Olga Krasnobay-Oganezov's ePortfolio

Olga Krasnobay-Oganezov, RN

Assignment #2

Women’s Health and Wellness Across the Lift Continuum

Due Date: 03/11/2018

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What do women know about heart disease? Unfortunately, the knowledge about cardiovascular health among female population is very limited and, oftentimes, factually incorrect. These myths, so widely accepted, cloud patients’ judgement and prevent them from taking timely precautionary measures to decrease morbidity and mortality from. One of the myths is that heart disease mostly affects men. In fact, according to Encyclopedia of Heart Diseases, “this is a false notion that cardiovascular disease (CVD) is more common in men than in women (Khan, 2011).” The same source reports that “after age 65, about one in four women have some form of CVD” and that “more than 350,000 women die of a heart attack and more than 120,000 die of a stroke in USA each year (Khan, 2011).” Moreover, according to the statistics, out of all CVD deaths, women show higher numbers than men, 52% to 48%, respectively. However, these statistics come into play when discussing CVD deaths in postmenopausal women after 48 – “most women are protected … up to age 48 because of their hormonal status (Khan, 2011).” Comparative data for myocardial infarction (MI) rates among men and women as they age clearly depicts the increase of incidence in women: “the incidence of heart attack in men and women at ages 35, 40, 50, 65, 70, and 75 is about 100:1, 20:1, 10:1, 5:2, 5:4, and 1:1 (Khan, 2011).”  Another misconception has to do with the leading cause of death among women in the US – cancer, breast and uterine in particular, is falsely considered the main cause.  According to Boston Scientific Journal, “heart disease is the leading cause of death for women, taking more female lives than all cancers, respiratory diseases and Alzheimer disease combined (Smith, 2015).” Encyclopedia of Heart Diseases states that “notably, breast cancer deaths are about 10% than that of CVD deaths, and deaths from all forms of cancer are less than 50% of CVD deaths (Khan, 2011).” People tend to think that heart disease affects men and women the same way. This understanding is wrong for many reasons. The factors that affect disease characteristics in terms of gender are heart size and strength. Since the size of the right ventricle is an atomically smaller in women, it is more vulnerable to damage. Anatomical weakness is leveraged by the abundance of estrogen in premenopausal women. In the same manner, people believe that CVD is a disease of the old disregarding the fact that it affects all age groups. For “younger women in particular, the combination of birth control pills and smoking boosts heart disease risks by 20 percent (Leuzzi, 2014).”  Another myth is that in order to be diagnosed, symptoms have to be present and they are similar among both genders. Sadly, American Heart Association (AHA) claims that “sixty-four percent of women who die suddenly of CVD had no previous symptoms… and … because the symptoms vary greatly between men and women, they are often misunderstood (Smith, 2015).” Moreover, since women’s symptoms like dizziness, indigestion and sleep problems, are very subtle, they can be brushed off or attributed to a number of unrelated conditions. It is falsely believed that men and women with heart disease get the same medical care. According to Boston Scientific Journal, “research shows that among heart patients, women were less likely … to receive medications such as beta blockers, statins, ACE inhibitors, which help prevent further heart problems (Leuzzi, 2014).” One more misconception has to do with the belief that gender differences are accounted for when it comes to heart disease research. In fact, heart care research tends to overlook gender differences focusing mainly on men. Heart clinical trials report “gender-specific results only about 25% of the time (Smith 2015).”

 

Even though medical community is aware of the fact that heart disease does not manifest the same way in men and women, all the diagnostic tests and treatments guidelines are universal for both sexes. The gap between cardiovascular diagnostic tests and resulting medical treatment exists based on the gender of the patient. Recent research published in Clinical Chemistry and Laboratory Medicine Journal showed that female heart patients experience longer wait time for treatment initiation for the same symptoms as their male counterparts. The reason for this inequality of treatment that creates the gap itself is known as Yentl syndrome. The syndrome represents the different course that heart attacks take in males as opposed to females. The problem itself, however, rose due to the overwhelming concentration of the cardiovascular research on white male participants. Heart disease does not discriminate among genders – treatment practices do. Sadly, with the existing amount and variety of CVD research and the amount of investments into the field, women of all ages are still more likely to die from a heart attack. Womensheart.orgmentions interesting findings of one Israeli study that claims that the CVD death risk for women is 1.7 times higher than for men. Looking at myocardial infarction (MI) example, timely administration of thrombolytic agents increases survival rates. However, according to womensheart.org, for unknown reasons, thrombolytics work better in male patients. While doctors look for more gender specific CVD treatments, nurses can play a role in decreasing this gender gap and saving lives through education. Studies show that women tend to wait too long before seeking medical attention for their heart attack symptoms. According to the American Heart Association (AHA), “about 95% of women notice that something wasn’t right in the weeks before their heart attack (Smith, 2015).” Timely arrival and diagnosis are the first and foremost determinants of how successful the outcome of treatment will be. Nurses should educate female patient on the symptoms of heart attack in women and necessity of emergent medical care shall the symptoms appear.

There are several teaching points that need to be addressed by the nurses during women’s education: risks, warning signs and symptoms. Risk factors can be subdivided into general and specific to gender. General risk factors include a list of common comorbidities: diabetes, obesity, hear failure, history of stroke, and kidney failure. Among gender specific, nurses can mention these risk factors during a teaching session: higher blood pressure during menopause, higher testosterone levels before menopause, autoimmune disorders, depression, smoking, anxiety, and stress.  AHA mentions that among heart attack warning signs for women, unusual fatigue, sleep disturbance, shortness of breath, indigestion, anxiety, and racing heart. As it was already mentioned above, the signs are very non-specific, and can be attributed to the number of unrelated conditions. In comparison to warning signs, the symptoms experienced by women during the heart attack, as per AHA, are: chest discomfort, shortness of breath, weakness with difficulty moving, unusual fatigue during and after activities, cold sweat, nausea, dizziness, lightheadedness, week or heavy-feeling arms, and pain in one or both arms, the back, neck and jaw. The characteristic that needs to be emphasized by nurse-educator is the fact that for both males and females the most common heart attack symptom is chest pain; however, women report it significantly less. To clarify the situation, compared to men, women report “diffuse chest discomfort – pressure, squeezing, and fullness – and, perhaps, do not perceive or report them as pain (#9).” Additional women-specific symptoms, as per AHA include: sudden pain that awakens the patient from sleep, sudden pain unrelated to physical exertion, pain specific to the left lower side of the jaw, pain in either arm (no just left like in men), and pain in the lower or upper back that starts in the chest (Khan, 2011).”

What life-style modifications can nurses recommended to female patients? First recommendation would be to quit smoking, according to AHA, tobacco acts like a vasoconstrictive agent that can highly increase women’s chances for development of heart attacks. Healthy eating would be another lifestyle modification. Nutritional recommendations are particularly important and should be well explained by the nurse. The outcome of the teaching about diet modifications would be favoring of fruits, vegetables and whole grains instead of deep-fried fast foods, bakery products, processed snacks by women. Special attention should be paid to the limitation of the saturated fats in beef, butter, cheese and milk and favoring polyunsaturated fats in fish and liquid oils. Significant decrease of alcohol consumption is necessary to keep blood pressure in check and prevent both CVD and CVA. Regular exercising would be is another valuable advice to give – a minimum of 30-60 minutes of daily physical activity is necessary for cardiovascular health. Daily exercising falls under a broader category of prevention from CVD – weight watching. With the reduction of weight, chances for the development of high cholesterol levels, hypertension and insulin resistance – all leading to CVD – become much slimmer. Stress reduction is another invaluable amendment to everyday lives. Stress, unfortunately, triggers most of the other types of unhealthy behaviors like overeating, smoking, and alcohol consumption. Last but not least, nurses should pay tremendous amount of attention and effort to regular health screenings. Adults should be taught to have their blood pressure checked at least every two years and cholesterol about every four to six years. Unfortunately, high blood pressure and elevated cholesterol my not cause symptoms, but they can permanently damage hearts.

 

Even though contemporary cardiology hasn’t come up with a specific plan for diagnosis and treatment of heart disease in women, decrease in mortality and morbidity can be achieved through thorough nursing education of females of all ages about prevention, risk factors, signs and symptoms and course of action during heart attack. The power of word and pervasion should be embraced and multiplied by thousands of nurses fighting for the same goal of female cardiovascular health.

 

 

 

 

 

 

 

References:

Common Myths About Heart Disease. Retrieved March 11, 2019, from https://www.goredforwomen.org/en/about-heart-disease-in-women/facts/common-myths-about-heart-disease

 

Heart disease in women: Gender gap still in need of repair. (2018, August 09). Retrieved from http://www.mysouthernhealth.com/heart-disease-in-women/

 

Khan, M. G. (2011). Encyclopedia of Heart Diseases. Totowa: Springer. Retrieved from https://onesearch.cuny.edu/primo-explore/fulldisplay?docid=TN_gale_gvrlGVRL6MJZ&context=PC&vid=ny&lang=en_US&search_scope=everything&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,encyclopedia of heart disease&sortby=rank&facet=rtype,include,books&mode=basic.

 

Leuzzi, C., Sangiorgi, G. M., & Modena, M. G. (2010). Gender-specific aspects in the clinical presentation of cardiovascular disease. Fundamental & Clinical Pharmacology,24(6), 711-717. doi:10.1111/j.1472-8206.2010.00873.x

 

Smith, G. N. (2015). The Maternal Health Clinic: Improving women’s cardiovascular health. Seminars in Perinatology,39(4), 316-319. doi:10.1053/j.semperi.2015.05.012

 

 

 

 

Olga Krasnobay-Oganezov, RN

Analysis and Personal Reflection of Wit

Pro Nursing Practice NUR 4130 OL64 (35884)

Due Date: 03/11/2019

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

“You have cancer” – the most horrible words one can hear. These words open a movie Wit, the story of a 48-year-old Dr. Vivian Bearing, who is diagnosed with stage IV metastatic ovarian cancer and is supposed to undergo painful, experimental treatment. The drama takes place at the research hospital where an accomplished professor and scholar of seventeenth century poetry spends her last weeks of life and finally finds peace.

Throughout the movie, Vivian mostly interacts with the healthcare personnel; despite her scholarly accomplishments, she has lived an isolated life, admiring the company of books rather than people. Her main interactions are with Dr. Kalekian – primary oncologist, head of the research, sober and determined “troglodyte”; Dr. Posner – research-oriented resident, “result-hungry “overachiever, former Bearing’s student; and nurse Susie – warm, comforting and patient-focused.

From the very first scenes, it becomes clear that Ms. Bearing is perceived and addressed differently by her caregivers. I believe that a choice of words can affect patient-caregiver interactions to the point of achieving therapeutic communications or a lack of thereof. Dr. Kalekian addresses professor Bearing as Dr. Bearing and not by her first name. This pure act of professional respect and scholarly dedication leaves the patient no chance to refuse the rigorous course of treatment or even question it. She would do anything to aid a fellow researcher in his project. However, Vivian does not understand till later how painful it would be to become a research sample and stop being a patient. Dr. Posner is very uncomfortable in his one-to-one communications with professor Bearing, he calls her professor in their first encounter during the physical exam – he is not hiding his callous lack of compassion to her as a human being from the very beginning. At the very end, when Vivian dies, he makes a daring attempt to resuscitate her against Vivian’s will simply because “she is research!” – at this moment, the viewers realize that the heroic attempt had to do with the fear of loss of his precious data and not the emotional connection with his former literature professor. The treatment that she gets from her doctors is depersonalized in nature. During Grand Rounds, Ms. Bearings makes a bitter observation, “What we have come to think of me is, in fact, just the specimen jar, just the dust jacket, just the white piece of paper that bears the little black marks.”

The only person who treats Vivian with dignity and respect is nurse Susie. The nurse neither dehumanizes nor does she patronize her patient. Susie treats Vivian the way she wants to be treated. In the beginning of their relationship, Susie addresses Vivian as Ms. Bearing, and closer to the end, as their relationship become more intimate and personal, they switch to first name basis. For the nurse, the scholarly titles are meaningless, she sees her patient beyond the letters after her name and treats her with respect, compassion and human kindness. Vivian makes the whole speech about how meaningless the question “How are you feeling?” becomes in patient-doctor interactions. However, she opens up to her nurse and expresses her exact feelings of pain and fear. Susie is always able to find a minute to console Ms. Bearing in a way of holding her hand, offering her a popsicle, spending time talking to her, and, finally, addressing the most difficult topic – Vivian’s code status. The fact that Susie is the one who brings up the DNR topic shows how deeply she cares for Vivian. Why did none of the doctors address the advance directives questions? Did they not know that the possibility of a cardiac arrest is very tangible in Vivian’s case? The answers are veiled and implicit – the doctors are more than aware of the situation; however, Vivian’s life is too valuable for research purposes. At some point of this ethical dilemma, “do no harm” got overpowered by “anything for the research”.  With this development, the nurse has to assume a role of a true patient’s advocate – she sees her patient past her research status and explains to Vivian what could be done if her heart stops. Most importantly, she assures Ms. Bearing that it is OK to stop fighting and accept her fate even if this decision affects the research. It seems that Vivian desperately needed this reassurance and permission to stop fighting. In this emotional moment, Susan promises Vivian to be with her till the very end. Susie fulfills her promise in the most dramatic scene of the movie when Vivian’s heart stops. This moment is not a quiet and peaceful one. Nurse Susie has to rise up against the code team’s effort to resuscitate the patient against her will and forcefully cancels the code. Even though the script does not allow Susie to show her intellectual side, she portrays what a real nurse should be – caring, fearless, and kind.

This movie raises many ethical issues. The one that stroke my soul the most was the ignorance of medical team toward patient’s resuscitation wishes.  I am extremely sensitive to this topic because cardiac arrest codes are a big part of my everyday ICU practice. We, as the ICU team, never push families into signing DNR for their loved ones. In contrast, we approach this topic slowly and carefully, with great degree of sensitivity. If the family decides to go through with the DNR status, we make sure that the patient goes comfortably with all the support he or she might need; moreover, we make sure the whole medical team is aware of the code status. Codes are idealized and glorified on television to such extent that the viewers (who become patients later) do not know what to expect. They know nothing about the fact that every code holds a 50% chance of their loved one not to wake up regardless how long the code was, or how many ribs are usually cracked during CPR, or that the chances of puncturing lungs with the rib fragments are 68%. Patients and families need to be educated about the codes to make informed decisions.  Nurses and doctors need to work together to address this ethical issue and make the practice more humane and respectful.

 

I am a critical thinker who does not freeze in life-threatening situations that nurses encounter in the Medical ICU on the daily basis. My ability of thinking on-the-go, vigilance, attention to detail and good assessment skills allow me to navigate through the most complex cases. Compassion and empathy that I possess make my communication with the patients and their families smooth and fulfilling for both parties. My ability to effectively and timely relay my concerns regarding treatment plans and current health situations of the patients to appropriate members of the healthcare team earned me a reputation of a knowledgeable nurse and a true patient advocate.  My leadership skills and fair treatment of all members of the team allows me to provide the best outcomes for the patient through smooth collaborative work of my team. My desire to advance my knowledge and understand medical cases that I encounter in full complexity draws fellow nurses to me for further education and preceptorship. Self-evaluation and reflection are vitally important and carried out every day giving me room and direction to grow personally and professionally. I have a strong desire to become the best nurse I could possibly be – this desire drives and motivates me to better myself personally and professionally every day.

 

Reflecting on my nursing education I realized that throughout the years of nursing school and my two-year practice as a registered nurse I have created a combination of values and beliefs for myself – my nursing philosophy. An interplay of my classroom experience, my interactions with patients, family members, members of interdisciplinary teams of doctors, social workers, nutrition and respiratory therapists – my nursing philosophy represents the growth I have achieved from being a student nurse to becoming a recipient of a “Best Critical Care Nurse” this year. As I continue advancing in my career, my ethics, cultural and critical care competencies will keep growing exponentially.

Nursing is not just a professional choice; it is a life style. Feeling an overwhelming need to help people determines the choice of the profession. I strongly believe that every patient should be treated with respect regardless of their race, age, gender, religious or sexual preference, socioeconomic status or life choices that he or she has made. Each patient has a right to receive the best possible care, honesty and a feeling of safety during my care. Not a single patient deserves to die alone. The critically ill patients, in particular, must receive holistic care full of integrity. The critical care nurse must be able to balance the need for highly technological complex care with human kindness, understanding, cultural competency, safety, privacy, comfort and dignity.

The critical care nurse’s ability to make solid decisions is rooted into a solid foundation of academic knowledge, experience and professional intuition. My main goal is to pursue life-long learning every day – not a day goes by without me learning something new, big or small and reflecting on what has occurred; moreover, I make it my personal goal to share my growing knowledge with as many people as I can reach out to. Educating patients and fellow nurses is something that I value greatly. Integration of evidence-based practice into my clinical experience makes it possible for me to gain positive patient outcomes.

I feel very strongly about creating compassionate and trusting relationship with patients and their families – the concept of patient-centered care is integral in my practice. I make sure to advocate for patients at all times. I represent myself as a devoted and valuable member of a multidisciplinary healthcare team and I am highly committed to helping my patients in reaching their best level of health and well-being.

 

Graduating from Baccalaureate degree program, I came to realization that the whole experience is vitally important in shaping me as a nurse. The invaluable knowledge that I acquired throughout the BSN program added significant depth to the information and skills learned during the ADN program. In this program the knowledge is broader and even more valuable to apply in everyday practice. BSN teaches the students to look at the problem from different aspects because positive patient outcomes are directly related to how well the clinical picture is addressed and looked at from every angle by the multidisciplinary team.

Management skills are also integral for all nursing staff, not only the managerial level. Seven though only 1% of nurses become managers, leadership skills are a must-have in day-to-day lives of staff nurses is a shape of efficient organization of work with PCTs and CNAs and conflict resolution among staff. Research taught us very important skills of deciphering though thousands of articles to find the right one that is pertaining to the topic of any current research using evidence-based practice.

Graduating from Baccalaureate degree program, I came to the realization that is only the first step, the beginning, the entry into practice. This is the degree that makes nurses understand that nursing is more than the bedside, nursing is the entire limitless world of opportunities awaiting for the learners. Baccalaureate degree taught me to never stop looking for knowledge, appreciate and reflect on the one already obtained and educate everyone I meet on my way.

Olga Krasnobay-Oganezov* RN Resume

Reflecting on my nursing education I realized that throughout the years of nursing school and my two-year practice as a registered nurse I have created a combination of values and beliefs for myself – my nursing philosophy. An interplay of my classroom experience, my interactions with patients, family members, members of interdisciplinary teams of doctors, social workers, nutrition and respiratory therapists – my nursing philosophy represents the growth I have achieved from being a student nurse to becoming a recipient of a “Best Critical Care Nurse” this year. As I continue advancing in my career, my ethics, cultural and critical care competencies will keep growing exponentially.

Nursing is not just a professional choice; it is a life style. Feeling an overwhelming need to help people determines the choice of the profession. I strongly believe that every patient should be treated with respect regardless of their race, age, gender, religious or sexual preference, socioeconomic status or life choices that he or she has made. Each patient has a right to receive the best possible care, honesty and a feeling of safety during my care. Not a single patient deserves to die alone. The critically ill patients, in particular, must receive holistic care full of integrity. The critical care nurse must be able to balance the need for highly technological complex care with human kindness, understanding, cultural competency, safety, privacy, comfort and dignity.

The critical care nurse’s ability to make solid decisions is rooted into a solid foundation of academic knowledge, experience and professional intuition. My main goal is to pursue life-long learning every day – not a day goes by without me learning something new, big or small and reflecting on what has occurred; moreover, I make it my personal goal to share my growing knowledge with as many people as I can reach out to. Educating patients and fellow nurses is something that I value greatly. Integration of evidence-based practice into my clinical experience makes it possible for me to gain positive patient outcomes.

I feel very strongly about creating compassionate and trusting relationship with patients and their families – the concept of patient-centered care is integral in my practice. I make sure to advocate for patients at all times. I represent myself as a devoted and valuable member of a multidisciplinary healthcare team and I am highly committed to helping my patients in reaching their best level of health and well-being.