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Final Blog!

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It’s hard to believe that in just a few days, we will officially have our BSN degrees! It’s always a happy moment when you finish a semester and realize that you are that much closer to finishing nursing school. Officially completing nursing school this semester, is a mix of emotions as we are closing the book on this chapter in our lives and starting a whole new one. This is our last semester of nursing and after 3 long years of hard work and dedication, it is hard to believe that it is coming to an end. We have all worked so hard to get where we are and now, all of our hard work is paying off. We will soon be working as nurses and beginning our careers as BSN’s.

This critical care course has truly transformed and prepared me for the real world. Before this class, in previous classes, we focused on specific aspects of the nursing profession and worked to perfect it. We have had classes dedicated to fundamentals, pharmacology, medical-surgical nursing, pediatric nursing, mother baby nursing, psychiatric nurse, and the list goes on. Each course has provided invaluable learning opportunities. It is this critical care course that has allowed me to put all of the pieces together and incorporate each aspect into my nursing practice. Rather than focusing on individual aspects of nursing care, I can see patients and their situations in a holistic way. I can effectively incorporate the nursing process into my nursing practice to competently provide the best care possible to my patients. More specifically, this course has provided us the opportunity to care for the sickest people in the hospital. This gave us the opportunity to fine tune our assessment skills and properly prioritize our care to promote well-being and prevent complications thereby improving patient overall outcomes. I have learned so much in this course and throughout nursing school. I am looking forward to beginning my career as a nurse and utilizing my knowledge and skills to improve the lives of patients.

End of the Road

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Image Retrieved from:https://www.flickr.com/photos/96614226@N00/447710918

I can still remember the first day of nursing school, thinking what a long journey laid ahead of me, three years of endless emotions and experiences. Now I am in my last week and it is unbelievable. The sensation seems unreal, time passed in the blink of an eye and just like that nursing school is over. It is an exciting feeling, yet overwhelming.  It is also unbelievable to think we will be transitioning from student nurse to a “real” nurse once we pass the NCLEX. We have learned many skills and it is time to put them to use.

I really enjoyed NRS 420 because it reviewed the majority of med surg content, it was concise and short. The book was very helpful and it had all the “need to know” information, which was pretty much the whole book :). Clinicals helped tie the material together and overall it was a great semester. An ending with a new beginning.

Last blog!! =)

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Wow, I cannot believe that this is already our last blog!

Anyhow, since I had such an interesting patient two weeks ago and since this blog has to relate to critical care I have decided to talk about his vent settings. I don’t know about anyone else, but I truly enjoyed learning about vents; which is also why I have decided to talk about vents: using the PSV mode to be specific. The pressure support ventilation (PSV) mode is a pressure mode that is commonly used for weaning off the ventilator. When a patient is placed on this vent mode, the patient has the ability to initiate their own breath. When the patient initiates a breath then the vent kicks in and assists them to the point where they achieve the desired pressure level. Not only does the vent help the patient reach a desired pressure level, but it also makes sure that the patient maintains the pressure level throughout the inspiratory phase of breathing. A advantage of this mode is that it decreases the work of breathing in the patient. on the other hand, a disadvantage is that the patient must have an intact respiratory drive.

Morton, P. G., & Fontaine, D.K., (2013). Essentials of critical care nursing: a holistic approach. Philadelphia, PA: Lippincott Williams & Wilkins.

Disaster

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Choose a disaster that has occurred in the last 10 years (in the United States or internationally). Research the event online. Blog your report about the event specifically addressing the healthcare perspective. What were the barriers for providing and/or accessing healthcare? Who responded? How long did it go on? How did socioeconomics and environment impact the event and environment? Imagine being a healthcare provider during that event. Are we better prepared for the next disaster?

In 2011, a magnitude-9 earthquake caused a huge tsunami and tremendous damage to northeastern Japan. In addition, the tsunami caused a cooling failure at the Fukushima Daiichi Nuclear Power Plant which resulted in a nuclear meltdown and leak causing release of radioactive materials into the Pacific Ocean.

Although Japan was prepared for earthquakes, they were not prepared for the tsunami – which caused most of the damage and deaths. More than 18,000 people were killed in the disaster, mostly to drowning (Oskin, 2013).

The damage impacted the country’s utilities, transportation, and healthcare facilities. Electricity, water, and gas were cut off during the disaster and were not restored for coastal areas for up to one-four months after the disaster (inland areas were restored within 3 days) (Nohara, 2011). The rural coastal areas did not have public transport, and many of the roads were damaged or blocked making access to the disaster areas difficult. In addition, initial lack of gasoline made health and medical support activities difficult (Nohara, 2011). Three hospitals in the coastal areas had been completely destroyed and half of the other clinics/health facilities were damaged, adding to the difficulty of providing medical services. Fortunately, other hospitals designated for disaster base medical care were able to provide emergency care (triage, emergency response, and transport of patients to inland areas/hospitals). A total of 28 Disaster Medical Assistance Teams (DMATs) were able to provide care from the day of the disaster (March 11, 2011) until July 2011.

 

 

References:

Nohara, M. (2011). Impact of the Great East Japan Earthquake and tsunami on health, medical care and public health systems in Iwate Prefecture, Japan, 2011. Western Pacific Surveillance and Response Journal, 2011, 2(4). doi: 10.5365/wpsar.2011.2.4.002.

Oskin, B. (2013). Japan earthquake & tusnami of 2011: facts and information. Retrieved from: http://www.livescience.com/39110-japan-2011-earthquake-tsunami-facts.html

Earthquake in Nepal

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The earthquake that occurred in Nepal this past Saturday, April 25, 2015, impacted this country significantly. This event especially struck home for me, because I have friends who are Nepali refugees; otherwise, I may not even have heard of this very small country that is tucked between India and China. As I researched this event in more detail, I became increasingly aware of the tremendous need for healthcare providers to respond; this country is very poor with approximately 25% of the population living below the poverty line, and consistently experiences economic imbalances (CIA, 2015). In addition, many regions of the country are rural, transportation is difficult and unpredictable, and power outages occur frequently. So far, the death toll as of today, Tuesday morning, is over 4,300 confirmed (CNN, 2015). Again, due to the difficulty with communication from the more rural areas, which were actually closer to the point of greatest impact associated with the earthquake, officials cannot yet determine deaths/injuries in these regions. Due to the fact that the structure and function of several healthcare facilities were compromised, CNN reported that there is a lack of facilities for necessary medical and surgical operations, which prompted providers to use locations that are not normally intended for surgery…which then increases the risk for infection (2015).  Earthquakes cause a significant loss of resources, with typical results being loss of electricity and water. Over 8,000 individuals so far are reported injured, and existing facilities are overwhelmed (CNN, 2015).

Typical injuries include TBIs, upper and lower extremity fractures, and pelvic fractures; due to the possibility of delayed care and insufficient personnel (responders are still retrieving victims from the rubble), there is the potential for hemorrhage and infection to cause death even if the initial injury is not fatal (CBS, 2015). Surgical equipment and antibiotics to combat infection are necessary supplies that are in severe shortage currently. A lack of sufficient water not only increases the risk for dehydration in the absence of injuries, but also can make crush injuries worse (renal dysfunction) and exacerbate medical comorbidities. Inhalation injuries from smoke/debris, tetanus infection, and communicable diseases (from lack of sanitation and crowded makeshift housing) are expected to be a significant concern as well.

Initial international responses to Nepal were actually delayed due to concern of possible aftershocks. Over 16 other countries have demonstrated aid with both financial means and sending people to help the existing structure. India, being in close proximity and also affected by the earthquake, has demonstrated particular initiative in sending aid to Nepal (CNN, 2015).  So far, organizations who have responded to this crisis, besides the national providers, include Red Cross, UNICEF, and various international search/rescue teams, with more aid expected.

The expected outcome is currently unknown, but Nepal will likely struggle to recover from this event due to the country’s pre-existing insecure economic and healthcare condition.

References:

Cable News Network (CNN) (2015). Nepal earthquake’s victims overwhelm hospitals. Retrieved from http://www.cnn.com/2015/04/27/world/nepal-earthquake-bir-hospital/index.html

Cable News Network (CNN) (2015). Nepal earthquake: India leads massive aid effort to help survivors. Retrieved from http://www.cnn.com/2015/04/27/asia/nepal-quake-india-aid/index.html

CBS News (2015). Medical crisis in Nepal in earthquake aftermath. Retrieved from http://www.cbsnews.com/news/medical-crisis-in-nepal-in-earthquake-aftermath/

Central Intelligence Agency (CIA) (2015). The World Factbook: Southeast Asia: Nepal. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/np.html

Nepal Earthquake: April 25, 2015

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Nepal Earthquake Rescue DogJust this past Saturday (April 25, 2015), the country of Nepal has experienced what has been deemed the worst natural disaster in Nepal’s history for more than 80 years. The Nepal earthquake was a 7.8 magnitude quake that has, so far, resulted in 5,000 deaths and over 9,000 injuries. Eight million have been affected by this disaster, so its effects are dramatic and far reaching. The earthquake has resulted in several offshoot disasters, including aftershocks, landslides and the well-publicized Mt. Everest avalanche. As tragedy strikes, 16 nations have hurried in to come to Nepal’s aid, including India, China, and Israel. The United States has sent several disaster relief teams as well as provided $10 million in assistance.

Nepal Earthquake Mt Everest Avalanche

Despite these international efforts, barriers remain to providing relief to Nepal and surrounding areas devastated by the earthquake. Barriers include unreliable means of communication, the terrain, badly damaged roads, weather (heavy rains), lack of supplies (food, drinking water, electricity, gas, etc.), unsanitary conditions and a continually rising number of injured. Hospitals in Nepal are overflowing with patients and healthcare professionals are running low on medications and surgical supplies. The relief efforts are ongoing for the country of Nepal at this time. They continue to require international assistance as they continue searching for survivors and cleaning up the rubble. The country of Nepal is dependent on income from tourism so this disaster will greatly affect their economic status.

Nepal Earthquake Relief Effort

I can’t even begin to fathom what it would be like to be a healthcare provider during this crisis. The overwhelming number of those affected and the destruction of homes and buildings is difficult to imagine. I have yet to participate in a disaster effort, let alone one of this magnitude, but it is essential that we learn from this disaster to better prepare for future disasters. Previous earthquakes and other international disasters have better equipped the world for more efficient and effective response to save lives and minimize devastation. With each new disaster, new obstacles are encountered and hopefully overcame and/or provided a learning experience that will improve the world’s preparedness for the next disaster.

References

Watson, I., Mullen, J., and Smith-Spark, L. (2015). Nepal earthquake: Death toll passes 4,800 as rescuers face challenges. Cable News Network. Retrieved from http://www.cnn.com/2015/04/28/asia/nepal-earthquake/

Shapiro, E. (2015). Nepal earthquake resucue teams en route in wake of devastation. Good Morning America. Retrieved from http://abcnews.go.com/International/nepal-earthquake-rescue-teams-en-route-wake-devastation/story?id=30609810

Mai-Duc C. (2015). Nepal earthquake: 8 million affected, 4 Americans dead; how to help. Los Angeles Times. Retrieved from http://www.latimes.com/world/asia/la-fg-asia-nepal-earthquake-what-you-need-to-know-20150427-htmlstory.html

Pesta, J. and Bhattacharya, S (2015). Rescuers struggle to reach outlying villages hit by Nepal earthquake. The Wall Street Journal. Retrieved from http://www.wsj.com/articles/nepal-rescuers-struggle-to-reach-quake-victims-1430113791

 

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Nepal: The Disaster Response

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Image: http://i1.wp.com/www.kollytalk.com/wp-content/uploads/2015/04/Nepal-Earthquake.jpg

This past Saturday, April 25th, a 7.8 earthquake struck Nepal that has led to over 4,600 deaths and 9,000 injured people (CNN, 2015). A disaster this large in size with so many people injured requires a significant international response to provide needed supplies and care. Countless buildings and homes have been destroyed, people have have lost their families and are in dire need of food, shelter, and medical care.  The United States Agency for International Development (USAID) has assisted by deploying a search and rescue team to Nepal, along with a Disaster Assistance Response Team (DART) to identify and prioritize needs (The White House, 2015). Humanitarian organizations such as Doctors Without Borders and the Red Cross have also responded to the incident to provide care to those affected by the earthquake and subsequent aftershocks (The White House, 2015).

Recent priorities since the earthquake hit have included search and rescue operations to find survivors and relief efforts (CNN, 2015). Even with the help that has arrived through international aid, however, there have been significant barriers preventing the provision of adequate medical care. Hospitals in Nepal have been overwhelmed and lack needed medical supplies, survivors remain buried in building wreckage, and rural areas are not easily accessed by rescuers (CNN, 2015). One hospital is operating at over 3 times its normal capacity with over 1,000 patients (CNN, 2015). Difficult terrain creates difficulty for surface transport to more rural villages in Nepal, while storm weather conditions preclude access via helicopters (CNN, 2015). However these villages are seeing serious damage. One village in particular saw about 70% of homes destroyed with trapped people inside, especially children and the elderly (CNN, 2015). Another cited barrier has involved the small Kathmandu airport becoming jammed with incoming aid workers, which prevents the ability of all needed aid and supplies to enter the country (CNN, 2015). The supplies highly prioritized currently are food, which approximately 1.4 million people need, and tents to withstand monsoon weather (CNN, 2015).

I believe that there are some aspects of a disaster response such as this that are difficult to control for. Earthquakes are unpredictable and as such are difficult to plan relief for as the size and magnitude cannot be know beforehand. However, in 2009 the Nepal government launched a Nepal Risk Reduction Consortium, which raised awareness of the imminence of a large disaster in addition to retrofitting hospitals to withstand an earthquake (United Nations, 2015). This act has potentially saved many lives in this earthquake as the hospitals are still standing and able to treat patients. The United Nations also plans to assist Nepal in reconstructing the country to be more resilient to disasters (United Nations, 2015). Hopefully other countries will learn from this event to strengthen their own disaster preparation.

References:

Asia News. (2012). For World Bank, Nepal is Asia’s third poorest country. Retrieved from: http://www.asianews.it/news-en/For-World-Bank,-Nepal%27s-is-Asia%27s-third-poorest-country-24668.html.

CNN. (2015). Nepal earthquake: Death toll passes 4,600 as rescuers face challenges. Retrieved from: http://www.cnn.com/2015/04/28/asia/nepal-earthquake/index.html.

The White House. (2015). America’s response to the earthquake in Nepal: What we can do to help. Retrieved from: https://www.whitehouse.gov/blog/2015/04/27/america-s-response-earthquake-nepal-what-we-can-do-help.

United Nations. (2015). UN allocated $15 million in emergency funds for Nepal earthquake response. Retrieved from: http://www.un.org/apps/news/story.asp?NewsID=50708#.VUAfI5Ozl2A.

Final Reflection

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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.

Natural Disaster

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Hurricane Katrina was the costliest natural disaster at roughly $108 billion (2005 USD) and one of the five deadliest hurricanes in the history of the United States (The Data Center, 2014). It first formed as a tropical depression on August 23rd, 2005 but upgraded all the way to a category 5 hurricane by August 28th, 2005. It struck the city of New Orleans with the intensity of a category 4 hurricane on August 29th, however, despite the weakening of the storm, levee failures caused flooding of 80% of the city with some parts being under 15 feet of water (History, 2009). Because of this, there was a widespread loss of power, communication, and clean water in the city (History, 2009). In addition, there was significant damage to infrastructure such that there was only route out of the city (History, 2009).

This disaster presented huge barriers for providing and accessing healthcare. Many healthcare providers were displaced by the storm and vital public health infrastructure such as laboratories and other facilities were damaged (CDC, 2014). It was also difficult to calculate exact resource needs because many of the city’s population of 500,000 had been evacuated (CDC, 2014). Since water quality and sanitation was poor, there was a huge risk for illnesses such as cholera and norovirus (CDC, 2014). Furthermore, a majority of the people who remained in the city were those that were very poor and had no means to evacuate the city so many took refuge in the Superdome stadium, thus increasing the risk for transmission of diseases (CDC, 2014). The stadium suffered damage from human waste and trash in addition to the elements and refugees were subsequently moved to the Astrodome in Texas (CDC, 2014). There was a response from local, state and federal agencies such as FEMA, the CDC, the Coast Guard, and the Louisiana National Guard but the federal response had been criticized due to mismanagement and poor leadership.

 

Even though the city held its first major convention in mid-June 2006 and major events like Mardi Gras were never disrupted, the New Orleans’ recovery is still ongoing (The Data Center, (2014). As of 2013, child poverty is higher than it was before Katrina, the overall poverty rate is still the same as pre-Katrina, and 36% of the city’s renters spend over 50% of their income on housing (The Data Center, 2014).

 

I imagine that working as a healthcare provider during this time must have been quite difficult. Power outages, unsanitary conditions throughout the city, limited resources, and possibly even damage to hospitals could have contributed to an environment unsuitable to deliver even basic patient care. In addition, it would be hard to not only take care of people with extremely limited resources but also to effectively care for patients while worrying for the safety of your loved ones and also if there is damage to your own personal property.

 

I think that since this disaster, there was a lot of focus on disaster preparedness and there were many lessons learned from various responding agencies. If something were to occur in Ventura County, I know the public health department has infrastructure in place to handle disasters such as stored medical supplies, food and water. Despite this, I don’t think the average citizen has even the minimum requirements of at least a 3-day supply of water for each person in the household, 1 gallon per person per day and two weeks worth of non-perishable food, not to mention extra cash, a first aid kit, and a disaster plan (CDC, 2014).

 

References

CDC. (2014, December 4). Gather Emergency Supplies. Retrieved April 22, 2015, from CDC: http://www.bt.cdc.gov/preparedness/kit/disasters/

History. (2009). Hurricane Katrina. Retrieved April 27, 2015, from History: http://www.history.com/topics/hurricane-katrina

The Data Center. (2014, August 28). Facts for Features: Katrina Impact. Retrieved April 27, 2015, from The Data Center: http://www.datacenterresearch.org/data-resources/katrina/facts-for-impact/

The Times-Picayune Editorial Board. (2014, August 29). Nine years post Katrina, a recovery still in progress: Editorial. The Times-Picayune .