Final Reflection

It is almost unbelievable that I am sitting here writing my “final reflection.” In fact I am sitting in the exact spot in which I have done most if not all of my assignments in the last three years with my pug by my side. I am still very unsure about how I feel about this “graduating” thing. I have many emotions flood over my as I have been reflecting for the last month or so. I am filled with happiness, sadness, anxiety, fear, and hope. Happiness because I am finally finished with school after 8 very long years. Sadness because I have met amazing faculty and students that I will not be seeing on a weekly basis anymore. Anxiety because I am unsure of where I will end up in the next few weeks, months, and years. Fear because I will not have my instructors and peers holding my hand through it all anymore. And finally, hope, I have hope that I will succeed in everything that I will do here on out.

Critical care was the first rotation where I actually felt that I could do this nursing thing and be successful at it. I don’t know if it is the staff at West Hills or if you receive more respect and trust from the nurses in your last semester. When asked by the nurses, “What semester are you in?” and the reply of “My last” and the excitement of them letting you have so much more autonomy. I actually felt like they trusted me to care for a patient competently. Of course if something went wrong you had them there as your number one resource. I feel blessed to have had critical care in our last rotation. I feel like a learned more in one day in the ICU than I did in an entire semester in Med-Surg. This has by far been my most favorite rotation out of the entire program.

As we close on our last days I can’t help but think about all the memories I have with many of my peers and wondering where the nursing professional will take them. I can’t say right now that I will miss nursing school and don’t think I ever will say that, however, I will miss many of the experiences I had with my peers and faculty.

Fukushima

On March 11th 2011 an earthquake of a magnitude of 9.0 hit the East of Japan. The earthquake did considerable damage but what followed did much more damage. A tsunami inundated about 560 sq km and resulted in a human death toll of over 19,000. Over 1 million building were destroyed or partly collapsed.

Eleven reactors at four different nuclear plants were operating at the time of the quake, all of them shut down when it hit. Subsequent inspection showed no significant damage to any of the reactors from the quake. The reactors were not affected by the quake it self but were vulnerable to the tsunami. There was power from the backup generators that were running the residual heat removal system cooling pumps at eight of the eleven units. The remaining 3 at Fukushima lost power when the site was flooded by the tsunami. The flood disabled 12 of 13 backup generators on site and also the heat exchangers for dumping reactor waste heat and decay heat into the sea. The 3 units were unable to maintain proper cooling methods and water circulation functions. The electrical switchgear was too disabled. Many weeks were spent trying to remove and restore the heat removal from the reactors. Radioactive material was released into the ocean and the air because of deliberate venting to reduce gas pressure, deliberate discharge of coolant water into the sea, and uncontrolled events. The emission into the sea is the most important individual emission of artificial radioactivity into the sea ever observed. Fukushima has some of the strongest currents causing dispersion to the Pacific Ocean.

Many inter-governmental agencies responded to the disaster; International Atomic Energy Agency, World Meteorological Organization, Comprehensive Nuclear Test Ban Treaty Organization. Most were concerned about the radiation exposure and populations around the world had lost faith in the use of nuclear power. Many countries have opted out of using nuclear power. International experts have said that workforce of thousands will take decades to clean the area.

The precise cost of the abandoned cities, towns, agricultural lands, businesses, homes and property located within 310 sq. miles have not been established. Estimates of the total economic loss range from $250-$500 billion dollars. 159, 128 people had been evacuated from the zones lost their homes and all their positions. Many of the people have not been compensated and some are still paying mortgage on homes that will never again be habitable.

There have not been any reports of people with radiation exposure because it is still early. However, when radioactive chemicals are released they are not only released in the air but in the water systems, and soil which will affect the population for years to come. Those who were closer to the incident are more likely to develop leukemia, thyroid cancer and breast cancer. There are barriers to accessing healthcare because the effects of radiation can take years to develop. It would be most beneficial to screen patients for early detection of cancers because of the exposure. This is an ongoing problem because there are the zones that are still affected by the radiation as stated above, the soil and water systems are contaminated. I could not imagine being a healthcare provider in such a huge disaster. Fukushima started as an earthquake where residents needed help with ruined homes and then for the tsunami to wreck more homes and kill more of the population and lastly constant radiation exposure in some areas. It was like 3 major disasters all within hours. I am unsure if in the future we are more prepared for a nuclear disaster. It has happened before Fukushima and I think unfortunately it is all about trial and error and having the proper policies and procedures in place.

References

Association, W. N. (2015). Fukushima Accident . Retrieved from World Nuclear Association : http://www.world-nuclear.org/info/safety-and-security/safety-of-plants/fukushima-accident/

Responsibility, P. f. (2015). Costs and Consequences of the Fukushima Disaster . Retrieved from Environmental Health Policy : http://www.psr.org/environment-and-health/environmental-health-policy-institute/responses/costs-and-consequences-of-fukushima.html

 

 

 

Death and Dying

I tend to think about end of life care frequently because of the exposure that I receive when I volunteer at Our Community House of Hope. While I am taking care of the patients on hospice there I can’t help but think how lucky the are to be in such a loving environment when so many other patients die in long-term care facilities or in the hospital, usually with no one around. I take care of the patients like they are my family because it is hard to not think about that person in bed being one of your grandparents, parents, brother, sister, etc.

Recently my grandmother passed away and I can’t help but think about her death and how she did not suffer from any physical ailment until the day she died because her heart gave up. When discussing her death with my family we have all concluded that she died in the best way possible, besides being in a hospital in which my mother will never forgive herself for not taking her back home when she asked her to. One thing that I do think about and it did not cross anyone else’s mind in the family is that she was a DNR and she was still resuscitated in the hospital because my grandfather verbally stated to do anything they could to save her. I often wonder whom I would pick to make my decisions if I were unable. You have to be able to trust that they will do what you wish them to do.

After she passed my family and I had a long conversation about advanced directives and how important they are to have. Neither of my parents have an advance directive and it worries me. I know what they want if there needed to be a decision made but without them having a durable power of attorney I know my siblings would fight me on the issue. I also know that my siblings would not be able to make the decision that my parents would want.

I do believe that culture plays a significant role in death and dying. I believe some cultures deal with death significantly better than Americans. Americans tend to not think about death and seem to grieve for long periods of time. I am an American and I definitely grieved over my grandmother but I believe that death should be a celebration of life. Celebrate the person’s life and reminisce of the person that they were and the lives that they touched. Death is part of the life cycle and even though people are missed it should not be such a sad, horrifying event. I also witness that death is rarely about the person who died but about the family that is left behind.

http://www.overgatehospice.org.uk/uploads/pics/dying-matters-logo.png

Family Medications

My significant other does not take any medications. However, if he does take something for a headache or any pain he takes ibuprofen. To my surprise he knew the trade name, class, normal dose, and side effects. When I asked him what the difference was from other pain medications he knew the basics. My parents do not take medications regularly either. If my mother has a headache she takes Excedrin and she has been taking it for years. Nothing else seems to help her headaches. She does know the side effects and therefore takes it sparingly. My parents have always used more natural remedies when a cold breaks out, such as echinacea, tea, vitamin C, and a medication literally called “wellness.” “Wellness has a variety of herbs in it and it does seem to cut the average cold in half. My sister takes anxiety medication (Xanax) and medication for depression (Zoloft). She is very aware of the medications she takes, hence, the anxiety. She has anxiety about EVERYTHING. Overall, my family tries to stay away from medications and try to treat the underlying cause with a natural remedy first.

 

Cardiac Health Procedure

I chose to look up information on the use of vascular closure devices (Angio-Seal) versus the use of manual pressure following a percutaneous coronary intervention or a CATH procedure. This is a discussion that I had in clinical recently with Lisa. We discussed the use of the Angio-Seal and how it isn’t seen as often. I believe it is preference of the Doctor doing the procedure. According to Gregory, Midodzi, and Pearce (2013) there has been conflicting data about whether the VCD’s decrease, increase, or do not alter the risk of access site complications. The authors had 11, 897 participants. 7, 063 participants received an angio-seal VCD and 4, 834 did not. There were two samples; in the CATH sample 4,845 received a VCD and 4, 030 did not. In the PCI sample, 804 did not receive a VCD and 2, 218 did receive a VCD. Vascular complications rates were lower with both sample groups with the use of VCD. The authors found that the use of VCDs have been associated with earlier ambulation and improved comfort. However, manual compression has been the “gold” standard for 60 years and remains a controversy in whether or not there is any more of a benefit with the use of VCDs. Overall, a low incidence of vascular complications were observed with the use of VCD (angio-seal) in comparison to manual compression (Gregory, Midodzi, & Pearce, 2013).

I found this article interesting and will look further into more research. Because of patient privacy I have chosen not to talk about my situation in clinical with an Angio-Seal versus manual compression.

References

Gregory, D., Midodzi, W., & Pearce, N. (2013). Complicaitons with Angio-Seal vasuclar closure devices compared with manual compression after diagnostic cardiac catheterization and percutaneous coronary intervention. Journal of Interventional Cardiology , 26 (6), 630-638.

 

Group Guidelines

Cesar:

-Strengths: organization, time management, has significant interest in topic (renal), consistently meets deadlines

-Weaknesses: group projects, busy schedule, lack creativeness in composing computer presentations.

-Values: appreciates equal workload, timeliness, quality over quantity

-Strategies for successful team functioning: setting deadlines, appreciating each other’s unique talents and perspectives, communication (especially if things do not go well), equal distribution of workload

Rose:

-Strengths: Possesses leadership qualities, dependable, organized, and creative

-Weaknesses: Busy work schedule, different schedule than team members, not computer saavy

-Values: Honesty, hardwork, and respect

-Strategies for team success: Meeting deadlines, respecting other’s ideas, equal workload, interest in topic

-Leadership Style: Democratic leadership style: Involving others in their decisions

-Communication Style: Hopefully, everyone uses an assertive communication style. Having a passive or aggressive communication style will get the group nowhere fast.

 State a team name, letter of your group (A-F), and describe the reason the name was chosen:

Our team name is the ACE inhibitors (B). This name was chosen because we are responsible in providing information about the renal systems.

Meeting time(s) and location(s) for the duration of the semester:

Between nursing 420 and 488 on Wednesday afternoons. Whatever was not taken care of we will meet after nursing 488. We will meet at various locations on campus; classrooms, library, student union, and outside.

Role of each group member (Are there roles? Or delegated tasks?):

Roles have not indefinitely be defined. Each person will pull their weight equally and we will work as a team to get the job done.

Who will lead each meeting? If you will rotate, detail how this will occur?

Each person will contribute to the meeting with no particular leader. Everyone will be encouraged to share their ideas and have an equal input.

Who will take minutes and record action items? If you will rotate, detail how this will occur?

Rose will take minutes and keep track of what is said at each meeting.

What will your process be for dealing with group members who miss meeting or who are late? How will you address first time offense and repeat offenses? Will the discussion happen one-on-one or in a group?

We hope that everyone is responsible enough to meet, however, things do come up and there will be another mode of communication to keep the absent group member updated; email, phone, googledoc, etc. Repeat offenders will be talked to in a group setting.

What will your process be for decision making? If you decide on a consensus vote, what will your process be for making a decision if consensus cannot be reached?

There will be a democratic vote. Everyone will have the right to have an opinion or idea. We will narrow it down to two topics and vote. Two out of three gets the vote. We are not worried that we will not meet a consensus.

What will your process be for dealing with a team member who does not fulfill his or her team assignment(s)? How will you address first time offense and repeat offenses? Will the discussion happen one-on-one or as a group?

Again, we are in hopes that everyone in the group is responsible and respects each other’s times and wishes. A person that does not fulfill their assignment will be talked to in a group setting. We will find an alternative to the student getting the assignment done.

What will your process be for resolving conflict within the group? Will the discussion happen one-on-one or as a group?

Hopefully, there is no conflict. If it is a conflict between two group members than the third does not need to be present. The conflict will be discussed in a professional manner in hopes to resolve it and move on.

First and Last Name of all group members:

Autumn Moon

RoseAnn Fischer

Cesar Rivera