Reflection Paper Cath Lab

Training for residency in a busy inner city hospital in Newark, which caters to the less privileged and ever growing uninsured population of New Jersey had its own advantages, as there was always a large population of patients admitted as inpatients in addition to outpatient services. I was also fortunate to have strong and dedicated mentors who simultaneously exuded compassion and confidence, and taught me to appreciate the beauty of medicine. During our cardiology service months, we had the opportunity to attend many cardiology didactic lectures and conferences. We were also trained to read EKGs, stress tests, and to interpret echocardiography basics. In addition we had the chance to witness numerous cardiac catheterizations, angioplasties, and transesophageal echocardiograms. During my close interaction with cardiology team, I loved the personalities of the cardiology fellows and attendings who mentored me. They seemed brilliant, energetic and vibrant, and there discussion and debate on rounds was always challenging and thought

When I arrive to the Trauma ICU 4800 unit, all of the nurses were already being followed by other students. The nurse in charge had me follow several different nurses, so I was able to observed several different patient cases. The first patient had received a triple bypass open-heart surgery. The patient had received a creatinine blood test. The patient had a dialysis machine next to them, which was used to function as the kidneys since the patient’s kidneys were not functioning correctly. Also, the patient’s body temperature was lowered from having a taken cool liquids so the nurses were keeping him warm with a bair hugger, which was a machine that helped regulate the patient's’ body temperatures.

It is a warm summer evening at Grady Hospital. It is my first day as an emergency room volunteer. I’m nervous and eager, hoping to see something exciting. However, it is surreally quiet. Suddenly, there is word of an ambulance en route. Minutes later the paramedics burst into the trauma slot pushing a man on a stretcher. His head and face are covered with gauze that is soaked through with dark blood. It is a flurry of well-orchestrated movement as the attendings and residents start to resuscitate him. They pull back the bandages to reveal a deep gash that is bleeding profusely. With much effort his vital signs are stabilized and he begins to regain consciousness. Later, after the excitement had passed, I learned what brought him here. He is diabetic and couldn’t afford to properly manage his condition. He had fainted due to hypoglycemia and hit his head. He had almost lost his life because of the unfortunate financial realities of modern healthcare. In that moment, I came to appreciate the very real cost of disease and the incredible role physicians have in ameliorating it. This formative experience was the beginning of my path to medicine.

After completing my bachelor’s degree at Florida State University in the fall of 1997, I began my career at a small hospital in Largo, Florida. I started on a thirty eight bed cardiac/telemetry unit. I had the fortunate opportunity to orient with a seasoned nurse who loved her career in nursing. She was an enthusiastic preceptor that not only educated me on the tasks of nursing but inspired and introduced me to critical care and critical thinking. I spent the next three years at this hospital working in the Coronary Care Unit until deciding to become a travel nurse and see the country. I began travel nursing with my best friend and we worked in Florida, Washington D.C., New York and Denver. At all of these locations we worked in the intensive care unit. Each experience provided a different population and vast new experiences.

As I walked toward the bright red sign that flashed emergency, I had no idea that I was about to witness the fragility of life. About a half an hour after my clinical shift began the rapid response alarm blared through the emergency room speakers. I was excited. In my previous shifts I had worked with the rapid response team. During rapid responses more extensive medical procedures are performed, and as a student I got to see and do a lot more. Once I reached the recess room, most of the team was already there preparing for the arrival of the patient. “It’s a STEMI” announced one of the nurses who was on the phone with firefighter’s that were bringing him in. After she announced this fright ran through my veins. I had never seen someone who

While working in the emergency department for my clinical this week I could see the staff members that help in the emergency department. There are RNs, EMTs that have different certifications like BLS or ALS, a nurse practitioner, and doctors. In the emergency department, they have staff members from different parts of the hospital to assess the patients. Radiology comes down to get X-rays on the patients for a closer look at their heart. The patients who come into the ER with shortness of air, chest pains, numbness in the extremities and dizziness with signs of fatigue are ordered an X-ray. The lab can come to draw the patient's blood or the nurse will draw up the patient's blood and then send it to the lab. More patients come in with chest pains or shortness of air while in the ER,

I don’t remember the patient’s face or his name. I do remember his father’s tears and distress on eyes while we performed chest compressions and pushed air into his lungs. I remember thinking if this could have been possibly avoided if my voice had a stronger role in the team and my assessment taken more seriously. I remember going to the lawyer’s office in the hospital and being asked if I saw the x-ray and replying that while I had, I was not qualified nor trained to interpret the image. It was this helplessness for myself, for the patient, for his father, wife, and young children that continues to motivate me to pursue continuous education. I do not want to stop when I am handed my master’s degree. I want to continue to be an expert in my field and share my knowledge in a critical care fellowship. I have seen the benefit of physician fellowship in the surgical intensive care unit at Massachusetts General Hospital. Not only does it allow for specialty training in critical care, it allows the fellow the opportunity to learn how to lead, teach, and collaborate with a team of not only doctors, but nurse practitioner, registered nurses, pharmacists, respiratory therapists, and many

For my community government participation, I will be going over a few democratic instances from a LTCC Board of Trustees meeting. These instances come from the meeting of Tuesday, September 26, 2017. To start off, the meeting included two examples of how the opinion of the people are heard at the board meetings. First, Marta Sternal, the International Student Program Coordinator, discussed to the board the update with ISP. More importantly, international students were able to answer questions about their experiences being in Tahoe. Each one had a special story and a testament to the ISP and how it was creating a positive impact in students lives. As Student Trustee, it is always very special for me to see students personally address the board that makes policies about the college. The direct communication is a great example of how the voice of the students are valued and included. This meeting was important for another reason, a reason that affects thousands of students without their citizenship living in America. The board approved standing with the California Community College Chancellor's Office to denounce the decision to end the DACA program. As Student Trustee, my position allows for me to bridge the gap between the students and the board, bringing the student voice into policy decisions for our local college. This was the first time being Trustee where I was able to reach out to students about this important decision, asking them for their opinion about this important decision. Since I am in this position, I have a glimpse of how a Trustee position functions in Congress. Of course, this is a very wide leap, comparing Student Trustee with a Senator, but I

Since I was young, I have always had the overwhelming desire to help people in a healthcare setting. Observing the nurse anesthetist (CRNA) in the OR was an eye-opening experience in which I was honored to participate in through an internship, and I knew right away that that’s what I wanted to be. Whomever came into the hospital with pain or in need of a procedure left feeling as mentally and physically pain free as possible, and this was inspiring to me as I wish to provide that for patients as well. Furthermore, I would like to be able to be an advocate, support system, and caring hand for patients when they don’t have anyone else to turn to. Having the opportunity to form a relationship with patients in these ways, and to help lead them down the road of recovery, has become a burning passion of mine that I’m determined to work hard for.

As a lab technician, I spent most of my time in my lab, but I would visit the Clinical Research Unit on slow days, as it deeply fascinated me. I couldn’t help directly, however I got to witness even more of the medical world. It didn’t happen all at once, but it was easy to see how my passion and desire to work with people in a nursing capacity unraveled. When my letter finally came from Utica, I knew that I was doing what was right for me—and eventually, the people I will treat.

Cardiovascular diseases have long been the leading cause of death in the United States (Narang et al., 2016). Research predicts the progression of cardiovascular disease will affect forty percent of our population by the year, 2030 (Narang et al., 2016). Furthermore, research shows that the cardiovascular workforce is inadequate to meet the rising demands of this patient population (Narang et al., 2016). In particular, a subset of cardiac nurses, a cardiac catheterization laboratory nurse is a key member of this cardiovascular workforce.

My clinical two observation began at 2:30 PM in the catheterization lab. Upon my arrival they were just finishing a radial heart catheterization with stenting. As they transported the patient to ICU the staff was preparing for an emergency catheterization. It was hectic in the operating room; there were two nurses suiting up in led suits, and a surgical technician was organizing instruments and equipment on the table. In addition, there was nurse Erin controlling the X-ray imaging from behind the glass wall.

The purpose of this journal is to reflect on my experience and skills gained during my clinical placement at Ben Taub Hospital. On my first clinical day, I was excited and nervous at the same time. My first placement was in the PREOP/PACU area. I was assigned to help a patient who had been in the PACU area going on 2 days. Normally, once the patient comes from surgery they are only in the PACU area for a short period of time before they are discharged home or given a bed in another area of the hospital. This particular patient still had not received an assignment for a bed. The physicians would make their rounds to come check on him daily. The patient was a 28-year-old Hispanic male, non-English speaking, he had a hemicolectomy. He had a NG tube, urinary Foley catheter, and a wound vac. My preceptor had just clocked in and she needed to check on the patient’s vitals and notes from the previous nurse. Once she introduced me to the patient and explained while I was there, she then asked me to check his vitals. (Vital signs indicate the body’s ability to regulate body temperature, maintain blood flow, and oxygenate body tissues. Vital signs are important indicators of a client’s overall health status (Hogan, 2014). I froze for a quick second. I have practiced taking vitals numerous of times and I knew I could do it correctly. I started with the temperature first, when I was quickly corrected on a major mistake I had made by my preceptor. I HAD FORGOT TO WASH MY HANDS and PUT

Several of the roles which I observed this morning were expected: the nurses took vitals for incoming patients, performed focused assessments, and were the main communicators between family, the patient, and the physician. I realized when the first patient came in around 10:00 am, the RN’s role in assessments, gathering blood work, and carrying out all the necessary steps to situate and stabilize the patient as soon as possible. It was incredible seeing the nurses work together, in sync, in those first moments when the patient was brought in. And though expected, I appreciated seeing just how much communication was held and information was gathered from the patient or family members by the nurse. Jessica asked the right questions from both parties, while still showing incredible empathy and not making the whole situation seem rushed and flustering. I understood this as another essential role of the nurse in the ED; he or she must maintain even in such a fast-paced environment empathy and focus in each interaction.

McBrien, B. (2007) Learning from Practice: Reflections from a critical incident. Accident and Emergency Nursing, 15 (3): 128-133