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. 

Delirium is an abrupt change in cognition and disturbance in consciousness, It develops very fast and is usually reversible and most often is preventable. It occurs too often and is a problem for older adults. Ways to prevent dementia are getting people up and moving after surgery or during hospital stays and orientating the patients frequently to person, place, time, and event. Other important aspects are making sure that the patients can communicate most efficiently such as making sure they have access to glasses, hearing aids, and dentures. I have cared for many patients experiencing delirium as a CNA this summer. The patients I have worked with generally just seem confused about the care that they are receiving and don’t fully understand why they are in the hospital. They become confused about the many healthcare staff taking care of them and can become combative and agitated. This makes it challenging to give them the best care because they don’t understand why they need IV’s or things like that.

My goals are to be kind and have a caring attitude while trying to orient patients at risk of developing delirium. I want to be able to talk with older adults and help prevent prolonged hospital stays for them. I also want to learn more about delirium because that is something that is very prevalent in hospitals and I will be a nurse in that setting. I am not nervous about this volunteering opportunity because I have had clinical at Maine Med already and am very familiar with the setting. I also worked as a CNA all summer with dementia and delirium patients so I have experience with those topics. There is no HELP program at Maine General in Augusta that I know of and they have a lot of patients developing delirium. It was really hard to see also the amount of patients with delirium and dementia that were just waiting for placement because no nursing homes had any openings for them.