All posts by Brittany

23Apr/15

U.S. Disaster

NRS 420

The Joplin, Missouri EF-5 tornado of May 22, 2011 claimed 161 lives, resulted in over a thousand injured, and damages were an estimated $3 billion worth making it the deadliest tornado in United States history since 1947 (Wheatley, 2013; Smith, 2011). This deadly tornado significantly impacted the Joplin community’s access to care as it demolished nearly ½ of its healthcare resources including the St. John’s Regional Medical Center (Missouri Hospitals Association, 2014). Emergency responders, volunteers (from over 400 different organizations), federal, and state responders all arrived to Joplin following the tornado to scour debris for human life and brought patients to designated triage areas such as the Memorial center where critical care patients were being cared for in-between stadium seats (Missouri Hospitals Association, 2014).Socioeconomics played a role in the number of fatalities related to this event due to many lacking safe rooms which can cost $6000 to $8000 to build (Johnson, 2013). The Joplin recovery efforts were still in progress as of 2013 with the new building of homes, safe rooms, schools, and a new hospital (Johnson, 2013).

I cannot imagine being a healthcare provider during this incredibly stressful time however; I know that if I had lived in this area it would have been required of me to know the emergency operations plan (EOP) of the state’s healthcare facility (Missouri Hospitals Association, 2014). According to the Missouri Hospitals Association (2014), hospital severe weather plans implemented a watch status at 5:11 PM on May 22nd and all three area hospital’s moved patients into safer locations such as hallways. St. John’s Regional Medical Center immediately evacuated to neighboring hospitals as protocol stated (Missouri Hospitals Association, 2014). And all neighboring hospitals set up triage areas in all possible waiting areas and because of this all hospitals were able to properly triage the large influx of patients the first 24 hours after the tornado hit (Missouri Hospitals Association, 2014). I can only imagine what must have gone on in a healthcare provider’s mind during this time, thinking of the status of their loved ones at home and their children all while trying to care for their patients. I think the only thing that would have kept me calm and focused would have been the fact that my patient is someone’s mother, father, son, etc. and just as I would be hoping someone was helping my family, I know my patient’s family would be depending on me as well.

According to recent research, it appears states in Tornado country, especially Missouri, are currently making progress to increase their preparedness evident by the Missouri Hospital Association release of a document (in partnership with the Joint Commission )called “Preparedness and Partnerships: Lessons Learned from the Missouri Disasters of 2011: A Focus on Joplin” (Missouri Hospitals Association, 2014). And according to the Missouri Hospital Emergency Preparedness Assessment, hospitals have made significant progress since 2011 in areas such as planning, their national incident planning system, communication, and safety and security (although much needed progress still needs to be made regarding a structured decontamination plan (42%)) (Missouri Hospitals Association, 2014). Evacuation-specific lessons learned from the Joplin tornado include the installation of battery back-up lit stairwells and disaster equipment in ready to go bags (Missouri Hospitals Association, 2014). With the tornado demolishing the St. John’s Regional Medical Center, a new hospital called Mercy Hospital has been built and has been constructed to better withstand future tornadoes (Johnson, 2013).

 

References

Johnson W 2013 Progress continues 2 years after Joplin tornadoJohnson, W. (2013, May 21). Progress continues 2 years after Joplin tornado. Retrieved April 22, 2015, from http://www.usatoday.com/story/news/nation/2013/05/19/progress-after-joplin-tornado/2322167 20150422225539387434840

Missouri Hospitals Association 2014 Preparedness and partnershipsMissouri Hospitals Association (2014). Preparedness and partnerships. Retrieved April 22, 2015, from http://www.jointcommission.org/assets/1/6/Joplin_2012_Lessons_Learned.pdf 201504222250231861290455

Smith A 2011 Deadly Joplin tornado could cost $3 billionSmith, A. (2011, May 24). Deadly Joplin tornado could cost $3 billion. Retrieved April 22, 2015, from http://money.cnn.com/2011/05/24/news/economy/tornado_joplin/ 201504222245461039591432

Wheatley K 2013 May 22, 2011 Joplin, Missouri EF5 TornadoWheatley, K. (2013, May 22). The May 22, 2011 Joplin, Missouri EF5 Tornado. Retrieved April 22, 2015, from http://www.ustornadoes.com/2013/05/22/joplin-missouri-ef5-tornado-may-22-2011/

08Apr/15

End of Life

Uncategorized

Although this is a difficult topic for some to discuss, it is absolutely necessary. As nurses we are subject to seeing more death and dying in one year, maybe even one month, than others will see in a lifetime. I think because of this nurses build up this resiliance to death and dying and in many ways you have to. However, with that being said, it is important to retain your compassion, practice empathy, and always ask yourself how you would want to be treated if you were in that patient’s and family’s shoes?

Death and dying is really nothing new for me and is a conversation that was brought up very early in my engagement to my husband because at that time we were unsure of my mother’s chances of having Huntingtons Disease, as well as my own. I grew up watching the end stages of my grandmother and uncles lives and currently see my aunt’s struggle. The nursing care that my family received from home health nurses inspired me to become a nurse as they were able to bring comfort to my family members in a way I couldn’t. In addition, these experiences with death and dying made me think about how I would like to be cared for and  what interventions to prolong my life I desired. Nursing school has certainly provided me with some insight as well, as I would not want to be stuck in a long-term vent setting for the duration of my life. I think my mother would be the best person to make decisions for me along with a nurse friend who could provide my mother with some insight. My husband is not capable of giving up on anything in his life and certainly not on me, therefore he really wouldn’t be the best person to make health care decisions on my behalf.

I had the conversation again with my family this week asking about what they would want. My husband wants me to allow all possible medical interventions and would never want me to ‘pull the plug’ on him even if they said he was brain dead (even with a nursing student as his wife who was explaining to him that he was indeed dead at this point, he still refused to hear that I would let him go). My mother shares similar thoughts to my husband as she believes a miracle would eventually occur that would reverse these signs of brain death. It is funny how a conversation that is so serious can quickly change into a light-hearted conversation, and I had to ask each of them again in a serious manner to get a real answer in which they both replied that if there were zero signs of life and no possbility of coming back then they would like to be let go.

I continued to discuss end of life care with my mother and we discussed that the above response would be appropriate if this was an acute situation such as a car crash. However, my mother did say that if she were to suffer from a long term degenerative disease such as all her siblings she would not want the g-tube feedings, or any other interventions that would only prolong her mere existance (to which I share a similar view). I was able to finish the conversation by requesting my parents to fill out advance directives which they completed.

18Feb/15

Customizing cardiac implants

Uncategorized

While conducting research for this week’s assignment regarding the newest cardiovascular technology, I came across this great article discussing heart implants and them being “tailor-made” (Bourzac, 2014). Current cardiac implants, such as pacemakers and defibrillators, are not custom made as they are basically “one size fits all” (Bourzac, 2014, para. 1). The article discusses researchers who have created a personalized heart sensor using a 3-D printer and their utilization of a stretchy material to create a perfect fit that would increase the level of monitoring and treatment of cardiac implants (Bourzac, 2014). The stretchy material would increase the effectiveness of oxygen monitoring, strain gauges, electrodes, and temperature monitoring as it would be customized to the person’s heart (Bourzac, 2014). An interesting concept presented in the article is the idea of sensors being placed on cardiac implants that could measure acidic conditions (Bourzac, 2014). In addition, light sensors could be placed on this stretchy material and would “provide information about heart-tissue health by identifying areas with poorly oxygenated blood, which is less transparent to light,” and could ultimately identify the occurrence of a myocardial infarction (Bourzac, 2014, para. 5). I think any time we are able to customize a treatment, we are able to better serve our patients and this concept of 3-D printing will most certainly contribute to higher quality patient care.

References:

Bourzac, K. (2014). Heart Implants, 3-D- – Printed to Order. Retrieved from:http://www.technologyreview.com/news/525221/heart-implants-3-d-printed-to-  order/