Category: Uncategorized (Page 1 of 2)

A clinical exemplar describes a clinical experience that held some significance for the healthcare professional in some way. The clinical narrative takes you through the experience of a nurse and should explain why this patient or situation had an impact on the healthcare professional.

I watched a YouTube video about a transgender man that got pregnant and had a baby with his wife that was called, “Man Gives Birth To His Child, My Pregnant Husband.” If I were to be assigned this birthing couple, or this birthing person my reaction would be excitement to meet the couple or person and really get to know who they are and their story while aiding them in the birthing process. Since labor can be such a long process, that was the case with Ari being in labor for 30 hours, you can really get to know the patient and I just know that would be such a special experience with this couple. To learn about their experience navigating gender fluidity and blurring the lines of the stereotypical heterosexual pregnant couple’s experience would be an honor. Anytime I can learn about other people’s experiences I take that as a gift because it helps me be more empathetic, more sensitive to what other people are going through, and aids me in acting more kind to all.

Some ways of promoting inclusivity in a healthcare setting would be by asking patients what their preferred pronouns are when you are meeting them and then also let them know what your preferred pronouns are during introductions. Nurses should always add a note into the patient’s chart and pass it along in report if a patient requests to be addressed by a certain name or certain pronouns to make sure the whole team is aware. There could also be a note left on the patient’s whiteboard in the room with something such as, “Please use he/him pronouns,” or something similar, if they were comfortable with it. As nurses it is important to create a safe space for patients to explain their emotions and advocate for themselves and this will help patients be more comfortable during their vulnerable time while they are at the hospital. We need to utilize therapeutic communication and be the best listeners we can possibly be!

If someone were to incorrectly use female-specific language while giving their nursing report to the next nurse coming on shift, it could severely negatively impact the delivery of care because the nurse could immediately misgender the patient when they meet them. If the nurse giving the report uses the wrong gender the other nurse will likely write that down and go with that information. This could negatively impact the client nurse relationship if the patient is offended and it is very likely to leave the patient feeling hurt and misgendered. The patient will then begin to distrust the healthcare workers around them if they are constantly having to remind people of their correct gender when it should be vital information that is passed onto all members of that patient’s care team. If this keeps happening to this patient in many healthcare settings they may start to distrust healthcare as a whole the more it happens which could be very detrimental to their health in the future. 

Three statements that the nurse made in this virtual scenario in which the nurse is giving report on a patient that made me uncomfortable were: “Who knows where he is from?” “He’s one of those, if you know what I mean.” and  “Oh you know the type of people that hang out at the park just east of here. The one the police are always at.”

Each statement is important because the nurse giving report does not see that these statements can be seen as racist and hurtful. She needs to be told that each of these statements indicate that she looks down on this patient and judges him for where he is from and where he hangs out. This judgment about the patient can affect how we care for the patient and may have negatively impacted the care she provided for this patient if she had a negative opinion about him before she even met him.

In this scenario I was really uncomfortable with how she was rolling her eyes and trying to rush through the report. Report is a time where you can tell the patient’s story to the next nurse on shift and help create a picture about who these patients are above and beyond what is factually said in their chart already. If I was receiving this report it would upset me and I would have to say something to the nurse because her comments are so negative and not respectful of the patient.

One time that I experienced an uncomfortable situation was when I was at a clinical and the nurse I was with was receiving report on a patient that had a history of IV drug use. During report I could tell that the nurse was judging the patient for their tolerance to pain medications. She was judging the patient for how she would ask for pain medications directly at the time that they were due and that the patient would be extra cranky when she wanted pain medications. All I could think about was how much pain this patient must be in because she had endocarditis and since she has a history of iv drug use, medications that help with pain are less effective. I feel like patients that have this history deserve so much sympathy from nurses because they are dealing with high levels of pain and the medications are not as effective as they would be for a patient that does not have a tolerance in their body from past opiate use. After the night nurse gave us the report I discussed with the nurse I was following about the night nurse’s tone of judgment while talking about the patient and the nurse told me she was going to speak with her manager about this because it made her uncomfortable as well and she didn’t know that travel nurse well enough to feel comfortable addressing the comments with the nurse herself in that moment. 

My grandparents have been leaders in their church community for their whole marriage and had basically an open door policy when it came to visitors. Anyone was welcome in their home, family, friends, people from the church stopping by for advice or help, people stopping by to help them, and anyone else that wanted to be blessed by their presence. Then the pandemic hit at the same time that they were aging into their 80s. We as a family were afraid to get them sick and further shorten the years that they had left. None of us would forgive ourselves if we did. So their visits suddenly turned from anyone and everyone, to just family members with masks hiding our smiles. My grandparents didn’t see my smile for about a year. They were sad to say the least. Frequent visits from friends solely turned to phone calls and that wasn’t the same for two people longing for interaction that also had a hard time hearing people on the phone. 

In the CECE video it discussed the topics of emotional wellness and cognitive wellness. Emotional wellness is about being hopeful and resilient despite challenges, and is also associated with cognitive wellness to increase satisfaction with life. Emotional wellness leads to positive perceptions of the world and a person’s future and can also be associated with the development of fewer mobility limitations. Cognitive wellness is described as seeing the link between needing control and self-efficacy, and the commitment to lifelong good health and lifelong learning. Keeping these two aspects in mind while caring for the older population is important because even though this population may need increased help, self efficacy and control is very important. Because someone is physically impaired does not mean that they are cognitively impaired. I see aging as a beautiful aspect of life and want to make patients comfortable that have to deal with the challenges of an aging body and mind. 

My knowledge of preventative factors for delirium expanded as a result of participating in the Hospital Elder Life Program because I practiced orienting clients, performing range of motion exercise, learned about their lives, inquired about their sleep, appetite, and pain management, and talked to them about their health goals for the future. Each conversation was vastly different but all had the same underlying goals: preventing delirium and helping older people stay as healthy as possible in body and mind. My goals were to be kind and have a caring attitude while trying to orient patients at risk of developing delirium. I wanted to be able to talk with older adults and help prevent prolonged hospital stays for them and learn more about delirium because it is prevalent in hospital settings. I would say that I definitely met these goals by working the three shifts and having many meaningful conversations with patients at Maine Medical Center. I displayed compassion and worked hard to get through my list of patients while spending adequate time with each one.

My most meaningful interactions as part of this program occurred when visiting patients that do not get many visitors and display increased loneliness. I could just tell which patients received visitors daily and had enough people to converse with versus patients who were only able to converse with their healthcare workers that have very limited time to spend just conversing. These patients get out of the conversation what they put into it. Some patients didn’t want to talk to me and that was okay, but the patients that were willing and excited got a lot out of it. I loved hearing stories about their jobs, children, grandchildren, and pets. I also received lots of advice as these people have led long lives full of lessons and experiences. I will remember these conversations forever and I really hope that they will do and that I at least helped a little bit to prevent delirium from occurring from their hospital stay.

I have participated in some telemedicine in the past few years. I have had some over the phone appointments with my primary care provider for things that did not require in person assessments. I have participated in zoom call counseling and zoom call therapy. During the pandemic I experienced a lot of social anxiety and health anxiety so the Telehealth that I participated in alleviated a little bit of that anxiety for me. Before the pandemic if you asked me what I knew about Telehealth or telemedicine I would not have known what that actually meant. I know now that telemedicine refers to clinical and medical services provided over phone or video call and Telehealth is more about counseling or patient education. I did not know what zoom was until we implemented it at UNE for classes. Something else that has changed for me personally since the pandemic is the implementation of online patient portals that connect you to your healthcare services much easier and quicker. I am now able to message my PCP through my portal and get answers that I need fast, get prescriptions filled without having to make appointments.  I think this change occurred because of the shift to online care due to the pandemic and also advances in technology in our society. 

I think Telehealth and telemedicine has helped a lot of people that have anxiety about entering healthcare facilities especially when there was a significant increase in chances of contracting COVID while being at a healthcare facility. I think it also helped people living in rural communities that have transportation barriers when trying to get to their appointments. I think one barrier with it though may have been if people struggle to have internet access, zooming may be hard for them, but phone calls may work better for that population. I want to keep all these aspects in mind in my nursing career because inquiring if telemedicine would benefit certain patient populations instead of being in person could be beneficial if they will be able to participate in that care more. Other aspects of telemedicine that may be beneficial could be patients with blood pressure, glucose meters, or oxygen saturation meters that can connect to the healthcare system via bluetooth so that their doctor can stay connected to the patient’s healthcare from a distance. 

I didn’t know much about the needle exchange program before this presentation. I had learned a little bit about it through hearsay and my limited knowledge was that they provided a service where people could  safely trade their old needles for new sterile needles. This exchange would keep drug users safer than if they were reusing old needles or finding used needles to use. I have always believed that addiction is a disease and the people suffering from addiction need allys and support. I kept this belief after the presentation. I learned from the presentation that instead of just being a needle exchange, their program has changed recently where people do not need to bring in old needles to get new ones. 

I think the biggest strategy to resolving health and healthcare disparities is to keep your eyes open and your mind open. Often if we are in a position of privilege we don’t always see the disparities that other people may be suffering from. We need to listen to our patients, make them feel heard, and be an ally to them whenever they are suffering from a health disparity. I look forward to being a nurse because healthcare can be a scary place for people and I want to be a safe place for patients to feel heard and advocated for.

Before the presentation about human trafficking, I had limited knowledge about the statistics and facts of the prevalence of human trafficking. I have heard on the news many times about people arrested for sex trafficking and I have seen so many articles and posts about how to avoid being trafficked. I have been advised that if someone is following you in public, try to go to a highly populated area. Another tactic that has been discovered that human traffickers may use is putting zip ties (or anything you would have to take time to remove from the outside of your car) on the outside of your car so you will take the time to remove it and be distracted. If you remove it at that time someone could be waiting to abduct you. In order to avoid this, do not remove it at that time and just get in your car and leave. 

I did not know much about labor trafficking before the presentation and it shocked me the amount of different jobs that could be affected by labor trafficking such as panhandlers, nail salons, and construction jobs. I would like to study more about  the signs of human trafficking that healthcare workers may see because it is our priority to keep patients safe and to assess for signs of abuse, neglect, or possible danger outside of the healthcare setting. I was really thankful for the little cards that the presenter handed out because I am going to put that with my hospital badge to reference if I suspect a patient is the victim of human trafficking.