This week has been really bittersweet for me, as I have been reflecting on the fact that we are finishing our education and entering a new chapter of our lives. I will miss the close friends and support system that we created for each other, the long nights of studying and becoming hysterically delirious as the hours go by and sleep deprivation increases, the stressing over care plans and exams…yes, I will actually miss these to some extent because their disappearance also represents the end of something good. But now we are each starting our own nursing journey independently, and there is also something incredibly special and exciting about that. As I am writing this final blog post, I’m thinking of what has impacted me the most this semester in regards to critical care, and I think that I have realized that now we each create our own nursing practice. Before, we were guided by academia and our faculty…but now we are new graduate nurses. I have seen some nurses treat patients and approach patients in a very rude and unprofessional manner in every semester of nursing school, and there will always be a few nurses like this. Critical care is a unique specialty that blends a high level of critical thinking and pathophysiology knowledge with a need for knowledge of public health and case management, and that is why I love the specialty. Patients in critical care and their family members are vulnerable, and need a higher level of emotional support in this time of crisis. So, there is an even greater need for nurses to be sensitive, communicative, and excellent healthcare providers for these families. So as new graduate nurses, each of us needs to make the choice. When someone asks me what kind of nurse I want to be, rather than replying what specialty I am interested in, in reality I want to say, “I am the kind of nurse who will give my patients excellent care regardless of what others may be saying or thinking…I am the kind of nurse who will not criticize patients behind their back…I am the kind of nurse who will hold your hand even if you don’t “deserve” it…I will work hard to gain more knowledge and skills to know how to care for you safely, and I am committed to your care, because I am that kind of nurse.” As student nurses, we are limited to some extent when we see nurses we work with treat patients with disrespect or provide suboptimal care. But now, we have the power to really make a difference and even change the culture of a unit that we work in. Critical care is what I want to do, but the above statements represent the kind of nurse I want to be. There is a difference. And that is what I look forward to as I begin my own nursing journey.

The earthquake that occurred in Nepal this past Saturday, April 25, 2015, impacted this country significantly. This event especially struck home for me, because I have friends who are Nepali refugees; otherwise, I may not even have heard of this very small country that is tucked between India and China. As I researched this event in more detail, I became increasingly aware of the tremendous need for healthcare providers to respond; this country is very poor with approximately 25% of the population living below the poverty line, and consistently experiences economic imbalances (CIA, 2015). In addition, many regions of the country are rural, transportation is difficult and unpredictable, and power outages occur frequently. So far, the death toll as of today, Tuesday morning, is over 4,300 confirmed (CNN, 2015). Again, due to the difficulty with communication from the more rural areas, which were actually closer to the point of greatest impact associated with the earthquake, officials cannot yet determine deaths/injuries in these regions. Due to the fact that the structure and function of several healthcare facilities were compromised, CNN reported that there is a lack of facilities for necessary medical and surgical operations, which prompted providers to use locations that are not normally intended for surgery…which then increases the risk for infection (2015).  Earthquakes cause a significant loss of resources, with typical results being loss of electricity and water. Over 8,000 individuals so far are reported injured, and existing facilities are overwhelmed (CNN, 2015).

Typical injuries include TBIs, upper and lower extremity fractures, and pelvic fractures; due to the possibility of delayed care and insufficient personnel (responders are still retrieving victims from the rubble), there is the potential for hemorrhage and infection to cause death even if the initial injury is not fatal (CBS, 2015). Surgical equipment and antibiotics to combat infection are necessary supplies that are in severe shortage currently. A lack of sufficient water not only increases the risk for dehydration in the absence of injuries, but also can make crush injuries worse (renal dysfunction) and exacerbate medical comorbidities. Inhalation injuries from smoke/debris, tetanus infection, and communicable diseases (from lack of sanitation and crowded makeshift housing) are expected to be a significant concern as well.

Initial international responses to Nepal were actually delayed due to concern of possible aftershocks. Over 16 other countries have demonstrated aid with both financial means and sending people to help the existing structure. India, being in close proximity and also affected by the earthquake, has demonstrated particular initiative in sending aid to Nepal (CNN, 2015).  So far, organizations who have responded to this crisis, besides the national providers, include Red Cross, UNICEF, and various international search/rescue teams, with more aid expected.

The expected outcome is currently unknown, but Nepal will likely struggle to recover from this event due to the country’s pre-existing insecure economic and healthcare condition.

References:

Cable News Network (CNN) (2015). Nepal earthquake’s victims overwhelm hospitals. Retrieved from http://www.cnn.com/2015/04/27/world/nepal-earthquake-bir-hospital/index.html

Cable News Network (CNN) (2015). Nepal earthquake: India leads massive aid effort to help survivors. Retrieved from http://www.cnn.com/2015/04/27/asia/nepal-quake-india-aid/index.html

CBS News (2015). Medical crisis in Nepal in earthquake aftermath. Retrieved from http://www.cbsnews.com/news/medical-crisis-in-nepal-in-earthquake-aftermath/

Central Intelligence Agency (CIA) (2015). The World Factbook: Southeast Asia: Nepal. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/np.html

My family is fairly well educated and able to search out the information they need when self-administering. However, there are still typically gaps in knowledge due to a lack of understanding of foundational aspects of pharmacology and pathophysiology. I have one family member who is on many medications, and she is actually highly motivated to educate herself; she knows most of her medications fairly well. However, there are certain aspects of which she is not aware and so I’m careful to ask her questions pretty regularly about which medications and doses she is taking currently. Some months ago, her physician changed some of her meds and forgot to add a potassium sparing diuretic to her medication regimen, which includes Lasix and Digoxin…and her labs that week indicated K+ of 3.4. Since she was not aware of the implications regarding potassium, I had the opportunity to educate her on signs of hypokalemia and Digoxin toxicity, and on the need to supplement her diet with potassium until her physician came back from vacation and could correct her medication regimen.

In terms of homeopathic and “natural/herbal” medications, I find that even my friends/family who are knowledgeable about the broad spectrum of supplements do not base their beliefs on evidence, but simply what is reported by respected individuals or magazines; there is a strong media influence on adoption of these supplements into a person’s lifestyle. They are especially not aware of the act that these natural supplements can interact with most medications, the most serious of which include the anticoagulants and anticonvulsants.  I have also found that this is the most difficult education in terms of meeting resistance.  Some of my family members will keep using homeopathic medications despite my explanations.

In conclusion, in addition to educating our patients in the facility, there is a need for us to ensure that those closest to us are practicing caution with the medications needed for their health. I am grateful for the opportunity to be a resource to my family and friends in this way; even if I do not know the answer, I know where to find a good source that can offer an explanation.

In researching for this assignment, I came across two articles of interest, one that describes attitudes of geriatric individuals on mobile health technologies in association with warfarin therapy, and the other, which sought to determine (through literature review), which telehealth methods were most effective for medication adherence and improving clinical outcomes (Granger & Bosworth, 2011; Lee et al., 2014). These telehealth methods include automated alerts sent through cellphone texting capability to remind patients to take their daily medications, refill reminders, nursing education audio-recorded and sent to patients, and digital medication reconciliation) (Granger & Bosworth, 2011). The reason that I wanted to read both articles is because when we talk about technology, which is easily accessible and somewhat simple to maneuver for many people, there are a few populations that we must consider as we move forward with these up-and-coming technological advancements in nursing education and patient support. 1) Our geriatric patients may be intimidated by unfamiliar technology and as mentioned in the article, require a great deal of support and positive reinforcement from both the healthcare professional and their family in order to be successful and consistent in using telehealth (such as cellphone automated alerts for medication administration reminders, etc.) (Lee et al., 2014). As nurses, we need to be conscientious of individual needs and remember that we feel the same way when we are trying to learn something new. 2) Low-income populations do not have the same access to technology that many of us take for granted; while medication adherence is a significant public health problem due to the prevalence of cardiovascular-related conditions such as uncontrolled diabetes mellitus and heart failure, individuals without financial means to even purchase their medications may not have the means to own an expensive phone to engage in some of the newer technology that improves medication adherence. Therefore, creativity is needed to reach out to both these populations. The best results in regards to medication adherence and improved clinical outcomes were those that combined mobile reminders and face-to-face interaction; methods that only used mobile phone reminders did not improve adherence or outcomes (Granger & Bosworth, 2011). Therefore, our challenge is to find the best way to help patients gain access both to personal care, and new technology such as automated medication reminders in order to improve their outcomes and quality of life; what is wonderful about nursing is that we can continue to practice in the best of both worlds by incorporating technology into our personal nursing care.

References:

Granger, B. B. & Bosworth, H. (2011). Medication adherence: Emerging use of technology, Current Opinions in Cardiology, 26(4), doi: 10.1097/HCO.0b013e328347c150

Lee, J., Nguyen, A. L., Berg, J., Amin, A., Bachman, M., Guo, Y., & Evangelista, L. (2014). Attitudes and preferences on the use of mobile health technology and health games for self-management: Interviews with older adults on anticoagulation therapy, JMIR Mhealth Uhealth, 2(3):e32, doi: 10.2196/mhealth.3196

NRS 420 Likes and Dislikes

Likes: As I reflect back on how far we’ve come in the nursing program, I am amazed at the growth I have witnessed both in myself and my fellow soon-to-be-nurses! This semester is exciting for me mainly because I look forward to “putting it all together,” and integrating all the knowledge that I have gained thus far. Last semester, each of us was able to successfully create change through nursing leadership, which we will continue to emphasize with our EBP policy paper. In NRS 420 and the corresponding clinical rotation, there will be an increased focus on case management and further development of the entire nursing role.  In addition, I am excited for this course because critical care is the specialty I am most interested in pursuing, and therefore, I look forward to exploring the characteristics of critical care and learning as much as possible to effectively care for patients affected by complex health conditions.

Dislikes: Unfortunately, I am very resistant to unfamiliar technology, and am not particularly gifted in this area. Therefore, the blog and unique online requirements of the course will be challenging for me. However, with that being said, technology is a necessary part of nursing practice and I also believe that challenge is a necessary and beneficial part of life in order to stimulate growth, and so I appreciate the opportunity to develop new skills. Although I am struggling a little with the blog, I am excited for the Voice Thread digital storytelling assignment; the interactive capabilities of Voice Thread combined with the opportunity to illustrate a patient case study will be fun!

In conclusion, although I start every semester with a little apprehension as I determine how I will find balance between class workloads, personal commitments, and my work schedule, I am so thrilled to be entering the last semester of nursing school and look forward to graduation in May with such an amazing group of people!

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