Professional Assignment: A Personal Reflection of Wit
Student: Hazel Ashby
Institution: New York City College of Technology
NUR 4130
Section: 0996
Professor: Irene Pearlman and Ellen Zimmerman
June 17, 2012
A Personal Reflection of Wit
The film WIT gave me a special unique opportunity of understanding the perception of the patient on the health care system in the US while fighting cancer. In watching this film, the concepts learnt in the course on nursing in regards to professionalism and caring came in handy while watching the film and interpreting the plot and content of the film. From the course, I learnt that a professional is a person who should be conscious in actions, responsible to themselves and to others placed under their care. A professional must be knowledgeable on subjects in their field and should be astute with practical chores. For example a labor and delivery nurse must be able to read and interpret a fetal monitoring strip.
In the film, Vivian who is suffering from ovarian cancer in various instances experienced behavior that may be said to be unprofessional from the care providers. For instance, the doctor who diagnosis her acted unprofessionally by blurting out that condition in medical terms by stating “stage 4 of metastatic ovarian cancer (IMBb, 2001).” While this makes sense to the doctor, to the patient, these are just words without meaning as she had no idea what stage 4 meant. Hence, she had no idea about the seriousness of her condition.
Further unprofessionalism is witnessed when the doctor tells Vivian that the next stage was to put her under chemotherapy treatment. This was irresponsibility on his part because he did not explain to her the treatment options available to her. He totally disregarded her freedom of autonomy. I this to be a serious ethical issue, she had no choice. Dr. Kelekian already made the decision for Vivian. He did not even ask her whether she would choose chemotherapy as a way of her treatment. In fact, throughout the film, Dr. Kelekian maintains this ugly role of the mockery to the professional standards of behavior in the nursing field. In her presence, he was explaining her condition to his students in professional terms incomprehensible to his patient. And even in some case points out crudely that his patient had lost her hair. Throughout, he displays irresponsibility and unconsciousness of actions to Vivian, his patient.
I also found is very unprofessional that a former student of Vivian, Jason, did not even bother to ask Vivian if she would voluntarily allow a medical examination. Putting myself in her situation, I found it very disturbing and uncomfortable for a former student to go ahead to ask me personal medical information an even greater insult is to perform an invasive exam on me. However, despite his unprofessional conduct, as the film nears the end, Jason finds time to interact with his patient Vivian and even talks to her on why he chose to be an oncology doctor. He is found to be caring, something that many doctors fail to establish with their patients. In contrast, the nurse to the patient, Susie Monahan is the representative of a professional who is caring. Nurses should provide comfort, personal and professional support in times of helplessness, loneliness, and anxiety. Susie exemplified these roles as she found time to talk with Vivian. I especially admired her when she fulfilled her duty in appropriately intervening for the sake of Vivian when the doctor wanted to increase the dosage in the chemotherapy (IMBb, 2001). Consequently, I have realized that my future role as a professional nurse is much more demanding and goes beyond just caring and educating the patient; it includes advocacy, standing up and supporting my patient especially when they are not capable of dealing in the conditions that they find themselves in. The negative experiences that Vivian goes through is an eye opener that nursing is more complex in reality than what the course may possible ever teach.
Reference
IMBb. (2001). Wit. Retrieved June 16, 2012, from http://www.imdb.com/title/tt0243664/
VNIP Assignment C
Hazel Ashby
New York City College of Technology
Professional Nursing
NUR: 4130
Section: 0996
Irene Pearlman and Ellen Zimmerman
June 11, 2012
Introduction
Effective Clinical decision making entails gathering data, processing, prioritizing patient care, implementing it and ultimately evaluation. According to O’ Reilly (2007), the concept of knowledge and experience are the key to implementation of efficient and effective patient care. This makes the nurse provide quality and prompt client services and which based on a scientific rationale. Effective decision making requires self- confidence and competence from the nurse so as to meet the patients’ health needs.
Some of the barriers of clinical decision making are:
Incompetence- this is the lack of sufficient knowledge, attitude and skills to execute duties. As a result, the affected nurses are not in a position to gather, understand and synthesize data from a patient and therefore cannot focus on the patient’s need and situation. Professional knowledge and its application to practice define the nurse’s competence in patient care (Journal of Nursing Education, 2003).
Lack of self-confidence- this refers to one’s self-belief to perform something. Absence of self-confidence makes the nurse feel out of control and is therefore notable in gaining influence in situations and making rational decisions. This therefore enslaves the nurse to the clinician’s plan even though wrong (Journal of Nursing Education, 2003).
Organizational structure- this in particular refers to the chain of command that at a time inhibits the go-ahead to make given decisions due to centralization. This is according to the nurse’s job description and design. This can only be solved if the nurse mangers delegate responsibility with the appropriate authority so that there is continuity of work even in their absence (Journal of Nursing Education, 2003).
Clinical reasoning refers to the application of experience and acquired knowledge to make decisions that have many possibilities to achieve the desired goal. In the article, ‘pain management interventions in bone marrow biopsy’, it is evident that the concept of critical reasoning is essential. It requires inductive and deductive thinking for the nurse to determine the type of analgesic to administer to the patient. This should be evidence-based and also incorporate other ways of pain management apart from pharmacologic ways.
It should also be put into consideration that invasive methods subject the patient to infections like osteomyelitis and intraosseous bleeding. In a practical set up, critical reasoning is essential in providing quality care to patients as well as avoiding adverse effects and errors while attending to patients. This therefore requires the nurse to be practically competent as well as apply science and technical skills while attending to a patient. The nurse should take into consideration the patient’s preferences, clinical progression, vulnerabilities and concerns. This entails things like drug allergies, previous response to given medications and other incompatible therapies.
The nurse will also be required to incorporate the family in the health care model as well as other social relationships. This is in consideration of the client’s family coping mechanisms so to enhance clinical ethical reasoning. The family will be useful in history collection regarding the patient (Journal of Nursing Education, 2003).
Critical thinking refers to the intellectual application of skillful reasoning to nursing practice. In the article ’Critical thinking is more than problem-solving’, one of the key concepts learned is that critical thinking can be nurtured and evaluated as a competency. It can be taught in the various nursing theories, models, frameworks and then its competency assessed through evidence based practice.
In nursing practice, these learned skills are used for sound reasoning. They include; data gathering, prioritization, remembering, focusing, analysis and evaluation (Norris et al, 1989).
From the article, ‘Critical thinking, intuitive, logical or both’ the aspect of critical thinking being considered as a contextual thing is necessary. Either logical or intuitive reasoning will be used depending on the circumstance. It is therefore wise to merge the two in practice so that there are more benefits than risks (Paul, 1990).
Evaluation YES NO N/A
1. I researched agency protocols pertaining to orientation, competence, & precepting. (y)
1. I determined my own personality, conflict and learning styles (y)
1. I added to my knowledge base regarding critical thinking and generational issues. (Y)
1. I will incorporate this knowledge to improve my capability as a clinical coach. (y)
1. The learning objectives were related to the general purpose of the learning activity. (y)
1. This was an effective format for presentation of this material. (y)
References:
Norris, S. P. & Ennis, R.H. (1989). Evaluating critical thinking. Pacific Grove, CA: Midwest
Publications, Critical Thinking PressSitzia J: Barriers to research utilization: the clinical
setting and nurses themselves.
Journal of Nursing Education (2003), 42(3):113-120. PubMed Abstract.
O’Reilly P (1993): Barriers to effective clinical decision making in nursing.
[http://www.clininfo.health.nsw.gov.au/hospolic/stvincents/1993/a04.html].
Paul, R.W. (1990). Critical Thinking: What Every Person Needs to Survive in a Rapidly
Changing World. Rohnert Park, California: Center for Critical Thinking and Moral
Critique.
Community Teaching Plan
Hazel Ashby
New York City College of Technology
Community Nursing
NUR: 4010 Section 2722
Professor Rita DeBonis
April 12, 2012
Community Teaching Plan
Data which supports the need for teaching:
The City of Summit is faced with several health disparities. In my teaching plan I will address two of the major health disparities in this Community. The two health disparities which I will be preparing teaching plan for are asthma, and drug abuse among adolescents. The purpose of the teaching is to provide the clients and their family with primary, secondary, or tertiary prevention about their health disparity. This will make the client and their family more aware of their conditions or issues. Furthermore it will encourage the clients to make life style changes or adjustments in their life which will promote healthier lifestyle for them and their families.
Teaching Plan 1
Ms. G, S is a 17year old African American who has a history of asthma. She is in 11th
grade and resides with parents, her maternal grandmother and two year old brother. Both parents completed college at a bachelor’s level. Grandmother completed high school and client has a B plus average in most of her classes. She is anticipating attending college to pursue a degree in Communication.
Nursing Diagnosis
Impaired Home maintenance R/T deficient knowledge regarding control of environmental triggers.
Goals:
1. To prevent recurrent exacerbation of asthma and minimize the need for emergency department visits or hospitalization.
2. Maintain normal activity levels including exercise and other physical activity.
3. To meet the families expectation of and satisfaction with asthma care.
Expected outcome
At the end of the teaching session the client will be able to:
(1) Perform return demonstration using a peek flow meter, to see how much air he/she can exhale. (P)
(2) Understand the need for using the peek flow meter is to detect the intensity of asthma attack. Client will understand the reason for knowing the things that trigger an asthma attack. (C)
(3) Will be receptive, listened attentively, asked questions and participated in doing some post teaching exercises. (A)
Interventions
What Is Asthma?
Asthma is one of the most common long-term diseases of children, but adults have asthma, too. Asthma causes episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. An asthma attack occurs when an allergen triggers it and is something caused by increased physical activity. The causes of asthma are unknown, and we do not know how to cure it. We know that if someone in your family has asthma, you are also more likely to have it.
Knowing the warning signs of an asthma attack, avoiding things that trigger an attack, and following the advice of your primary care physician can help you control your asthma.
When your asthma is under control you will not have symptoms such as wheezing or coughing. You will be able to breathe better and will rest or sleep better. Absentee from work or school will be decreased and you will be able to participate in physical activities without being out of breath.
How Is Asthma Diagnosed?
Asthma can be diagnosed by keeping regular physical checkups that include checking your lung function and checking for allergies. It can be diagnosed in children at an early age because they tend to have difficulty breathing and are seen in the emergency room as frequently as infants. “Closely monitoring children and keeping follow up visits with their doctor or other medical professional helps them make the right diagnosis.” (“Asthma prevention,” 2012)
During a checkup, the doctor or other medical professional will ask you questions about whether you cough a lot, especially at night, and whether your breathing problems are worse after physical activity or during a particular time of year. Doctors will also ask about other symptoms, such as chest tightness, wheezing, and colds those last more than 10 days. They will ask you whether your family members have or have had asthma, allergies, or other breathing problems, and they will ask you questions about your home. The doctor will also ask you about missing school or work and about any trouble you may have doing certain activities.
“A lung function test, called spirometry (spy-rom-e-tree), is another way to diagnose asthma. A spirometer (spy-rom-e-ter) measures the largest amount of air you can exhale, or breathe out, after taking a very deep breath. The spirometer can measure airflow before and after you use asthma medicine.” (“Asthma prevention,” 2012)
What Is an Asthma Attack?
An asthma attack happens in your body’s airways, which are the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucus that your body produces clogs up the airways even more. The attack may include coughing, chest tightness, wheezing, and trouble breathing. Some people call an asthma attack an episode.
What Causes an Asthma Attack?
“Patients with recurrent asthma should undergo test to identify the substances that precipitate the symptoms.” (Smelter & Bare, 2004, p. 589) An asthma attack can occur when you are exposed to things in the environment, such as house dust mites and tobacco smoke. These are called asthma triggers. Some of the most important triggers are available at Important Asthma Triggers. If you have asthma, your airways always have some level of irritation. When you have an asthma attack this irritation gets worse and causes your airways close, which may be partially blocked with mucus. Asthma attacks may include coughing, chest tightness, wheezing, and trouble breathing. Your personal triggers can be very different from those of another person with asthma.
Asthma action plan
All people with asthma should have an asthma action plan. An asthma action plan (also called a management plan) is a written plan that you develop with your doctor to help control your asthma. The asthma action plan shows your daily treatment, such as what kind of medicines to take and when to take them. Your plan describes how to control asthma long term and how to handle worsening asthma, or attacks. The plan explains when to call the doctor or go to the emergency room. If your child has asthma, all of the people who care for him or her should know about the child’s asthma action plan. These caregivers include babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan.
Try to avoid your triggers
Some of the most common triggers include, tobacco or secondhand smoke, dust mites, outdoor air pollution, cockroach allergen, pets, mold, strenuous physical exercises, cold, upper respiratory infection, influenza, gastro reflux, and inhalation of chemicals.
According to the Center for Disease Control, environmental tobacco or secondhand smoke occurs when you breathe in smoke from others who smoke near you. For example, a friend or parent who smokes in the home or next to you. Dust mites are everywhere in almost everybody’s homes. This causes some people to have an asthma attacks. To help prevent asthma attacks, it is important to keep a clean environment, use mattress covers and pillowcase covers to make a barrier between dust mites and yourself. Don’t use down-filled pillows, quilts, or comforters. Remove stuffed animals and clutter from your bedroom. Do not sweep your home, instead vacuum and use a damn cloth to dust. This will prevent inhaling dust particles. Pollution outdoor may trigger asthma, for instance industrial emissions, automobile exhaust, and pollen. Listen to air quality forecasts on radio, television, and Internet and plan your activities for when air pollution levels will be low if air pollution aggravates your asthma.
Cockroaches and their droppings may trigger an asthma attack. Get rid of cockroaches in your home. Remove as many water and food sources as you can because cockroaches need food and water to survive. Keep a clean environment, vacuum or sweep areas that might attract cockroaches. You can also use roach traps or gels to decrease the number of cockroaches in your home. Dogs and cats may trigger an asthma attack. When these pet is suspected of causing asthma attacks, the simplest solution is to find the pet another home. If pet owners are too attached to their pets or are unable to locate a safe, new home for the pet, they should keep the pet out of the bedroom of the person with asthma. Bathed pets weekly, kept them outside as much as possible and vacuum often to clean up anything that could cause an asthma attack. If your floors have a hard surface, such as wood or tile, and are not carpeted, damp mop them every week.
Inhaling or breathing in mold can cause an asthma attack. Get rid of mold in all parts of your home to help control your asthma attacks. Keep the humidity level in your home between 35% and 50%. In hot, humid climates, you may need to use an air conditioner or a dehumidifier or both. Fix water leaks, which allow mold to grow behind walls and under floors. Infections linked to influenza (flu), colds, can trigger an attack. Sinus infections, allergies, breathing in some chemicals, and acid reflux can irritate airways and trigger asthma attacks. Getting vaccinated for the flu and visiting your physician for any of the above conditions can help you control your asthma. Strenuous physical exercises can also causes asthma attacks, taking your inhaler or a treatment prior to strenuous exercises can alleviate an asthma attack. Some foods and food additives can trigger an asthma attack. It is important that you ask your Doctor to refer you to an allergist to check your allergen. Be alert for a possible attack when the triggers cannot be avoided. (“Asthma prevention,” 2012)
Whom will you teach?
I will teach the client and her parents and grandmother who will be assisting client with care.
Rationale for the above selection:
Summit Community has a high rate of asthmatics. They need to be aware of the causes and preventative measures to avoid having an asthma attack. The goal of post-operative nursing care is to teach patients how to promote optimal lung expansion, promote mobility, improve circulation and prevent venous stasis.
What considerations or adaptations I have made to meet the learning needs of the person?
– Assess patient’s cultural practices;
– Verbally explain important information and repeat;
– Enhance verbal instructions with written materials, pictures, models, and diagrams;
– Face patient and family members, maintain eye contact, and do not cover my mouth when speaking;
– Slow down and pause between sentences and phrases;
– Use short sentences and repeats or re-phrase;
– Use facial expression and gestures;
Choose materials written for patient level of education;
– Present only essential material to master skill/information;
– Use vocabulary that patient already knows in familiar context;
-Give specific, not general instructions;
How to use peek flow meter
A peak flow meter helps you check how well your asthma is controlled. Peak flow meters are most helpful if you have with moderate to severe persistent asthma.
Move the marker to the bottom of the numbered scale.
Stand up straight.
Take a deep breath. Fill your lungs all the way.
Hold your breath while you place the mouthpiece in your mouth, between your teeth. Close your lips around it. Do not put your tongue inside the hole.
Blow out as hard and fast as you can in a single blow. Your first burst of air is the most important, so blowing for a longer time will not affect your result.
Write down the number you get. But, if you coughed or did not do the steps right, do not write down the number. Do it over again. (“National Institute of Health,” 2012)
Evaluation of the teaching session(s)
1. Client was eager to read the brochures about asthma which were given to her. Brochures entailed use of the peek flow meter and triggers of asthma. (A)
2. The client was able to perform return demonstration use of the peek flow meter. (P)
3. Client was able to restate step by step the triggers for asthma. She was able to verbalize how to use the peek flow meter. (C)
Move the marker back to the bottom and repeat these steps 2 more times. The highest of the 3 numbers is your peak flow number. Write it down in your log chart.
TEACHING PLAN 2
Data which supports the need for teaching:
My client L, A. is a 16year old Mexican American male who lives with both parents. Mom is a housekeeper and his dad works as a landscaper at the local golf course. He was seen by the nurse today. His mother brought him in because he refuses to stop smoking Cannabis. The client’s mother explained that he has been very disruptive in the home. He attempts to fight with older sister and younger brother frequently. Client denies he smokes cannabis often, but admits to smoking it once a month with his friends.
Nursing Diagnosis:
Impaired adjustment R/T failure to failure to intend to change behavior:
Expected Outcomes: At the end of the teaching session the client will be able to:
(1) State acceptance of change in health status. (A)
(2) Verbalize request for assistance in altering behaviors to adapt to change. (A)
(3) State personal goals for dealing with change in health status and means to prevent further problems. (C)
Intervention
1. Assess client’s perception about the illness or event. Ask him to state feelings related to the change in health status.
2. Assess the family for the presence of additional stressors e.g. financial difficulty.
3. Assess the influence of cultural beliefs, norms, and values on the client’s ability to modify health behavior.
4. Validate the client’s feelings regarding the impact of health status on current life style.
5. Allow the client adequate time to express feelings about the change in health status. (Ackley & Ladwig, 2002, p. 136)
Whom will you teach?
I will teach the client his parents and siblings who are affected as a result of L, A. condition.
Rationale for the above selection:
L, A is in denial of his health status change. He has failed to take actions that would prevent further health problems and demonstrates non acceptance behavior.
What considerations/adaptations will you make to meet the learning needs of the person(s) above?
– Assess patient’s cultural practices;
– Verbally explain important information and repeat;
– Enhance verbal instructions with written materials, pictures, models, and diagrams;
-Use of power point and video tapes;
-Distribute literature in native language to parents;
-Provide a translators if needed;
– Face patient, maintain eye contact, and do not cover mouth when speaking;
– Slow down and pause between sentences and phrases;
– Use short sentences and repeats or re-phrase;
– Use facial expression and gestures;
– Choose materials written for patient level of education;
– Present only essential material to master skill/information;
– Use vocabulary that patient already knows in familiar context;
-Give specific, not general instructions;
Evaluation of the teaching session(s) (Use your expected outcomes):
1. L, A verbalizes acceptance of health status. (A)
2. Client has requested assistance in altering behavior to adjust to change. (A)
3. Client has established and verbalized personal goals for dealing with change in health status and means to prevent further health problems. (C)
References
Ackley, B. J., & Ladwig, G. B. (2002). . In B. J. Ackley, & G. B. Ladwig (Eds.), Nursing Diagnosis Handbook A Guide to Planning Care (6th ed., pp. 136-140).
Asthma Basic Information. (2012). Retrieved from www.cdc.gov/asthma/faqs.htm on 4/13/2012
How to use a peak flow meter. (2012). Retrieved from www.nlm.nih.gov/medlineplus/ency/patientinstructions/000043.htm on 4/13/2012
Smelter, S. C., & Bare, B. G. (2004). Management of patients with Chronic Obstructive Pulmonary Disease. Asthma. In S. C. Smelter, & B. G. Bare (Eds.), Brunner & Suddarth’s textbook of Medical Surgical Nursing (10th ed., p. 589)
