Clinical Week 3

1) Vivien: The two areas of difficulty I have encountered this week at my clinical site were about patient revoking hospice services related to patient changing his mind about end-of-life care measures versus wanting to seek alternative and aggressive treatment for his cancer. The second challenge I have to face today in my clinical site, was having to observe how another clinician explain the benefits of hospice to a patient and her family. I get to see how uncomfortable the situation can be for some family members to hear the whole thing of what to expect during end of life. 

At the time I get to learn about a patient desire to seek aggressive treatment for his cancer, and not wanting to stay under hospice, I was prompted to have the patient sign a revocation form to discontinue hospice services. A form was given to me by the office staff, I have to read it and explained it to the patient, and have him read and sign it afterwards. I was taught that this form is a very important form to have, because it states that the patient or the beneficiary had chosen to no longer receive Medicare covered hospice benefits. In order to revoke the hospice benefits and services, the beneficiary or representative must give a written statement of revocation (CMS, n.d.). 

I also get to participate and witness the signing and explanation of election of benefits to hospice, or what often called as “EOB”. The election statement is intended to ensure that the beneficiary understands the hospice benefit, particularly that hospice care is palliative, not curative, and that the beneficiary waives the right to Medicare payment for treatment of the terminal illness except for services provided by the hospice (CMS, n.d.).

2) Kamela: This week at my clinical site I was in place to register the incoming new families for the distribution center.  I had to assess and interview the connection of their situation to the growing pandemic. I also had to collect personal information of the person being registered and everyone in their household. As simple this may sound, it became challenging when I found myself struggling to understand the heavy accent of a specific culture. This was an interruption to the time management plan I originally had in my mind and it stirred quite a bit of frustration to the person trying to give me the information. Now I have been in a position before where language posed a problem between myself and the patient, but we had interpreters for cases like that. At distribution centers, interpreters aren’t accessible.

We live in a diverse population and communication can sometimes be a factor in care or services given. It is helpful to educate staff on cultural differences they may encounter because miscommunication when it comes to cultural differences can lead to conflict if individuals mistakenly believe someone is intentionally being rude (McGuire, 2018). It’s important to remember, even though it can be frustrating, we are to remain calm and respectful.

Public Health Week 3

1) Olga: The research study of health conditions or diseases in a defined group of populations is called epidemiology. This research study helps healthcare policy makers to make informed decisions about public health. The researches about the harmful effects of smoking on the health of smokers help the community leaders to make policies about educating people to bring the smoking incidence down. Research is the scientific study conducted to determine the effect of research on the research outcome. Research studies are very common in the field of epidemiology. There are definitive steps for conducting a research study. The first step is formulating the correct research question. It should be remembered that the question should be answerable and specific. 

Research question: What effect does daily use of tobacco have in relation to lung cancer development?

After the formulation of the question, the decision of the type of research study is taken. The research study is of two types namely observational and randomized control trial study. In an observational study, the researcher only observes the variables occurring in a natural way and the outcome while in randomized control trial study, researchers ask people to change their lifestyle and then observe the outcome of that change. For example, in the observational research study of smoking and its link with lung cancer, researches observe and report the incidents of lung cancer in smokers and in not smokers as well. While in a randomized control trial, a group of people is asked to quit smoking and the effect of quitting is studied making a comparation between them and the smokers. 

The design of the study is the next important step. The study can be descriptive and analytical, the descriptive study collects the data and explains it while an analytical study analyzes the data (Ranganathan, 2018).

2) Maria: Research question: What is the relationship between teen vaping and mental health disorders?

Determine what kind of study should be undertaken. I believe that the best option for this topic is a cross sectional study. Cross-sectional studies gather information from a group of people, analyzing the frequency of a disease in that specific population (Lancaster & Stanhope, 2016).

Surveys would be given to teens between the ages of 13-17 years old while at school, to ensure anonymity. Surveys would collect information such as exposure to vaping, use of vaping, if they have ever tried vaping, how long have they vaped for, and how often do they vape for in one day. Cross-sectional studies are great in that they can provide the frequency of existing cases of a disease in a population (Lancaster & Stanhope, 2016).  Surveys would also include questions about their mental health, such as, do they experience anxiety? Depression? Loss of interest? Rage? anger? Extreme irritability? Sleep too much? Paranoia? Listening to voices? When did any of these symptoms begin?

Capstone Week 3:

1) Sonia: One particular ethical dilemma that I encountered was early in my nursing career, when I cared for an elderly nursing home patient, that had been in a permanent vegetative state for over a year. The patient was a full-code, with her daughter as the primary decision-maker. I admitted the patient post cardiopulmonary arrest with ROSC x2.  The patient was in such a neglected condition that she had maggots out of her trach stoma site, as well as having multiple decubitus. I placed the patient on multiple vasopressors, and she coded twice on my shift. When I was finally able to reach the daughter to let her know that she should come and see her mother, because she was very unstable, the daughter refused; she stated “I don’t care what she looks like, you better do your job and keep her alive!” At that point I told her that we were doing everything possible for her mother, but that I wanted her to know of the grave situation.

This was a very difficult situation for me, because as nurses our duty is to protect the patient, but in my patient’s case I also encountered the ethical issue of futile care. This is difficult to understand, because as Modra & Hilton (2016) point out, family members are sometimes hopeful that patients are taken to ICU because they are very ill, and that the patient will be given the care that will provide some form of minimally acceptable physical, mental or social functioning, but when that goal is unable to be met withdrawal treatment should be considered (p. 36).  Legally we had to abide by what the code status dictated but taking into account the patient’s condition, it seemed morally and ethically unreasonable to keep her maxed out on all the medications she required and continuing to resuscitate her despite her poor quality of life. The biggest lesson I learned was to understand that I cannot judge anyone on their choices, but I can be an advocate by utilizing the resources I have available to me. This was my first encounter where I had to recommend that the ethics committee become involved, and therefore I was left to care for my patient without feeling the burden of not being a voice for her. 

2) Suanne: I’m having a very difficult time remembering one dilemma in particular. I’ve had many in the past. I’ve seen patients from a large prominent hospital (this has happened for years and still happens, though we are not contracted with them anymore) sit in emergency rooms in chest pain without ST elevation and finally be transferred to our hospital after ST elevations develop. The patients left ventricle and myocardium is shot by the time we get them. What frustration is mostly that this large hospital brags about how wonderful it is to be in its group and plan, but refuses to attend to emergencies. This hospital will put the patient on the list of scheduled patients but the staff will not be called in for an emergency ST elevated MI. Because the staff goes home and does not have to take call for these issues, these patients must be transferred out of the emergency department to contract hospitals willing to do this bigger hospital’s dirty work. This is more harmful to the patient because the door to balloon time is extended. If the patient arrives to the big hospital first, gets the first EKG, then gets transferred to another hospital, the door time is reset to the door time of the second hospital. I’ve seen an original ST elevation EKG that was two hours old, we were still waiting for the patient to arrive at our facility, and I was told that the patient had died during the transport. There was no incident report from our hospital, because the patient was not our patient yet. I know now that another hospital is taking this health network system’s contract now. I also was asked by some staff at this large health system, if I would like to work there and help them set patients up with portable external LV pumps and I declined because I am too aware of how many of these patients get their damaged left ventricles. What I have learned is, that nurses are a patient’s only defense and advocate. We are the storytellers, the force behind the health of our community.

 

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