Author: elangland (Page 2 of 4)

Preparing for Transition

September 8, 2022 / elangland / 0 Comments

I am excited to begin working and making meaningful impacts on patient outcomes. I am also excited to continue my educational journey as a nurse and to find out what kind of nursing I really enjoy. I am most anxious about making a mistake or not knowing exactly what to do in practice. While I understand that there is still plenty of orientation and learning to do, I get nervous thinking about being in a situation where I could make the wrong choice. Lastly, I will celebrate by spending time with friends and family.

To stay focused and on track I will adhere to a weekly review/study schedule. I will set small attainable goals for each day of each week varying on class, clinical days, and practice. By taking it one day at a time, this will help me to feel less overwhelmed and more able to properly manage my workload. I will also be utilizing academic resources such as tutoring services and attending group study sessions. I think that these strategies will help to bring me success in my academics and in my future.

I thought the nurse logic modules were helpful. Hearing about nursing concepts, clinical judgement, priority setting frameworks, and testing/studying strategies was a great reinforcer. I think it will be helpful to keep these concepts and ideas fresh in my mind during the semester. Being able to refer to these during clinical/simulations, while studying, and during class will be helpful to furthering my progress to becoming a nurse.

Adult Health IV Reflections on the Older Adult

May 4, 2022 / elangland / 0 Comments

As the semester has gone on, I have been able to gain a better understanding and perspective on geriatric care and the aging process. With the Lifebook project/narrative life review especially, I feel like I obtained valuable insight on the progression of aging and just life in general. I was fascinated to hear the different stories about their life and how they have adapted to older age. Also, in the classroom the issue of elder abuse was brought to greater light. As sad as this was to hear about, this provided me with good insight on the issue and how to better detect abuse.

Elder abuse is defined as the intentional act or failure to act that causes or creates a risk of harm to an older adult. When our guest speaker came in and spoke about elder abuse and provided stories/pictures of abuse, it really struck a cord with me. Having a grandfather who may be requiring nursing home care soon, it upset me to know that he could be at risk for potential abuse. This was something that really sat with me and for all I know it could happen to someone I know and love. However, with learning more about elder abuse, I do feel better equipped to combat it. And in my future practice, it will always be something I monitor for as it is someone’s loved one who is on the line.

My second insight from this course was having a better understanding of how short life is and how important it is to take care of yourself. One thing that my grandmother has always prioritized in her life is exercising each day and drinking water. She always says it is the reason why she can still move as good as she does at almost 80 years old. Seeing this helped to show me how important nutrition and exercise really is to get the most out of your life. Which brings me to my final point of how short life is. Seeing myself almost out of college I can now understand what my parents and grandparents have been telling me. Each day we have is a gift and our lives are shorter than we may think. It’s important to take each opportunity we get and to live each day to the fullest.

Post-Interview Reflection

March 9, 2022 / elangland / 0 Comments

I was able to learn a lot from my mother about her different styles of leadership. She talked about how it was most important to stay organized with sterilization records, to communicate/be flexible with the surgical team, and to advocate for herself. She told me about how surgeons and reps are always in contact with her about having specialized kits for surgery. I can remember talking to some of these representatives and picking up these supplies for surgeries. These kits would ideally come in day before surgery and would have to go through the entire sterilization process. Keeping tabs on these things and staying in the loop was very important to her success as without her, these surgeries could not happen. I would say she was very aware of her management style, needs, and social impacts. I was not very surprised by any of this because of my experience of working with her. Her responses only further reinforced my knowledge.

This interview only further influenced my feelings about my mother as a leader. She is someone who I look up to and has been my inspiration to joining the medical field. Her passion and driven attitude has been a great motivator for me. She is my role model and I am thankful for being able to work along her side. I know I will only continue to learn from her and that she will be someone I can always refer to throughout my career.

Presenting Change

December 3, 2021 / elangland / 0 Comments

While we are still awaiting feedback on our dissemination project from peers and floor personnel, I feel like I have been able to learn many valuable things about the nursing process and documentation. Documentation of input and output in particular can be an overlooked and a tedious task. Not only is it time consuming but, it is something I have seen nurses just forget about. This is concerning especially for patients dealing with heart problems. Many of these patients are on diuretics or experience edema due to fluid overload. The input and output has to be accurate for this reason so that doctors can prescribe proper dosages for their patients. Without this information it can result in unwanted outcomes and longer patient stays.

During our research we came across a study that examined the use of automated urine output devices. This study was able to conclude that these devices could be used without sacrificing accuracy of documentation. Also, we found that documentation of input and output improved with increased staff education. This education could be done via in person class or through online resources. These were all important to increasing accuracy of documentation and raising awareness to staff. This was a large part of our topic proposal and is a critical part to nursing as we are constantly learning and educating.

Reflecting on the work we did as a team, although I was not able to share a clinical experience with the rest of my group, I was able to learn a lot about myself as a communicator. Because I was not able to meet weekly with floor personnel or their instructor directly, it forced me to adapt and find different ways to communicate with my group. This was done via text message, talking with group members individually, and during our time in class. Also, I was roommates with one of our group members so this was also very helpful. This will only help me in my future because as a nurse you must be adaptable. In a constantly evolving field where we see new technologies and medicines coming out every year, communication and education is key to success. In addition, being able to work as a team regardless of circumstances is crucial to improving quality of care. Overall, this project was able to teach me how important is to be an effective communicator and how to critically think as we participate in evidence based initiatives.

EBP2 Final Project Download

Final Proposal

December 3, 2021 / elangland / 0 Comments

Group-6-Project-Proposal-FINAL_clean-copy Download

Reflective Writing

November 29, 2021 / elangland / 0 Comments

One patient experience that sticks out to me took place while I was working in the psychiatric unit. This individual was homeless, suffered from substance use disorder, and was suicidal. I was able to have a good conversation with this patient and learned a lot about his situation. To start, he had been homeless for a few years, poor personal hygiene/nutrition, had no family members to look to for support, and had an extremely difficult childhood in which both of his parents were alcoholics. He also had a high school education and had been retired for almost 5 years. It was pretty safe to say that he had a pretty tough upbringing and has been struggling lately. He then talked to be about how he had been living in shelters, eating at soup kitchens, and struggling to get by each day. Additionally, with the weather getting colder, it was also a concern for him as he had no guaranteed place to stay. He acknowledged to me that he had a drinking problem but, told me that it was the only thing that made him happy anymore. He said he would often find himself back at the tavern drinking constantly to fill the void in his life. This was really sad to hear as he was a very nice individual cracking jokes every now and then and seemed to have a jolly side to him. His addiction however, had taken away his life, family, and any money that he had.

After talking to this patient, it really made me reflect on my childhood and how I was brought up. I lived in a financially stable household with parents who had a positive influence on me. I can remember there always being someone there when I was hurt, sick, or crying. Seeing how difficult of a childhood this patient had really opened my eyes into how easily someone can go down the wrong path and turn to things such as substance abuse. This patient never really had a positive influence in his life to guide his decisions. He did not know any better so it really made me feel for him. Substance use just became a normal coping mechanism for him. Seeing his side of the story helped me to be less judgmental and more understanding of his problems and others who may be dealing with the same thing. I feel like many of us are so quick to judge homeless people we see on the streets. But in reality, many of these people deal with untreated health problems only hurting them more. This caused me to reflect on the poor access to healthcare in the United States and how many people are left on the streets helpless.

This patient has been disadvantaged from the start. This has been due to social status and lack of money. He has no way to receive the medications he needed, has no way of taking care of his personal hygiene, no means of transportation, and no place to live. What was difficult was that there was very little we could do for him after he gets out of the unit. The patient did not have money to receive all the treatment he needed, and there was no guarantee that he would be able to get his housing situation under control. This was left in the hands of policy makers as the hospital could only do so much for him. At the end of the day, I was wondered if the unit would see this patient again after discharge. This had not been his first trip to the unit, and it seemed as if he had a long way to go in his recovery. I could only hope that he was able to get the support he needed to live a good rest of his life.

Overall, this patient experience has brought a new awareness and understanding to me. I have learned about health disparities/health inequity in class and through watching videos on it, but to witness it in person was very moving. I will always remember this experience and use it in my future to be more understanding of the less fortunate. We are all brought up in a different way, and it is easy to see how one can go down the wrong path without proper guidance. This has helped me to become a more aware health care professional and has opened my eyes into a new way of thinking. I now have a better understanding of health care disparities people experience each day. This will only motivate me to provide quality care to all the clients I may have with hope of a bettering their futures and helping as many people as I can.

Simulation Reflection

November 19, 2021 / elangland / 0 Comments

I had a difficult time in simulation last week. Working with actors and working in a group made me very nervous and hesitant to speak or jump in with my other group members. I would often have what I wanted to say in my head prepared but then when it was my turn to speak, my mind would go blank and I would forget what I am saying altogether. This is not who I am and I think that this emotional response was just me being overwhelmed. This was frustrating for me because I came prepared and have been able to have great conversations with patients in the clinical setting.

However, with that being said, there were plenty of positive takeaways from this experience. The actors that came in gave me a better idea of what to expect with certain patients. For example, I have never had an encounter with a currently manic patient before so to be able to see this and interact with them in person was very helpful for future practice. Another positive from this experience was just to be able to learn from each other and the mistakes each one of us made. Having the ability to make mistakes and learn from them in the simulation environment rather than the clinical setting was helpful to learning.

Overall, even though I could have performed better, I was able to learn from the different interactions and from my classmates/the feedback we received. I understand that emotional reactions are normal in the simulation environment and I will take this experience and learn from it continuing to progress.

Topic Proposal (Draft)

November 14, 2021 / elangland / 0 Comments

Importance of Accurate Intake and Output Charting Including IV Fluids and Medication Drips

Daisy Bryant, Amanda Bushway, Stephanie DiFrancesco, Olivia Harnum, Eric Langland, Sam Ljunggren, Mike Mammone, Emily Simpson

University of New England

Title: Importance of accurate intake and output charting including IV fluids and medication drips.

Background of practice/clinical problem: Documenting fluid intake and output is a critical part of patient care, and gaps in a patient’s chart can cause harm. Two factors that researchers believe to be the main problem behind inaccurate fluid documentation stem from the lack of awareness of the importance of fluid monitoring and the use of excessive and unnecessary monitoring (Vincent et al.,2015). Lack of awareness, as Vincent discovered, is found primarily in the medical assistant staff who carry out most work with fluids from little education about the importance of charting fluid. It has been reported that many healthcare workers have expressed dissatisfaction with the accuracy of patient’s chart. Evidence-based measures need to be implemented to improve the accuracy of documenting patient’s fluid intake (Liaw et al. ,2018). Research has shown that the act of manually entering fluid measurements with a nurse’s workload can cause this task to be overlooked (Kushnir et al., 2020). This makes treating patients more difficult in an acute care setting when orders placed are a direct result of certain lab values. Researchers have been trying to find a solution to remind and encourage health care workers to be charting their fluid measurements the moment it is collected.

Project aim: The aim of this project is to emphasize the importance of accurate intake and output charting including IV fluids and medication drips.

Method: The educational proposal design was created from the synthesis of multiple research studies to determine the most appropriate strategies to emphasize the importance of charting accurate intake and output including IV fluids and medication drips.

Finding/conclusions/implications for practice: While utilizing a UOP (automated urine output device), timeliness of documentation improved without compromising accuracy (Kushnir et al.,

2020). This reduced the workload and fatigue for nurses, which was identified to be a reason for incomplete intake and output documentation. This could break barriers such as time constraints, poor handovers, and patient compliance (Thompson et al., 2020). Addressing these barriers is extremely important and should be a priority because patient outcomes can improve when their fluids are closely monitored, especially if they are fluid restricted patients. R7 at Maine Medical Center (MMC) does not use the UOP device to measure urine output. To remove these barriers, the staff and nurse manager of the floor should be informed of the impact on patient care and nurses. UOP device use should be encouraged with all patients needing strict urine output documentation. Through education, promotion of best practice, and varying audits on cardiac patients specifically, 100% of staff became compliant and 75% of patients became involved (Yang et al., 2019). This had a positive impact on clinical practice, including documentation and increased awareness of fluid record needs.

Implementation plan: This project will be implemented throughout R7 at MMC. We will educate the staff using informational pamphlets on how inaccurate intake and output charting can have effect on a patient’s plan of care and identify the barriers to accurate charting of intake and output.

Method of evaluating outcome: To evaluate the effectiveness of our implementation plan, an electronic survey will be done prior to and following the distribution of educational materials that promote the importance of accurate charting of intake and output. The survey will evaluate whether our interventions to help this issue have had an impact on the healthcare staff working to resolve it.

References

Kushnir, A., Palte, E., Morris, N., Shahabuddin, Z. A., Hammond, J., Vukelic, S., & Rabbani, L. E. (2020). Improving fluid output monitoring in the intensive care unit. Journal of Intensive Care Medicine, 885066620979663. Advance online publication. https://doi-org.une.idm.oclc.org/10.1177/0885066620979663

Liaw, Y. Q., & Goh, M. L. (2018). Improving the accuracy of fluid intake charting through patient involvement in an adult surgical ward: A best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports, 16(8), 1709–1719. https://doi.org/10.11124/jbisrir-2017-003683

Thompson, E., Batacharyya, M., Bowers, A., Walker, G., & Prina, C. (2020). Quality improvement project: Identifying the barriers to accurate assessment and documentation of fluid status monitoring. Clinical Medicine, 20(Suppl 2), s76. https://doi-org.une.idm.oclc.org/10.7861/clinmed.20-2-s76

Vincent, M., & Mahendiran, T. (2015). Improvement of fluid balance monitoring through education and rationalisation. BMJ Quality Improvement Reports, 4(1), u209885.w4087. https://doi.org/10.1136/bmjquality.u209885.w4087

Yang, S. H., Mu, P. F., Wu, H. L., & Curia, M. (2019). Fluid balance monitoring in congestive heart failure patients in hospital. JBI Database of Systematic Reviews and Implementation Reports, 17(10), 2202–2211. https://doi.org/10.11124/jbisrir-2017-004021

Proposing Change

November 8, 2021 / elangland / 0 Comments

My main takeaway from this topic proposal and review is that through using automated urine output devices it can improve the timeliness of documentation without compromising accuracy of documentation. This can be very useful in reducing nursing workload, fatigue, and most importantly, nursing error. This gives nurses more time and energy to focus on other lifesaving interventions. Researching this topic reinforced the importance of documenting input and output as this data is very important for making potentially lifesaving decisions for patients. I have seen nurses overlook or forget to document input and output before in clinical and in my work as a CNA. This made this topic especially important to me as it seems to be neglected at times.

Researching this topic did not change any assumptions I previously had. Having the experience from clinical and the work done in the classroom I think helped with this. My team also did not need to revise the topic proposal that much. We just had to make very minor tweaks with the formatting and citations. Our group was also successful in finding a wide range of peer reviewed articles. This was a benefit of having so many group members. Because of this, we were able to pick and choose from a wide variety of articles for our proposal. Lastly, having a larger group was useful for revising our proposal and providing feedback to each other. This helped us to put forth our best work and ideas.

On the other side of things, there were some minor difficulties. It was difficult for me to find times to meet as I was not a part of my groups clinical. This made it hard to find times to meet and work together. However, I was able to work through these difficulties as one of our group members was also my roommates so this made communication much easier.

Group 6 Project Proposal FINAL_clean copy Download

Planning Change

September 19, 2021 / elangland / 0 Comments

This team dissemination project will be accomplished through good communication and teamwork. We have a group chat that we will use in order to communicate assignments and due dates. Through this group chat, we will provide feedback to each other and keep each other accountable for our work. Also, if a group member does not hold up on their end or turns in poor/late work, we will be able to address the issue through the chat.

One barrier to this project is that I am currently not taking adult health III. This will be challenging because I will not be learning the same material as my group or sharing a clinical experience with them. I will overcome this barrier through great communication and teamwork. Additionally, I am roommates with my group member Mike. Having this will be great for sharing ideas and collaboration. It will also be beneficial to keep up to date with information and research. I am confident that I will overcome any barriers in the future with this project. This will only help me in my future as a nurse as you never know what new challenges you will face each day on the floor.