Reflection Hours #4: Furthering Your Education

Today's reflection hours started a little later than usual. We'd just finish taking our OB ATI exam, and the students were trickling in one-by-one until an hour after our exam. We had the pleasure of speaking to Prof. "A" about our service hours and the need to further our education. Many of the students in class voiced their concerns about completing a bachelors: Should we wait until MDC have the BSN available or should we complete the RN-BSN program at FIU? What field of nursing are we interested in? Have we thought about the academic skills we need for the BSN (which has more "theory" classes than the ADN)?

It seems overwhelming for us to think about the BSN, since we're still trying to complete the ADN and being bogged down with reading assignments and examinations. However, for those of us who believe the salary difference between ADN and BSN are minimal, we can use the BSN as a "stepping stone" to an MSN. Some of us may want to remain a bedside staff nurse, and that's a very respectable position. Without staff nurses, hospitals cannot effectively provide patients holistic care. Maybe one day, after working on the floor for so many odd years, we would want a change, something less physically demanding yet still be involved in nursing. Maybe nursing management, insurance consulting, home health, and more. The great part of nursing, is that the opportunities are endless.

Today's vocabulary word: managed care (completely off-topic, I know). Managed care is an insurance-based approach that includes a collection of strategies such as prepayment arrangements and preadmission authorizations to control costs. With managed care, patients are being treated minimally and discharged early in order to reduce the costs to insurance agencies for medical treatments. This is a major ethical dilemma -- on the one hand, the costs of medical treatments have become very expensive and it's hard to manage effective treatment and keeping the costs to the hospital down. On the other hand, these patients are human beings and are being reduced to liability costs when they should be treated -- regardless of how they became sick (by not practicing disease prevention).

Miami Children's Museum -- Third Visit

Today I spent over 4 hours at the museum today. I did more of the usual stuff- showing children the anatomy of the human body by using a doll; playing with medical equipment toys (they like to use the fake stethoscopes on each other); and teaching them the importance of exercise, choosing nutritious foods at Publix, and dental care. As usual the kids love playing "pretend", dressing up as doctors and nurses, and showing their parents how much they know of the human body. Parents are often eager to express their conviction that their children will be in the medical field someday.

Today I learned that being involved in the community includes being comfortable in the community you're serving. If you don't feel confident in or have the desire to serve the community, you can't put 100% effort in community health activities. There were times where I felt winded, tired, and unmotivated to do community service hours. The hardest part of completing community service hours, at least to me, is initiating, or gathering the energy to attend the meetings, and health fairs to complete our hours.

Today's vocabulary word: community-based nursing. Community-based nursing includes the setting and the practice of the community health nursing. Community health nursing, according to our ATI book (pg. 1), refers to "nursing activities specific to the health promotion and prevention of disease that affect a community's general health status". To expand the definition of community health nursing, community health nurses (CHNs) are accountable to the public. CHNs also possess a greater sense of intimacy with their patients than in others areas of nursing. Since we are experiencing some of the responsibilities of CHNs, it's natural to feel a closeness, even awkwardness, with serving the community. It's a very involved, personal experience that we commit ourselves to, and I'm much more appreciative to the CHNs that serve the community on a full-time basis.

Reflection Hours: #4 -- RELAX, RELATE, RELEASE!!!

Today we talked about the different community health projects that our peers our involved in: the Miami Children's Museum, YMCA (interesting story about a volunteer football coach being too "touchy" with the abs of overweight kids), and the benefits of health fairs. We had finished our Peds rotation the week prior, and we're all feeling the stress of taking an exam (almost) every week until the end of this semester. So, our instructor asked us to stand up from our chairs, turn to the person in front of us, and massage their shoulders! When we were done, everyone felt a bit awkward, but more open to communicating. The theme of the day, we must remember to talk care of ourselves too, otherwise we are no help to the community or to our patients.

This leads me to today's vocabulary word: Ethics. Ethics can be defined as the values, practices, standards, and code of principles. Ethics guide the distinction between right and wrong based on the moral consequences of actions. As health care professionals, we must clarify our own values when taking care of patients whose beliefs are different from ours. In the case of the volunteer football coach, he may believe it is appropriate to touch the children's stomachs after they've exercised. However, these children had different beliefs about what is appropriate vs. inappropriate touch, and he was removed from the coaching position.

We will be faced with tough, ethical dilemmas in the community as well as the hospital (access to health care, child/sexual abuse, abortions, etc.). That's why we need to look at ourselves introspectively before we can help our patients.

...And it doesn't hurt to treat ourselves first to shoulder masage or two.

Miami Children's Museum -- Second Visit

Today I spent my first visit, aside from orientation, with the kids at Miami Children's. I was there for only 5 hours, but I was very exhausted when I was done! I love kids, but they can wear you out!!! I can't count how many times I've explained the human body and it's body parts -- I think I've memorized my "anatomy speech" to the kids by heart now. At the museum, there's a Baptist Health "ER Room" where kids can learn about the human body from a doll stuffed with fake organs, and x-ray machine with cool x-ray films of different body parts, and a video on what kids experience in the "ER".

It helped to have other nursing students there, as I was not comfortable approaching the kids until I've watch their techniques on teaching the kids about health care. I felt more comfortable by the 3rd hour, when I was trying to explain to two sisters how the spine looks on x-ray film. The older sister was VERY competitive, answering all of my questions before her little sister can get a word in! It's nice that they know a lot about the body, but it's important to give others the opportunity to learn as well.

Today's vocabulary word: Culture. According to the ATI book (pg. 18), culture incorporates the learned, shared, and transmitted values, beliefs, norms, and practices of a particular group that guide thinking, decisions, and actions in patterned ways.

• Culture is learned.
• Culture is taught.
• Culture is social.
• Culture exists at many levels.

The girls I encountered at the museum were very competitive, as well as their parents, who were encouraging each girl to top her sister. Some individuals are culturally raised to be competitive people, as evidenced by many individuals in the U.S. who pride themselves on individuality and succeeding in the workforce, school, or even their social lives.

It's interesting to note how powerful cultural influence is, from or moral, ethical values down to our personality.

Reflection Hours: #3 -- Child Abuse

Today we talked about child and sexual abuse, and our duties as future nurses to patients who approach us with these problems. We talked about the signs of child abuse, as defined by the ATI book of Community Health Nursing: physical evidence of abuse; conflicting stories about the "accident" or injury from parents or others; inappropriate response of caregiver: exaggerated or absent emotional response; refusal to sign for additional test or treatment, etc.

According to our ATI book, one million children are abused each year, and these numbers are expected to increase. Abusive caregivers usually single out only one child to abuse, and the long-term effects on the child's mental, intellectual, social, physical and sexual health are detrimental. Sexual abuse often involves a person known to the child and is often incestuous in nature.

Several people in class today talked about their experiences with children and child abuse. "J", a male nursing student in our class, has been having trouble finding a community health site that accepts him. He talked about his experiences with KidCo, how he didn't want to help a male child use the bathroom for fear of being labeled a sex offender. Unfortunately, the actions of others in our community that commit these crimes makes it difficult for men who legitimately want to help children, especially in nursing. "J" also talked about the BACA group (see image above), or Bikers Against Child Abuse. He finally found a group he identifies with that also protects children from individuals who would harm them.

Today's vocabulary word: Primary Prevention. Primary Prevention is the prevention of the initial occurrence of disease or injury. Primary prevention is directed toward well people. As faras preventing child abuse, we need to equip parents with information on support networks for parents who are overwhelmed with the responsibility with raising children, among other things. In Florida, the Department of Children and Families has a child abuse prevention plan that has been implement for the years 2005 to 2010.

Overall, this experience was helpfuil in providing us the tools with helping the most vulnerable in our society.

Miami Children's Museum -- Orientation

Today I visited the Miami Children's Museum in hopes of volunteering their Wellness Center exhibit. I also saw a few of my nursing buddies there (Hi, Latoya!). We toured the museum's different exhibits for kids (alot of hand-on learning activities from infants to school-aged). The hospital room looks impressive -- a giant set of teeth where kids can learn about oral care and emergency room where kids can learn different parts of the body. Alot of different people from MDC and high school student came to the orientation. Most, if not all, are there for the community service hours. That's not a bad thing, at least, you get to choose where you get to complete your hours.

The volunteer coordinator did say something "interesting" in the orientation that gave off mixed messages about the volunteering experience. She emphasized treating kids from "poor" neighborhoods who come to the museum "free days" as well as "rich kids" who pay more than $300 for galas at the museum. This suggests some of the problems of favoring private philanthropy (such as catering to big donors) over the public who may not have the funds to support the museum, but would benefit from the education tools that abound there. The problem with non-profit organizations in the US that public interests are usually funded by private donors who make up the majority of the funding. If the money came from a public source, the way that nonprofits work might be more democratic.