As I look back on my journey I can not believe how fast it went. Even at rehearsal for pinning, I couldn’t believe that all these chairs and stage were for us. I remember how I felt the first day of nursing school as I felt overwhelmed with the workload and trying to find my way in the nursing world.

Before I started critical care I believe that it was just another rotation that I have to complete to graduation because my true passion was public health. During clinical, I was surprised that critical care held my interest and I looked forward to clinical. I remember feeling so nervous for my medical surgical clinical that I would be worried the whole day before. I felt my comfortable with my skills and taking the more of a leadership role. I believe that critical care gave me the confidence that I needed to start my care in a hospital setting. With every patient I had this semester I felt that I made a difference in the patient’s care by actively asking questions and wanting to understand the care of a critical ill patient.

I am currently excited, but terrified of the future. CSUCI nursing was my home for three years. I felt that I was supported by staff and created long lasting relationships that will continue to impact the kind of nurse I will be.

The Santa Clara Waste Plant in Santa Paula had a chemical explosion in mid-November 2014. The plant had mixed sodium chlorite and waste that caused an explosion. The mixture exploded when chemical introduced in a vacuum truck. Over 1,000 gallons of the material spilled, crystalized, dried and ignited into flames. The mixture was not identified when fire fighters went into care for the injured individuals of the explosion. Once the fire fighter trucks went over the mixture the tires began to burst into flames. The fire fighters and injured party were treated at the local hospital for inhalation injury, and rashes.

I believe some of the barriers for healthcare providers and providing care included dealing with an unknown chemical substance. If the environment is not safe for health care providers to be at it is almost impossible to expect the injured individual to be provided adequate care. Fire fighters responded to the injured individual, but caused more injured because the environment was not cleared before emergency responders charged into provide care. As a health care provider I feel that it would be better to neutralize the chemical first then to increase the number of individuals that need to be cared for by exposing myself. If the disaster occurs in the future health care providers should have a list of chemicals that were involved in the explosion.

After the explosion the 126 free way was closed down while detoured traffic and caused local schools to shut down. The plant made a pledge to clean up the spill and remain closed until they went through the proper channels for approval to be reopened. Environmentally, the effects of the mixture are still unknown because the sodium chlorite and waste made a new chemical. Socioeconomically, the plant employed hundreds of workers that lost their jobs when the plant shut down. These workers had to seek unemployment. I feel that we can continue to learn from this disaster.

Chen, T., & Goff, K. (2014). Dozens Treated After California Waste Plant Fire. Retrieved April 22, 2015, from http://www.nbclosangeles.com/news/local/Firefighters-Hospitalized-After-HazMat-Explosion-283059521.html

Wilson, K. (2015). Chemical that triggered Santa Paula blast . Retrieved April 22, 2015, from http://www.vcstar.com/news/local-news/county-news/chemical-that-triggered-santa-paula-blast-identified_47049879

My husband and I were in the car on our way to visit family for Easter, I looked at him and asked him what he would want for end of life care. I tend to bring up random topics during our car rides, but this particular topic took him by surprised. He asked me what I meant by end of life care. I knew I had to be more specific with the topic. I started by asking him if he would want me to  make health care decisions for him if he was in a state he could no longer do it for himself. His response will be with me forever. He told me that he trusted that my decisions for his care would be out of a place of love and years of knowing how he would want to live his life. I was deeply touched by his response and I knew that I felt the same. We both had to lean on each, when we  have lost loved ones in the past, but it did not prepare us for talking about the death of each other and I knew it was important for us to explore our feelings.

Our wishes and desires were similar. We both had buried loved ones in cemeteries and felt that even though our loved one’s physical bodies were there, we did not feel that their spirits were. We both agreed to have our ashes spread in a location that was filled with happy memories we both shared. Additionally, I brought up the option of donating our organs. I explained to him that the pink sticker on our drivers license that states “organ donor,” will over ride any feelings of opposition he may have to donating my organs. He then expressed how he would honor any wish I had to donate my organs. I told him that I wanted to specifically outline how my body was going to be donated. I wish not be used for research, because I still want a part of me to remain with him. The conversation during our car ride was harder than I originally thought it would be. The car ride showed me that this should be one of many conversations to come and that both my husband and I should set aside dates that we would begin to outline an advanced directive. I feel that this conversation brought us closer. I am starting to realize the importance of an advance directive beyond advocating for my patient’s wishes to be up held, but to make these situations easier for my loved ones.

It was interesting to find out how much my family and friends knew about their medications. Many of the responses I received entailed that they knew what the medications was for and when to take their medications. One of my friends knew that medications, the purpose and time to take the medication, but was unaware of any of the side effects or what to do if they miss a dose. Another friend of mine was visited her primary physician and was sent home with codeine and a cough suppressant. My friend was not aware that the medications would cause her to be drowsy and only knew that the medication was to help her cough. I have also noticed that many of the questions with my family’s medications begin to form when they begin to take the medications at home. My family would have questions about what do when they miss medications or what they should do if they developed specific side effects of the medications.

Additionally, my family had developed their knowledge of medication through generations. A family member of mine is notorious for pulling medications from multiple bottles and putting them all in another bottle. When she offers me Tylenol I will only take the medications if it is in the labeled Tylenol bottle. It scares me when I see her pull out her bottle of medication that had many other medications mixed in the bottle and she is trying to distinguish between which medication is an over the counter medication and what her prescription. There was a time she gave another family member one of her prescription medication by accident. It was fortunate the medication did not have any damaging effects on the other family member, but it could have. Upon asking that family member about their medications they were unaware of the interactions between over the counter medications and prescriptions. She was aware of the indications, side effects she has experienced and when she should take her medications. This way of medication management can be seen through multiple generations in my family. I hope with my educational background I can alter those practices.

Due to the advancements of technology, Jenna and I thought it would be beneficial to research current cardiac applications available on our smart phones from the patient’s perspective; HeartDecide was quickly discovered. This free application, available for all Apple products, introduced an all-encompassing cardiovascular easy-to-use tool for patients to understand their respective cardiac anatomy, conditions, and procedures. Although this application was released in 2012 by Orca Health, Inc. at Harvard University, it is continuously updating its information with a copyright date until 2015. Once downloaded, the user has the option of entering the application as a doctor, nurse, or patient. We reviewed the information as if we were a patient, browsing to find a specific medical condition. For instance, we searched “heart attack” via the “conditions” tab and found a simple video lasting 1 minute and 32 seconds. In addition, there are written materials provided after the video by swiping the screen to the left. Here we found a frequently asked question and answer section detailing “what is a heart attack,” “what causes a heart attack,” “what are the symptoms,” and “how is a heart attack treated.” Furthermore, there are numerous conditions available to search such as angina, atherosclerosis, atrial fibrillation, sudden cardiac death, heart failure, and many more. We both believe this to be a great informational tool for patients in order to understand more about their clinical condition.

HeartDecide can be used as a supplemental tool to the education provided by the cardiologist. Often, when patients are newly diagnosed with a cardiac condition or a trauma occurs, they are not able to fully comprehend and/or process the education provided by the clinicians. They can learn great detail about their condition(s) on their own time once they are psychologically prepared to do so. Therefore, we highly recommend this application to all clients with a cardiac condition <3