Wow! I can’t believe this semester is almost over! Actually, the last three years have truly flown faster than I had ever expected. It is true what the students from prior semesters and faculty shared with us at our first orientation regarding the cohesiveness and strong bonds we would form with one another by the end of the three years. It is strange to think that we all sat together in a room three years ago, and didn’t speak or know one another. It feels as though we have become a family – in the truest sense of the word, with all the ups and downs all families experience.

In reflecting on my learning this semester, I can’t help but think of the large role technology has played. I remember sharing in our first ever blogpost that I was slightly skeptical about the idea of forming an “online identity.” I also felt skeptical about reconstructing our way of learning and shifting to a lot of voice thread, blogposts and videos. I have to say however, that I personally felt like I learned a great deal more after transitioning over. Additionally, I felt more efficient when creating voice threads, recordings and videos and felt that a significant amount of learning took place in a shorter amount of time. When I look at my growth over the span of three years however, it is remarkable to see myself as a completely different person.

It is almost strange to think of myself 3 years ago, before having learned as much as I have. I remember being told our first year that the program was designed like a spiral staircase, where each year we would have the opportunity to build on those things we learned the first time around. As I entered critical care, I was able to see how true that statement was. This semester I was able to utilize the concepts I had worked so hard to learn our first and second year and adapt them to the new material we were covering. Although I know that there is a large learning curve up ahead after graduation, I can say I feel confident to confront it. I feel I have learned a lot – but more importantly I now know where and how to access the resources needed when I come across something new. I feel prepared to move on to the next chapter as I develop my skill set as a novice nurse and put into action the values and knowledge I have gained from this amazing institution. On to a new adventure!

On November 8, 2013, Typhoon Yolanda swept the Philippines and is still considered the most powerful storm recorded in history. The devastating outcomes of this storm left the country with millions of dollars worth of damage. Although the storm lasted only one day, its winds, reaching speeds of greater than 250 km/hr, ravaged several cities in Central Philippines(WHO, 2013). As a result, there were 6201 deaths, 4.1 million people were displaced, 1.1 million homes damaged and 16 million people were affected (USAID, 2014). Government preparations began three days prior to the storm’s arrival and included preparing and allocating food and relief items, evacuation, and healthcare and rescue personnel deployment (GovPh, 2014). Despite these preparations, the aftermath proved the country to be ill-prepared for a storm of this magnitude. Both government aid, the World Health Organization (WHO) and the United Nations Disaster Assessment and Coordination (UNDAC) responded in an effort to provide much needed supplies and aid to the country (WHO, 2013). Emergency kits were provided to cover basic health needs of 120,000 people and 400 surgical interventions. Additionally, international support came in form of medical teams and hospitals to provide emergent care to the country’s wounded (WHO, 2013).

In addition to destroying homes and uprooting trees and telecommunication equipment, the storm destroyed all hospitals. Road blockages and lack in emergency relief stations and shelters posed a significant barrier in the response to the disaster. Both air ports and sea ports were closed, which further contributed to a lack of access to care and responders. On November 22, 2013, 14 days after the storm hit, one million food packs and more than two hundred thousand liters of clean water were distributed to the areas affected (GovPh, 2014). By this date, almost one thousand aid centers were established. The Philippines continues to see the effects of the catastrophic storm a year later as they finally transition out of the emergent humanitarian relief phase to the rehabilitation stage (USAID, 2014). Although the country anticipates and prepares for an expected amount of storms each year, it was clear that this catastrophic event required a significant amount of preparation. Humanitarian funding totaling $87,735,775 as of February 18, 2014 was reported to help significantly in the country’s initial emergent phase (USAID, 2014). The country’s low socioeconomic status certainly affected the initial access to resources and continues to be an issue plaguing citizens today. As mentioned in the USAID report (2014), the country’s economy depends heavily on the production of coconuts, thus affecting the livelihood of more than one million coconut farmers after the storm destroyed 33 million coconut trees. Lingering public health concerns associated with the storm include the shortage of dengue fever prevention and treatment, immunizations, mental health and psychosocial support (USAID, 2014).

As I imagine myself as a healthcare provider, I can see the hopelessness one might feel amidst such a catastrophic event. I can only imagine the desperation and overwhelming feeling as one of the only healthcare providers with thousands of severely injured people to help. Knowing you can only do very little with the limited resources and without a rescue shipment in sight would only deepen the desperation one might feel in the wake of such a calamity. Days seem like years in these instances, and although aid finally arrived, it proved to be too late for so many. The Philippines has since focused on disaster preparedness by establishing projects making the Eastern Visayas less vulnerable to typhoons and preparing with sufficient food, medical kits and generators. In May of 2014, government agencies and private organizations launched an application that provides satellite images and high resolution hazard maps to be used in rehabilitation efforts in the Philippines (GovPh, 2014). Although the Philippines has made great strides in rehabilitating since the storm, it still is unprepared to face another of such a magnitude as it is still working toward re-establishing to its baseline function. I think it’s important to consider however, that as healthcare providers we must be prepared for possibility of such an event occurring in our own state or country.

References:
USAID. (2014). Fact Sheet #21, Fiscal year 2014. Retrieved from http://www.usaid.gov/sites/default/files/documents/1866/philippines_ty_fs21_02-18-2014.pdf
WHO. (2013). WHO responding to health needs caused by Typhoon Haiyan (“Yolanda”). Retrieved from http://www.who.int/mediacentre/news/releases/2013/typhoon-haiyan/en/
GovPh. (2014). Typhoon yolanda a year later. Retrieved from http://www.gov.ph/crisis-response/updates-typhoon-yolanda/

This week’s exercise truly gave me a greater appreciation for patient education in nursing. I took this opportunity to ask my family members about specific medications that are commonly used such as Tylenol, Advil, Aspirin and Insulin. I was surprised to find such a limited knowledge about commonly used medications. I found that many in my family honestly believed Tylenol and Advil to be the exact same medication. My husband for instance, only knew that you take Tylenol for headaches, and “are not supposed to take Advil before working out” according to his high school cross-country coach. When asked about common side-effects on Tylenol and Advil, all of the family members I asked could not come up with any. However, Aspirin tends to be a better known medication in my family it seems. Both my mother and husband were aware of common uses of the medication, such as heart attacks, heart conditions and common side effects, such as bleeding. Although most of my family members understood the use of insulin, they did not know the various types of insulin and potential adverse effects. I really enjoyed completing this assignment, as it gave me a better understanding of baseline knowledge our patients might have in the clinical setting. It also gave me the opportunity to open-up this discussion with my family and practice educating. The assignment also reminded me how unrealistic it is for a patient to be sent home without a proper explanation of each medication prescribed. If my own family members, who have regular contact with a health care professional, know so little about common medications, there is no doubt in my mind that many others know even less. I hope that as I enter the nursing field, I am able to use the knowledge I’ve gained throughout this program to educate my patients about the treatments they’re being prescribed.

Aortic valve replacement continues to be rejected in patients over 75 years of age and who have severe cases of aortic stenosis. This procedure is considered far too risky, with poor health outcomes (Rozeik et al., 2014). However, technological advancements have made it possible to revolutionize the placement of an aortic valve, which is generally performed under open heart surgery, to a less invasive procedure. The transcatheter aortic valve replacement (TAVR) procedure allows for a valve to be placed percutaneously and makes it possible to avoid open heart surgery altogether (AHA, 2014). Similarly to stent placement, TAVR replaces the old valve through a catheter without having to remove the old one (AHA, 2014). Once the new valve  expands, it pushes the old leaflets out of the way and begins to take over as follows:

Although the procedure is currently only FDA approved to use in high risk patients with severe aortic stenosis, it is incredible to know that there is now a solution for those who were previously denied treatment. Technological advancements continue to revolutionize both the science and art of medicine. Although the procedure is not free of possible complications, it does have a shorter recovery period (3-5 days) as compared to the alternative open heart surgery (AHA, 2014). In one case, a high risk patient with severe aortic stenosis previously turned down by a multitude of surgeons underwent TAVR and immediately saw a transvalvular pressure gradient decrease of 24 mm Hg and a 3% improvement in ejection fraction indicating promising outcomes (Rozeik et al., 2014). Although this procedure continues to be performed in selective facilities, it is promising to know that one of our own local community hospitals, Los Robles Hospital and Medical Center, is currently pioneering it (Los Robles Hospital). I look forward to witnessing and taking part in the revolution of medicine that technology has allowed us to have!

References:
Rozeik, M.M., Wheatly, D.J., Gourlay, T. (2014). The aortic valve: structure, complications and implicationsfor transcatheter aortic valve replacement. Perfusion, 29 (4), 285-300.

American Heart Association. (2014). Retrieved from http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/What-is-TAVR_UCM_450827_Article.jsp

Los Robles Hospital. Retrieved from http://losrobleshospital.com/service/transcatheter-aortic-valve-replacement-procedure

State a team name, letter of your group (A-F), and describe the reason the name was chosen:
Group 11 (Nikki, Carl, Janine)
COPD – we chose this name because it is the disease we chose to highlight in our project

Group Meeting time(s) and location(s) for the duration of the semester:

Jan. 28 – Broome Library – delegated first portion of project
Feb 8 – Deadline for voicethread outline and powerpoint on Googledocs
Feb 13 – Nikki’s home – recording voicethread/PPT for 1^st part of project

March – TBD
April – TBD

Role of each group member (Are there roles? Or delegated tasks?):

Nikki – Leader
Tasks: Voicethread assignment – Patho/Presentation of disease
Carl – Recorder/Online coordinator
Tasks: Voicethread assignment – Interventions & related complications to disease process

Janine – Researcher
Tasks: Voicethread assignment – Pharmacological interventions

Who will lead each meeting? If you will rotate, detail how this will occur?:

Nikki Ives

Who will take minutes and record action items? If you will rotate, detail how this will occur?:

Carl Eisenthal

What will your process be for dealing with group members who miss meetings or who are late? How will you address first time offense and repeat offenses? Will the discussion happen one-on-one or as a group?

-Missing meetings or being late is understandable with proper reason.
– First time offense will be excused and we will try to work on scheduling around
everyone’s schedule
– Repeat offenses will be communicated with member of the group alongside
all the members of the group
– If it is merely difficult to meet based on differing schedules we will attempt
to meet evenings utilizing Skype

What will your process be for dealing with distractions (side bar conversations, cell phone conversations, etc.) during a meeting? How will you address first time offense and repeat offenses? Will the discussion happen one-on-one or as a group?

-If a group member does not fulfill their assignment after expectations have been
communicated, an extension will be made so that they may be able to turn in
their portion of the assignment in time.
– If the offense continues, other group members will have to step in to complete
the assignment to receive credit by instructor. However, the group member’s
failure to cooperate and meet deadlines will be communicated to the professor.
The amount & quality of work (or lack thereof) will be evaluated by the group
alongside Dr. Jaime Hannans to designate the grade this group member merits.

What will your process be for resolving conflict within the group? Will the discussion happen one-on-one or as a group?:

Conflict will be resolved using discussion and compromise by all group members. If conflict is due to a group member underperforming, the process mentioned above will be utilized. Discussion will occur as a group and will involve respect of all group members and their opinions.

List any other applicable group norms that your group committed to:

It was agreed by the group that constant communication and early deadlines will be set throughout the course of the semester. Group deadlines will be prepared far in advance of the class deadlines in order to control any unexpected complications. All group members agreed to respect the early deadlines and each others’ opinions.

First and Last Name of all group members: 
Nikki Ives
Carl Eisenthal
Janine Villanueva