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??