This is an experience that I have had during a clinical rotation at UNE. I feel that this story has shaped the kind of nurse I hope to be. I was able to identify personal bias and an ethical dilemma and responsibly remove myself from the situation. This has taught me therapeutic communication skills that are only learned by experience.

I would feel surprised and interested to talk more to this couple. I would feel surprised as I haven’t had a patient like him before during my maternity clinical. I don’t think being surprised is negative as I enjoy learning more about other people’s lives. I would ask questions and make sure the couple is healthy as a whole because the pregnant person and the spouse can be affected by this pregnancy. I think I would also like to know more about the medical side of this patient. I would want to work with the endocrinologist to understand more about how his hormone treatments could potentially affect the growth and development of the fetus. I would also make sure that the medical team is all using the correct pronouns and asking for consent whenever they are performing any assessments on any patient.

I would make sure the chart is all up to date with proper pronouns and verbiage about this patient’s care. I would also make sure that we use neutral terms like pregnant person or dad when referring to this patient. As a nurse in the maternity unit, we are with the patient 24/7. We have to make sure that they feel comfortable during this transition and ways we facilitate that is by asking questions to see what they may have in mind for the birth of their child. This is their birth experience that we are assisting them with. The patient should have complete control over what they would like to happen. As for education since the patient no longer has breasts I would make sure the lactation specialist doesn’t come in and start talking about breastfeeding as this is unrealistic. I would have the specialist talk about other options such as donor breast milk or formula feeding. This is a choice the couple can make together. I may also look up support groups in the area that could facilitate an easier transition into the world of parenthood. Overall, I would try my best to ask questions and correct any inappropriate comments. 

I would like to have a conversation with this patient before birth about what vocabulary they would like to use regarding their genitalia. This is something that can cause mental stress on the patient as they identify as a male but have female genitals. This is just as important as keeping the patient’s wishes concerning religious or cultural requests. I would also make sure that the chart is updated so that everyone in their healthcare team can be up to date with this information and provide a comfortable environment. If this couple were to have a good experience with the quality of care during the pregnancy they may be more likely to have another child. This may also demonstrate to other people in this situation that they can have a similar experience. A trusting relationship between the patient and their healthcare team is very important and will last a lifetime. If a person doesn’t feel comfortable with the healthcare system they will not be as open to receiving the care they may need in the future.

A few of the comments and gestures made by the lady giving me a report made me very disgusted and mad. The nurse started by stating the patient’s name which was difficult for her to pronounce. The nurse then said “Who knows where he is from” with a chuckle and an eye roll. This comment was weird to me as she just spent 12 hours with this person and didn’t seem to ask him how to pronounce his name or if that was what he wanted to be called. Another comment was made about his skateboarding accident. The nurse goes on to say “he is one of those people you know what I mean” with an eye roll implying that he is not a good person for enjoying skateboarding just because it is in a less fortunate side of town. The nurse also mentioned that the patient had a skateboarding accident and used air quotations. This implies that she doesn’t believe the patient’s story.

Each of these statements is important for me to address because they contain implied bias. This is a pre-reflective attribution of particular qualities by an individual to a member of some social out-group. The nurse is stereotyping her patient and this could affect the quality of care this patient may be receiving. The nurse may not trust the patient and it could harm the patient’s mental and physical health. The nurse may be implying that the patient was getting drugs since he was hanging out on this side of town and may not give him the proper analgesics because she thinks that he may be an addict. This is one of the ways these statements may be impacting this nurse’s delivery of care.

If I were the nurse to receive this report, I would feel confused and uncomfortable. I would be confused as to what evidence she has to be making such accusations. The way the nurse is implying that this patient is participating in illegal activities is harmful to him and his family. I would ask if she asked the patient how to say his name and if he has any nicknames. I would then ask the nurse if she asked the patient about his injury directly rather than just reading the notes. I felt uncomfortable because I did not know how I would respond to the nurse. I would ask her for the facts politely to try to restrict her use of bias within the report. I am not sure I would address each of the comments directly as I would be trying to get ready for my shift and receiving reports from other people. I would put it in the back of my head to ask the patient directly to prevent these biased thoughts from affecting my quality of care. The best thing any nurse can do is ask the patients questions directly to better understand their lives.

I have recently witnessed a report between two prenatal care nurses about a new mother who had a lot of mental health issues. The nurse began to say “My four-year-old knows how to function better than her” and began to laugh. This made me sad as the patient did have Asperger, anxiety, depression, and was on the Autism Spectrum. Birth is a traumatic and hard event for all new mothers. It is important to realize that this transition from pregnancy to postpartum is emotional and can be very stressful. This may alter the new mother’s way of thinking. This patient in particular has preexisting mental health conditions that are managed at home therefore this eventful time was a lot for her to deal with. The nurse receiving the report giggled at this comment as it seemed to not phase her. I did not say anything at the moment to the nurse I was following as I felt I did not have the authority to say anything. Thinking back now, I realized that if it made me uncomfortable I should’ve told my clinical instructor about this interaction.

At the beginning of this course, my baseline views on gerontology in nursing were negative. I have not had much experience with taking care of the older population. I feel like my previous thoughts would be that these people are always upset about growing older and have negative views of the world now. My views on gerontology in my personal life are slightly different as I am comfortable around older people but have thought that they are always thinking about the future. I can understand now how their thoughts about the future can affect their mental health and subsequent views of the world. I have never thought about becoming a gerontological nurse. I have had my heart set on the opposite, pediatric nursing. I feel like part of the reason why is that children have no prior knowledge about the world around them and have a more optimistic perspective on the future. 

I feel like my views on how the elderly population is unknowledgeable have changed. I think as nurses it is our responsibility to educate and inform our patients about medications, procedures, diagnoses, etc. This is the same for all populations. Nurses can help the older community learn and grow as they can do the same for us. Everyone has a different perspective that we can use to learn from. I will use the information about sexuality, polypharmacy, and elder abuse that I have learned in this class in my conversations with my gerontological patients. I feel that I will be better prepared to facilitate health conversations about sexuality and support patients who have always wanted to be a part of the LGBTQA+ community. I hope to use the knowledge I have gained about the nurse’s responsibility of understanding medications and performing adequate medication reconciliations in my care of all older patients. Medications can greatly alter a person’s health and this is a way we can help them feel better. Lastly, I hope to be able to spot the signs of elder abuse to stop this dangerous cycle. I will be able to recognize the warning signs and properly report this issue. 

One of the main takeaways from this course is the importance of exercise on our health in the future. Exercise is a tedious act in my opinion since being in nursing school and having different priorities. This class has highlighted the ways exercise can minimize future chronic illnesses and enhance our well-being. I hope my legacy will be that I have always been kind, hardworking, and fully myself. I would like to be remembered as someone who is unapologetically themselves and has lived their life to the fullest.

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. 

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.

Since completing my medication reconciliation on my patient, I noticed that my biggest concern was with the patient’s lack of knowledge. She did not quite understand the potential complications that could come with taking these medications together. My patient had a difficult time understanding what to do in the case of an emergency and how to see the warning signs before it happens. The patient did understand what amlodipine and loratadine were for and how they could help. She did not know what the gabapentin and the haloperidol were for. It is important for the patient to know the purpose of each medication to be an advocate for their own health. She did not have multiple medications that did the same thing, but she had a few medications that had side effects that were similar to the purpose of her other meds. Amlodipine is to decrease blood pressure and haloperidol has a side effect of hypotension. These together may cause very dangerous outcomes such as the increased risk of falls, stroke, and organ failure. The patient did not know of this potential risk factor and was made aware when we conversed. I believe this conversation really helped my patient feel more comfortable and confident with her medication list.

In 2019 I created a 5k running and walking event that raised money for the PCD Foundation. I created this event from scratch for my high school senior project. I thought to connect two important aspects of my life which are exercise and my chronic illness. I have a lung disease called Primary Ciliary Dyskinesia. This is a genetic disease that affects the cilia in the respiratory system. Cilia are microscopic hairs that attach to the walls of the respiratory system that move mucus. PCD is when the cilia bend improperly making them semi-functioning or completely immobile. Without proper moving cilia, mucus builds up in the lungs, sinuses, and ears. Excess mucus causes chronic issues such as lung infections, sinus infections, as well as hearing loss.

Having a mild version of PCD has enabled me to help others by creating awareness and raising money for a cure. I organized a nonprofit 5K to benefit the PCD Foundation. Organizing such an event was very time-consuming however extremely rewarding. Family, friends, and teachers all showed up to support my cause. In the end, we had over 100 runners and I was able to raise $2,920 for PCD!

Throughout the year I have noticed a dramatic improvement in my critical reading skills. In high school, I was told to read and mark anything that I had a question about or thought could be important. I didn’t have any system or structure I could follow to make my notes meaningful. Once attending UNE I learned how to used different letters to categorize my annotation to help me use them later on in my writing. This system helped me write a more meaningful analysis. This also helped me find quotes in the reading to use faster therefore completing my essays faster. Understanding what I am reading has always been a struggle for me but I have found that my new system has helped me tremendously.