Author: acrawford4 (Page 2 of 7)

Throughout my time of seeing patients with the HELP program I feel that I got a routine down of how to talk to the patients and be observing for signs of delirium simultaneously. I did not see any clients experiencing delirium, but I was able to look at the paperwork to get a sense of what their baseline was and observe for any changes.

            The most meaningful aspect of my volunteer experience was with a patient I saw first in the HELP program and then at clinical the next week. I had a really good conversation with this patient, as we talked about all the books he liked to read and how he liked that he was able to read in the hospital. He was in a great mood and was very enthusiastic about his recovery. At clinical I was able to help him with the discharge process, so that was a cool moment for me to be able to care for a patient in two different settings.

            I did meet my learning goal of getting better at recognizing and remembering signs of delirium. None of the patients I saw were in active delirium, but I was able to observe for any changes from previous visits and look for factors that could potentially cause delirium. I also met my goal of becoming more comfortable seeing patients in a different setting, which is something I will take with me moving forward, as I may be caring for patients in many different settings as a nurse. 

During the pandemic I talked to my grandma quite often as she was pretty nervous about what was going on. Thankfully, she lives with my uncle and has other family close by so she was never by herself. She did talk about how she was sad she wasn’t able to go to church and the senior center and often felt isolated in her house. However, she did call her friends and sister almost every day, and started writing letters to her college roommates, which they still do today. I think she was as stressed about the pandemic as I expected and was nervous about getting covid. but found some good ways to cope with being stuck inside. 

            I learned some new information about older adults from this presentation, specifically that they are very resilient yet need emotional support as well. Many older adults suffer from loneliness and depression, so it is important to provide them with support whether that be in the hospital or in an outpatient setting. Helping elderly patients improve their wellbeing might include making sure they are adhering to their medication, have food resources, and things they might need close by such as glasses and hearing aids. It is also important to provide mental health resources to older adults, and make sure that they know they have support. This presentation changed my perspective on aging as I found out older adults are much more resilient than I thought.

Before this presentation I was not aware of the difference between telehealth and telemedicine. I had become more familiar with telehealth during the pandemic, as I had a few medical appointments on telehealth when I couldn’t go into the providers office. I think that telehealth visits have become a great option for many, as it can be much more convenient than having to go into your provider’s office. I had not heard about telemedicine in acute care until this presentation so I was not sure what teleICU nurses and providers were able to do with this technology. I learned that nurses who work in tele medicine are able to continuously monitor the patient, and alert the nurses and provider of any changes. I also learned that they can help guide the nurses on the floor in doing procedures if they are having trouble.

            I believe that telehealth and telemedicine have had a positive influence on nursing, especially since the pandemic. Telehealth visits can make it easier for the provider to see more patients, and is often the more convenient option for the patient, if they can’t get time off work, or find childcare etc. Telemedicine in acute care seems to be a huge help to everyone on the care team. Nurses can’t be in two places at once, so it is great to have someone who is keeping an eye on your patients even if they are not physically on the floor. I think that telemedicine in acute care will contribute to more positive patient outcomes. Being able to continuously monitor the patient and recognizing changes quickly will lead to a better quality of care. If I end up working on a floor that offers telemedicine, I will use that to make the quality of my patients care better. I think using what I learned about telehealth and telemedicine will help me recognize changes quicker, and help me be more confident in my care, as my patients will be continuously monitored. 

Before this presentation I had heard of needle exchange programs but did not know too much about them. I knew that some needle exchange programs would take dirty needles from clients and give them clean ones. One preconceived notion I had about needle exchange problems was that needle exchange was the only service provided. I now know that there are many services provided to clients such as blood tests, safe supplies, Narcan, and test strips. I was also not too familiar with the concept of harm reduction, but this presentation gave me a better background on it. This presentation gave me better knowledge of how “meeting people where they are at” works much better than stigmatizing drug use and shaming clients for it.

I think harm reduction is a good way to help resolve healthcare disparities with this affected population. I believe that educating people about harm reduction will also help stigma around this issue as some people believe the principle of harm reduction is not effective, and don’t agree with the idea of needle exchange. Many people who use drugs also experience mental health issues, so being able to provide free and accessible mental health services would also help improve this healthcare disparity. I will apply what I learned in this presentation to nursing practice. I will be mindful of how I care for patients who use drugs and provide them resources if they would like them.

One pre-existing thought I had about human trafficking prior to this discussion was that human trafficking mostly involved bringing people over state lines for work, sexual favors, etc. I was not aware that the majority of human trafficking occurs close to where the person being trafficked lived. One thing that surprised me from the presentation were the different types of trafficking, such as how someone can be coerced into providing healthcare for another person. After this discussion, my thoughts have changed in the sense that I am now more aware of what is defined as human trafficking and what to look for. I would love to know more about resources that are available for victims of trafficking. I would also love to know more about the process involved of helping a victim of trafficking escape or get out of the current situation with their trafficker. 

I will definitely apply a lot of what I learned in the human trafficking lecture in future practice as an RN. I will be more aware of what to look for in victims of human trafficking (ex. Barcode tattoo, bruises, withdrawn, etc.) and how to speak to a patient that you suspect might be involved in trafficking. I will also think about how a trafficking victim may react in the hospital, and how to ask the right questions. This lecture also made me more aware of resources in the hospital that can help with human trafficking victims. I also learned more about what a forensic nurse does, which was very interesting.

Disaster events can be a nerve-wracking experience for everyone involved, so in the case that one happens it is important for the healthcare providers involved to have a plan. Most hospitals will have an Emergency Operating Plan to follow in case of a natural or man-made disaster, so it is very important for the nurse to stay updated on their role in this plan. During a mass casualty or disaster event nurses will most likely be triaging patients. This can be difficult as the nurse’s role in a disaster event is a bit different than it would be in an emergency room triage. Patients are triaged based on who is most likely to survive, and those not expected to survive usually receive treatment last. Along with treating patients during a disaster, nurses also help with transporting and evacuating patients to other hospitals or safe areas.

            I think that both ethical codes bring up good points when thinking about disaster nursing. Provision 2 states that “a nurse’s primary responsibility is to the patient” and I think that is true as long as the nurse is being mindful of their safety during the disaster. While a nurse might have to put themselves in harm’s way to care for a patient, they will not be able to perform good care for other patients if they get injured. That is why I would agree more with Provision 5 which states “a nurse owes the same duty to self”. A nurse might push their own wellbeing to the side when caring for patients, since we want to do the best, we can for them while they are under are care, but it is important to remember your own safety as well.

Delirium usually begins over a few hours to a few days. Delirium is not the same as dementia which has a slow progressive onset. Delirium often happens in the hospital where patients are bed bound and in a new environment that may be upsetting or confusing to them. Medications, infection, sleep deprivation, malnutrition, pain, stroke, and heart attack are some causes of delirium that are commonly seen in the hospital. Delirium can present as reduced environmental awareness, such as being distracted or not responding to the environment. You also might see disorientation, poor memory, difficulty speaking, hallucinations, and restlessness. Delirium also includes disturbed sleep habits, fear, depression, and mood and personality changes. 

I experienced caring for a patient with delirium at clinical this year. The nurses described this patient’s delirium as “waxing and waning”. This patient went from being oriented to where they were and asking questions about their care to being very restless and distracted, not knowing where they were, and having trouble speaking. After this patient had an episode of delirium they returned to their baseline neurological status a few hours later, so it was interesting to see that shift.

            One learning goal I have for this experience is to get better at recognizing signs of delirium since that will help me to provide better care for the patients. The next learning goal I have for this experience is to become more comfortable working with patients who are experiencing delirium, as this is not something I have a lot of experience in. I am a little bit nervous for this experience since I have only seen a few patients experience delirium so far. However, I do feel ready to work with patients in a bit of a different setting than clinical, and still provide them with good care. A few community support networks for the aging population that I am aware of include senior centers, and meal delivery programs.