Pre-community partnership reflection

I will be going to the Pine Tree Camp in Rome, Maine for my community partnership. I know this is a camp where people with disabilities can come for an all-inclusive vacation. This camp has accessible outdoor activities and living quarters. I know the population can vary by age, disability, and gender. This will make the experience worthwhile as I will get a chance to meet people from all walks of life. I have had some experience working with a little boy who is on the spectrum. My sisters and I have been his babysitter ever since he was 4 years old. This was such a difficult but rewarding experience. I have been able to watch him blossom and thrive within our community. When I first met this little boy, he had two leg braces and glasses with an eyepatch. He was mute and only communicated with an iPad and pointing. I have been given the opportunity to watch him grow and get to kindergarten and now he is in 2nd grade!  

One of my goals during this experience is to learn how to communicate with children of all disabilities. Every child will have their own specific way of communicating which is fascinating and can be vastly different. I will try to spend time with as many children as I can! My second goal is to gain a better understanding of how family members adapt to life with their disabled family members. I hope this will give me more insight as to how to care for the family as a unit. I am nervous about potentially experiencing a breakdown in one of the kids and not knowing what they may need at the moment. I am very excited about this experience. I feel like I will be able to interact with the kids the best because I have experience with all ages when I babysit. I also hope to become a pediatric nurse and this will help me dig into that field. There is a local branch of the international club called Best Buddies this is a group that is dedicated to people with disabilities. This is a fantastic group that will create events throughout the Portland area to get people together. 

Being Mortal and Advanced Directives

  • How did the documentary influence your thinking about the ‘final days’?
  • Do you or your loved ones have an advance directive?  Why or why not?
  • Have you ever discussed your thoughts about your own mortality with those you love?  Why or why not?

This documentary was extraordinarily well-directed and produced. It made me start to think about how life is short and unexpected. I may be healthy right now but there is no telling what the future may hold for me. I have a rare chronic lung disease called Primary Ciliary Dyskinesia and because of this, I have thought about what may happen. My parents both have an advance directive. They have one because they believe it is important for our family to be on the same page if something were to happen. I am a part of a family of 6, so opinions and points of view vary between all of us. I can see how making medical decisions may become a problem.

I have discussed my own mortality with my parents. I was especially curious when I was younger and trying to grasp the concept of my disease. I remember my parents explaining to me that even though this is a rare disease they have trust in the medical professionals. My disease is similar to Cystic Fibrosis but has a better life expectancy. This information helped me feel safe. I have not recently talked about death with them because everything is going right with my health right now. After watching this documentary, I am going to ask them their thoughts about this topic.

Simulation Reflection

I have learned a lot from this experience about mental health and myself as a future nurse. Before today, I had not had a one-on-one conversation with a patient with BPD or Schizophrenia. Going into this experience I was very nervous about the questions I was supposed to ask and how to respond to unexpected situations. I have learned a lot about how the variety of demeanors made us have to rapidly alter our communication styles to fit what was best for the patient. I can see myself using this skill within clinical practice. Our direct and focused question style for a person with BPD was completely different than the questions we asked a patient with severe depression. I also learned that I have to expect the unexpected with how patients may react. Specifically, during our conversations with the BPD actor, I was very caught off guard as the woman called me out for smiling. I was smiling because after our mid-interview debrief we had a coherent plan as to where we wanted this conversation to go. As the second half of our conversation began, it did not go as planned which made me smile and laugh. I was quickly able to adjust my frame of mind and correct my wrongdoings. This situation threw me for a loop which is something to always expect in practice. I hope to eventually develop a large skill set to therapeutically respond to situations like this one. Another thing I have learned is that upon instilling hope in a patient it is important to figure out what the patient thinks their individual strengths are. This can provide motivation for the client which may be one of the biggest factors to regaining one’s mental health. This is one of the many tools I will use throughout my nursing career.

Fertility Rates in Women with Cystic Fibrosis

Cystic fibrosis is a genetic disorder that has recently developed more medical attention and knowledge. In the beginning years of this disease, the life expectancy was around the late 20s to early 30s. New medical technology and pharmaceuticals have prolonged the patient’s life expectancy to the late 60s. This improvement has uncovered new issues from cystic fibrosis such as infertility. As new research studies arise, they have all shown that this disease has an impact on fertility rates.

Final Reflection

Reflecting back on the evolution of this research paper, I have learned a lot about myself as a future nurse. I have learned that nursing is about helping people get better in the present moment and making the future better by introducing new policies, medications, and procedures. This is very important as this is an ever-changing profession. As new technology and disease arise it is important to re-evaluate the current practices to find the best outcome for the patients. As nurses, we have personal experiences that can provide insight as to what is working on a unit and what may need improvement. This is where evidence-based practice comes into play within the nursing profession. For this assignment, we were able to work with a peer. This has improved my communication skills, time management, and interpersonal compatibility. I have learned how to delegate certain tasks to my partner in order to break up the workload. I also learned how to read research articles and evaluate whether or not they are reliable. This is important because I may need to develop new guidelines for my floor based on the evidence from various articles. All in all, I have learned that a nurse has many roles and responsibilities some of which may change the course of our practice for the better!

Ethical Considerations for EBP

My understanding of the nurse’s role in the ethical conduct of research has changed immensely. I had not thought about how long ethics has been a part of the healthcare profession. I understand that nurses and doctors alike are in charge of holding each other accountable when confronted with an ethical dilemma. As a nurse, a big part of our job is to advocate for our patients and provide them with all of the information in order to create an informed decision about their care. It is important for nurses to understand the historical importance of the principles of research ethics because it creates a similar point of view from a different time period. This is the same issue but in a different way. This movie shows the disastrous consequences of going against the right thing to do. In the view of the doctor, it seems as though they are creating a historical study with data that will make them famous regardless of the expected outcome which is death. The nurse in this movie is faced with charges due to her role in letting this study happen even though it was very unethical. The nurse knew what she was doing and was opposed to it at first. She tried to encourage the use of penicillin once it was confirmed to treat syphilis but the doctors shot down her request for the sake of the study. This historical movie is important to watch because things like this still happen today. It is important to be the change you want to see for your patients. Throughout this course, I have learned how to ethically collect, analyze, and document research. I am now able to participate in evidence-based practice initiatives with knowledge about the past and how it has shaped research and clinical practice today. This ability is very important when providing the best care for my patients

Assumptions

I assume that a nurse contributes to the conduct of research by making sure consent is given. In the pre-surgery units, a nurse is in charge of making sure that consent has been given. It is not our job to obtain it. I also think that a nurse has to make sure that the study is not violating any state or medical laws and guidelines. This can include the population that the study can use as well as the use of new medications or procedures. We must have a moral compass to navigate these muddy waters when conducting research. This is not only a skill that is used in research but especially in clinical practice.

Appraisal and Synthesis

I discovered many new things about fertility in women diagnosed with cystic fibrosis. My original assumption was that women with this disease have little to no ability to conceive naturally. As I analyzed our research studies, I was pleasantly surprised with the results. Women with cystic fibrosis have a slightly decreased ability to conceive naturally and if they need an alternative means such as IVF, this usually works. This finding will impact my future as a nurse, by being able to provide the best support and education for patients with CF. Having a support system is beneficial when dealing with the conception of a child. I may be able to educate the patient on alternative ways to become pregnant that have been effective for other women with this condition. As I reflect on this project, I have enjoyed the individual steps that have been helping me with the paper in little pieces. This has helped me with my time management skills considering I have other classes that are just as important. An issue that my partner and I have run into is dissecting the information in our articles. The evidence table and the critical appraisal worksheets have helped us break down all of the evidence in a manageable way. 

From Inquiry Through Discovery

My partner and I did not need to revise our PICOT question upon searching for research articles. We encountered an issue with finding articles within the given time range. This assignment required us to find relevant articles that were written in 2017-2023. When I originally began looking for articles I did not find many that were conducted within our given year range. I then solved this issue by narrowing the year bracket to then populate articles that would qualify. Our PICOT question directly targets fertility in females, but when researching for articles many of the articles were about fertility in males. This was very interesting but was not what we were looking for. In order to fix this problem, I decided to change the keywords I was using in my search. I changed “Females” to “Women” and I also tried to use the word “Ladies”. This then helped narrow the search even further. Thus far this assignment has been manageable. I have used my time appropriately and given this paper about 30 minutes of my time each day depending on the assignment for class. A few things I will take away from this assignment are to change the year bracket before researching the topic. I would also think of synonyms for a word if I am not coming up with many results before I resort to changing my overall question.

Ostomy Reflection

An ostomy bag is an appliance that is used when there is a needed change in the way urine and stool are excreted from the body. In order to correctly use an ostomy bag the patient will have to go through an ostomy surgery to create a stoma. A stoma is an artificial opening of the intestine to the outside of the abdominal cavity. This allows for the excretion of waste products to bypass the malfunctioning intestinal tract. A patient can have a temporary or permanent ostomy depending on their diagnosis. Prior to the surgery, the nurse is taking care of the patient and preps them for the procedure. The nurse may make sure the patient is NPO and provide pain management in the meantime. Other than medical management, the nurse should also begin to think about the patient’s mental and emotional status since they are about to undergo a major lifestyle change. For 48 hours, I was given the chance to wear and care for my own ostomy bag. The purpose of this experience was to give us a better understanding of the impact this appliance has on a patient’s life. I believe that this assignment will help me become the best nurse I can be for patients with an ostomy bag by getting the first experience with device placement and maintenance.

As I began my day with my new ostomy bag, I noticed right away that my first issue was going to be with my clothing. I was wearing high-waisted jeans and a cropped sweatshirt. I usually don’t have to think twice about this outfit but as I allowed a peer to draw on my stoma I noticed that I had to unzip my pants to allow for correct placement. This challenge only got worse as I began to place my ostomy bag onto my abdomen. I noticed that I had to then place my bag into my jeans in order to zip them back up. This was a very uncomfortable experience as I had to sit for the rest of my school day with my ostomy bag in my high-waisted jeans. As I sat in class, I began to wonder ‘if I had a stoma would I feel comfortable with my jeans pressing on it?’ It was interesting to see how even the little things like my wardrobe would affect my experience. A different physical experience I had, happened during the removal of the bag. As I pulled the adhesive dressing off of my skin I noticed that my skin was very irritated. Underneath my skin was very red and sensitive to the touch with various small bumps. This may have been a sign of hypersensitivity that I did not know I was experiencing. My immediate thought after, was how actual patients are unable to take a break from the bag and would’ve had to place another adhesive dressing onto the irritated skin. These are just some of the physical challenges that a patient with an ostomy bag may go through in their day-to-day lives. 

Another concern I noticed was about what outsiders would think of me. I found myself becoming hyperaware of my physical appearance because of the ostomy bag that was sticking out of the top of my pants. Constantly thinking about my looks and worrying about what other people may think of me is exhausting. This really made me think about how patients with real ostomy bags may feel the same way. I also became anxious about the contents inside the bag and worried about if it smelled or would accidentally leak. These are some serious concerns to have with an ostomy bag. It made me think about how a patient with a new ostomy may have unique stressors and mental health issues because of it. I feel a patient with a new ostomy and stoma may be in shock and grossed out by the looks of this opening from the intestine. A patient may need someone from their support system to help them with the care of this new device for the first few months while they adjust to their new normal. 

All in all, I believe this experience, though a difficult one, was very beneficial in developing a new perspective on patients with ostomies. My beliefs have changed as a nurse having to care for these types of patients. I hope to prioritize more of the needs of Maslow’s hierarchy. A patient that has to live with one of these devices may struggle with esteem, love, belonging,  and self-actualization. These are very important pieces of a patient’s overall well-being. In my future endeavors as a nurse, I hope to not only care for the medical components of an ostomy but also look at the bigger picture and how it may affect a person’s life. If I have any advice for the future students of this class it is to wear low-rise jeans, leggings, or sweatpants to this class despite the dress code. This will help you feel more comfortable for the rest of the day. I would definitely recommend this experience to any nurse because it can give us a better understanding of what it may be like for the patient thus providing the best care possible for them.