortunately, because of my job as a nanny and Communication Chair position in a campus organization, I was unable to turn off my phone a computer completely for the full 24 hours. I did text and email during the day, but only for pertinent circumstances. Everything else I uninstalled from my phone and I’ve spent the last few days without.

I typically don’t spend much time anyway with social media or television, but it was definitely a new experience having no notifications on my phone from all the apps. I’ve kept the apps off my phone and it has been refreshing to not feel obligated to answer every single message, birthday, or update. I’ve found that I’m staying more focused on what I’m doing at any given time, rather than stopping to check something on my phone and then get back to work. I think this will be helpful in the upcoming weeks, when we are finishing up the semester, so that I can be sure that I am completely invested in my studying ans school work.

Generally, I think this is an important exercise for everyone to try every once in a while. It is obvious that many people spend a ridiculous amount of time using electronics, whether it be video games, social media, online shopping, etc, and not enough time focusing on the present. It seems as though we are so absorbed in the lives of others that sometimes we are lacking in the attention to ourselves and to the people around us in our own lives. I hope this becomes a more common realization and people are able to take a step back, leaving the technology aside to truly experience life.


Radial Ulnar Fracture Dislocation/ Galeazzi Fracture (The “S” Arm)

Alex Bultman, Alyson DelPoso, and Natalie Titcomb

  • Caused by a fall onto an outstretched arm with a flexed elbow
  • Ensure the patient has full range of motion in the shoulder
  • Elbow, wrist, and hand exercises are only begun after a physician prescription
  • To test for motor function, ask the patient to make the ‘OK’ sign by toughing the tips of the first and second fingers with the thumb. The radial nerve can be tested by having the patient extend their fingers or wrist against resistance, and the ulnar nerve can be tested by having the patient separate their fingers against resistance.
  • Treatment depends on the type of fall. If there are fragments, internal fixation is used. If there are no fragments, it is treated by closed reduction with a long arm cast


Image retrieved from:


Patient Education: Colostomy Care

There are a multitude of websites and YouTube videos available for patients seeking more information on colostomy care. However, for patients that do not have access to internet resources or who are not educated in technology usage, finding information may be a challenge. I found a booklet from Cedars-Siani Medical Center given to patients for colostomy education and information. I found the booklet to be helpful in the sense that it addressed troubleshooting issues such as intimacy, travel,  leakage, and how to approach friends and family about this medical condition. There is also detailed information about the anatomy of the abdomen, tips for taking care of and cleaning the stoma, skin care, and diet. I found the images throughout the booklet to be lacking detail, so I think a good supplement to this would be a take home dvd so that patients  are able to view the techniques being put into action. Below is the link for you to check it out!