November 2020 – Becca's Site

Ethical Considerations for EBP

Prior to completing the ethics assignments, I wasn’t sure about much about the nurse’s role in ethics. I assume that nurses would want to be their patient’s best advocate in the entire process, so I’m curious if they would be more cautious with informed consent and weighing possible risks and benefits for them because of that. Since the nurse has arguably the most time at the bedside with the patient, they most likely would gather the most evidence if a project was implementing something in that setting. Prior to this class and watching videos from other chapters, I didn’t know that nurses were a part of the research role and could even come up with possible PICOT and ideas to better their facility and patient-care. I believe nurses will always keep their patient as their top priority and depending on the style of the study will need to be aware of maintaining confidentiality and respecting the research study and only providing what information the patient is allowed to know to them. Nurses could also answer any questions that the patients have throughout the process.

Completing these ethics assignments has broaden my view on how much of an impact nurse’s have to the ethical side of research. The most eye-opening was the movie Miss Evers’ Boys since that went into detail to the story of the Tuskegee experiment and the impact it had. The role of the nurse portrayed by the character Eunice rides the fine line between wanting to protect the nature of the study but yet provide accurate information on treatment to the patients some of whom are her friends. She was forced to withhold information from the patients about how this was still a worthwhile study to be a participant in even though Penicillin had already been found to be a valid treatment for Syphilis. This example shows how it may be difficult to treat certain patients, especially in this case when the morals of the study weren’t strong to begin with. Nurses should be aware of the history of ethics in order to self-reflect and analyze our own morals prior to possibly participating in a research study. With the many checkpoints now that research studies have to go through now there is a much slimmer chance for anything unethical like this to occur again. This course has introduced me to the basis of what nursing research is and what is possible to attain in my career. I will continue to gain knowledge in the next EBP course and get more confident in my research skills. I have enjoyed broadening my skills of using research engines through this course and learning how to make searches more specific.

Mental Health Simulation

Before this simulation day, I was somewhat nervous due to the fact that we had yet to have had experience in working with mental health patients in person due to our virtual simulation for this course. From my experience in undergrad with simulations with live actors, I knew very well that any plan made ahead of time with questions or a flow that you had envisioned was not going to go the way that you planned. This can be due to natural flow of conversation and the patient providing information at their own rate. One aspect that I was excited for was the fact that we were in groups as a part of an ACT team working with the mental health clients. This allowed us to bounce ideas off of each other and jump into the conversation when we had ideas and then let others voice their ideas. I wish that my group and I had more time to prepare together as a group for each of the clients rather than the short break in between patients.

Each patient brought unique challenges that I didn’t anticipate. Our first client was Carla who was experiencing a manic episode as part of her Bipolar disorder. This was particularly challenging for me because her outward energy was overwhelming for me and made me apprehensive to join in the conversation. When I did, she made comments to me about my appearance and how she liked my hair and others that made me uncomfortable and as a provider I wasn’t entirely sure on how to continue the conversation other than ignoring it. I wasn’t sure if I should acknowledge the comments or continue with asking questions. The second client of Paul made me feel more confident in the skills and tactics that I have learned through this course and felt as if I asked appropriate questions regarding his auditory hallucinations. The last client of Marnie and Borderline Personality Disorder was a unique case because she had a guard up very high and even made comments to us about how we were just asking questions off of a checklist. This was very apparent in our group as we had a very long awkward pause towards the end because we ran out of questions to ask her and personally, I avoided eye contact in that moment because I didn’t have anything to add to the conversation. This was a very good lesson to learn not to treat them like filling out a worksheet, they are a person with many dimensions, and we are there to get to know them in the moment and treat them like we would like to be treated as providers.

From this simulation, I learned that these interactions should be more of a fluid conversation rather than going down a checklist. This will come with time and practice and I think this was a great first practice. I learned that I need to have more experiences with mental health patients to gain more confidence in interacting with them because I am still apprehensive with knowing what the right things to say. I am grateful for this simulation day and for the great work of the standardized patient actors.

Appraisal and Synthesis Reflection

Completing the first draft of our synthesis paper and final assignments leading up to this has been a very smooth process working with Harrison. Both of us agreed that it wasn’t as time-consuming as we initially thought it would be to put together this draft. I can attribute this thought to the well-placed assignments that led up to this point, where I can see now all work together like puzzle pieces to give us the paper. When completing the evidence appraisal table, this allowed us to clearly lay out the major facts and pieces of information that we wanted to include in our synthesis. One thing that really stood out to me was that there was no clear answer in answering our PICOT question the way it was worded. This was based off of research that showed how infants that had a diet mostly of breast milk had lower fat mass only during a portion of the first year as compared to a diet mostly of cow’s milk formula having lower fat mass during the opposite time period in the twelve months. This makes me think that more research should done to have a mixture of diets and utilizing each during different months to have an overall low fat mass rather than the alternating lead in fat free mass. Also, another finding was that in one study that also included data about Soy Formula, that was the leader in fat-free mass as compared to the other two diets, this surprised me as I didn’t know this was an option for nutrition and more data should be completed among other alternatives. These findings will impact my future nursing practice as a hopeful labor and delivery nurse in supporting mother and parent’s decision for the diet of their child. I would advocate for breastfeeding for the beginning to aid in the mother-baby bond and then transition to using cow’s milk or soy formula. Yes, we both came to the same conclusions and I look forward to hearing his opinions on our findings.

Medication Reconciliation Reflection

Medication reconciliation is an essential safety task that nurses often get to complete for their patients, and this allows for their interprofessional team to be aware of medications that they are prescribed as well as over-the-counter medications that they use. The Joint Commission has published National Patient Safety Goals to regulate a safe method of gathering all of the information for patients and help develop a regularized method to do so. The process of a medication reconciliation entails comparing “the medications a patient should be using (and is actually using) to the new medications that are ordered for the patient and resolves any discrepancies” (The Joint Commission, 2020). Completing this process accurately will allow for clear communication to both the providers and the patient on how to safely administer medications and also know the purpose behind their uses as related to the individual. According to the section 03.06.01, the fifth goal highlights discharge instructions on medication usage as well as informs on when to notify the provider when medications are discontinued and added or changed. This aspect of the patient safety goal aligns with the Medication Reconciliation I performed for KL, as her medications included one over-the-counter medication that had the same use as one that was prescribed for her allergies. This individual is allergic to dust and animal fur and also lives with two cats so there is an abundance of allergens which forces KL to utilize both her prescribed ProAir as well as OTC Allegra to combat the allergies. When visiting with her provider it is essential to let them know about her additional medication to have on file in the case of ever adding another medication to be aware of possible interactions. Through this project, I learned how to utilize outside sources such as UpToDate and drugs.com for their drug interaction checker which not only pointed out drug-drug interactions but also drug-food interactions to be aware of. KL feels that she can easily access her medications and is well educated on what to expect as possible side effects.

References

The Joint Commission. (2020, March 26). National Patient Safety Goals Effective July 2020 for the Hospital Program[PDF]. The Joint Commission.