Category: NSG 444

My Eportfolio project focused on the importance of reflection in my academic experience. Having this as a resource to track my progress throughout the nursing program is valuable. I have enjoyed seeing how much I have grown since the start last summer, I have seen a lot of progress in my physical wellness thanks to an assignment in Passport to Integration. I have been able to keep the goals I made last July and have improved since. Additionally, I found this class Integrated Experience to be the most valuable class for reflection assignments.

Following the Fundamentals ATI adaptive quiz, I was content with my results, but still have room to improve. As compared to my first ATI Adaptive quiz, I improved on my average time for each question, improving by 10 seconds to have an average of 33 seconds but it is still far from the NCLEX average of 1 minute 21 seconds. For several of the questions, I was familiar with what they were asking, but had a hard time recalling the knowledge or felt like I couldn’t pick out the right answer from the answer choices. I was content with having completed the adaptive quiz in less questions than my mental health quiz, and hope that continues to improve with the reviewing and amount of practice questions. One area of improvement that could be done before taking another adaptive quiz could be reviewing more key content areas in that area before taking, especially if it was a course that was awhile ago. Another area that I am going to change for my next time taking an adaptive quiz is to be in a place that is not distracting to me, the past 2 I have taken in public places with people walking around and that is not helpful. Considering how I was more nervous to take the fundamentals quiz over the mental health quiz I am happy how it went and will continue to review my remediation forms and make them detailed to help me. 

• Following the ATI Critical Thinking Assessment, write a brief description and analysis of how your exit exam results compared with your entrance exam results. What steps will you take to further develop your critical thinking skills as you look ahead to the transition from nursing student to professional nurse? 

My exit exam score was surprisingly lower than my entrance exam grade by a few points. I’m not upset with a slightly lower score because my initial score was a 75% and I went down to a 70%, so only a few questions different. Scheduling this exam a few hours before an exam for maternity was not the easiest to shift my mindset and take a break from reviewing. To further develop my critical thinking scores, I can: do practice NCLEX critical thinking problems, slow down when taking the exam, do more deep breaths and feel less anxious during the exam and try and not feel as distracted when others are completed with their exam. Some specific areas to improve on based on my ATI Report are inference, self-regulation, and interpretation so finding specific practice questions in these areas would be most beneficial. Inference is drawing conclusions based on evidence and identifying gaps in knowledge. Self-regulation is reflecting on your own thinking and analyzing added information to make a decision. Interpretation is understanding and explaining written directions data and graphics. Over the course of the next couple months about to prepare for the NCLEX, these areas would be the best to prioritize and look over to improve my critical thinking skills as I become a professional nurse. 

In a thoughtful, two- to three-paragraph post, reflect on the following: 

1. Describe individual, environmental, and societal factors influencing the health of vulnerable and marginalized populations. 
2. Examine the historical, social, cultural, political, and economic forces that influence vulnerability and marginalization. 
3. Discuss strategies for resolving health and healthcare disparities and improving the health of vulnerable and marginalized populations. 
4. How will you apply what you learn about care of marginalized persons to enhance the care of diverse populations? 

After this week’s insightful class meeting with Bob Fowler, the Portland Maine Public Health Director, he shed light on the various public health initiatives and efforts that the city offers for the community. For those of vulnerable and marginalized populations in any area or specifically in the Portland, Maine area they could experience deficits in their everyday life because of unfair treatment. One specific example that is prevalent right now is someone possibly not being able to have the chance to register for a COVID-19 vaccination due to being in a marginalized population. Many things can affect a person such as: not fluent in English or any offered languages of a facility, not being literate, not having access to technology, not having consistent living situations or an address to write on forms, not having healthcare or an income. Often the initial forces that influenced marginalization and vulnerability for populations goes back to gender and race, favoring Caucasian males. This historical perspective continued forward throughout decades and can still be seen in the economy and social movements in today’s culture. This way of thinking is: being anything out of the ‘norm’ puts a target on you and you can be seen as different and not deserving of the same treatment or pay. No matter the amount of traction or support that movements going against this POV, not much has changed and vulnerable populations still exist. 

To improve the health of these populations, healthcare facilities can expand on the amount and quality of interpreters and options for communication that are available, having a well-diversified staff to welcome and treat these patients, connecting and having community resources available if-needed could be a start for strategies. Not all these strategies can be implemented overnight but admitting that it is a goal and making progress over time would be beneficial. To enhance the care of these populations I will ensure to: prioritize all patients and treat all with the same respect that I would expect to have for myself, utilize motivational interviewing techniques throughout all encounters, build therapeutic relationships, work inter-professionally to connect my clients with resources and make them feel involved and supported throughout their care. Learning more about the community that we reside in can be an important step for when starting a new-graduate nursing job and be able to work towards these goals. 

1. What are the nurse’s primary roles and responsibilities in the event of a disaster (natural or man-made)? 

A nurse needs to know about the disaster plan within their facility and know what could be expected of them to help in case of the event of a disaster. As a new grad nurse or a new nurse in any environment, it would be important to ask about the policies for disasters if they are not mentioned in orientation. Nurses will be looked on to help with the effort to protect the facility and their patients in any way that their facility’s disaster plan asks. For an example with Hurricane Sandy in 2012, on the night that many hospitals and facilities in the New York City metropolitan area if you were on shift, you had a large task in front of you that you may or may not have seen coming. Living only a few miles outside of New York City, I remember this storm well and could not imagine being a healthcare worker during this event and potentially be in a facility that loses power. Many patients were at risk based on how much we rely on technology to assist with care especially cardiac telemetry units and critical care patients who were potentially on ventilators or other mechanical life-sustaining equipment. One responsibility to gain is to be comfortable with uncomfortable situations and be ready for anything and everything to go wrong at any time. Being able to work with all members of the organization and willing to help in anyway, being flexible and prioritize health and safety of everyone involved is essential. 

1. As nurses, it is often our compassionate nature that compels us to help others in need. In the event of a disaster, ethical components come into play. Provision 2 of the ANA Code of Ethics states that a nurse’s primary responsibility is to the patient, yet Provision 5 of the Code also states that a nurse owes the same duty to self. Discuss your thoughts on the two ethical codes in the context of a natural or man-made disaster. 

This is a tough ethical dilemma that is very situation dependent in my opinion. As a nurse, yes your primary responsibility is to advocate and provide safety and safe care to your patients but that is dependent on if it is a safe environment for you. In the case of a disaster and asked to assist in particularly dangerous situations I believe it should be your choice to volunteer to put yourself in more danger. Your patients are in their most vulnerable state when in a hospital seeking care so they often are unable to care for themselves and would require someone to step up and potentially risk their own health and safety but that shouldn’t automatically mean you are required to hypothetically go into a burning building. I believe most individuals pick the nursing profession because at their core they care about helping people and are compassionate and often times put others in front of themselves especially when it comes to self-care, but we have the right to say no if it is a dangerous environment. Following the facility’s disaster policies as best as possible but being aware of your own health and safety would be the fine balance. In order to continue to provide care to others is dependent on your own health status so it would be beneficial to evaluate each situation as it arises.

Completing the Mental Health Adaptive Quiz gave me my first experience with taking a true NCLEX style quiz/test that turns off after successfully completing a certain percentage of questions. I knew that it could stop at any point after 75 questions and when I reached 75 I definitely felt more pressure that I had to keep going, but I took a deep breath and remained focused until it stopped at 99. Many of the questions were heaving drug based and shows that I should look over that material more and become more comfortable with it again. I plan on starting remediation today (the day of completing the exam) and will divide up the amount of questions to do several a day to have it completed within a week. I would say about half of the questions that I answered incorrectly were because I wasn’t able to recall the correct answer and half were if I had not heard of something within the question or the correct answer. There were definite themes of questions that I got wrong including questions prioritizing care for clients with bipolar disorder in manic states, several questions about buspirone and prioritization for patients of suspected abuse. One area that I would like to improve on for my next adaptive ATI quiz is to take more time on each question. I get anxious when I have a question in front of me and think that I need to go fast but my average time for each question is one minute under the average. Ensuring that I can simulate a NCLEX environment and lower my anxiety will hopefully help and be a good test-taking strategy to do well.

• How does trauma exposure impact psychological, physical, spiritual, environmental, and social well-being? 

Experiencing trauma severely negatively affects a person in all dimensions of their wellness. Stress puts extra pressure on the body and increases the number of hormones that circulate as well as increase the workload of several critical muscles such as the heart and lungs. Someone’s psychological well-being can be the most critically impacted in my opinion since it links with physical as well. Being in a hypervigilant state a large portion of the time forces the body to use more energy and again increase the overall workload to a point where someone can be in constant fear and anxiety but yet extremely fatigued. Spiritual well-being is affected and can cause an individual to feel less trust in their beliefs or can increase as a result of the trauma event and feeling comfort in their spirituality. Social well-being can diminish as an individual who has experienced trauma can feel embarrassed to divulge that they have experienced a traumatic event, be more anxious around other people or even want to spend time away from other people. Environmental well-being can be affected as an individual may avoid the location where the trauma occurred or over time start to see similarities in their own environment as the trauma event environment had. Each of these aspects blend into one another and all perspectives should be balanced and analyzed to assist a person work on their well-being. 

• What are some long-term impacts of adverse childhood experiences (ACES)? 

Adverse childhood experiences have been linked to several negative health outcomes and can increase a person’s likelihood of developing chronic health conditions. According to the CDC, ACES account for “up to 1.9 million cases of heart disease and 21 million cases of depression.” The higher number of adverse childhood experiences an individual has incrasese their chance to experience or participate in risky behaviors later in life such as: injury, STIs, sex trafficking, unsafe sex practices, chronic diseases like cancer, diabetes, heart disease and suicide. These experiences bring on an increased amount of stress on the individual and can change their perception and decision-making process when faced with unsafe situations. In addition to having higher chances of developing health conditions, individuals may also have difficulty in forming and maintaining relationships with others, having a consistent work history and managing their finances. (CDC, 2020).

Link: https://www.cdc.gov/violenceprevention/aces/fastfact.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Ffastfact.html

• How will you apply the Trauma-Informed Care (TIC) principles to your future nursing practice? 

As a future nurse, I will work towards utilizing trauma-informed care in my everyday care by following several steps. The first step would be to approach each patient in a caring safe manner and treat each patient the same and start developing a therapeutic relationship with them. Meeting the individual where they are at, speaking in calm tones, maintaining eye contact, listening to what they have to say and include them in their own care and care plan. If an individual were to disclose any information with me I would ensure that I would thank them for sharing that with me and take steps if needed to report. I think an important aspect of trauma informed care is working on building up the individual’s empowerment and ensuring they know they have a voice in their own care and are in the driver’s seat for their own health and the choices they make. 

1. Discuss your preconceived thoughts and baseline knowledge of death with dignity. Include your initial thoughts, feelings, and viewpoints on the topic prior to completing the readings and watching the videos.

Death with dignity is a topic where I don’t know too much about the logistics of how it is done, however I am aware that it is only available in certain states and countries around the world. This is an option for someone with a terminal illness to be able to choose when they would like to end their life with the help of medical professionals before the disease process becomes unbearable or when they lose the ability to perform occupations throughout their day. I believe they need to go through a mental evaluation as part of the long process as well to see if they are doing this for a reason and to see if they have any underlying conditions that could hinder them from making a clear and sound choice. I value life, but I also see the value in allowing those that are terminal to have a say in their death and allow them to have it occur on their terms. I would feel uncomfortable right now with not having enough education on this topic (prior to readings and videos) to be a part of the process. I think that there is a possibility that I would support those that are interested in going through this process, but as of right now I am not interested in hospice or end of life care nursing.

How does death with dignity challenge your beliefs of the first ethical principle, nonmaleficence, or do no harm, which is directly tied to the nurse’s duty to protect the patient’s safety?

One detail that I am surprised to find in the Maine Death with Dignity Act was that the deciding person is a physician and doesn’t mention an NP being an example deciding person and able to prescribe the medications. I would hope in the future that this could change and have NP’s be an authoritative figure in this ethical matter. Death with dignity challenges my belief against nonmaleficence as it is an action that is ending someone’s life, however in the eyes of the patient it is not doing harm it is giving them the chance to end their life how they wish. As nurses we want to advocate and include patients in their own care plan and if we are in a state where there are laws that allow this process to take place then it is our duty to provide accurate and up-to-date information to them about this topic. We don’t need to voice our own opinion on the patient and tell them how we feel ethically, if we are employed by a practice where this is possible and could take place then we should just support them through it. Protecting their safety and promoting their health throughout treatment is what we can do through education and supporting all of their areas of wellness.

Course Description and Objectives

COURSE DESCRIPTION:

This course examines the intentional connection of concepts explored in nursing coursework and experiential activities. This active inquiry and engagement fosters the application of clinical judgement, interprofessional collaboration, and acquisition of leadership within professional practice.

COURSE OBJECTIVES:

Upon successful completion of this course, the student will be able to:

1. Apply knowledge from the humanities, interprofessional education, andnatural/behavioral sciences in the provision of holistic nursing care.
2. Apply principles of reflective practice, appreciative inquiry, and therapeuticcommunication across the spectrum of health in multiple settings/patient populations.
3. Integrate the moral, ethical and legal elements inherent in the formation of professionalnursing values.
4. Demonstrate the use of data and resources that impact health outcomes.
5. Integrate principles of self-care that represent values inherent in the profession ofnursing.
6. Apply concepts of nursing theory in the planning and evaluation of care for clients.
7. Demonstrate evidence of clinical reasoning and clinical judgment in the plan of care forclients across the health spectrum and lifespan.