Week 6 Discussion Responses

PUBLIC HEALTH

Maria Rodriguez:

I have encountered a similar scenario currently as I am working with patient caregivers, who care for family members with one more comorbidity, and some have some form of intellectual disability. The patient caregivers relied on the adult day center I do clinicals at for respite care, however, since that has been taken away, they are experiencing burnout, caregiver stress, and caregiver fatigue (Sarabia-Cobo, 2015). Burnout can be defined as emotional and physical exhaustion, caused by the stressful demands of the nurse’s work, as well as the caregiver workload (Sarabia-Cobo, 2015). It is good that the pastor noticed this and mentioned it, so that someone he can reach out to others for help. The nurse in this scenario should meet with a grief counselor to discuss her emotions, and possibly even see a therapist. The pastor could also help coordinate daily support from the church to get volunteers to donate 1-2 hours per day. The nurse could use this time to do some self-care activities, such as hobbies, meditation, exercise, and other things.

Kamela Goodman Top of Form

Taking care of love ones can be very rewarding and challenging at the same time. Not only is this woman the daughter of the 86-year-old but she is also a nurse. Both roles involve the desire to help those around them. Support can be given in so many ways. Financial support is always a plus, helping with food relief can be helpful in relieving the stress of having to worry about the extra job of preparing food for the family. Many times, that just isn’t enough. It is important for the family or caregiver to have a time to rest and rejuvenate.  Mental rest is needed during times of high stress.

Being a care giver can be stressful. As illnesses progress, requirements are often escalated, and that family member may require more frequent medication, special wound care and assistance with feeding and toileting. Respite care would be a great help to this daughter. Respite care allows a family caregiver to get a break of up to five consecutive days and nights from caregiving duties while the patient is cared for in a Medicare-certified inpatient facility. Collaborating with a hospice team can allow for a set up of respite care to give the daughter an opportunity to get a break. The faith community can fill in the areas of providing the needed assistance such as financial help, food preparations, and emotional support.

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CAPSTONE:

RE: KAMELA GOODMAN

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Electronic Health Records are very common throughout healthcare. Another name sometimes used is “Electronic Medical Records (EMR).” EMRs have a more narrow view of the patient’s history while electronic health records contains the overall view of the patient’s history. This technology has proven to enhance the delivery of care because unlike in the past the patient’s medical history is available at the click of a button versus waiting days for a paper to mailed or the risks of loosing information or privacy exposure through fax. It is mentioned that the use of EHRs can improve patient care, decrease practice costs, and increase provider productivity and revenue (Chin & Sakuda, 2012).

Using the gathered data from these records help to coordinate care for our patients. We are able to connect disease processes, tests results, and collaborative treatment plans for our patients that have to see multiple providers. A basic HER can contain the patient’s history and demographics, problem list, physician clinical notes, comprehensive list of patient's medications and allergies, computerized orders for prescriptions, and ability to view laboratory and imaging results electronically (Chin & Sakuda, 2012). This is how we currently provide collaborative care for our patients at my current employment. Providers are able to view the treatment or plan of care by other providers , as well as medication regimes. This has allowed for improved patient care and outcomes for our patients.

Although the EHR system has proven helpful, it can have some negative impact as well. One issue can be due to privacy and security concerns. This is always a possibility with computer base programs. Financial issues can also arise. Hardware must be upgraded and replaced on a regular basis, as well as ongoing trainings for the users of this system. Another disadvantage is the interruption of work flow among the staff. The loss of productivity happens from users having to learn new systems that may in turn  lead to loss of revenues (Menachemi & Collum, 2011). 

EHRs/EMRs are great systems to have in healthcare, in my opinion. The pros out weighs the cons from my experience. It is very helpful when it comes to managing care among many providers. It also allows for easy access to medical records. It saves time and paper. Technology is constantly improving, so it can only get better.

RE: Shelley Williamson

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The idea of meaningful use (MU) is supported by the five standards of health outcomes which are:

1. Improving quality, safety, efficiency, and reducing health disparities

2. Engage patients and families in their health

3. Improve care coordination

4. Improve population and public health

5. Ensure adequate privacy and security protection for personal health information

 

MU allows for the exchange of health information to improve the quality of care provided to a  patient and includes three stages, with the first stage setting the foundation which established requirements for the electronic capture of clinical data; stage two expanded on the first stage with a focus on furthering clinical processes and making sure that the MU of electronic health records (EHRs) supported the goals and priorities of the National Quality Strategy; and the third stage focusing on certified electronic health record technology (CEHRT) to improve health outcomes (Centers for Disease Control and Prevention, 2019)

With EHRs, I am able to see information for my patient which relates to their admission to the hospital, their history and physical (H&P), and lab outcomes.  I can see who has been to see the patient and what services have been provided to aid in their recovery.  Being on the COVID-19 unit, I can review the various physicians involved in the patient’s care, such as the pulmonologist, the primary care physician, the infectious disease doctor, as well as the respiratory team.  This is helpful in knowing what plan of care the patient is on and how the patient has responded to treatment.  For example, I have had a relatively young patient with no comorbidities that has received the Plaquenil therapy, Remdesivir therapy, and convalescent plasma transfusion in order to treat their COVID-19 positive status.  With the Plaquenil and Remdesivir, the patient had tested positive for a second time, plus continued to experience SOB and near syncopal episodes due to the side effects of the treatments.  The convalescent plasma therapy is investigational, just as the other two therapies the patient has received, and I hope the patient has been re-swabbed since I last worked and that the test finally came back negative.  Because of EHRs, as nurses we are able to see the treatments, tests, and interdisciplinary notes on how our patients are responding, making MU an invaluable tool in healthcare.

The negative aspect of the EHR is misuse of private information, say for famous patients, that allow someone on a healthcare team to sell the information to news outlets, which will air that information to the general public. Not only is this type of behavior by the healthcare team member unethical, it is illegal. 

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CLINICAL:

Lisa Otten 

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Today, at hospice clinical site I sat in on a IDG (intradisciplinary goup) meeting. This was accomplished through modern technology and the use of zoom as they are still discouraging any group gatherings. This meeting is held every week and they cover 1/2 of their patients every week so every patient is reviewed every 2 weeks. This meeting moves very fast as we went through 160 patients in 3 1/2 hours. Demiris, Washington, Oliver, and Wittenberg-Lyles (2008) reports that "interdisciplinary collaboration and teamwork are essential components of efficient health care services and team meetings are required by law in the U.S." (p. 621). The meeting composed of a doctor, various nurses including the QAPI nurse, social workers, bereavement counselor and a chaplain. During this meeting, they go through any problems or issues and address the needs of the patient and family. Demiris et al. (2008) states, "the U.S. federal mandate requires hospice agencies to facilitate IDT meetings that provide a platform for team members to share responsibilities and design their assigned tasks, review and modify care plan, if  necessary, and oversee the coordination and provision of hospice services" (p. 622).  It was noted that this team was a cohesive group and the patient's needs are being actively addressed. This meeting or the care that is provided could not happen without information technology tools. It is through the computer and cell phones that a lot of information is shared and communication occurs. Furthermore, Demiris et al. (2008) states, "a holistic care model is based on solicitation of input from and dissemination of information to a diverse group of professionals" (p. 627).  It is clear and concise communication that allows the team to analyze, evaluate, and make changes to their plan of care to enhance the patient's quality of their last days of life and assist the family in adjusting.

There was another interesting fact that the doctor stated while waiting for everyone to join the zoom meeting related to COVID-19. The University of California of San Diego is planning for their students to be back on campus and in the classroom this fall. I had heard they were testing/screening students recently but Dr. Hergesheimer stated that they had screened/tested 6000 staff of UCSD. Those tested had no symptoms. Out of the 6000 tested, only 4 had positive results. That is 0.067%. That is a low percent. He also made note of people that do not live here and in this area that come over the area to be tested, if they test positive are getting in statistics as living here and not in Mexico. I know there has been many questions about the accuracy of the reported results, especially by the media. This doctor was a reliable source and has been individually involved in the testing at UCSD. Do we need to continue to isolate? I don't think so. Do we need to take precautions? Yes. Wash your hands. Stay home if you are ill. Those that are immunocompromised should be cautious and use precautions to protect themselves, as they always should. We cannot continue to live isolated all the time.

Annonan Salomon 

RE: Week 6 Discussion Prompt

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     When it came to difficulties that I have had at clinicals this week there has been none because I have completed my hours for clinicals.  My one big difficulty that I am having is more stress and concerns.  I have been caring for COVID positive patients and I worry that I will bring “something” home with me.  I perform all the necessary precautions by wearing the PPE’s and my mask and face shield and I take a shower at work before I head home, but there is that little voice in the back of my head that keeps saying what ifs.  This has probably been one of my biggest issues since taking care of these patients.  We have been lucky so far in the place where I am at with the amount of patients that we receive, but then it feels like there is going to be a influx of these patients and we will not be prepared for them.  In the larger hospitals I am sure that they are prepared for this type of pandemic, but in the rural hospital that I work at it is a day by day thing.  It continues to evolve when we get patients, but then there is the issue of the hospital has just been sold and there is a feeling of being in limbo where there is no money being spent on this hospital and we are just struggling to maintain.  I have been maintaining my distance from my grandchildren and my father in concern that I might pass something on to them.

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