Getting out of clinical this past Sunday, I knew that it was the last day of clinical ever, but for some reason it didn’t really hit me as the end of nursing school. I went to class on Monday and still, it just felt like another regular week of school. It wasn’t until Tuesday night, when I sat with my group to finish up our presentation that it really hit me, this will be the last assignment, no more late nights, no more coffee runs before school, and no more class time. As I sat there, I couldn’t help but remember the first semester during pathophysiology. The room filled with unfamiliar faces, strange personalities, and now, three years later there is nothing weird about sitting with my group members, expressing our opinions about which direction we want our project to go. The change is unreal. We have come so far, overcome boundaries, shared tears, worked on countless projects, called each other during joyous and stressful occasions, and to think this will all be over soon is so bittersweet.

This class has been such a learning experience. It was more than just focusing on all the critical care content, using technology and blogging came as a pleasant surprise. I never knew how much I would enjoy blogging; it sure does make blackboard discussion board look bad. Thanks Jaime! I think this was a great way to end our nursing education, venturing into the vast world of technology, which can be scary and so beneficial at the same time.

Coming in three years ago I knew it would be challenging for me, as I am not the most outgoing or loudest person in the room, but I thank the instructors and above all, my classmates for making me feel at ease with them. Now, there is nothing I am afraid of, we came together for this experience, shared failures and successes, laughter, and that is something I will always cherish. Cheers to the memories that have past and to the memories that are to come! I love you all!

The disaster I chose to discuss is the earthquake that occurred in 2010 in Port Au Prince, Haiti. It was a 7.0 magnitude earthquake that affected the southern part of Haiti. Haiti is considered a third world country where poverty and limited resources are very common. Although it occurred over a great distance, the impact was felt internationally. On the date of January 12, 2010, and the following weeks and months, the death toll estimate ranged from 230,000-316,000, 300,000 were injured, 85,432 individuals were displaced, and help from all around the world was centered on this country. A review on the event by CNN five years after the earthquake determined that billions of dollars have been utilized in efforts to restore their country. Many organizations including The Red Cross, the Peace Corps, the U.N., Habitat for Humanity, and more played a role in the restoration of Haiti either by traveling there and providing support or by raising funds. Personally, the reason I chose this disaster is because I was fortunate enough to travel to Haiti in 2012, two years after the incident as part of a medical group with International Service Learning (ISL). Although we did not travel into the city for safety purposes, it was evident how much of an impact the earthquake had on the rest of the country. Our group traveled to little villages on the border between Haiti and the Dominican Republic, and everyone we spoke to was affected by the earthquake, just about every family knew someone that lived at the capitol since many family members migrate there with hopes of finding jobs and more opportunities that the little villages do not provide. While we talked to the villagers on occasion, it was evident that they were distressed about not knowing where their family members that had moved to the city were or whether they were still alive. It was interesting to observe how different their life style was compared to ours in the U.S. we might have the luxury of contacting hospitals, police stations, or even fire stations to look for our loved ones in case of an emergency, these individuals did not even have a phone or any form of communication or transportation to go and look for their loved ones that possibly were affected by the earthquake. Through our work with this country, we observed the great impact of cholera post the earthquake incident. Individuals were banned from using water from local streams and rivers due to the great possibility of obtaining cholera, a deadly bacterial disease that may cause dehydration and diarrhea. In the U.S, we may think how hard could it be to treat cholera? Well, in a third world country such as Haiti, sometimes their only source of fresh water is from these cholera-infested streams. Then, when its times to get treatment, there is no access to health care (such as in these small villages), or when there is access there is no money to pay for treatment, so as a result many people ended up dying as a result of cholera after the earthquake.

An impactful story I heard from one patient we were treating in Haiti was that her child had become infected so she attempted to travel to the nearest medical center, which was across the border in the Dominican Republic (3 hours away). She traveled on foot to the border, which is identified by a large river, a bridge, and a chain blocking the entrance into Haiti at the end of the bridge, guarded by a heavily armed military man. She begged and pleaded to the guard to let her cross as her child was sick and she had been traveling on foot for many hours. The guard was not compelled. She contemplated crossing the river, but knew it would make it worse since it was probably infested as well and the guards would probably catch her anyways. She returned every day, but ultimately her child ended up passing, probably from dehydration. It is sad to think that no matter how many billions of dollars were donated from many countries, it was not enough to help the residents of Haiti.

Some barriers identified that prevented Haiti from obtaining help were lack of resources, lack of proper money handling from the superiors of this country, and no proper infection control. Although I would like to say that we would be better prepared for the next international disaster, it is a difficult situation when we are 100% prepared but the resources from the country that needs relief are minimal. I believe the United States is very prepared for most situations, but when the number of people needing help surpasses the amount of supplies and providers, it is evident that many individuals will die or suffer terrible consequences resulting from inadequate resources.

After working several years for a home health and hospice agency, I have cared for several hospice patients and have developed a deep appreciation for hospice. Ideally, I would want to go experience end of life in the comfort of my own home with hospice services. Realistically, however, death can occur in many forms and in emergency situations, I think the best person to help make decisions for me would be my fiancé, or a close friend that can make informed decisions. I believe that culturally, my family being Latino have traditionally relied on family members to help support one another on decisions like these, and without a doubt my family would appoint either their significant other, a sibling, or children as proxies. I have had discussions with my family members about end of life care, but have not officially completed advanced directives. I think as I continually bring up topics like these, my family has become more comfortable discussing this topic and it has become easier to have a serious conversation regarding end of life. When I tried talking to my family members about my personal decision of who my proxy was, they were a bit surprised to discover that I had not selected my parents as proxies. I believe it goes back to the cultural aspect of always using family members. I have decided to appoint a close friend, and my family was very surprised that it was not a family member, but they do understand my reasons.

It was clear within the first few minutes of speaking to my aunt that the common person does not know much about medication. Luckily, she is pretty healthy and only has hypothyroidism, for which she takes synthroid. When I spoke to her about her medication, she did know what she was taking it for but was not aware of possible side effects or other significant drug facts. I also asked her about regular over the counter medications she takes or has taken such as the very common Tylenol. She was not aware that Acetaminophen meant the same thing or its possible side effects. More importantly, she did not know about withholding it when taking other medications with acetaminophen. It was a big eye opener, I couldn’t help but think that here I am with so much knowledge gained throughout the nursing program and I have not yet attempted to share my knowledge about things so simple yet so significant. Perhaps sharing our knowledge just for fun might actually be beneficial to some people, we can never assume what they do or do not know.

I found this article that studied predictors or risk factors for readmission after a CABG surgery. The study was done in 2011, and they determined post CABG readmission rates remained high. Consequently, this was a big problem since the procedure itself is expensive and the possibility for complications that influence readmissions are vast. Additionally, the readmission will ultimately not be covered if it falls within the 30 day limit established by medicare after the surgery, which further emphasizes the importance for nurses to be vigilant for possible complications or risk factors that indicate a complication. In 2004, hospital readmissions accounted for about 17 billion dollars out of the total 102 billion dollars paid by medicare that year. One can only imagine how those numbers are duplicated to present time. The results indicated that the most common reasons for readmission after a CABG were infection, heart failure, and other complications of surgical or medical care. As nurses, we  are responsible for preventing such occurrences. some ideas are to assess for complications, assess for comorbidities that can further cause complications such as Diabetes Mellitus. in situations like these, education is key! Educate and stress to the patient about the importance of proper glycemic control and the repercussions of failing to do so. Regarding heart failure, we can further educate the importance of following a drug regimen that is prescribed to them as well as emphasize the importance of contacting a physician in case they feel something wrong or if we detect the regimen is not functioning.

Source:

Hannan, E., Zhong, Y., Lahey, S., Culliford, A., Gold, J., Smith, C., et al. (2011). 30-day readmissions after coronary artery bypass graft surgery in new york state. Journal of American College of Cardiology , 4 (5).