Graduating Nurse

At orientation I felt like I was starting the greatest journey of my life. With all the helpful information from third year students, I felt like I was mentally preparing myself. My first clinical day I felt confident to perform skills such as ADL’s. Getting used to the equipment was something that made me a … Continue reading “Graduating Nurse”

At orientation I felt like I was starting the greatest journey of my life. With all the helpful information from third year students, I felt like I was mentally preparing myself. My first clinical day I felt confident to perform skills such as ADL’s. Getting used to the equipment was something that made me a bit uneasy. I felt year one I was just getting to know the patient and practice my assessment skills. Year two I felt pushed to know medications better, time management, and documentation. Year three I feel I have all those pieces moving smoothly together. I’m able to tackle the tasks of the day with much less stress because I’m more efficient and knowledgeable. My critical thinking skills have improved through the years which helps make the clinical day run organized.

In a year from now I have a few goals in mind. I would like to feel more competent in my training most especially. I try to model nurses that have qualities I thrive off of and want to embody that fully in 1 year. My other goals involve fitness, dieting, and lifestyle. In 3 years, I’d like to be fully competent and applied or in a nurse practitioner program. In five years I hope to be set in the best job for me and my lifestyle. I’m ready to graduate from nursing school. I’ve learned so much and just need to bring all my knowledge to the field and live and appreciate the life I created for myself and worked hard for.

 

This picture was taken for orientation at VCMC for critical care. This represents how I feel about graduating the program. Like I’m excited and ready but still bound to schooling and not quite free!

Graduating Nurse

The very beginning of nursing school was very up and down. I got an email that I was accepted! Then I got an email that the previous message was a mistake. Then later surprise! I’m back in! Even at orientation I wasn’t 100% sure that I was officially allowed to be here. Year one was … Continue reading “Graduating Nurse”

The very beginning of nursing school was very up and down. I got an email that I was accepted! Then I got an email that the previous message was a mistake. Then later surprise! I’m back in! Even at orientation I wasn’t 100% sure that I was officially allowed to be here.

Year one was a whirlwind. Year two was a marathon. And now this last year is playing out like the Wizard of Oz, where I’m Dorothy and the Good Witch is reminding me that I had the power all along.

I am so ready to graduate. My year one goal is to get a job in Med Surge, then in 5 years use my experience to go into public health.

Real Disaster

On October 1, 2017 a single man shot into the Route 91 music festival  killing 59 people and injuring 546. He shot from the 32nd floor of Mandalay Bay hotel on the Las Vegas strip. Barriers for providing care rested in the uncertainty of the shooter being on the ground or up in one of … Continue reading “Real Disaster”

On October 1, 2017 a single man shot into the Route 91 music festival  killing 59 people and injuring 546. He shot from the 32nd floor of Mandalay Bay hotel on the Las Vegas strip. Barriers for providing care rested in the uncertainty of the shooter being on the ground or up in one of the surrounding buildings, getting adequate medical personnel to assist the hundreds of people injured and transport them to one of the 3 surrounding hospitals. Paramedics, nurses, and doctors both on duty and off duty rushed to help people get to safety and provide medical care until transferred to hospitals. The shooting took place from 1005pm to 1015pm. While people trampled over each other and tore down fences to escape it created some difficulty to get the injured immediate attention. After the shooting, there were hotel cancellations and business’ had some fall in sales the first 3 days after the shooting. Trauma care needed was tourniquets, pressure to bullet wounds to stop bleeding, and CPR for some that lost adequate perfusion. With the amount of people that came into hospitals injured, the healthcare team would have to call in additional employees and even keep some employees significantly overtime in order to manage the influx of trauma patients. I believe real disasters like this give emergency and medical personnel the tools they need to provide faster effective care. They can evaluate the protocols they already have in place and see what works and what needs adjusting.

Hurricane Maria

Last clinical, I needed a drug from the Pyxis but it wasn’t there. The pharmacy said that there wasn’t any in the hospital so we had to wait for a shipment later in the afternoon. My nurse explained that there are more shortages now than there used to be because of the Hurricane in Puerto … Continue reading “Hurricane Maria”

Last clinical, I needed a drug from the Pyxis but it wasn’t there. The pharmacy said that there wasn’t any in the hospital so we had to wait for a shipment later in the afternoon. My nurse explained that there are more shortages now than there used to be because of the Hurricane in Puerto Rico. A lot of our medical supplies are made there, and the island is still having problems.

Interested, I read about the disaster in Puerto Rico on Wikipedia. First, Hurricane Irma hit September 4th, 2017 and left 80,000 people without power. A state of emergency was declared in PR at that time, and FEMA started setting up teams on the island on September 6th. Two weeks later Hurricane Maria hit the island, causing 64 deaths and leaving all 3.4 million people without electricity. These two hurricanes completely destroyed PR’s electrical grid, cell towers, phone and internet cables. Hospitals were damaged and operating on backup generators.

According to a December article in the New York Times, the federal response included setting up field hospitals and medical shelters that treated 30,000 people, a federal prescription reimbursement program, and the aid of the US Navy hospital ship Comfort, aboard which 191 surgeries were performed. The ship was in PR from October 3rd to November 15th. The Trump administration was heavily criticized for not doing enough.

Barriers included bad weather, rough terrain, destroyed roads, no electrical power, unusable communications, and unclear organization. 7 months later many people are still without power. It will take billions of dollars that Puerto Rico doesn’t have to repair the damaged infrastructure. In my opinion, the US response was very poor, and it does not look like it will be getting better as our politicians are more hostile and adversarial than ever.

References

 

Hurricane Maria

By the time Hurricane Maria hit the Dominican Republic, it had reached 155pmh winds making it a Category 5 hurricane. Like Puerto Rico and many other Caribbean countries, the Dominican Republic faced deaths and flooding. One barrier that affected the access to care for those after hurricane Maria was that the Caribbean islands had just …

Continue reading “Hurricane Maria”

By the time Hurricane Maria hit the Dominican Republic, it had reached 155pmh winds making it a Category 5 hurricane. Like Puerto Rico and many other Caribbean countries, the Dominican Republic faced deaths and flooding.

One barrier that affected the access to care for those after hurricane Maria was that the Caribbean islands had just been hit with hurricane Irma fairly recently. Just as the population was beginning to clean things up, another category 5 hurricane comes and destroys many of the already battered shelters and healthcare facilities.

Luckily the Pan American Health Organization is just one of the organizations taking steps to cover medical supplies and establish health services in the countries in need.

The flooding made sanitary conditions a priority. The hurricane caused an increase in mosquito and rodent activity on the island. This cause not only causes a risk for vector born diseases, but also flood associated diseases, including cholera and hep A.

Trauma care that might be needed in a situation like this would include providing clean water and clean shelters. Other trauma interventions that would be important could be mental health treatments. Trauma affects people in different ways and there might be a high need for mental health services after an even like this.  

I think we are still learning, but after events like this it becomes apparent the importance of preparing for these events. The teams did a great job helping out the population that was affected, but there is always room to improve.

References:

Critical Health Response Ongoing due to Hurricanes Maria and Irma in the Caribbean. (n.d.). Retrieved April 11, 2018, from https://reliefweb.int/report/dominica/critical-health-response-ongoing-due-hurricanes-maria-and-irma-caribbean

Hughes, T. (2017, September 21). ‘The country is in a daze’: Hurricane Maria ravages Dominica. Retrieved April 11, 2018, from https://www.usatoday.com/story/news/2017/09/20/hurricane-maria-blamed-least-7-deaths-caribbean-islands/685030001/

Osborne, M., Winsor, M., & Jacobo, J. (2017, September 22). Hurricane Maria leaves trail of death and destruction in the Caribbean. Retrieved April 11, 2018, from http://abcnews.go.com/International/hurricane-maria-strengthens-category-ravaging-puerto-rico/story?id=49997188

Neuro

According to Swearingen, Cox, Lesko, Lucas, and Clark (2018), there is a new stroke neuro check called SNAP (Stoke Neuro Assessment by Providence). It is defined by four assessment components; LOC, pupillary response, extremity movement, and originating symptoms. The purpose of this article was to examine SNAP checks between a comprehensive stroke center (CSC) and … Continue reading “Neuro”

According to Swearingen, Cox, Lesko, Lucas, and Clark (2018), there is a new stroke neuro check called SNAP (Stoke Neuro Assessment by Providence). It is defined by four assessment components; LOC, pupillary response, extremity movement, and originating symptoms. The purpose of this article was to examine SNAP checks between a comprehensive stroke center (CSC) and a primary stoke center (PSC) for any stroke patients that had IV alteplase and/or thrombectomy (Swearingen, 2018). A primary stroke center primarily cares for ischemic strokes while a comprehensive stroke center cares for all types of strokes. In order to check compliance with the SNAP assessment, the number of documented SNAP assessments were divided by the opportunities for the checks. Of the 37 patients in the study, SNAP check compliance was 68%. In the SNAP checks, the highest compliance fell under LOC and the lowest was originating symptoms, 90% to 45% respectively. Comparing the CSC to the PSC, CSC’s had higher compliance rate, 82% to 62% respectively. In conclusion, there needs to be more emphasis on originating symptoms during assessments and compliance with SNAP checks in PSC’s.

 

Swearingen, N., Cox, K., Lesko, A., Lucas, L., & Clark, D. (2018, January). Abstract 9: Compliance of a New Standard in Stroke Neuro Checks in a Comprehensive Stroke Center Compared to Primary Stroke Centers for IV Alteplase and Thrombectomy Patients. American Heart Association Journals, 49(1).  Retrieved April 06, 2018, from http://stroke.ahajournals.org/content/49/Suppl_1/A9

Trends in Elder Care

I did a lit search for trends in elder care and came across an interesting article about meeting the needs of older people who are trans-gendered. My previous perception of gender issues was that it was a movement spearheaded by young people but of course people have had their own gender identities forever, it is … Continue reading “Trends in Elder Care”

I did a lit search for trends in elder care and came across an interesting article about meeting the needs of older people who are trans-gendered. My previous perception of gender issues was that it was a movement spearheaded by young people but of course people have had their own gender identities forever, it is just now talked about more.

This Australian article discusses negative experiences that patients have from interactions from staff in nursing homes such as pathologizing, misgendering, marginalizing, and coercive queering, collectively known as cisgenderism.

As a nurse I will take the article’s suggestions to heart, and focus on providing privacy, researching ‘scripts’ that are respectful regarding personal care, using the preferred pronouns for the patient, supporting gender expression and appearance, and advocating for my patients to get the prosthesis or hormones that they express a need for.

Ansara, Y. G. (2015). Challenging cisgenderism in the ageing and aged care sector: Meeting the needs of older people of trans and/or non-binary experience. Australasian Journal On Ageing, 3414-18. doi:10.1111/ajag.12278

Favorite Patient

My very first patient in nursing school was my most memorable patient. She had a song that she loved to sing and perform for herself and others to hear. Her special instructions were that you clap with her. During the shift I had sang the song with her many times, sometimes even in the hall. … Continue reading “Favorite Patient”

My very first patient in nursing school was my most memorable patient. She had a song that she loved to sing and perform for herself and others to hear. Her special instructions were that you clap with her. During the shift I had sang the song with her many times, sometimes even in the hall. By the end of my day, some other classmates and I rounded up the clinical group, instructor included, to listen to her song. It put a smile on all of our faces and certainly brightened up the day. We still try to sing her song to this day.

My favorite patient

My favorite patient was especially troublesome. He was someone that marched to the beat of his own drum and was not at all inclined to follow other people’s rules. He had been homeless for the last 12 years, drank alcohol everyday, and was intoxicated when he was struck by a vehicle and broke 4 bones. … Continue reading “My favorite patient”

My favorite patient was especially troublesome. He was someone that marched to the beat of his own drum and was not at all inclined to follow other people’s rules.

He had been homeless for the last 12 years, drank alcohol everyday, and was intoxicated when he was struck by a vehicle and broke 4 bones. He was in a lot of pain, but that didn’t stop him from trying to roll a cigarette in bed. After I swept the tobacco off the floor, I explained that he couldn’t smoke in the building but was able to at least get him a nicotine patch. His CIWA score wasn’t high enough to warrant an ativan, although I think that could have helped him.

He was my introduction to a radically different type of patient who lived outside of societal norms, and for that reason he will always stick out in my mind.