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Growing ThroughOral Comprehensive Capstone Project
Angela Panek RN BSN MS(c)Regis UniversityApril 13, 2015
Challenges:• Mother’s diagnosis• Loss of pregnancy• Marriage troubles
Life isn’t about
waiting for the storm to
pass, it’s about learning to
dance in the rain
Motivators:• Lack of growth in current position• Burn out in oncology• Craved more autonomy• Focus of care
• Prevention • Increased quality of life
Why Regis, Why Now?
In-Depth Knowledge of a Discipline or Content Area
Bachelor of Arts – Psychology from CU Boulder, 1999
Bachelor of Science- Nursing- Regis University, 2002
Medical/Surgical 2003-2004
Pediatric Oncology 2004-2006
Nursing Instructor 2006-2009
Radiation Oncology 2009-2012
Adult Oncology 2006- present
Oncology Certified Since 2010
Nursing Theorist Patricia Benner’s Novice to Expert levels
Expert
Novice
Graduate from Regis University May 2015
Pass ANCC exam August 2015
Primary Care position
Obtain prescriptive authority
Patricia Benner RN, MSN, PhD
Nursing Theories
Virginia Henderson (1897-1996) •“I would like to emphasize that I am not presenting my point of view as one with which I expect you to agree. Rather I would urge every nurse to develop her own concept, otherwise she is merely imitating others or acting under authority”
Martha E. Rogers (1914-1994)•Unitary Human Beings
• Energy Fields• Integral with the Universe
• Exchange of Energy with Universe• Progressiveness of Theory
• Physics of Energy•Combines Science and Art of Nursing
In-Depth Knowledge of a Discipline or Content Area
Situation: Eleven year-old male presented to the clinic with malaise for ten days, fevers on average 100.1 (F) for 8 days, cough for 4-5 days, and left arm pain starting this morning.
Background: Healthy eleven year-old with no past medical history, on no medications, with no allergies. He has two siblings, both of which have been healthy. He lives with both parents in Highlands Ranch and attends Ranch View Middle School as a sixth grader. Assessment: Vital signs: T: 100.2 (F), P: 114, R: 24, PO2: 82%, rechecked with different pulse oximeter, 93% on room air. Upon examination, patient appears tired with hunched posture. Eyes appear to have some peri-orbital edema. Patient was not using his left arm and it appeared flaccid. He was able to move it on request, but with marked shoulder pain and obvious weakness. Left grip strength 2/5, Right grip strength 4/5. Skin on left arm mottled and cool. Skin on right arm warm and pink. Patient reports pain in left shoulder. Patient is slumped, breathing with mouth open, tachypnea, with minimal use of accessory muscles. Lung sounds coarse in the right lower lobe and distant in the left lower lobe.
Pediatric Case Study
NR602, NR605, NR630, NR642, NR645, NR649, NR 663, NR664
Differentials with Pertinent Positives (green) and Negatives (red):Cardiac issue- tachycardia, pain radiating to left shoulder, agePulmonary Embolus- tachypnea, tachycardia, pain in left shoulder, age, normal
activity level**Pneumonia- coarse right lung sounds, distant left lower lung sounds, stooped
posture, mouth breathing
Recommendation: The pertinent positives led us to believe the patient had pneumonia was a probable diagnosis. Without immediate access to X-ray, the patient was referred patient to Children’s Hospital of Colorado for immediate further work-up.
Follow-Up: We received a call from the mother a few days later thanking us for sending him to Children’s as he had bilateral pneumonia and a partial pneumothorax on the left side.
Pediatric Case Study Continued
Knowledge of Diverse Cultures, Perspectives and Belief Systems
NR601, HCE604, NR640, NR663, NR 664
Each patient is rare, like a snowflake
• Unique experiences
• Distinct coping mechanisms
• Individual ways of communicating
• Diverse perspectives
• Different efficacy and response to
treatment
No two people will be the same…ever
Therefore, we must tailor care• Approach• Communication• Treatment• Follow-up
Knowledge of Diverse Cultures, Perspectives and Belief Systems.
Metro Community Provider’s NetworkHispanicAfrican Farsi
Project Homeless Connect
Elderly
Knowledge of Arts, Sciences, and Humanities
“What you are in love with, what seizes your imagination will affect everything. It will decide what will get you out of bed in the morning,
what you will do with your evenings, how you spend your weekends, what you read, who you know, what breaks your heart and
what amazes you with joy and gratitude.” -Pedro Arrupe, S.J.
Knowledge of Arts, Sciences, and Humanities
NR601, NR602, NR605, NR608, NR630, NR642, NR663, NR664
The science is taught, the art is how we apply the science, and the humanity is how we fuse the two with our patients, making a difference in their lives and the world
Just like a rainbow:•Where one color touches another, a change occurs•A part of one soul blends with a part of another soul, and they are both eternally different•We are able to take from each other, and in the process, something is created that enriches all who surround us
Situation: 65 year-old female with Dobhoff feeding tube displaced and coiled in mouth while being evaluated by speech therapy for swallowing study. When trying to remove the tube, the Dobhoff weights got stuck between her oropharynx and nasopharynx.
Background: Patient seven days post bone marrow transplant following intubation and ventilation for twenty-four hours. She is currently off ventilation, with a nasal cannula at 2LPM. Dobhoff was placed on day four post transplant for feeding and medication administration use.
Assessment: Every attempt at removing the feeding tube caused the patient to call out in pain and tube was unable to be removed. Lubrication was applied multiple times to the tube prior to withdrawing without success. The nurses attempted to replace the tube multiple times without success. There were two registered nurses, a bone marrow resident, a pulmonary attending, and I. When looking in the patient’s mouth, we were able to see the weights in the back of her oropharynx.
Ability to Think Critically
Ability to Think Critically
NR602, NR605, NR607, NR630, NR645, NR649, NR663, NR664
Differentials with Pertinent Positives (green) and Negatives (red):**Displaced Dobhoff feeding tube: Weights observed in back of throatPotential aspiration: Displaced feeding tube, no respiratory difficulty, no decreased oxygen saturation
Recommendation: After assessing the situation, my plan was to use hemostats to grab the weights at the back of her throat and pull them out of her mouth, cut the tube and pull the remaining tubes out both her mouth and her nose. The first attempt was successful and did not cause the patient any pain. One registered nurse then stated she was going to get another tube to be placed. I asked her to delay, while asking the pulmonary attending and the bone marrow resident if the tube re-placement was necessary. She was working with speech therapy, if she was able to swallow her pills and eat without any risk for aspiration, was the tube necessary.
Follow-up: Speech therapy determined she was fine to swallow without risk of aspiration. The tube was no longer needed, therefore sparing the patient further discomfort of another tube and possible recurrence of the new tube getting lodged.
Ability to Communicate Effectively
Verbal:•Words•Language•Tone•Articulation•Delivery
Non-Verbal:•Body
• Position• Movement
•Eye Contact•Touch•Facial Expressions•Dress•Silence/Listening
Audience:•Patients•Staff•Colleagues •Inter-Professional•Community•Public
Digital and Electronic:•EHR/EMR•Social•Email•YouTube•News•HIPAA
Ability to Communicate Effectively
NR601, HCE604, NR608, NR630, NR640, NR645, NR651, NR663, NR664
Ability to Use Contemporary Technology
NR602, NR607, NR640, NR651
Commitment to Ethical and Social Responsibility
NR601, NR604, NR607
Commitment to Ethical and Social Responsibility
Commitment to Leadership and Service to Others
Commitment to Leadership and Service to Others
NR601, NR604, NR651
Commitment to Learning as a Life-Long Endeavor
Conferences
Journals
Procedures Class
Commitment to Learning as a Life-Long Endeavor
NR601, NR640, NR651
Maybe?
Short Term Goals:
•Pass ANCC exam within 4 months of graduation•Find employment in a clinic with a mentor to complete necessary hours for prescriptive authority•Create an educational program for the clinic’s patients and surrounding community•Become more involved legislatively to include giving testimony on for or against a bill I am passionate about•Find an organization to volunteer with serving the homeless population
Long Term Goals: •Gather necessary resources and find like minded professionals to open my own practice•Have an active presence in the community, with regularly scheduled community educational programs•Create a non-profit organization with an emphasis on populations having difficulty with healthcare access•Become a mentor to APRN students and newly graduated APRNs
• Becoming an associate professor• Clinical preceptor
•Consider applying and completing a DNP program
Goals
How did I grow?
Professionally:•Evidence-Based Knowledge•Critical Thinking•Differential Diagnoses•Politically Active•Clinically Confident•Organized•Better with Prioritization•Better Communicator
Personally:•Stronger•Calm, More Centered•Self-Reflective•More Compassionate•Determined•Resilient•Powerful
Questions??