Category: Uncategorized (Page 2 of 2)

My freshman year of college I joined the women’s rugby team. They were lacking numbers in the freshman class and only had one freshman prior to recruiting myself and a few others. This one freshman’s name was Smitty. When I first met Smitty I thought to myself, “how can this girl who’s barely over 5’ play rugby?”. Once I saw her play though I understood. Right from the beginning she’s been the leader of 2020 rugby girls and a force to be reckoned with. She went on with another teammate and myself to be captains our senior year. Prior to selecting captains our coach asked us to vote for who I wanted to see as captain. I immediately said Smitty and then she asked me why. 

When telling someone about this individual, leadership is the first quality that comes to mind. I’ve never seen someone be able to move a group of people and motivate them with just their words. She also was always leading by example by always giving it her all on the field. She’s that teammate who will finish her conditioning drill then go back and run more with those who are struggling to finish. Off the field she was the first one that anyone would call. No matter the hours of the night she would answer, and she would listen. 

I think what made her such a great leader is her ability to adapt and come to an even ground that everyone will listen to her on. She makes people want to be a better player on the field and a better person off. Now after college she’s working in an emergency department down in Pittsburg. I have full confidence that she will succeed in emergency medicine. She’s someone who’s willing to put in the long hard hours in order to reach an outcome she’s working for. Although being captain of the rugby team was a former position, she is still a leader in her ER department. Now I don’t work with her but from year of friendship and watching her work ethic, I know she will be an informal leader in her department. Even though she doesn’t have a designated role, like nurse manager, she still has an opportunity to lead others. During my interview I’m excited to dive into her time working in the ER for the past 14 months. I’m curious as to what leadership qualities she’s brought over to her job and which ones she’s decided to hold back on. 

We often think we have no control of our life. Now that being true in many ways, we do have the power of autonomy. No one can choose where they are born, what genitalia they have, how rich their parents are or if they even have present parents. Someone might look at a homeless person and blame them for their choice. They may have decided to do things that put them in a bad situation but there are also things that may have no control over. If an individual was born into a home that was in a neighborhood with lots of crime, poor education system, no good access to healthy foods or medical care, they might live a life poorer health than someone with the opposite. The things and people around us influence one’s likelihood to live a long healthy life. Environmental factors such as air quality, access to fresh foods, and transportation can negatively affect vulnerable populations. If someone is working a job with no health insurance and just got diagnosed with diabetes, that will greatly influence their life and health. Societal factors like growing up around drug users and crime can influence someone to also grow up to live a life like that. The environment and community we grow up molds and shapes our values and outlook at a very young age. This then moves on to affect us for the rest of our lives. 

Over the years we’ve seen a push to help these populations. More and more people are recognizing that certain populations are facing problems in which they have no control over. Unfortunately, a lot of people lack the education regarding social determinates of health. A lot of politicians use this misunderstanding that people have and turn it into hate to drive elections. Lack of momentum within our government has continued to put these populations on the back burner. Programs such as MaineCare, WIC, English language learners (ELL), and public transportation are just some examples of ways the government is helping the public. There still is much more to be done though. To help these populations we need to further educate others and continue to voice to government officials the needs of one’s community. In Maine we have high rates of heroin use. This is just one example of a public health crisis occurring here in Maine. It’s a public health issue as it causes addiction, transmission of blood born diseases, and death. Safe and clean needle use is a public health intervention that would better the health of many. Education regarding safe needle use and knowledge of where to get access won’t stop their addiction, but it can save their life. 

In my first undergraduate degree I took some sociology classes that talked about the social determinants of health. I never looked at the world the same after that. After that I learned about nursing and determined that was what I wanted to peruse. Not only did what I’ve learn help drive me to further my education, but it will help me be a better provider to my patients. It will help me to start the conversation of how I can help them. It’ll make me want to peel back a few layers to really determine what is driving their issue. I think it’s also taught me to be a much more understanding human being. 

Prior to sim I wasn’t sure as to how it would go. This was the first time we’ve had sim with real actors and not a human made of plastic. I was nervous because I knew I would have to be quicker with my responses since it was a real human. I was also unaware as to how good the actors would be. As sim went on, I thought it went much better than I had anticipated. The hardest case for me was the first one, borderline personality disorder. The actors were so good at portraying the mental illnesses. When talking to the actor with BPD, I got to learn how quickly things can change with them. I went from starting to form rapport then I looked down at my paper for too long and she freaked. I wasn’t ready nor knew what to say when she began yelling. It most certainly caught me off guard. I also was not anticipating for our manic patient to be this high energy. I’ve meet with patients who are experiencing manic and they exhibit those traits but they were all older so they didn’t have the same spunk. It was hard for myself and my group to separate him from his alcohol. I kept feeling like I didn’t want to step over boundaries but knew I had to for the session to be successful. 

            Once the day ended I felt like I had learned a lot. It helped me realize that I my communication needs some work but I know that it will come with experience and confidence. I tried to do my best and stay ahead with some responses but the patients did well with saying answers that I wasn’t expecting. This taught me that I can’t prepare in mental health nursing because everyone is different. Today’s experience taught me that my mental health nursing process is better than I thought but it still needs much work. 

Throughout the semester, I’ve been excited to finally be in a psychiatric setting. Much of our hours in clinical throughout nursing school are in a med-surge-like floors. When I found out I was going to BHU Sanford I was quite excited. As this class has gone on though, I’ve realized that mental health isn’t just for the behavioral health units, it’s everywhere. During my 6^th week on the medical-surgical unit I met a young man who was going to change my perspective on mental health in all health care settings. 

During my clinical shift, I was assigned a man in his late twenties who came in with stroke-like symptoms. Upon reading his chart I found out he had recently been hospitalized out of state for an alcohol withdrawal seizure while on a plane. His flight was diverted and he had hyponatremia upon arrival. The hospital staff had increased his sodium levels too fast causing his pons to demyelinate. His symptoms of slurred speech, left-side weakness, and unsteady gait got worse over the week after his discharge. Because of his worsening symptoms, his parents decided to bring him in. Prior to coming into any hospitals, this patient worked down in the Florida coasts as a merchant marine. Both him and his wife lived down in Florida as merchant marines but they worked on separate boats and didn’t live together. Around the new year, the patient began drinking out of boredom. He stated that “it started as a few drinks once a week or twice a week then turned into a 750mL of whiskey or vodka a night”. It didn’t appear that the patient had any close support system down for him in Florida. When he became bored he turned to the bottle. He never reached out to his parents or wife about this drinking issue. His parents noticed a change in his behavior and became very worried so they decided to fly him back to Maine. 

The patient’s psychological problems of isolation and maladaptive behaviors have now turned into a physical disability he will have for the rest of his life. When talking to the patient, he appears very depressed. He doesn’t talk much and gives short answers to questions. He understands that it is drinking that got him here but I don’t see that he’s making the connection between the deeper issue and his drinking. I would have liked to gain rapport with him and possibly find out if there are any other reasons besides boredom that caused the alcohol binging. I would also like to see if the wife has been contacted and her knowledge about her husband’s current condition; both mental and physical. If the patient didn’t appear so tired and express that he wanted to rest, I would have tried to talk to him more to try and find out more information regarding support systems. I would also like to sit down with him and gain insight as to how much he knows about his current diagnosis of osmotic demyelination syndrome.

This is a condition that will stay with him forever. It could have been potentially corrected if he went to the hospital within 24-48 hours after raising his sodium. I wish I would have had more time with the patient but I unfortunately didn’t. If I could have more information on him I would have wanted to gather a family history of any mental illnesses and substance use. I would also like to assess the substance use of his wife, is this something they do together too? The patient has ineffective role performance so I would want to assess what his daily activities entail and if he’s performing his basic ADLs (brushing teeth, bathing, etc). I would also want a mental health examination to take place because drinking 750mL of liquor a day usually has a reason. This could uncover if the patient is dealing with any stressors and is ineffectively coping. With the binge drinking, I would also be very concerned for his nutrition. Drinking heavily puts you at risk for malnutrition and is most likely what caused his hyponatremia. I would want to assess his diet, where he gets his food from, and if he is able to afford it. 

Some examinations I would want to perform would include the mini mental status exam, and CAGE. I would want to assess for any mental illness as well as his own perception on his drinking. The CAGE will give me insight as to what he perceives other thoughts to be about his drinking. Once the reason behind his drinking is uncovered, more support can be directed as needed. I would see what the patient’s thoughts on rehab or programs such as AA are.  I feel that the hospital that we were at did a good job in addressing his physical problems, but didn’t pay so much attention to the psychological issues. I didn’t find anything in his chart regarding psychological examinations. The only thing regarding substance use that I could see was a CIWA. I think since the reason for his physical issues is his psychological issue, the medical staff should take a deeper dive into what the major issue is. 

(5) Explain the importance of managing medication information to the patient when he or she is discharged from the hospital or at the end of an outpatient encounter:

So many medications come with adverse effects and drug-to-drug interactions. Performing a medication reconciliation prior to discharge is so important. It can help prevent drug interactions and can prevent the same drug from being prescribed twice. When someone is discharge, it’s important to get a gauge on their knowledge of their medications. It’s important patients know how to take, when to take, and where to store their medications in order to receive the proper effect. I learned the importance of managing medication information when interviewing my friend for this assignment. I had realized the dangers of not knowing proper administration and dosage of medications. In todays society, we feel very comfortable taking over the counter meds and often don’t realize they come with adverse reactions just like our prescriptions. By making sure a patient is on the same page as their provide, in regard to medications, it can help promote healthy patient outcomes. Managing medication information can also identify any potential problems. For example a patient could be taking an OTC drug that interacts with a prescription they received in their hospital stay. By providing proper medication education prior to discharge, we can ensure patient safety.

            I think that the stigma behind mental illness is driven by our societal norms and how we believe we should behave and act. Those with mental illnesses are often seen as weak and/or unstable. There are many factors that affect mental illnesses like age, gender, and culture. I believe that in our society we don’t want to share our stories of mental illness because we are afraid of being judged by others. As I’ve grown older I’ve found that the stigma associated with mental illness has begun to subside but it is still very present. Self- stigma is influenced by your community, your support system, and social media. I’ve found that social media makes me often compare myself to others and influences me into believing that I should behave, look, and feel a certain way. 

            Culture is something that heavily affects how someone perceives mental illness. Some areas don’t have the resources or education to properly help those with mental illnesses. Someone’s culture might also change how someone talks about mental illness with a provider. How they perceive their symptoms or how they think they should feel will affect their response. Someone might think that the way they feel or are behaving is normal when it isn’t. Religion also affects how someone may perceive mental illness because it often outlines how someone should or shouldn’t feel. For example, someone who is believes in heaven might not understand why someone has become depressed over the death of a loved one. An example that I’ve seen within my culture is LGBTQ individuals, who also practice religions such as Christianity, who believe that their feelings regarding their sexuality and/or gender is wrong.