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Helping Relationships

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  • What are the characteristics that seem most natural to you given your present style of helping?

The characteristics that seem most natural to me in my given style of helping are that it is meaningful, involves communication and interaction, and understanding and involvement. A meaningful relationship comes natural for me because I look for meaning in everything I do. If it is helping someone out when they came to me for help it means they trust me and that is meaningful. Also a relationship that involves communication and interaction comes natural to me because I like to communicate with others and if communication helps someone even better. Interaction is also natural because I believe when I interact it makes others feel better and makes them feel like I do care. Lastly it would be understanding and involvement because I need to understand what is  going on without judging or jumping to conclusions, Involvement is also natural because is someone came to me for help it’s because they need help in something that I could possibly help them in.

 

  • So what characteristics may be difficult for you presently to model or try out?

The characteristic that may be difficult for me to presently model or try out are being approachable and secure as a person, and shows a clear structure. It’s not hard for me to be secure as person but to seem approachable because I feel like I am very honest and I feel like some people may take that as me being mean. Also I sometimes look like I am angry when walk or don’t talk because of my face expressions. Also showing a clear structure would be hard for me because when someone approaches me for help there is no clear way where things will go.

 

  • Now what can you do to integrate some of these more difficult characteristics into your helping style?

I can integrate them by trying to be honest in a nicer way and thinking before I speak because I can be too honest at times. Also I can try to control that when someone approaches me with a problem I try control where the situation is going so it doesn’t get out of control. It will be a bit difficult for me to learn how to integrate these characteristics I am having difficulty with because it’s something new. But, by doing small activities everyday I think it can become a natural characteristic. What I can do is start by thinking before I speak because other can take offence to what I say. Also I can try to smile more so I look more approachable as a person. This will not only help me be a better leader but it will help me overall.

Post CABG hospital readmission

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I found this article that studied predictors or risk factors for readmission after a CABG surgery. The study was done in 2011, and they determined post CABG readmission rates remained high. Consequently, this was a big problem since the procedure itself is expensive and the possibility for complications that influence readmissions are vast. Additionally, the readmission will ultimately not be covered if it falls within the 30 day limit established by medicare after the surgery, which further emphasizes the importance for nurses to be vigilant for possible complications or risk factors that indicate a complication. In 2004, hospital readmissions accounted for about 17 billion dollars out of the total 102 billion dollars paid by medicare that year. One can only imagine how those numbers are duplicated to present time. The results indicated that the most common reasons for readmission after a CABG were infection, heart failure, and other complications of surgical or medical care. As nurses, we  are responsible for preventing such occurrences. some ideas are to assess for complications, assess for comorbidities that can further cause complications such as Diabetes Mellitus. in situations like these, education is key! Educate and stress to the patient about the importance of proper glycemic control and the repercussions of failing to do so. Regarding heart failure, we can further educate the importance of following a drug regimen that is prescribed to them as well as emphasize the importance of contacting a physician in case they feel something wrong or if we detect the regimen is not functioning.

Source:

Hannan, E., Zhong, Y., Lahey, S., Culliford, A., Gold, J., Smith, C., et al. (2011). 30-day readmissions after coronary artery bypass graft surgery in new york state. Journal of American College of Cardiology , 4 (5).

Oh! My beating heart…

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What fortuitous timing that we should be covering cardiac intensive care during February, our National Heart Health Month! There was a smorgasbord of articles to choose from, but I was drawn to one on hemodynamics since just spent a good week or so completely immersed in that wild and wooly world…

Since 1996, pulmonary artery catheters, once considered the gold standard in hemodynamic monitoring, have been falling out of favor due to mounting, yet inconclusive, research finding that they are associated with increased likelihood of patient death. Central venous pressure monitoring has similarly been found to have minimal effect on patient outcomes when treating shock, compared to the use of conventional fluid replacement protocols (Johnson & Ahrens, 2015). Rather, Johnson & Ahrens (2015) propose that effective hemodynamic management of critically ill patients is best achieved by focusing on stroke volume optimization.

Stroke volume is the earliest and most reliable sign of hypovolemia because it is least affected by compensatory mechanisms, and the most effective means by which to measure stroke volume while maintaining the context of preload, contractility and afterload, is esophageal Doppler imaging (Johnson & Ahrens, 2015). This article proposes that correction of hypovolemia is best achieved through stroke volume optimization (SVO), a type of cyclic fluid replacement algorithm that recommends administration of fluid boluses for improvement of stroke volume by increments of 10% or more. When stroke volumes no longer increase by the full 10%, no more fluid is needed (Johnson & Ahrens, 2015). Hemodynamic monitoring of SVO protocol utilizes esophageal Doppler imaging, (or other indirect methods measuring cardiac output when contraindicated) (Johnson & Ahrens, 2015).

Implementation of SVO is supported by 11 large-scale, randomized controlled trials conducted by agencies such as the National Health Service, the Agency for Healthcare Research and Quality, the Centers for Medicare and Medicaid Services and Aetna. And though esophageal Doppler imaging, bioimpedance, and pulmonary artery catheters are all reimbursed by Centers for Medicare and Medicaid Services, esophageal Doppler monitoring is the only one of these endorsed by the Agency for Healthcare Research and Quality (Johnson & Ahrens, 2015).

I just can’t wait until next week when I have my very first day in ICU…

Reference

Johnson, A., & Ahrens, T., (2015). Stroke volume optimization: The new hemodynamic algorithm. Critical Care Nurse (35)1: 11-27.

 

BNP for Heart Failure Treatment? Yes!

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     While reviewing for the exam doing case studies, the book I was reviewing pointed out a new therapy about BNP not only being used as a marker for heart failure, but also as therapy.

While BNP is elevated in acute exacerbations of heart failure, it is also available for IV administration and is marketed as nesiritide (Melander, 2004). Nesiritide is a recombinant human brain natriuretic peptide, BNP 1-32, and is a vasodilator that has undergone clinical trials in patients with acute heart failure (Colucci, 2015). The high level of vasoconstrictors and high systemic vascular resistance and possibly low levels of bioactive BNP in patients with heart failure provides the rationale for therapy with vasodilators, such as nesiritide (Colucci, 2015). Nesiritide has been proven to reduce preload and afterload, and increase cardiac output in people who are experiencing an acute exacerbation of heart failure (Melander, 2004). Also, when compared to it has been proven to improve hemodynamics more quickly than nitroglycerin (Melander, 2004).

            I think further studies should be done on this drug and there should be greater awareness in hospitals about this treatment. The window for treating patients when they are in an acute exacerbation of heart failure should be narrowed so that the damage that is done can be minimized. Since BNP is already produced by the heart as a peptide secreted by the ventricle in response to fluid overload, investigating further in the advantages of using a naturally occurring peptide for treatment should be looked into!

 

References

Colucci, W.S. (2015). Nesiritide in the treatment of acute decompensated heart failure. UptoDate. Retrieved from http://www.uptodate.com/contents/nesiritide-in-the-treatment-of-acute-decompensated-heart-failure

 

Melander, S.D. (2004). Case studies in critical care nursing. Philadelphia, Pennsylvania: Elsevier.

LEAP Statement of Ethics

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LEAP Mission Statement:

The Leaders in Education Awareness Program facilitates the college exploration process for elementary and middle school students by teaching students the basic foundation of higher education through interactive workshops and providing engaging tours of CI. In addition LEAP volunteers serve as leaders for visiting students and the campus community.

What is LEAP?

It is a student leadership program within University Outreach that seeks to develop both social and personal dimensions of each student leader in a team setting. These students are committed to social justice and embody a spirit of volunteerism.

I felt I could not give a Statement of Ethics without providing some background information about the peer group I belong to, alongside my coordinator, and peer, we came up with this Statement of Ethics for LEAP, explaining what we do and why we do, while using the mission and the definition of LEAP as the base/foundation for this statement:

In an effort to give back to the CI community, we abide by these ethics.

*Always create a positive environment/safe zone, for not only the children that we serve every Friday, but for our team as well. Try to make a big effort not to make someone uncomfortable.

*Impartiality, because by having so many students on campus, you never want to just favor one student or group that comes for a campus visit, to be fair minded of all students.

*Be a positive role model at all times, do not say inappropriate things in front of campus visitors, because that is not positive and people will think badly of you.

*Respect, constructive criticism is implemented a lot in LEAP, even if you do not always agree, you always must main professionalism and respect to what the other person is telling you, and instead of taking the wrong way, the the critique and internalize it for the future.

*Have patience,  not all groups that we serve are the easiest, some are more louder than others. Learning to have patience with the kids will go back to being a positive role model and creating a positive environment.

*Be the person you would want to look up to (if you were in middle school), this is just what it sounds like, if you were in middle school, what qualities would look for in a person? If you think that you yourself do not have these qualities, then the students you serve will notice that as well, you are your own best critique, use that as a tool to better yourself, so that someone else will want to say “I want to be like you when I grow up.”

New Heart Failure Drug Possibly on the Horizon?

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Novartis, a company that develops drugs and vaccines has just been granted an FDA priority review of a new heart failure drug called LCZ696. The company is well known worldwide for the manufacture of drugs such as clozapine, valsatan and methylphenidate. This new drug, LCZ696, has its final FDA action date in August of 2015 and has received accelerated assessment in the European Union. The drug will be dosed twice daily and will work by strengthening protective neurohormonal systems of the heart while also reduces harmful effects of the renin-angiotensin-aldosterone system. This new drug is predicted to reduce the risk of cardiovascular-related deaths by approximately 20%.

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A study was conducted by Novartis and overseen by an executive committee, an independent data and safety committee. The trial consisted of three phases where informed patients who were 18 years of age, had New York Heart Association class II, III or IV symptoms, ejection fraction of less than 35% and required to have a plasma B-type natriuretic peptide level of at least 150 pg per milliliter. The first phase consisted of patients receiving enalapril (an ACE inhibitor), a single-blind run in which all patients then received LCZ696 and then a double-blind treatment in the two study groups. A total of 10,521 patients in 1043 centers in 47 countries were recorded with 4187 patients going into the actual trials. Death from cardiovascular causes or hospitalization for heart failure occurred in 914 (21.8% of patients in the LCZ696) & 1117 (26.% of patients in the enalapril) patients. LCZ696 reduced the risk of hospitalization from heart failure by 21% (P<0.001) and had higher proportions of patients with hypotension, nonserious angioedema but lower proportions with renal impairment, hyperkalemia and cough than the enalapril group.

I thought that this article was really interesting to know what kind of new drug could be appearing in hospitals in the future. It is great that this shows some improvement than the ACE inhibitor it was compared against in this very large, multi-continental study. I wonder what will happen with the FDA later this year and if this drug will be on the market in the United States in the near future. I also wonder what those implications will be for those with heart failure and the different side effects that nursing will manage if this drug does come onto the market.

Sources:

http://www.nejm.org/doi/full/10.1056/NEJMoa1409077#t=articleBackground

http://www.bidnessetc.com/34902-novartis-ag-adr-heart-failure-drug-granted-fda-priority-review/

Protected: New Treatment for High Cholesterol

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3-D Printing

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In the article “Heart Implants, 3-D – Printed to Order” by Katherine Bourzac, Bourzac (2014) discusses how the science community has advanced to where they are experimenting with 3-D printing to enhance treatment of heart conditions. Scientists have recently used a 3-D printer in conjunction with various cardiac images to produce a 3-D replica of the desired heart (Bourzac, 2014). Using this replica heart, scientists are working on creating thin wrinkle-free sheets incorporated with greater sensing capabilities that will cover the individual’s heart to enhance monitoring (Bourzac, 2014).

It’s inspiring to witness how far science is coming in regards to the advancement of medicine. I greatly feel that the use of 3-D printing will enhance patient care because it will enable doctors to specialize equipment and treatment to the individual, allowing the necessary equipment to better fit within the individual anatomy and ensure that all anatomical areas are addressed. Additionally, as Bourzac (2014) explained, current implanted defibrillators only use a couple electrodes to monitor heart rhythm and could potentially make the wrong decision to shock the patient because of only two monitoring sites. With the use of sheets filled with sensors, hardware such as the defibrillator will receive input from many sites around the entire heart. This will allow more precise treatment that is based on feedback from the entire heart and not just certain aspects of it.

Overall, I think the potential of these scientific advances is astronomical to medicine. Although much can be determined about a patient’s heart from various medical tests and scans, creating a 3-D version of the heart to test theories and equipment and applying additional, individualized sensors on the heart takes more of the guesswork out of the treatment. Patients receiving this form of care will hopefully benefit greatly from this scientific breakthrough.

References:

Bourzac, K. (2014). Heart Implants, 3-D- – Printed to Order. Retrieved from:

http://www.technologyreview.com/news/525221/heart-implants-3-d-printed-to-  order/

Advances in Technology Related to Cardiovascular Health

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Article: 2015 to ring in advances in prevention, interventional procedures, heart repair

The article highlighted on a couple different areas related to advancements in cardiovascular health in the 2015 year. One of the areas highlighted on wearable technologies such as watches with heart rate monitors (Polar, Garmin, Fitbit). Although some of these products have been around for several years, its use within the health care setting is minimal. The article discusses how wearable technology will allow individuals to monitor their health outside of the physician’s office. Apple for example has recently created a watch that can measure pulse rate and use sensors to track the duration and type of exercise being done. Paired with an app, the individual can combine various wearable devices and share it with their physician.

Personally, I own a TomTom GPS watch that can track my heart rate, calories, pace, and distance when I run. Additionally, I have a Fitbit that tracks the amount of steps I take, the calories I burn throughout the day, and it also allows me to track the food I have eaten. I think that these devices should be promoted by physicians. These wearable technologies don’t track everything about an individual’s health, but it can be a useful tool during a doctor’s visit. It provides insight into how much activity an individual participates in each week, what their diet may look like, how their heart rate is when they are exercising. It provides a wealth of health information as well as allows individuals to keep track of their progress and goals they set for themselves.

Reference:

American College of Cardiology. (2014). 2015 to ring in advances in prevention, interventional procedures, heart repair. Eurekalert. Retrieved from http://www.eurekalert.org/pub_releases/2014-12/acoc-2tr122214.php

Polar Heart Rate Monitor

 

Meet a SURFer: Esmeralda Carretero

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Undergraduate research is shown to be particularly effective among first-generation college students. Esmeralda Carretero is the first person in her family to attend college. Her research is combined with community action. Take a moment to get to know her.

Esmeralda Carreterro

Esmeralda Carretero is a Liberal Studies Major, emphasizing in bilingual education at CSU Channel Islands.

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