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- 1. Growing Through Oral Comprehensive Capstone Project Angela Panek RN BSN MS(c) Regis University April 13, 2015
- 2. 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?
- 3. 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
- 4. 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
- 5. 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
- 6. 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, age Pulmonary 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
- 7. 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
- 8. Knowledge of Diverse Cultures, Perspectives and Belief Systems. Metro Community Provider’s Network Hispanic African Farsi Project Homeless Connect Elderly
- 9. 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.
- 10. 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
- 11. 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
- 12. 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 throat Potential 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.
- 13. 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
- 14. Ability to Communicate Effectively NR601, HCE604, NR608, NR630, NR640, NR645, NR651, NR663, NR664
- 15. Ability to Use Contemporary Technology NR602, NR607, NR640, NR651
- 16. Commitment to Ethical and Social Responsibility NR601, NR604, NR607
- 17. Commitment to Ethical and Social Responsibility
- 18. Commitment to Leadership and Service to Others
- 19. Commitment to Leadership and Service to Others NR601, NR604, NR651
- 20. Commitment to Learning as a Life-Long Endeavor Conferences Journals Procedures Class
- 21. Commitment to Learning as a Life-Long Endeavor NR601, NR640, NR651 Maybe?
- 22. 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
- 25. Questions??
Editor's Notes
- Hello, I am Angela Panek and I am here to share with you how I have grown through the Regis University family nurse practitioner program. I say grown through as I have had a very challenging two years in my personal life and while completing this rigorous program, I have grown a tremendous amount, both professionally and personally.
- At the time this program started in May 2013, my life was very chaotic. I had just learned my mother was diagnosed with Myelodysplastic syndrome and was going through chemo down in FL. I had just miscarried after thinking I could never get pregnant. And my husband and I were having marital issues, causing a lot of conflict in the home. I considered putting off the program until my life calmed down, but I knew I would be waiting forever. Being in oncology for 12 years, I realized my only opportunity for growth would be into management, which is not my dream job. I knew to stay in this position I would be giving chemo the rest of my career, and this didn’t appeal to me either, In oncology, RNs have more autonomy than in the hospital setting, yet I craved more autonomy. I also wanted to make a difference in lives from a perspective of prevention. When my mother got diagnosed, I gave her a card with this quote on it. I took this quote to heart and decided despite the challenges in my life, I needed to move forward with my educational goals to become a family nurse practitioner.
- Patricia Benner’s theory Novice Advanced beginner Competent Proficient Expert
- I like Virginia Henderson as she said in a commencement speech she gave she does not want us to follow her nursing theory, but come up with our own concept. I have chosen a different nursing theorist each semester we were required to choose one. However, at the end of it all, I think Martha E. Roger’s Unitary Human Beings nursing model is closest to how I see things. When you walk into a room, sometimes you can feel a palpable energy radiating from an angry person. This is covered by Roger’s theory. She states we interact with our environment in ways we aren’t even aware of. She also states health and illness are on a continuum. I also feel this energy and exchange of energy can affect our health.
- As we have been told as children, no two snowflakes are alike. When my mother was diagnosed, I saw the specifics of her disease and how different her pathology was from all the other MDS patients I had worked with. I then began to think about how every person sees the world through their own eyes, and they will perceive the same event differently as well as communicate those events in a diverse way. I then came up with the theory of every patient being a snowflake. We must encounter and treat each patient as such, realizing they must all be treated individually and we cannot give universal care to everyone. The Hidden Messages in Water is a fascinating book revealing how water exposed to different conditions, such as classical music or verbal insults, when frozen, will create a certain type of snowflake or ice crystal. Overtly positive messages caused symmetrical, beautiful crystals and negative caused chaotic, random ones. If this theory is correct and the idea we are at least 70% water, states it makes a difference how we “treat” our water. I thought this was an interesting anecdote to include when talking about the uniqueness of snowflakes and how this may come to be.
- I spent my Adult 2 clinical hours at MCPN, an organization who’s mission is to partner with the community to provide excellent, culturally sensitive health services to meet the needs of each individual, every touch, every time. I learned how important communication is with non-English speaking patients and also saw how frustrating it can be, for both the patient and the provider. I learned in order to provide good care, I must take the extra time to communicate fully with this population. Using an interpreter or service will take extra time, and how I will need to schedule extra time of allow for this, otherwise my care will be lacking in quality. I also did service learning with Project Homeless Connect. It was an eye opening experience in which I learned the challenges I think the homeless would face are much different from the reality. I learned how I cannot anticipate the needs of a population without listening fully as they know their needs more fully than I can even comprehend. I wrote a paper about the unique needs of the elderly as a diverse population. I always forget as we age, even if we are the same race and gender, our needs change. Their bodies function less efficiently than in their younger years and I need to keep this in mind in order to provide excellent care.
- During Professional Integration, we took a walking tour of the campus. It was then I realized how truly immersed the Jesuits are in living a well rounded, full life. It isn’t about the religion, but about how God fits into everything. This quote explains perfectly how important it is to live an intentional, well rounded, passionate life filled with many disciplines.
- This statement is how I relate arts, sciences and humanities to one another. This relates to the last slide on how many disciplines interact with one another to create a more well rounded, complete comprehension. My mother passed away on her 66th birthday last year. My father gave me a story he received in his grief support group. It talked about drawing love. I would first paint a bold stroke of red. Then I would dip my brush in yellow and blend it in. On the other side of the yellow I would place a bold stroke of blue; then step back to view my creation. The canvas would still show splashes of blue, and yellow, and red, but look in between! My new rainbow would hold not just three colors. Green and orange would glisten in the center of each combination.
- I have had many wonderful teachers in this program, but my mother was my greatest teacher in this program. I don’t mean this literally of course, but I took care of her in the spring of 2014 while she was going through a bone marrow transplant. In fact, she received her new bone marrow one year ago today. She had a rough time and had many complications during this process and I was there everyday, seeing the changes, asking questions of her providers. I watched the labs and the scans, the biopsies and her physical exams. I watched her not only through a daughter’s eyes, but as a provider. She taught me so much during this time and although I didn’t receive clinical hours for this time, I learned so much.
- Many people don’t think about how much goes into communication and how easily miscommunications can occur if you aren’t cognizant of the different factors. To communicate effectively, Regis has helped me see all the factors contributing to good communication. The words are not as important as one might think. The tone, articulation and even volume can convey a message. The majority of communication is non-verbal and can send very powerful messages to your audience. One of the most important non-verbal communicators is silence or active listening. My communication approaches have to change based on the audience. If I am talking to a patient the communication tactic will be different than if I am speaking with a colleague. Communication through digital and electronic media is also very important. In this age of technology, we all have a very public digital presence and our communications through the various means can affect how we are perceived. The way in which I chart to the way I email , to my linked in profile. Communication is so much of what we do and to be effective we must constantly improve. I have seen in personal life how communication can break a relationship. However, in my current position as an RN, I have been complimented on my listening skills and my ability to speak with ease and educate in a manner fitting the audience. Regis has helped me improve my communication through writing papers, oral presentations, simulation exercises and clinical practice.
- These attributes are all important when talking about communication. I have learned the importance of being non-judgmental, receptive and open to others thoughts, beliefs and needs. As an APRN, I will communicate with compassion, hopefully educating, empowering and collaborating with my patients to plan for their care.
- In today’s society, technology is everywhere. Regis has shown me how many resources are available at the click of a mouse or touch of a finger. I use multiple resources daily for clinicals, class, and life in general. Using EMRs in clinical sites, to mobile applications, to websites such as up to date or clinicaltrials.gov all give me access to information I would have otherwise had to know and memorize, or take so much time to look up in a book. A clinical preceptor said something that made so much sense. They said know the information that is not easily found and utilize the resources for everything else. For example, I need to know the assessment skills and how to come up with differential diagnosis, but I can look up a cardiac med or antibiotic, and to not waste my time memorizing this information as it will come with time.
- Ever since I can remember I have been looking out for the greater good, and here at Regis I learned this ethical theory is called Utilitarianism. I am a caretaker at heart, even outside of nursing and I always think about how my actions will affect others and the bigger picture. I am compassionate towards animals and people. I give back to my community and try to live a life respecting those around me. An ethical principle I strongly relate to in the spirit of utilitarianism is beneficence. Doing what is best for the patient or community, to benefit their health and growth in a positive way. I always try to act in a way to promote overall good. Autonomy and respect for persons are other ethical principles I feel are important to consider in our new role. Like my snowflake theory, every person is an individual and has the right to live as such. I will respect each individual as an autonomous being and collaborate with them to choose the path they see as right for them. I also wanted to talk about biomedical ethics. In this age of medical technology and advancement, we will be faced with ethical dilemmas. Our ethics course opened my eyes to some of these and how important it is to be familiar with my personal beliefs and ethical philosophies. I must be able to stand back and think about the expected consequences and unexpected consequences of these technologies to not only educate but realize my potential limitations to some if they deviate from my views. At the beginning of our ethics class, I thought “we either have ethics or we don’t” not quite understanding the purpose of this class. However, I now see it goes much deeper to the reasons we do something. I thought I knew exactly where I stood with regards to certain topics, yet the discussions made me realize I have to see both sides before forming a true opinion.
- Social responsibility is something I am truly passionate about. Throughout this program, many papers have surrounded our social responsibility as APRNs. In health care policy, I presented a bill in the Colorado legislature last year about the responsible disposal of medications. I am glad to say this bill passed and hopefully we can keep unused medications out of our landfills, groundwater and city water supply. There is already an alarming presence of pharmaceuticals in our drinking water. I am also concerned about GMOs and pesticide use in our food supply and wrote about its potential health effects in a pathophysiology paper. The exorbitant amount of money spent in healthcare is another topic of focus in a paper for healthcare policy. The greedy side of healthcare as a business is something I have seen and it is disheartening. We need to reduce the overall cost of healthcare making it more accessible to everyone. The ACA was an okay first step, but we still have a long way to go. I care about the earth and how the way we live affects our planet and those not able to make decisions about our world. Therefore, I compost, recycle, eat responsibly raised and grown food. Social responsibility is my answer to the question Regis asks of “how ought we to live?” I hope to educate my patients and community about the importance of social responsibility in the way we live. For example, even if global warming weren’t a valid claim, I feel making socially responsible changes in our lives is still the right thing to do.
- Ever since I attended Regis for my BSN, I have liked the tagline “Learners becoming leaders”. The quote on the bottom right of the slide embodies what I feel has happened over the past two years, both in school and in my personal life, I have been growing myself in preparation to help others to grow. This is exactly what I hope to do as an APRN with my patients and in my community. I want to educate, lead and empower people to live a healthy, more full life. I found great power in words and one of my favorite quotes is the one in the bottom left corner. I want to let my light shine and give others permission to do the same. I feel I will make a good leader as an APRN. Regis has given me the tools to listen, communicate, act and reflect.
- Since I was 12 years old, I have been serving others. I used to say volunteer, but I Regis taught me the part that differentiates volunteering from service learning is the reflection and I feel I have always reflected on my experiences with my volunteering. I volunteered for Camp Wapiyapi, a camp for kids with cancer and their siblings, for ten years as the activities director for 8 of those years. The picture on the right is of one of the camper’s, Galen, and his sister, Kelsey, holding hands the day he passed away this year. Galen died of a secondary cancer at age 21, after surviving a brain tumor as a child. I was at camp with him when he was 6 years old and his sister was 10. I saw how his experience with camp changed him and his life. I saw how giving of myself and time can make a lasting impression on someone else. Service learning is a way to create a lasting legacy to those around you, to the lives you touch. The top picture is showing the population I hope to continue service learning with after graduation. I have always wanted to work with the homeless population as I feel they are often forgotten and people forget they are human and treat them as less than. The bottom picture is a population I just recently realized I felt the draw to help. I was recently involved in a domestic violence situation and realized how manipulated I have been over the years. The feelings this all created in me has drawn me closer to this population I never thought I would find myself within. I found the two pictures fascinating as the eyes were so similar, giving me the sense that as different as these two people are, they are actually quite similar. They are both humans with a need for respect, kindness, and compassion. Service learning helps me step out of my own experience and learn and see the experiences of another. I gain perspective and a deeper sense of purpose when I commit my time and myself to others in the spirit of giving.
- I am intrigued by how nutrition and integrative therapies can supplement my practice as an APRN. I have looked into a master nutrition therapy certification and an integrative medicine internship. One program even offers an integrative medicine DNP degree. However, I did receive my other two degrees from Regis, so if I decide to return for my DNP, I may as well stay with the same school. Although, having gone through this program during the toughest time of y life, I am ready for a break. My first learning adventure after this program is to take some gardening and bee keeping classes. It will be nice to focus on learning something in an outdoor classroom after being inside for two years.
- I am a seed and the past two years I have been dropped in the dirt and covered in darkness. Regis University, the faculty, my family, and all of my classmates were the light and nutrients encouraging me to grow through this time into a seedling who will soon grow into a plant bearing fruit to feed and nourish others.